HomeMy WebLinkAbout15102 Bolsa Chica St - CofO (15)�J
HUNTINGTON BEACH
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Business Addrl
Business Owne
Business Name
Business Type
CERTIFICATE OF OCCUPANCY 020� - �O`6
CITY OF HUNTINGTON ACH -
DEPT. OF PLA ING & BU DING APPL ATION— --
714/536-5241 (3rd Floor —Must Apply In -Person)
Date 6-00 —[
Zip Code 13a0iq
Telephone No. 1 �.%
Bus. Phone �—@Srj—jg0L[
ProDertv Owner Information (required) Tenant/Emergency Contact (required)
Name Name
Address ( Home Address Ct,Ej ° eY
CityState/Zip City +Vb State/Zip LJq
Telephone No. ��—� rja�—a �rQ� Telephone No. t40
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or A'risting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner AChange of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yesk' NOD
■ Is the building sprinklered? Ye$N�— . No❑
■ Will operations produce dust/wood shavings or similar material? Yes ❑ . Nc�-
■ Will operations involve the repair or replacement of automobile parts Yes D Now If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes[.] Now/
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo�
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes []No
■ The following best describes my operation: ❑ Office Only detail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
Other (describe)
For Official Use Only
Occ Group: Area: R I Occ Load:
Area:
Occ Group: Occ Load:
Occ Group: Occ Load:
Total Sq Ft Occupied: No. of Stories: TIF Review: Y/ N
Bldg. Permit ## I Entitlement #: Zoning:
Plnr Initials: I '"( Date � �l ( Aan Chkr Initials�ate:4�O y Insp Initials Date: Z.
Area:
dv
Conditions of Approval or Other Notes:
Inspection Date:
x South Coast
Air Quality Management District
" 21865 Copley Drive, Diamond Bar, CA 91765-4182
' E (909) 396-3529 • http:// www.agmd.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: N-41,5tjj `n u O
Property Address: 15ID3, IbDU,: . Mc�. � + (�l , 4— �
City: �11,U 1�1r(�C.t�� h- Zip Code: GO&Ii
Contact Person:-0P,6f\1 'Fe r` �--�� U <Dl Title: 0W(W/'
Type of Business: Telephone: a�_ e4rv— -3a4-j
fl p�fi��1-r,�dl�o%Yl
Fax Number: l e-mail a ress:
Applicant ( rmt name): Signatu
�:
,:JP,(1t(11 1�- rGU Y\ Date: �'�
J
• Will the facility have any of the following equipment? Yes ❑ Na�K
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? Ye 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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