HomeMy WebLinkAbout15051 Goldenwest St - CofO (3)714/-'�36-5271
Busine�,,s Licen
Business Addrf
Business Owne
Business Name
Business Type
CE ' ICATE OF OCCUPANC 020
CITY OF HUNTINGTON`BEACH-----
DEPT. OF PLANNING & BUILDING APPLICATION
(3'd Floor - Must Apply In -Person)
Date
Zip Code���
Telephone No -71gp? c- :?5a5
Bus. Phone ��y a-'�2,�
Property Owner Information (required) Tenant/Emer enc Contact (required)
Name 9i/%j IJG Name
Address Home Address Loqq
City Z- State/Zip C,gL 5?Qr;,gj City -j 61Qg.-�K State/Zip _CA.
Telephone No. 71q ���(/ Telephone No. 99/ 977 9la 9
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or )q Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner 0 Change of Occupant ❑ Change of Use 0 Additional Occupant
■ Indicate former type of business ae
■ Are you requesting that the electricity be tune n? oYes o ❑
■ Is the building sprinklered? Yes ieNo 0
■ Will operations produce dust/wood shavings or similar material? Yes ONoCY
■ Will operations involve the repair or replacement of automobile parts Yes QNo 0 If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes QNo
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo &I
■ The following best describes my operation: El Office O y Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food ❑ Warehouse /Manufac on
(describe process and end product)
❑ Other (describe) ? [)C2r—= `-� �-
For Official Use Only
Occ Group:
Occ Group:
Occ Group:
Area:
Area:
Occ Load:
Occ Load:
Occ Load:
Total Sq Ft Occupied: C71TO No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitl ent #: Zoning:
Plnr Initials: ate: 6 -I(,-1, Plan Chkr Initials: Date �(v nsp Initials: +zt _ Date: C(lz
Conditions of Approval or Other Notes:
S I 9#51a-( Yl v,4jg7 PEY1Ann VT-f.%::;r►
o
Inspection Date:
Area:
1'�9 -$uilding/Forms/document id goes here) ��j�
�,a
th Coast
Air Quality Management District
21865 E. Copley Drive
"Diamond Bar, CA 91765-4182
(909) 396-3529 htpp://www.agmd.gov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy 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: /SOS/ Cn�}(.d�,r,��� s"f
City: Zip Code:
Contact Person: y��%Civ �t�� Title: t�fQw
Type of Business: Telephone: ()-
Applicant: (print name) Signature:
0 Will the facility have any of the following equipment? Yes
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 million BTU/hr. maximum input)
Abrasive blasting cabinet/room
Baghouse/cartridge type dust filter/scrubber
Motor fuel storage and dispensing equipment
Q Will any of the following operations be performed? Yes U No 2L--
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
01f you answered "No" to both questions, this checklist is your clearance from AQMD.
Q 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 (800) 388-2121.