HomeMy WebLinkAbout10061 Adams Ave - CofO (2)J�
HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020] -
CITY OF HUNTINGTON BEACH -
DEPT. OF PLANNING & BUILDING APPLICATION
Business License #
Business Address l no
Business Owners Name
Business Name .Sua
Business Type / Z
(3`d Floor - The Applicant Must Apply In -Person)
Date � - 29— l C/-
Zip Code 9,2 c VC
Telephone No. �7/Y-443 -
Bus. Phone��Y-63> Gcvo
ProneLty Owner Information (required) Tenant/Emergency Contact (required)
Name /„ c ,sra,c_,) Name 1_ 6 .rs c rN
Address ? Go �. Sua,N�2 Ste. Sc "ram � Home Address 121Ste, /y1A Tz o �r
City LN 4 State/Zip 1944 9 D $ City I oo ,u Mg,,j r4ccF r State/Zip
Telephone No. �76 .7_- �rqo —bogo Telephone No. 71V- V 6 3- zs x 2-
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or XExisting Building
IS THIS BUILDING SPRINKLERED? Yes No ❑
CHECK ALL THAT APPLY:
)Z: Change of Business Owner ❑Change of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business orw,�, (S�� 2f
■ Are you requesting that the electricity be turned on? Yes❑ No!t/
■ Will operations produce dust/wood shavings or similar material? Yes❑ NoIY
■ Will operations involve the repair or replacement of automobile parts Yes❑ No E-If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ❑ Now
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes[] NoCK
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes El Noly
■ The following best describes my operation: ❑ Office Only Detail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take-Out Food
■ Will the Food Service Establishment Generate Fats, Oils Greases? Yes❑ Nei
■ Does the Facility Have a Grease Interceptor? Yes ❑ Now
■ Other (describe)
For Official Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Planning Initials: _Date: gj7r
--7-
Area:
Area:
Area:
No. of Stories:
Entitlement #:
Occ Load:
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning: Cfz�,-
Building Reviewed By Initial Date �al �4
Conditions of Approval or Other Notes: ► )Ay - 12 SETS _ (')IJL-"-i
Grease Interceptor Verified Inspected By Initials: Date:
i
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: l) u Q F (�I%CI-
Property ddress: / 00 ` / �� s ST S� �
City: U,u/ N'i,*.,j � Zip Code: 9 aG Va
Contact Person: Title:
Type of Business: AC•;SSG,,.a Telephone: ?/-I/ 9C5- 6r.o0 ,,��
Fax Number: e-mail address: �% J;V/?7 t d Yre.0 Y.9• 6, 0„�1
Applicant (print name):. e hra Ye i Signature:
Date: 2—.2 9-1 y
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❑ Nook
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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