HomeMy WebLinkAbout15070 Edwards St - CofO (3)H
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HUNTINGTON BEACF
CERTIFICATE OF OCCUPANCY 020 CEO E(Q ( O
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
(3'•d Floor - The Applicant Must Apply In -Person)
Business License # A raCA\ �-'L^)3
Business Address
Business Own
Business Nam
Business Type
Date 0 (-A 4 0� 1 1� G
Zip Code I„Lx-)
Telephone No._S:, ;,)ka,S -4SZ
Bus. Phone -1101 99R - 111-)
Property Owner Information (required) Tenant/Emergency Contact (re uired)
Name �11 �L� L �.r. 1'C c.nc.�J r S1- Name o- Ca U 4 n i�
Address 127 (,R,9 C-, w cs;)r !P- Home Address
City, 2,sji w ,r,- Vzi State/ZipC(2- 2k City_LQ 6r"tiC�,` State/Zip 1 C(\-- qn k-L(1
Telephone No. 'i t-\ g 1 c1 ~l �� Telephone No. rS '�;- r)• Xa - 6 S'1
THIS USE WOULD BE DESCRIBED AS:
O Newly Constructed Building or Existing Building
IS THIS BUILDING SPRINKLERED? Yes No
CHECK ALL THAT APPLY:
g Change of Business Owner ❑ Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business -";-
■ Are you requesting that the electricity be turned on? ❑Yes ❑ No
■ Will operations produce dust/wood shavings or similar material? ❑ Yes ;KNo
■ Will operations involve the repair or replacement of automobile parts? ❑Yes XNo If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? ❑ Yes No
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
ISIYes ❑ No --
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? bVes ONO
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑Medical/Dental
ElWarehouse /Manufacturing/Distribution Itestaurant/Take-Out Food ❑ Other
■ Will the Food Service Establishment Generate Fats, Oils Greases? kYes ❑ No
■ Does the Facility Have a Grease Interceptor? Ayes ❑ No
For Official Use Only
Occ Group: Az Area: Ej GO Occ Load: 214
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: '5-'j G'Q No. of Stories: TIF Review: Y,+/N
Bldg. Permit # G
Entitlement #: Zoning: 0
Planning Initials- Date: Building Reviewed By Initial�� ' r/�i- 1 DateT -
Conditions of p v 1 or Other Notes:
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 (AQMD).
Company Name:
Property Address: L 50-10 2_
City: � !E2 C Zip Code: a ;1. to L�
Contact Person: m v - ,,Title:
Type of Business: Telephone:
Fax Number: e-mail addr s: ,,,. V n,N @- i
Applicant (print name): Signature. Date: 01A r 5
• Will the facility have any of the following equipment? Yes L No ❑
Charbroiler — C-) ev S
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❑ NoX
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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