HomeMy WebLinkAbout15182 Bolsa Chica St - CofO (22)I_A
r
r • 1�
.�J
HUNi1NGM BEAO
CERTIFICATE OF OCCUPANCY 020L� (7 6 36 73r
CITY OF HUNTINGTON BEACH —.
DEPT. OF PLANNING & BUILDING APPLICATION
Business Address
Business Owners Name
Business Name
Business Type
Name
city��,�'
Telephone No
(3'd Floor — The Applicant Must Apply In -Person)
Date
Zip Code Z
Afigm!14�,Telephone No. 33
a Bus. Phone '7�L-
vlsPc.�,g�oN /
Formation _(required) Tenant/Emergency Contact (required)
[/ g� Name ✓�
kb%}4 _Home Add ess C
State/Zip U City State/ p %, tGg
Telephone No.
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or C- Existing Build'
IS THIS BUILDING FIRE SPRINKLERED? ❑ Yes Ia�No
CHECK ALL THAT APPLY: �
❑ Change of Business Owner CI Lnange of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? []Yes o �
■ Will operations produce dust/wood shavings or similar material? ❑ Yes 2f o
■ Will operations involve the repair or replacement of automobile parts? ❑Yes En<o If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? ❑ Yes o
■ Will the bus's be a drinking, dining or assembly use with an occupant load of more than 50 persons?
ElC�
Yes No
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? ❑Yes
■F
wingbest describes my operation: ElOffice Only ❑ Retail Sales ❑Medical/Dental
Ouse /Manufacturing/Distribution ElRestaurant/Take-Out Food ❑Othermeat products including beef, poultry, and/or fish bee cooked or fried onsite? ❑ Yes O
If you answered yes, please proceed to the next question.
• Does your facility current have a grease control device (i.e. grease trap or grease interceptor)?
Check one: ❑ Yes 2 No
For O.ficial Use Onl
Occ Group: B
Occ Group:
Occ Group:
Total Sq Ft Occupied: c"O
Bldg. Permit #
Planning Initials:—<I4 Date: 5 IS
Conditions of Approval or Other Notes:
Area: aD CTa Occ Load: 6
Area: Occ Load: /
Area: Occ Load:
No. of Stories: , TIF Review: Y/ N
Entitlement#: Zoning: JL_
Building Reviewed By Initials: ',� ate: 'i W_
-52
Grease Interceptor Verified Inspected By Initials: Date:
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 fAQMD).
Company Name: Q Af7 AV) / act --
Property Ad ress: %s/,0Z 7-
City: 1>� Zip Code:
Contact Person: djo� Title:
Type of Business: �Telephone:
Fax Number: y 9S `7n —e-mail address: 129AO-- l
Applicant (print name
Will the facility have any of the following equipment? Yes ❑ NoL]---
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❑ No2---'
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
Wt,- . Gd —,,—
,s�2-q
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).
-2-