HomeMy WebLinkAbout10044 Adams Ave - CofOf �
J. ,
HUNTINGTON BEACH
Business License #
Business Address
Business Owners N
Business Name
Business Type
CERTIFICATE OF OCCUPANCY 020 1 3 - DOS 523
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
7141536-5241
i
(3`d Floor — Must Apply In -Person)
Date 9 — 3 -- 20 13
Zip Code CIS 6 U 1,
Telephone No. -1 1 t, l G 2' C
Bus. Phone 7 14 4:h�r
Property Owner Information (required) Tenant/Emergency Contact (required)
Name (j U S (tUM �1'Oq Qrfl 11) M cc uCo.w►.ewt wyame . ckoVL
Address lit, & 1 f j �k 0 Home Address 72-6 W. kAd I t .
City 1 lrvco__ State/Zip GA- cl Z6l LtCity (',os�(A pp. a State/Zip CA q 26 21
Telephone No. r1 y 6l I L'Xv (l Kq p Telephone No.
THIS USE WOULD BE DESCRIBED AS:
0 Newly Constructed Building or )fExisting Building
CHECK ALL THAT APPLY:
0 Change of Property Owner (Change of Occupant El Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes O No ❑
■ Is the building sprinklered? Yes ❑ No V
■ Will operations produce dust/wood shavings or similar material? Yes ❑ No Cq-
■ Will operations involve the repair or replacement of automobile parts Yes NoM--' If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes O No D-
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo 91'
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes ONO [Y
■ The following best describes my operation: ❑ Office Only 0 Retail Sales ❑ Medical/Dental
0 Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
--=t;? Other (describe) _ ; or/'
For Official Use Only
Occ Group:
Occ Group:
Occ Group:
Area: (0D
Area:
Area:
Total Sq Ft Occupied: 10 p No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials: '� Date: Plan Chkr Initials: ,�'� Dater Insp Initials:W Date: lb ?J
Conditions of Approval or Other Notes:
Occ Load:
Occ Load:
Occ Load:
--Inspection Date:
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: tk M ty T& -IOr 36 P
Property Address:
(70 4 Li A-acwn S AvL .
City: i 11 r, Zip Code: 2 61, h
Contact Person: V�Ott 0 vt� Title: CW WJZ/V'
Type of Business: TCcA O- _ Telephone:
Fax Number: e-mail address:
Applicant (print name): 11u ► t/C�m'rignature: 21 ,,;117���1--,
16��
Date:
Will the facility have any of the following equipment? Yes ❑ No [El
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).
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