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4.!*J' APPLICATION FOR CERTIFICATE OF OCCUPANCY
HUNTINGTON BEACH
` � ti OEP CITY OF 0 TE
ARTMENT OF COMMUNITY DEVELOPMENT
HUMMON rowpAcm PRINT OR TYPE ONLY)
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Business Name.. —
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TmIS USE WOULD BE DEERMED AS:
CONSI HUMED M IQ ,MNQ
Fx),,' )T)N(,2 BMI-DiNO
lndlcalil totmOt user , if XIV
$QUASJFT ()V- t3ull t'INO TO BI 00MMI 11
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NOTICE: 1,
oc(Upajjcy otaviv building if; pr(liibitod and a hilymmy Wore w0l not be issued uiwO lbebuddlng has been
2,
inspieuMd and a cwhWaM 01 0=41wY IS s6m'k'
N, daklqW SeMco, will 0c, itsicised for V,Wmg wdd un; yjvwe has boat umpeded and
ceitified uale. All applicant-i for occolialwy ire ,11) 1, ximit, hmOnq me wqmwd to twwdWa an dixtrical
'ruse urf inepetsboll in the Departr0c'm to cm"Mrtytwctitt,niisrat,.iiit hme uw jW"coon W bled
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challge of occupancy or use inspectloin toc. w(lonove! it cfwckr�!try to
preirimaps I" order W dolemonvilat"willOr"ay1w
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Hutifinglon Beach Fife Code Section I 0-1wt
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A be fso�"ted ol" Yow t1tL0'01f'l WcAtj'� lt�'tl w;om th, c1rfivt
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WON 0FROC, U.' U ONLY$
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS
2. Person to contact in case of e m erg en cy:
Telephone number: —
3. Does the ouilding in question have electricity?
(a) If No, are you requesting that the electricity be
turned on?
4. The building is sprinkiered?
5, Operations will produce dust/wood shavings or similar
material?
S. Operations will Involve the repair or replacement of
automobile parts?
7.
91
If Yes.
(a) Describe the components repaired or replaced.
9 Yes
0 No
rj Yes
13 No
Yes
CAI No
Yes
No
Yes
No
(b) Doos the operation involve the use of on open flame? C1 Y 0 s
IN No
The burainess i-s drinking, dining or as.sombly use that will
result in an occupant load of more than 50 persons. rj Yes
No
Tiro folilowmy best describes y opot.'O.w'
Office Only
Retail salon
Warehouso
(doacribe procov, and end product)
ostauranti Take Out Food
Medical f Dental
Other (doscribe)
SUPP.LEMIENTA!� WFORMATION (Continued}
O(p and ccrrect 11(y
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South C. -s.
AIR QUALITY MANAGEMENT DISTRICT
N B65 E Copley Onve, Mimond Bar, CA 91765 418q, (901J) ',396 k1100
AIR QUALITY PE10MIT CHECKLIST
for nonresidential buildings only
Company Name:—
Location of Property.-
City:— Zip ("'Ode:
Contact Person: q'itic
Telephone Number; 'ax N'tiniber: F
Type of In(lirstry/Business:
To apply for to nonresidential building permit, you must complete this checklist. If you have any
questions about completing this checklist, please call (800) 388-2121.
YES NO
I .
Will the, facility leave a charbroiler?
2.
Will airy intemal, combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles).'
3.
Will operations at the facility involve mixin8, blending, or processing of
volvents, adhesives, painta or coatings?
4.
Will dust or smoke be generated at the facility.)
S.
Will i efining of any liquids or solids be done at the facility?
L I M
0.
Will any platisig or cowititt, of materials be clone at the facility?
7.
Will atiy combustion equipment rated greater than 2,000,000 B1,01ir be
operated at the facility?
S.
Will may acids, nolvents, or motor fuel be used or storca at die f4c;lity*?
[54
9.
Will any orgartie, liquids of gases be reacted or pr-oduce -4.9
M
10.
Will any oventi tie used to, dry or cure products at the illcility?
IL
Will a.ay CFC (I"reon) recycling nwehincs operate at thr:! facility?
Appliexit: -- x-. , mat. te`
(flihit nam.0 clearly)
If you live mz,,,rked "NO' inL11 t1w, tvxeE,-. xiair (Itiality permit is v--t necdedat this time,
and this cheviJist is your written
If you market "NTS" in any of tjjtii jjo.wes, you must content the South Coast Air Quality
Management District Please Wad the lequirenw-;wi Oil tile tv'ck of the chceklist,
(80011.1388-12121