HomeMy WebLinkAbout15202 Connector Ln - CofO (7)J
' 14/536-5271
-Certificate of Occu No. 0200 700`�3
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY
usiness License
(3'd Floor —Must Apply In -Person)
:usiness Address /5-a02 (fZ )V A 5C7Z)1a 6Ar1Z5
ihsiness Owners Name G A r2,1
Business Name Ja�,2� Car�lysvor� r
Business Type Y►1 FG
;,.j1NoovJ 4-1 SZip
Date tok1l07
Zip Code 9A & q
Telephone Nor-7 I iL) 91-0 8�3
Bus. Phone
Property Owner Information (required) Tenant/Emergency Contact (required)
Name '5lC1�-V 'QFi91_-1-y Name i125�
Address -7595 ep2. Home Address d6V ,1DeiyE
City Xfgwr, 7a nl ,(3C'_t{. State/Zip 0,4. 92.& 4 7 City Gig, Fz%e,=—s i State/Zip Cq-, 9.2_6 q 9
Telephone No. ('7t �) 3 -U =1,3 0 o Telephone No. ( R 492 S'a 7- 0'3
THIS USE WOULD BE DESCRIBED AS: - -
❑ Newly Constructed Building or Existing Building �.
CHECK ALL THAT APPLY: M&U) 8t ist�l�s s Dcv�cElZsr{t R
❑ Change of Property Owner ❑ Change of Occupant ❑ Change of Use ❑ Additional Occupan' t
■ Indicate former type of business MAr1VF'kAyy-I Nh
■ Are you requesting that the electricity be turned on? Yes ONo❑
■ Is the building sprinklered? Yes 0No0
■ Will operations produce dust/wood shavings or similar material? Yes D?Io ❑
■ Will operations involve the repair or replacement of automobile parts Yes ONo U-"' If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes U-Ko ❑
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 parsons?
Yes ONo V
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dent-al
❑ Restaurant/Take Out Food VWarehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use OhI , C --a
Occ Group: _ ' 1 —1 Area: (;pop Occ Load:_
Occ Group: — Area: 6' qbo Occ Load: I`I
Occ Group: A Area: 6 01b Occ Load:
Total Sq Ft Occupied: la15-00 No. of Stories: TIF Review: Y/
Bldg. Permit # Entitlement M Zoning:
Plnr Initials: Dater �� �5 Plan Chkr Initials Date: 11 �� "' Insp Initials Date: l
Conditions of Approval or Other Notes:
-'tom -i n- ,--i12 r-.
C i4Yz_-,c c J-X e_" e,-41 M-G27.-•per 2
Inspection Date:
(G:Building/Forms/document id goes here)
,
M
"' South Coast
Air Quality Management District
r 21865 E. Copley Drive
- Diamond Bar, CA 91765-4182
(909) 396-3529 htpp:/Iwww.agmd.gov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy 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: Dal t2 �6 C&g o/ V t CDOJ2 a
Property Address: /Sa l Co N 1l c -Z>P,-'-
City: 1 n NCB 1261 3ALf! Zip Code: gZ�� g
Contact Person: eYFh2 i rfetnu JpcM 0,�Iz 6 Title: A2,6 s /,p&A/7-
Type of Business: ✓ WMI Fl (- y f g1,1PL, ,.J6 Telephone:
Applicant: (print name) Signature:
Will the facility have any of the following equipment? Yes 0-110 ❑
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 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 C<o ❑
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
Q If you answered "No" to both questions, this checklist is your clearance from AQMD.
QIf 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 (800) 388-2121.