HomeMy WebLinkAbout10126 Adams Ave - CofO (3)J�
HUNTINGTON BEAa
CERTIFICATE OF OCCUPANCY' Q7 d20 1 �- 03
CITY OF HUNTINGTON BEACH -
DEPT. OF COMMUNITY DEVELOPMENT APPLICATION
Business Address
Business Owners Name
Business Name
Business Type -145O-h-
(3'd Floor - The Applicant Must Apply In -Person)
Date //-'30-7-
��12/ Ssl�r Zip Code 6
s S Telephone No. 7 / f4 y - Vo i.2
Bus. Phone
Property Owner Information (required) Tenant/
Name `P i�o P&ICT Name
Address HFe,l-i Home ddres:
City 1 P-f/ //t1 State/Zip g z leylf City 4A-/�
Telephone No. `_ 9 1' le/ 2's9Dy Telephone No.
THIS USE WOULD BE DESCRIBED AS:
ONewly Constructed Building or xisting Building
IS THIS BUILDING FIRE SPRINKLERED? OYes (*!�No
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IeVi �aate/Llp C f-r 716 Y--
Walq-11012, UA
?r (,0 � 3 Z - : '35-0 ee-
CHECK ALL THAT APPLY:
O Change of Business Owner Change of Occupant ®Change of Use OAdditional Occupant
■ Indicate former type of business9 -
Z't� 1
■ Are you requesting that the electricity be turned on? OYes 12) No
■ Will operations produce dust/wood shavings or similar material? OYes 6No
■ Will operations involve the repair or replacement of automobile parts? OYes Wo If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? O Yes (Wo
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
OYesT0
■ Will there be storage racks, gondolas, or shelving exceeding 5fee6fetail
ches in height? OYes o
■ The following best describes my operation: OOffice Only Sales ()MedicaUDental
OWarehouse /Manufacturing/Distnbution ORestaurant/Take-Out Food OOther
■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite? Oyes ()�10
If you answered yes, please proceed to the next question.
• Does your facility currently have a grease control device (i.e. grease trap or grease interceptor)?
Check one: OYes 0&0
For Official Use Only N'
Occ Group:
Occ Group: 13
Occ Group:
Total Sq Ft Occupied: 3 CT1
Bldg. Permit # 1 G `703 1
Planning Initia Date:LUL(Q
Area: t Cl 610
Area: F JG4
Area: T
No. of Stories:
Entitlement #:
Conditions of Approval or Other Notes: V V-A'-'C) '-
Occ Load: 6
Occ Load: /
Occ Load:
TIF Review: Y/ N
Zoning:
Building Reviewed By Initials,_Bate: 1 '/l G
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: -7 I F^D N I Cif N �
Property Address: AW-M S
City: iA Zip Code:
Contact Person: SI attr Q Title: �� �l� S
Type of Business: Telephone: % /�493 Z - %3_r0
Fax Number: 7 / V( Z V - L(7 °% Z e-mail address: 6 n. S r M o rl t avt-It/S'a n - c0 A► .
Applicant (print name)5 [YVItWe SSi,IASignature: Date: 1( /34
/4
• Will the facility have any of the following equipment? Yes ❑ No Ll
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❑ NoE3<
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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