HomeMy WebLinkAbout15061 Edwards St - CofOJ�
HUNnNaON BEACH
CERTIFICATE OF OCCUPANCY 020 11 - 6519
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION
(3'd Floor — The Applicant Must Apply In -Person)
Business Address L�W d5 S-rV04646 W Date V J�
Business Owners Name Zip Code
Business Name ims(4RAnCF CEt = Telephone No.
Business Type —mod W'(n C4- Bus. Phone
ProveProvertv Owner Inf rmati n (required) Tenant/Emergency Contact (required) 7'
Name Name
Address [��al I Home Address t Go
City flw&e& IWState/Zip City State/Zip
Telephone No. — — Telephone No. % .Z- g a
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or ❑ Existing Building
IS THIS BUILDING FIRE SPRINKLERED? 01Yes ONO
CHECK ALL THAT APPLY:
❑ Change of Business Owner ❑ Change of Occupant ❑ Change of Use 04,Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? OYes 6No
■ Will operations produce dust/wood shavings or similar material? OYes d[No
■ Will operations involve the repair or replacement of automobile parts? Oyes ONO If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? OYes ONO
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
O Yes )�,No
■ Will there be storage racks, gondolas, or shelve g exceeding 5feet 9 inches in height? OYes P,NO
■ The following best describes my operation: 1P Office Only ❑ Retail Sales ❑Medical/Dental
❑Warehouse /Manufacturing/Distribution ❑ Restaurant/Take-Out Food []Other
■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite? O Yes j6No
If you answered yes, please proceed to the next question.
• Does your facility currently have agrease control device (i.e. grease trap or grease interceptor)?
Check one: O Yes O No
For Official Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied: _
Bldg. Permit #
Planning Initials: N Date
Conditions of Approval or Other Notes:
Area: Occ Load:
Area: Occ Load:
Area: Occ Load:
No. of Stories: TIF Review: /
Entitlement #: Zoning:
Use Permitted: Y / N Parking Meets Code (for use): Y / N
Building Reviewed By Initials: Date:
Grease Interceptor Verified Inspected By Initials: Date:
011-3519
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 Co
the South Coast Air Quality Manage
ment (AQMD).
Company Name: B V V, "(;�, '0ncp
Property Address:
City:
Zip Code: )17
Contact Person: V Title:am
Type of Business: Telephone:
Fax Number:1 0 — 1h —e-mail addres a b1lk vn5 - o
Applicant (print name): jkto?,mw doiyglsignature-1,;&ulVi�mpm,-'
• Will the facility have any of the following equipment? YAEJ No
Date: 4-
1 /
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 I 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? YesC] NoV
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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