HomeMy WebLinkAbout15071 Goldenwest St - CofO,ry
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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 02000 -
CITY OF HUNTINGTON BEACH -
DEPT. OF BUILDING & SAFETY APPLICATION
714/536-5241
Business License # All
Business Address d
Business Owners Name
Business Name
Business Type -,7-41
(3'd Floor - Must Apply In -Person)
Date to Ag/1 g
ST. Zip Code 9d 1b i7
Telephone No. 71V 37.E-.?777
Bus. Phone
Property Owner Information (required) Tenant/ ergency Contact (required)
Name L�STF-p- u t-L Name
Address / Z60 3 / zc'i n- Home Address �" �a L�o/�sN� �► ,�,�i�
City /r° V Ioye- State/Zip C'/a 5W)/ Y CitysT/YI�f�Si7z,2 State/Zip z2 P,_g
Telephone No. Y7y —89Q'0 Telephone No. :z/!f
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Xxisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes El NoX
■ Is the building sprinklered? Yes ❑ NQ)<
■ Will operations produce dust/wood shavings or similar material? Yes❑ . NaK
■ Will operations involve the repair or replacement of automobile parts Yes 1.1 No< . If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes 0 NQK
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes �]No>�
■ The following best describes my operation: ❑ Office Only Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
❑ Other (describe)
❑ Change of Use ❑ Additional Occupant
For Official Use Only .Z0�� h
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load
Occ Group: S � Area: 4LOO Occ Load:
Total Sq Ft Occupied: No. of Stories: TIF Review Y/ N
Bldg. Permit # Entitlemre� -nj #: Zoning:
.10 31 /I.b �
Plnr Initials: Date. Cllan Chkr Initi is l'Dated Insp Initials:--6F' CDate: ,
Conditions of Approval or Other Notes: /
Inspection Date: \'J\-J ` \ "
(G: Bui ldingAdmin/WebDocuments/CertificateofOccupancy)
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: Robs QC Ho b 6 cos
Property Address: /SD 7/
City: An&jAX, 13edck Zip Code: v 7
Contact Person: Tubed (SabroWstq
B sins e.�ad 14�6
Type of u e s. R
Fax Number:
Applicant (print name): "eO Signature:
S,SMTUY__�_y Date:
Will the facility have any of the following equipment? Yes ❑
Charbroiler
Title: Cj&Q
Telephone: 7/`) j2 ,39�,,9
e-mail address: Fobs rc�ob bms 60
pa+—klia- nd-
'gym
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-
Revised June 2005