HomeMy WebLinkAbout15021 Goldenwest St - CofO (3)HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 0200 fib_
CITY OF HUNTIN GTON BEACH -
DEPT. OIF BUILDING & SAFETY APPLICATION
714/536-5241
(3'd Floor — Must Apply In -Person)
Business License # A 2 7 S/.3 Date
Business Address G0I DEf4WE57- Zip Code '?2647
Business Owners Name U S 84AIK Ji A7'1AV,4 t 4550C f4 r 0"V Telephone No.7/4 - 37.3 - s1106
Business Name [dS AA,V,,X Bus. Phone
Business Type 84,oV&
Property Owner Information (required) Tenant/Emergency Contact (required)
Name SUS//VE55 _ r/1. R&7ZT19S Name Y-SM XORN5014 (POdbAM7Li AYAH.46!LX
Address 17631 Fl i9 Home Address 95`01 T
AL-?A&96r 90 �00c7
City !/d.t//VE State/Zip CA 9264/ City fV fir State/Zip CA 9ZG60
Telephone No. 474 > 8200 Telephone No. 14 9 - 50 % - 4 2-2-
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or XExisting Building
CHECK ALL THAT APPLY:
Change of Property Owner ❑Change of Occupant ❑Change of Use ❑Additional Occupant
• Indicate former type of business $AN K-
• Are you requesting that the electricity be turned on? Yes[] No><
• Is the building sprinklered? Yes No
• Will operations produce dust/wood shavings or similar material? Yes[] No`,1�
• Will operations involve the repair or replacement of automobile parts Yes NoX If yes: Describe the
components repaired or replaced.
• Does the operation involve the use of welding or open. flame? Yes NOK
• Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes I]No K
• 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)
For Official Use Only
Occ Group: Tn� Area: ti610 0 Occ Load: LkZ
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: bO No. of Stories: 0 TIF Review- Y/
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials Dater an Chkr Initials: Dater ��% Np Initials: �� tte: ���
Conditions of Approval or Other Notes.
Inspection 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: US 8, HIe—
Property Address: l_51021 6 0e beW We57
City: RUiWNMH 8 Zip Code:
Contact Person: KFJI�t %T0,"1V50/'/
Type of Business: o Af0 P_
,?Z64_7
Title: �/06Xn Af6la
Telephone: 242 - 6 `®1� - 4 Z 2 9
Fax Number: '7401 — e-mail address: lleiyylo ,9bdaJk3
Applicant (print name): Signature: MoLo'Z100-- (9msaw&-o C®wp
amlysoN Date: 7//0 ZB 9
• Will the facility have any of the following equipment? Yes ❑ NoW
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[:] Nop�
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).