HomeMy WebLinkAbout10036 Adams Ave - CofOCERTIFICATE OF OCCUPANCY 020�a -
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
HUNTINGTON BEACH 714/536-5241 (3'd Floor— Must Apply In -Person)
Business License # n ?:�I
,� 15 ,
Business Address 10036
Business Owners Name
Business Name , 4,4 L,'c i b, ,n.oc Q 7;' ba ce-.i
Business Type
Date - / - 13
Zip Code Z
Telephone No. o z - rooL
Bus. Phone -
Pro a Owner Information (required) Tenant/EmergencyContact (required)
Name .1 a L/ I p�1 U b e M Name oMct va Al-bibzll
Address Home Address / 9rD Win, 4Ave-,
City u% pr ke11 State/Zip o City Cosa 04g4 State/Zip 97-6
Telephone No. _� , y) s-IDy - 4 B Fr Telephone No. yS5/
THIS USE WOULD BE DESCRIBED ,AS:
❑ Newly Constructed Building or C)(Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes O No❑(Jasf Caw�plzf�
■ Is the building sprinklered? Yesk No❑
■ Will operations produce dust/wood shavings or similar material? Yes ❑ No�
■ Will operations involve the repair or replacement of automobile parts Yes0 No� If yes: Describe the
components repaired or replaced. Al R-
■ Does the operation involve the use of welding or open flame? Yes D NoW
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes ONo R
■ The following best describes my operation: ❑ Office Only XRetail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product) Rtj& / .54 e5 a E/ecjyv,, is h 51,gelfes { Tob&cee
Other (describe)
For Official Use Only
Occ Group: V:2 Area: Occ Load: l
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: No. of Stories: TIF Review: Y/ N
Bldg. Permit # Ent' ement #: Zoning: C&
Plnr Initials: 1A Dater 1 3 Plan Chkr Initials: Date. Insp Initials: Date: Q Z3 aj
C itions oq-f A proval or Other Notes: -
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
DI3—y'�te�
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).
I
Company Name: /3r,,��Q!-, S 1 &P-2S �%p 1o4cca
Property Address: 100 31Q 1}d_AAw 5 A_tl_� .
City: F► 4 4i)-A 8er,c � Zip Code:
Contact Person: Title: n el ,, c,
Type of Business: Telephone: 1311)) S'2 — fboZ
Fax Number: e-mail address: MrAa616e4
Applicant (print name):- Signature: o C
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 filter/scrubber
Motor fuel storage and dispensing equipment
• Will any of the following operations be performed? Yes[:] NOR
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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