HomeMy WebLinkAbout15102 Bolsa Chica St - CofO (35)y
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HUNTINGTON BEACH
Business Licen
Business Addrf
Business Owne
Business Name
Business Type
CERTIFICATE OF OCCUPANCY 02011 - 5120
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
Property Owner Information (required)
Name In)I.USOno-ML25,]:r Nam
Address Kpr17E2K-VV Hom
City S-MwTum State/Zip Of Nog 0 City
`(
Telephone No. ��`'[ 1 1 13 Telel
THIS USE WOULD BE DESCRIBED AS: �Existing
❑ Newly Constructed Building or Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occupant
■ Indicate former type of business
■ Are you requesting that the clectniq*ty/be turned on? Yes 0 Nov
■ Is the building sprinklered? Ye No❑
■ Will operations produce dust/wood shavings or similar material? Yes❑
■ Will operations involve the repair or replacement of automobile parts Yes
components r paired or replaced.
■ Does the Opel tion involve the use of 1
■ Will the bus' ess be a drinking, dining or
Yes ONO
■ Wi there be storage racks, gondolas, or
■ Tye following best describes my operatio
Warehouse /Manufacturing/Distributio
(describe process and end product)
Other (describe)
(3'd Floor — Must Apply In -Person)
Date b
Zip Code
Telephone o. l
Bus. Phone
❑Changepf Use QAdditional Occupant
0
No If yes: Describe the
or open flame? Yes 0 NJ9
ably use with an occupant load of more than 50 persons?
.tg exceeding 5feet 9 inches in height? Yes No ❑
lGffice Only ❑ Retail Sales ❑ Medical/Dental
Restaurant/Take Out Food
For O icial Use Onl I_
Occ Group: (
Area: 00 ® Occ Load:
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: V No. of Stories: TIF Review- / N
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials Date Plan Chkr Initials. Dated 1 Insp Initials: (� Date:
1. D
Conditions of Approval or Other Notes:
Inspection Date:VM
Y
t 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: V, C to
Property Address: /�—/ — L Sft G!// C ST L 7
City: f Gf & %tNC7 (0 IV Zip Code
Contact Person:
Type of Business:
Fax Number:
Applicant (print name): Signature:
Title:
Telephone:
e-ma��4I ress: Z
Date:
• 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❑ No
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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