HomeMy WebLinkAbout15102 Bolsa Chica St - CofO (16)7141536-5271
Business License #
Business Address I
Business Owners r
Business Name I�ar1%C�%c,�C►aa 5�C2S �r'[.•
Business Type 2i-1S<(Wufk0-�
CERTIFICATE OF OCCUPANCY 020\�__ - G-
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(Yd Floor - Must Apply In -Person)
Date
9Zip Code D_I.M.
Telephone No. n-,7�$
Bus. Phone c 61)0 !j70C)
Property Owner Information (required) Tenant/Emergency Contact (required)
Name rtt .J Wkkbo,� Name Ct�kYUs'CoP�t2R. Tea
Address epr AV, Home Address %i4Z5 5a 1 Zt4/e-
City A 1 State/Zip O City Ry,-Tt%ra�� SaXoState/Zip CA 9Z(o48
Telephone No.71 1 �J2�'" Telephone No. (77ly) 3�3"76(fS
.a
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or & Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner 05, Change of Occupant 2. Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? YesKNo ❑
■ Is the building sprinklered? Yes IgNo❑
■ Will operations produce dust/wood shavings or similar material? Yes oNol-
■ Will operations involve the repair or replacement of automobile parts Yes DNA If yes: Describe the
components repaired or replaced. _
■ Does the operation involve the use of welding or open flame? Yes DNo A (N-'t o�4l• 5t
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo 9
■ The following best describes my operation: & Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food �* Warehouse /Manufacturing/Distribution
(describe process and end product)naAw- /-fooL/ r-no►P,- , Wm4Aoe� d L-
EI Other (describe)
For Official Use Onl
Occ Group: Area: Z-0 0
Occ Group: Area: j ?-�
Occ Group: Area: T
Total Sq Ft Occupied: No. of Stories:
Bldg. Permit # I Entitlement #:
Plnr Initials:4� ate:/Flan Chkr Initial .
Conditions of Approval or Other Notes:
Inspection Date:
�(G:Building/Forms/document id goes here) )
Occ Load:
Occ Load
Occ Load:
TIF Review: Y/ N
Zoning: ---! U
Date: Ci t%nsp Initials: G i Date: Jos 17, ��
• .M
South Coast
Air Quality Management District
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp://www.agmd.gov
Air Quality Permit Checklist
California Government 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 Air Quality Management District (AQMD).
Company Name:Ji.1AM�C CsJ�U IGTI�� G%1(1LS
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Property Address: , 52t psp
City:
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Zip Code: Opcpq )
Contact Person: (SkQ Srt-Of 6L&ZY t5l-e t
Title: ?ZQ,6\060-c'
Type of Business:
Telephone: IA � 3z,3-35U
Applicant: (print name)C�(Ijg�OQI�QS�-�'re„�
Signature:
Cl Will the facility have any of the following equipment?
Yes QNo R
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 50HP) (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
o Will any of the following operations be performed? Yes 0 No L9
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 fumes, dust, smoke or strong odors
t�.Uf you answered "No" to both questions, this checklist is your clearance from AQMD.
DIf 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 (800) 388-2121.