HomeMy WebLinkAbout15051 Goldenwest St - CofO (4),► ... � � I�-i 5 -23 � �Z )
• CERTIFICATE OF OCCUPANCY 0200 - a
CITY OF HUNTINGTON BEACH -
DEPT. OF BUILDING & SAFETY APPLICATION
HUNTINGTON BEACH 714/536-5241 (3'`' Floor - Must Apply In -Person)
Business License # 2.-T CEO 2 9 Date 01d)W9
Business Address 505 I Gt0LZrj,n IjF,_ 5 ► Zip Code
Business Owners Name BLV& STA h S £ (, ua tT i FS Telephone No.
Business Name 9 L Ug S.r A IZ Bus. Phone
Business Type 30500-4WCf- ACred y
Property Owner Information (required) Tenant/Emergency Contact (required)
Name BUS IN C155 PrkorEaV S Name AMES OCT VY> IV
Address 116 -rG 0 Home Address $OS S. C 0 r TOIJTA i c V
city �'� t State/Zip C.A .9 161)1 City A'N A to e ' N1 State/Zip C 14 940
Telephone No. (°) 7 h t; go 0 Telephone No. C7 1W $6 1— 9 A 9
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or ❑ Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occupant []Change of Use ❑Additional Occupant
■ Indicate former type of business 1 N S O K AN c& A CKO C Y
• Are you requesting that the electricity be turned on? YesQ Noll
■ Is the building sprinklered? Yes ❑ NW
■ Will operations produce dust/wood shavings or similar material? Yes ❑ Noll
■ Will operations involve the repair or replacement of automobile parts Yes 0 Noj If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes El N(V�
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONot
■ 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 O ficial Use Only
Occ Group: Area: �Jd Occ Load:
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: No. of Stories: _ TIF Review: Y/
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials: A& Date: I1 12 Plan Chkr Initials: Date: I l,Inp Initials: Date: iZ4 �kub
Conditions of Approval or Other Notes:
VSL, MVzMrtTV1b M_ )VN116 NSTA1011 ' No WIN 04 MKIKS inM_(-f .
• 0
:a
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: 06 S (AP_
Property Address: 15051 Q'r6 Lb'0A)rd F1s T' S�
City: 1-1U NT iN Oro n) 49AG µ Zip Code:
Contact Person:
Type of Business:
^^ his N Ct �fi�
0) �6 t17
:Er0SU2AUGi✓
Title:
Telephone:
Fax Number: l"l wl-89yo e-mail address: _
Applicant (print name): `311014 00M "Signature:
Date: t 0 a
• Will the facility have any of the following equipment? Yes ❑ No
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[-] Nod
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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