HomeMy WebLinkAbout10176 Adams Ave - CofOa
• • • r
c
�J •
HUNTINGTON BEACH
Business License #
155-IY1-2'�
CERTIFICATE OF OCCUPANCY 0200
CITY OF HUNTIN.GTON BEACH —
DEPT. OF BUILDING & SAFETY APPLICATION
714/536-5241
Business Address
Business Owners Name
Business Name
Business Type
A (3'd Floor —Must Apply In -Person)
Date 91_ 0-0
Zip Code
Telephone o.
Bus. Phone Ilclr1�35-
Property Owner Information (required) Tenant/Emer enc Contact (required)
Name"` L9 Name '(_(Y
Address Home Address 14 f luz =Pz (,,u—& ke_ -
City 44 t 6 r? QjD___State/Zip _6-4 . City Asw r (0 rd State/Zip C4 .
Telephone No. r L Telephone N lU _ 4 Sri 57 3 �—
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner EAPhan a of Occupant ElChange of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes El No�
■ Is the building sprinklered? Yes No❑
■ Will operations produce dust/wood shavings or similar material? Yes 0 . Not'
■ Will operations involve the repair or replacement of automobile parts Yes O No If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes Nl�]
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo Cc
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution 0,,Restaurant/Take Out Food
(describe process and end product)
0 Other (describe)
For Official Use Only `j W
Occ Group: V, Area: tOcc Load: ,
Occ Group: '? L7✓�,v,� Area: Co6•, Occ Load
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: l� �� (o S'.�, No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitlement #: Zoning: (_ C
Plnr Initials:` _ Date: F Z7 Plan Chkr Initials:C72/ „Date: Insp Initials: Date:
Conditions of Approval or Other Notes:
SD.M,tr_ (ie;E_
1, r
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • http:// www.agmd.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 (AQMD).
Company Name: Lo ,S p r ( wJ
Property Address: 10 / -4 6 A- b 4L (K5-
City: gFip Code:
Contact Person: 05 91� (CL
1qL Type of Business: &r__i j ^ j r
4 vt -
G9 GLi
Title:
Telephone: K 2-7 7 3 5'
Fax Number: �� (eZ ts'- - ail addressS
Applicant (print name): t4 � 5 naZf&gnature: �vX0,
I' Date:
V
• Will the facility have any of the following equipment? Yes No ❑
4/-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-