HomeMy WebLinkAbout15062 Bolsa Chica St - CofO (3):f 04/27/2004 11:36 7143741 CITY TREASURER H PAGE 05
APPLICATION FOR CERTIFICATE OF OCCUPANCY
cay of HuNTLNGTON BEACH - DE? T OF BUILDING & SAFETY
9111- (3rd Fioal, --11 ILyt Apply Ig-persojt)
Date
Business Licease 44 -
#-h-,1A . // 4
Address jJ�l1h 2 �r�rdra _ C'_�.c'a_, {�%a„rt�7'd1� �
Business Name 711 TelepizonZe
Business Type Al
-Frojoerty Owner Information Business owner
� S he S Name �"6 Tns ch�n�
Name . r • n�,
Address '�� �� Home Address I
cityN or
.
Tel. I - I
THIS USE WOULD BE DESCRIBED AS. CA Gl.X 61
[Newly Constructed Building or OFxisting Building
CHECY ALL THAT APPLY'
A!?Change of Owner Change of Occupant CiChange of Use QAdditional Occupant
Indicata former use, if any
Does the bi ildiiag, have electricity? Yes Nod
If No, are you requesting that the electricity be turned on? Yes Q No
The building is sprinklered? ' Yes z • No Q
,Operations will product dust/wood shavings or similar material? Yes C2 NO
Opmations will involve the repair or replacement of automobile parts Yes
C3 NO
If yes: Describe the components, repaired or replaced.
Does the operation involve the use of welding or open flame? , Yes No
The businaess is drinkng, dining or assembly use that will result in an occupant load
of more tlaan SO personas. Yes 0 NO
The following best describes my operation:
COffice Only ORetail Sales C]MedicallDental QRestaurant/Take Out Food QWarebDuse
❑MaaufactuliagMistribution (describe process and end product)
Qther (describe)
Adrp, stirs S
Stories.:
Sq Ft Occupied: O OO Oce Group: _----- -
parking Spaces:
Occ Load:
Aazt Paid$,
p,id BEFOP.� Fins! lnspcctior
•r"`. « 04/27/2004 11:36 7143741� CITY TREASURER HE PAGE 07
South Coast
Air Quality Ma1 agement District
21865 E. Copley Drive
Diamond Bar, CA 91765�41.82
(909) 396-3529 htpp://Yrww.aqmd.gov
Air Quality Permit Checklist
California Gover=ent Code 65850.2 prohibits cities from issuing a Certificate of (Occupancy 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 Aar Quality Management District (AQMD).
Company Name:
I'M-)
Property Address: l �J� �l bridga,._
City: � a4ml UQSLV Zip Code: 902(oe
Contact Person:�(� _ Title:
Type of Business: per AUC _ Telephone: ()
Applicant: (print name) I /O (�rsr 1/0signature:
• Will the facility have any of the following equipment? Yes ❑ No W
Charbroiler
Dry cleaning machine
Spray Booth
Printing ]:Tess(screerdlithographic/flexographic)
internal combustion engine (greater than SOH?) (excluding motor vehicles)
Boiler/combustion equipment (greater than. 2 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 A No ❑
Application, of paints or adhesives
Etching, plating,. casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of hones, dust, smoke or strong odors
if you answered "No" to both questions, this checklist is your clearance from AQMa.
• If you answered "Yes" to either question, you mast contact AQMD to determine if air quality peVnits are
required. If permits are needed, AQMD will assist you in, submitting permit applications) and then provide you
With a clearance letter. You can call AQMD at their Small Business Assistance Office at (800) 388-2121-