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Home My WebLink About10044 Adams Ave - CofO (4)"6- CERTIFICATE OF OCCUPANCY 0200-7 - g 2`Z CITY OF HUNTINGTON BEACH - DEPT. OF BUILDING & SAFETY APPLICATION (3r1 Floor - Must Apply In -Person) Business License # C\-Z�-gs-o Business Address lc?o* /idamf A✓C Business Owners Name --r'rr = S-t-e ttz Olro o o-Cics �rwc- Business Name Qulik oo".O p Business Type xNTZrnGI- SZICS ConlJ��`ils� Date Zip Code Z Telephone No. 7/y- Q6f= 72W Bus. Phone 7/1,l-Qiis=-/, Property Owner Information (required) Tenant/Emergency Contact (required) Nameys,'n sf Prwrt,1�s ParmerfA,PName 7"7k— tei:22jr&'lC Address 17631 r'YY4 AW Home Address g1zl 47M,,vyA 411,e City _-1aVtJ4 State/Zip 6A 26(y City Y13 State/Zip CI- Telephone No. C tiO G��-�qc�b Telephone No. QZy- 2-3v -ytoh% THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or X Existing Building CHECK ALL THAT APPLY: ❑ Change of Property Owner [XChange of Occupant ❑Change of Use ❑Additional Occupant ■ Indicate former type of business Pe4,( ,E to aFrtke • Are you requesting that the electricity be turned on? Yes❑ Noff ■ Is the building sprinklered? Yes❑ No[t ( • Will operations produce dust/wood shavings or similar material? Yes❑ ' No[X ■ Will operations involve the repair or replacement of automobile parts Yes[] NoX If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? Yes[] Nox ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes CINo A ■ The following best describes my operation: 0 Office Only X Retail Sales U Medical/Dental 11 Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and end product) Other (describe) For Official Use OIL/ Occ Group: Oce Group: Occ Group: Total Sq Ft Occupied: Bldg. Permit # Area: Area: Area: No. of Stories: Entitlement #: Plnr Initials-V ' Date: I01fld Plan Chkr Initials: Date: Conditions of Approval or Other Notes: Inspection Date: Occ Load: Occ Load Occ Load: TIF Review: Y/ N Zoning: G 0- lnsp Initials: Date: (G:BuiIding/Dorms/PermitApplication/Co ts ON) South Coast Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-3529 • http:H 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: / vv A141 4d4(ml 4jle. 1, / City: Yu"f,Vh,,) 9,(4(% Zip Code: IZ�O`%lam Contact Person: — v6( Fracsfi2� Type of Business: 1�17trffet Siviel Fax Number: 714 -1 bS 794 - Applicant (print name): Signature /aI� A irP��sNZt Pl`tfr4(4T' Date: Title: r•�e^.-- Telephone: 111I— maia ,l�ddress: Cati�� Will the facility have any of the following equipment? Yes ❑ No 2 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 l 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❑ No2'-' 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 &�v" Itdry. , C"" 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 WARNM HUNTINGTON BEACH FIRE DEPARTMENT HAZARDOUS MATERIALS DISCLOSURE OFFICE 2000 MAIN STREET • HUNTINGTON BEACH, CA 92648 (714) 536-5676 - FAX (714) 374-1551 HAZARDOUS MATERIALS DISCLOSURE INFORMATION MANDATORY REPLY REQUIRED PRIOR TO ISSUANCE OF BUSINESS LICENSE Complete and return to the Business License Division PLEASE PRINT RD/h Business Name: (�j �I K �Iy✓� Phone: -71q — Business Address: loo 4ltl "",f Ave dy„ ,-.kAN fie4c h 54 N nun ,bi�er Street V Unit lip Code Owner/Manager:zlwy /'fwyy'jy— Date Business Will Start Operation: Description of Business: --e,�rdwr fwlel 4 , //y California's emergency response network requires all businesses to notify their local emergency response agency if they store or use hazardous materials above certain threshold quantities. In the City of Huntington Beach, the emergency response agency is the Fire Department, and the method of notification is by filing a Hazardous Materials Disclosure Package with the Fire Department's Hazardous Materials Disclosure Program office. Types of hazardous materials that must be disclosed include: oils, solvents, paints and coating materials, gases (compressed or cryogenic), fuels, and hazardous wastes. You are required to submit a Hazardous Materials Disclosure Package if you store or use hazardous materials in quantities equal to or greater than the following amounts: ➢ 500 pounds of a hazardous solid ➢ 55 gallons of a hazardous liquid ➢ 200 cubic feet of a gas (or the compressed or liquefied equivalent) ➢ Extremely hazardous materials that exceed the threshold amounts listed in 40 CFR 355 Appendix A ➢ Radioactive materials that exceed the amounts listed in 10 CFR sections 30, 40 or 70 ➢ Hazardous wastes that exceed any of the thresholds amounts listed above ➢ Other materials determined to pose a significant hazard to human health and safety, or the environment Disclosure is NOT required for the following types of hazardous materials: ➢ When contained in a food, drug, cosmetic or tobacco product. ➢ When packaged for direct distribution to consumers (retail products). ➢ When the materials are stored, used, or handled at a facility for less than 30 days. ➢ Infectious waste generated by health care facilities. Please indicate which category most appropriately describes your business: No hazardous materials are, or will be, used, handled or stored at the above location. O Hazardous materials are present, but in quantities less that the amounts listed above. O Hazardous materials are used, handled, and/or stored at or above the amounts listed above. A Fire Department representative will contact you at a later date to verify the above information and determine if you need to File a Hazardous Materials Disclosure Package. If you have any questions about the Hazardous Materials Disclosure Program, please call (714) 536-5469 or (714) 536-5676. You can also obtain additional information on the City's website at www_surfbity_ hb.org in the Fire Department page under the section Fire Prevention. I certify, under the penalty of p Jury, that the above information is true and correct to the bestofmy knowledge. Signature: licpz' i Home Phone: qzg- �30' L��7� Date: -3- F Dep'w nww dwo pI,,! S'3f"ty AN,) Fa r, �- i 1m) -Igtwl f3carl,, CA 926-4, Pt'ow 1 Occupancy Application . . . . . . . . . . ficafion Binder •Atemw Job-Addi RD T z' i4jo: Ellook ot 5" 'P'4q 4y P2 Certificate of Occupancy j 0*9 106/mm oil y4e'- Two —00" "'Su Usse Plata elt", 'c 000" Y(*" NOW 02001'0� Y .......... . ................. . . ..... "Pb J, "g; 'V =1cate of Occupancy TYPE 0ayments N Inspections . .... .. . ... Issued Date Printed Date, Ut 00 ii ba" the BusWmft License iJ zoop- r Ah'o, '0 of Oocwancy- .... . ... .. 806"Iftes$ Narv*' Aspe M& S K,-& SOUFgX 61 6'"s Type W14MERSOUWX lirkiis Ph" '(7 14)M WATER Al "L 40XS$ ETC xroposw Ilse Approved, 006)pfod Area (Sq Ft}60 00 r X STORE #of $We$ 1 FOrr" U$4MAIL BO -50 omLqwft? Wiiii1ft OW F AuWnWto Repairs Occupancy Group/Load 7,MTi Map" Dei4r �'Area i B 10 z