HomeMy WebLinkAbout10081 Adams Ave - CofOo /9S 0
I Certificate of Occuvancv No. OMB I
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY
714/536-5241
Business License #
Business Address MOT
Business Owners N
Business Name
Business Type 5 —
(3rd Floor — Must Apply In Person)
l?�
ProDertv Owner Information. (required)
Name ok)Ajv-%S /-J---C- N
Address Ih
City VjVX State/Zip C
Telephone No. 9g9^ q 7T — mod T
THIS USF WOULD BE DESCRIBED AS:
Newly Constructed Building or ❑ Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Xlchange of Occupant ❑ Change of Use ❑
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes ONoD
■ Is the building sprinklered? YesNOD
■ Will operations produce dust/wood shavings or similar material? YesONo❑
■ Will operations involve the repair or replacement of automobile parts Yes QNo>'
components repaired or replaced.
Date 7 �LXWO
Zip Code
Telephone No. f - 7 3-7/.5.6
Bus. Phone -3 t 0,100 r3��
State/Zip
No. 71 q—"?1-/ �— ?I S -C
■ Does the operation involve the use of welding or open flame? Yes QNo
Additional Occupant
If yes: Describe the
■ Will business be a drinking, dining or assembly use with an occupantlo'ad of more than 50 persons?
Yes No ❑
■ Th fo lowing best describes my operation: ❑ Office Only X Retail Sales ❑
❑ Restaurant/Take Out Food ❑ Warehouse /Manufac istribution
(describe process and end product) cy-
❑ Other (describe)
For Official Use. Only (1 -;:
Occ Group: Al
Occ Group: S
Occ Group: &--
Total Sq Ft Occupied: 5 2-0
Bldg. Permit # '$ 2,f�b +73 _oo1r CSC_)
Medical/Dental
_S.
Occ Load: 122 /
Occ Load: ,A
Occ Load: 8o
TIF Review: Y/ N
Zoning: rc7
Plnr Initials: Date:_--/� Plan Chkr Initials: Date: Insp Initials: ii / Date:
Other Notes:
Inspection Date:
Area: _ 36 G45-
Area: .9
Area: Tel 69
No. of Stories:
Entitlement #:
(G:Building/Forms/PermitApplication/CofD2006)
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • http:// www.aqmd.gov
Air Quality Permit Checklist
California State Law Code 65850.2 prohibits cities from issuing an occupancy permit 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 (AQMM).
Company Name: Al AS
Pro a Address: �b% a 2
p � 1 � ms�
City: Zip Code:
Contact Person: —Fro I ; toas*2 J Title:
-?Y3 �71 � Type of Business: �� 1S �'i��' Telephone: I
Fax Number: O " G%� e- -1 s: � • �1Cz ` ��
Applic t not name): Signature:
Date: % ju',7
• Will the facility have any of the following equipment? Yes ❑ No
Charbroiler
Dry cleaning machine
Spray booth
Printing press (screen/lithographic/flexographic)
Internal combustion engine greater than 50 HP (excluding motor vehicles)
Boiler/combustion equipment (greater than 1 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 ❑ No
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding, extruding, or curing of plastics
Mixing and blending of liquids and/or powders
Storage of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke, or strong odors
If you answered "No" to both questions, this checklist is your clearance from AQMD. 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 1-800-CUT-SMOG (1-800-288-7664).
_2.
Revised June 2005