HomeMy WebLinkAbout10061 Adams Ave - CofO (4)J�
HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020k - 000'8 Z
CITY OF HUNTINGTON BEACH -
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3'd Floor — Must Apply In -Person)
(Business License # A 270SOIF Date - 7 -
Business Address 1006 1 A77Am .4V. �� 0 Zip Code G2ZCz,,e
Business Owners Name kw-c:v, IA,, Telephone No. 7/�z -7¢3 -7413
Business Name 3 ,; Bus. Phone 114
Business Type !✓S UP A/t"rt
A- Property Owner Information (required) Tenant/Emergency Contact (required)
Name Nx/e5;EF4U . 4H5o Name
Address %� _ 5�,'7�I� S�; Home Address
City 1 f: State/Zip ! CQ 94)C City State/Zip eft QZ ?G Z_
Telephone No. � - Y-5-PC>- O� —Z Telephone No. 7 /V - 7cl 3 - 7 jC
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or XExisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business /z L:J
■ Are you requesting that the electricity bp turned on? YesO No
■ Is the building sprinklered? YesP31 No❑ /
■ Will operations produce dust/wood shavings or similar material? Yes❑ Noff
■ Will operations involve the repair or replacement of automobile parts Yeso NoQ-""' If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? YesO No
■ Will the busiss be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ON(
■ The following best describes my operation: ❑ gffice Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution Restaurant/Take Out Food
(describe process and end product)-tf�
Other (describe)
For Official Use Only
Occ Group: Area:
Occ Group: Area:
Occ Group: Area:
Total Sq Ft Occupied: No. of Stories:
Bldg. Permit Entitlement #:
�A 0
Occ Load� �
Occ Load
Occ Load:
TIF Review: Y/ N
Zoning: Cgs—
Plnr Initials: Date:-40'1I Plan Chkr Initia D Insp Initials: Date:
Inspection Date:
X- 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 (AQMD).
Company Name:
Property Address: 10 v 6 1 A—PAk7 f 4c
City: 410iu i7�%/� Zip Code:
Contact Person: '7Z>" ts'N
Type of Business: /2&s7riPf zf—
Title: , j4—,:'
Telephone: 2LV-7,K�?-76/3
Fax Number: 21(f(- 5,C-g - � 5 e-mail address:
Applicant (print name): %-Z>N`-/ 1/1 Signature:
Date:
• 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 f lter/scrubber
Motor fuel storage and dispensing equipment
• Will any of the following operations be performed? YesO Nom/�
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).
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