HomeMy WebLinkAbout10035 Adams Ave - CofOCertificate of Occupancv No. 0200`t _v v "a
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY
714/536-5271
Business License # R
Business Address 1c,6,JX� //D/*1 r zj
Business Owners Name /-16-.L� /yi�/Icc
Business Name
Business Type
(3'd Floor — Must Apply In -Person)
Date
Zip Code
Telephone No.
Bus. Phone
Propoy Owner Information (required) Tenant/EmergencyTenant/Emergency Contact (required)
Name 4 tic/ , C/L'' ' Name
Address G (� r2�NG - , oZQb Home Address ' %ZIlP elo/��
City State/Zip G', Z/� ���� City State/Zip 6V, 2)y'7
.
Telephone No. ��, - X70 - F Telephone No. WZ-6�:f Y -JAI, %
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or 1k Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner A C�ange of Occupant ❑ Change of Use ❑
■ Indicate former type of business
■ Are you requesting that the electricity be turp d on? Ye$.l5.�No ❑
■ Is the building sprinklered? Yes)�No❑
■ Will operations produce dust/wood shavings or similar material? YesONgX
■ Will operations involve the repair or replacement of automobile parts Yes ONoX
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes 0 ❑
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo X
■ The following best describes my operation: ❑ Office Only Retail Sales ❑
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For O acial_ Use O��
Occ Group: VV'
Occ Group:
Occ Group:
Total Sq Ft Occupied:_ -'01
Bldg. Permit # 1
Area: / I I I
Area: 111 2-
Area:
No. of Stories: 1
Entitlement #:
Plnr Initials: I M Date: i Plan Chkr Initials:
Inspection Date:
Additional Occupant
If yes: Describe the
Medical/Dental
Occ Load: 3 %
Occ Load:
Occ Load:
TIF Review: Y/
Zoning: 6i
Date: Insp Initials: Date: l lG
(G:1 uilding/Forms/document id goes here)
.f
South Coast
Air Quality Management District
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp://www.agmd.gov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy to a business without
clearance from the local air quality agency. This checklist .will determine if you need to obtain clearance from the
South Coast Air Quality Management District (AQMD).
Company Name:
Property Address:
/6oj ,�- Awl-15A,-- //0 3
City: ,j--�*a4/ z Zip Code: ��ZylyC
r—
Contact Person: ��� ,,� /%/1,������� Title:���1
Type of Business:/2/j Telephone:
Applicant: (print name) ^�a ��/��'�1� Signature:
[.]Will the facility have any of the following equipment? Yes 0 Nox
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 million BTU/hr. maximum input)
Abrasive blasting cabinet/room
Baghouse/cartridge type dust filter/scrubber
Motor fuel storage and dispensing equipment
[.] Will any of the following operations be performed? Yes ,K1No ❑
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
DIf you answered "No" to both questions, this checklist is your clearance from AQMD.
DIf you answered "Yes" to either question, you must contact AQMD to determine if air quality permits are required.
If permits are needed, AQMD will assist you in submitting permit application(s) and then provide you with a
clearance letter. You can call AQMD at their Small Business Assistance Office at (800) 388-2121.