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Home My WebLink About10111 Adams Ave - CofO (7)r *105!5;-(e J� HUNTINGTON BEACH CERTIFICATE OF OCCUPANCY 020L-3 - 7Y CITY OF HUNTINGTON BEACH — DEPT. OF PLANNING & BUILDING APPLICATION 714/536-5241 (3rd Floor — Must Apply In -Person) Business License # 2 � (o > Date (.o` 1-- - 13 Business Address ?0111 d ac, vas l� v e Zip Code 9 2 4 % Business Owners Name (PC),,*, G A t pa-,- Telephone No.& Z 6 - 2-35 S8/ Business Name 4ct,,4,jA- xBus. Phon��t y `'f �03 3S SS Business Type I)•e,., 1 p 'c e Property Owner Information (required) Tenant/Emergency Contact (required) Name DOrmin is Ga a Name Address 4�Ipl(1 P�dctjyn& e, Home Address 1�N • G1( City k6A&cM ".(,Q" State/Zip a City Lqa Z19,Qfj A State/Zip CA 110 L Telephone No. �(21g)_q (3 -3 SSS Telephone No. THIS USE WOULD BE DESCRIBED AS: / ❑ Newly Constructed Building or R Existing Building CHECK ALL THAT APPLY: ❑ Change of Property Owner dChange of Occupant ❑Change of Use ❑Additional Occupant ■ Indicate former type of business S - QWhx Wi C2 ■ Are you requesting that the electricity be turned on? Yes No ■ Is the building sprinklered? Yes No ❑ ■ Will operations produce dust/wood shavings or similar material? Yes ❑ No z/ ■ Will operations involve the repair or replacement of automobile parts Yes Not/ If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? Yes O Nog, ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes ONo V ■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes ONO F( ■ The following best describes my operation: ❑ Office Only ❑ Retail Sales EiMedical/Dental ❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and end product) Other (describe) For Official Use Only Occ Group: Area: 1 3 (3c) Occ Load - Occ Group: Area: Occ Load: Occ Group: Area: Occ Load: Total Sq Ft Occupied: 13C)OD No. of Stories. TIF Review: Y/ N Bldg. Permit # Enti went #: Zoning: C4 Plnr Initials:_ Date: - 17 -1 Plan Chkr Initial Date r-%sp Initials:' Date: 7 S13 Conditions of Approval or Other Notes: 11 InsUection Date: 6U C 20i4 A-M 1 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: W6[05 AV (- Property Address: MU U �dawv City: 64UJJJ�W tea(j �ru e Zip Code: Contact Person: DD Iln [ n i C ci�GIS Q k Type of Business: Q(AAjx.j 6 f f i CC Fax Number: 0` Y) Iq I✓ 3- 3 S S S Applicant (print name):Pg%_ u c (fIrc-- Signature: Date: Title: Telephone: e-mail address: 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/Ef 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- Department of Planning & Building 2000 Main Street Huntington Beach, CA 92648 .x. Phone: (714) 536-5241 Fax: (714) 374-1647 CERTIFICATE OF OCCUPANCY FRED C LEE DDS INC Cert. Number CO2007-007297 DENTISTRY - FAMILY & AESTHETIC Date Printed 06/17/2013 10111 ADAMS AVE SUITE # 111 HUNTINGTON BEACH CA 92646 Address: 10111 Adams Ave 111 Issue Date: 08/12/2008 Permit Number: B2007-007297 TCofO Issue Date: Business Name: DENTISTRY - FAMILY & AESTHETIC TCofO Expiration: Business Type: Professional / Other Approved Sq Ft.: 0.00 Current Use: DENTIST OFFICE # of Stories: Occupant Groups: Description: Area: Occupant Load: B MED OFFICE 1300 13 Conditions of Approval: Contacts: Contact Type: Name: FRED C LEE DDS INC Phone: (714) 369-8970 Business Owner Address: 10111 ADAMS AVE SUITE # 111 Cell: ( ) - City / State: HUNTINGTON BEACH CA Fax: ( ) - Zip: 92646 Pager: Contact Type: Name: COWGILL ROBERT H ]R Phone: (000) 000-0000 Property Owner Address: 2760 E SPRING ST #200 Cell: ( ) - City / State: LONG BEACH CA Fax: ( ) - Zip: 90806 Pager: ( ) -