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HomeMy WebLinkAbout10035 Adams Ave - CofO (10)Certificate of Occu I5S-©SI -% o. 0200 Q -- 38 2 -S APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY (3r" Floor — Must Apply In -Person) Business License # Business Address Business Owners Name W C HUAI 0�e Business Name e"St C kmer Business Type flu et erg Date Zip Code Telephone No. �11- Bus. Phone Property Owner Information (required) Tenant/Emergency Contact (required) Name 13 R Vl Ce-_ r-D W q i l Name HI,� A \/4 Cj GNul�t1 �7 Address _ q o E, S'Pri n S'f �' Home Address agq(q Mf'S1� �%C'Y'cif' D�� 103 City fteh State/Zip ��^� City ��S'� ,�lf'S State/Zip � 92I G 26 Telephone No. 5-62- 4-q 0 •- 00q 9 Telephone No. 1&-- 033 -- �7& THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or XExisting Building CHECK ALL THAT APPLY: Change of Property Owner 0 Change of Occupant ❑ Change of Use ❑ Additional Occupant ■ Indicate former type of business W4 CkIMCr5 ■ Are you requesting that the electricity be turned on? Yes ONo ❑ ■ Is the building sprinklered? Yes 'J�No ❑ ■ Will operations produce dust/wood shavings or similar material? YesONoy ■ Will operations involve the repair or replacement of automobile parts Yes ONo If yes: Describe the components repaired or replaced. Does the operation involve the use of welding or open flame? Yes ONo Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes ONo K The following best describes my operation: 0 Office Only ❑ ' Retail Sales ❑ Medical/Dental ❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution (describe process and end product) ❑ Other (describe) riPm-pr5 For Official Use Onl Occ Group: 15 Area: 1¢ ('0 Oo Oce Load: Occ Group: Area: Occ Load: Oce Group: Area: Occ Load: _ Total Sq Ft Occupied: No. of Stories: TIF Review- Y Bldg. Permit # Entitlement #: Zoning: L`1 Plnr Initials: 1 Date: jl Oq Plan Chkr Initials:�Date: d' a Insp Initials: — C-- Date: �(3 Conditions of Approval or Other Notes: NmOeOF S dvokww— Ots G F, 'OT- IJSF. ©c- 9 Inspection Date: (G:Building/Forms/document id goes here) Y e = 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: t G%.C»Qy em Property Address: hdam�_A� f r = (A jQ ; i 1 �� City: %3 eo c-h Zip Code: Cl� q Contact Person: JIMA Cy 611Uj/I%LTj Title: Type of Business: c1fty.-Y-S, Telephone: ( ) Applicant: (print name) 181A)AV04) r—O�5'gnature: ❑ Will the facilityhave an of the following equipment? l� Yes o Y gF1 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 Q Will any of the following operations be performed? Yes E]No 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 QIf you answered "No" to both questions, this checklist is your clearance from AQMD. Q If 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.