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HomeMy WebLinkAbout15301 Connector Ln - CofO (4)FAB 4 HUNTINGTON BEACH CERTIFICATE OF OCCUPANCY 0200 - 0 CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY APPLICATION 714/536-5241 (3`d Floor - Must Apply In -Person) Business License # A 23q 54( Date / U� Business Address 15 2>0 ` CQ3l'\e671-Q(_ Zip Code q 164 cl Business Owners Name L 1,50- fY DS- Telephone No. Business Name MS q Con51_RLJ TI 0r) C,0. D19A ; -Iji& 111t,55 e-Om - 04 Bus. Phone 71 cf - F99. '150' Business Type �C-Iene+-al Ccn'i-1r�.c'i� Property Owner Information (required) Tenant/Emergency Contact (required) Name 1 o van (A A' 6 11-n Name 1— I Sc.- MOSS �r Address 7'2%/ At0 (lArI4 7>1^+ Home Address &V/Q l �(ct• C City I4uA-h11cAon 6c_k State/Zip CA , 4921,g01 City 4V r1-(vn &(-State/Zip CA, gZL-C-l_7- Telephone No. -11 N - zu W ` I y 1 Telephone No. 3'I°I-aSa2, THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or /Existing Building CHECK ALL THAT APPLY: 0 Change of Property Owner Change of Occupant El Change of Use ❑Additional Occupant ■ Indicate former type of business bin a K i ry,, -rCa i n I } ■ Are you requesting that the electricity Ve to ed on? Yes'6 No ■ Is the building sprinklered? Yes No ■ Will operations produce dust/wood shavings or similar material? Yes ❑ No� ■ Will operations involve the repair or replacement of automobile parts Yes[] Nov If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? Yes Q No ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes ONO U� The following best describes my operation: ,LNOffice Only ❑ Retail Sales ❑ Medical/Dental VWarehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and end product) eFFi cc�' ad mty\ Lv� t/lc%J : � 5dz7;acTe ❑ Other (describe) For Official Use Only Occ Group: Area: oL 3 Occ Load: _ Occ Group: _ Area: 7 d ` Occ Load: 2 _ Occ Group: Area: Occ Load: Total Sq Ft Occupied:_No. of Stories: 1 TIF Review: Y/ N Bldg. Permit # Entitlement #:_ Zoning: Plnr Initials:_ Date: 6 2 Plan Chkr Initials:��ate:'�/` 01 Insp Initials: (ate: (� Conditions of Approval or Other Notes: 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:-( 0,0(N5'T12Lt'I � � � --d jp- (no:U 6 do (YA(X111� Property Address: 15301 CvOn8C� Lr`' City: 40 100(1�1 PVC di Zip Code: d 2(.0 cl C1 Contact Person: b sc— Mo.-5! Title: �0 P. T e of Business: , -na-ci L �rv+r4t " � �e " el `�� yp Ej Telephone: "7 `� � Fax Number: 71N' 5rg6 " c►5%D e-mail address: Z.�m6/4 Applicant (print name): L, . m Signature: CCU ,40 Li ��'GTlL7 oC©�rL Date: E5 b �Ua) Will the facility have any of the following equipment? YesEl Nox 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❑ 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). -2-