HomeMy WebLinkAbout15102 Bolsa Chica St - CofO (6)CERTIFICATE OF OCCUPANCY 02015-- D D ---3 7,sy
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
(3`d Floor — The Applicant Must Apply In -Person)
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HUNnNam mto
Business Addi
Business Own
Business Nam
Business Type
Name
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Existing Building
IS THIS BUILDING FIRE SPRINKLERED? Yes ❑No
CHECK ALL THAT APPLY:
�j Change of Business Owner XChange of Occupant ❑ i
■ Indicate former type of business /I?070/ feu; S& U'
Date - Z61 S
Zip Code Zb .
Telephone No. -
071
Bus. Phone 71q MS,- 3
of Use ❑ Additional
■ Are you requesting that the electricity be turned on? XYes ❑ No
■ Will operations produce dust/wood shavings or similar material? ❑ Yes KNo
■ Will operations involve the repair or re lace }ent of au �m bile arts? , Yes ❑No If yes: Descri_b the
components repaired or replaced. (il {'�� f ��� CSSD �$ Q
■ Does the operation involve the use of welding or open flame? ❑ Yes A No
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
❑ Yes KNo
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? PqYes ❑No
■ _ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑Medical/Dental
[Warehouse /Manufacturing/Distribution ❑ Restaurant/Take-Out Food ❑ Other
■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite? ❑ Yes K No
If you answered yes, please proceed to the next question.
• Does your facility currently have a grease control device (i.e. grease trap or grease interceptor)?
Check one: ❑ Yes A No
For Official Use Only r
Occ Group: I Area: Occ Load: 3
Occ Group: �_ Area: uysz' Occ Load: �O
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: 2 j'—] 2 No. of Stories: f TIF Review: Y/ N
Bldg. Permit # Entitlement #: Zoning: 1 lr
Planning Initials: Date:6-2— 1 S Building Reviewed By Initials:
Conditions of Approval or Other Notes:
Grease Interceptor Verified Inspected By Initials: Date:
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South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(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:
Property Address: 1`0 (U` OULM ' (,ffl Un N ( UN l (" fT
City: jh&/Aa /� 8�%G) Zip Code:74(�
Contact Person: MC, c C—t J� �l
r Title: PP6S �'r T
Type of Business':/iiwl� aC RL/'%���1'elephone: 7%`7 - ff — W 73
Fax Number: 7L -b 25 r & l & 7 e-mail address: U
Applicant (print name): 60G SCtH Signat 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? 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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