HomeMy WebLinkAbout15102 Bolsa Chica St - CofO (23)1
HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020 /D
CITY OF HUNTINGTON BEACH —
DEPT. OF BUILDING & SAFETY APPLICATION
714/536-5241
(3`d Floor - Must Apply In -Person)
Business License # A, a.-7 Qj 2`7 Date 2>-2,j - /n
Business Address I �t a� -��� P,''r.�, �, „lam ��. Zip Code 9 Z1,UQj
Business Owners Name Telephone No. ?�,I CSy �I
Business Name 1_ b ] r_ t Bus. Phone Ey=,2 fT2 : j j)
Business Type
Property Owner Information (required) Tenant/Emergency Contact (required)
Name �,�(/g I �� %; Name
Addressl2 7 _ �� Home) -
City �,,� - State/Zips !742L_,, City tate/Zip
Telephone No. 1 t_.t. Telephone No. lzi A2.g2g S t
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or lot Existing Building
CHECK ALL THAT APPLY:
0 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 0 No B'
■ Is the building sprinklered? Yes O� . No❑ /
■ Will operations produce dust/wood shavings or similar material? Yes , NoM
Will operations involve the repair or replacement of automobile parts YesQ Nog/ If yes: Describe the
components repaired or replaced.
• Does the operation involve the use of welding or open flame? Yes Now
Will the busi}ess be a drinking, dining or assembly use with an occupant load of more than 50 persons'?
Yes ONo I" ■ The following best describes my operation: Woffice Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
❑ Other (describe) &I,
For Official Use Onl
Occ Group: S" I Area:
Occ Group: 43 Area: 2c� s i
Occ Group: Area: r-
Total Sq Ft Occupied:_ oo _r No. of Stories:
Bldg. Permit # Entitlement #:
Occ Load:
Occ Load:
Occ Load:
TIF Review: Y/ N
�j Zoning: I L
Plnr Initials: �/V� Date: Plan Chkr Initials: Date: o Insp Initials
Conditions of Approval or Other Notes:
Inspection Date:
04__ Date: 414 Z uO
►*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: LY-,? C:
Property Address:
City: I--/ Zip Code: C./1
Contact Person: y 51� Title:
Type of Business: f �s,A�i' l Telephone: 3 jZ56Z00 j 1
Fax Number:e-mail address:
Applicant (print name): Signature:
Date: - ?oJ - tl-;>
• 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 BP (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❑ NoP----
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).
Revised June 2005
-2-