HomeMy WebLinkAbout15013 Goldenwest St - CofO (3)Ja
HUNTINGTON BEACH
CER IFICATE OF OCCUPANCY 020 ! - D� )-`� �Z
CITY OF HUNTINGTON BEAC —�
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
Business License #
Business Address k 5 b\ 3S1-
Business Owners Name e
Business Name
Business Type _MkA±[ � Ma Q Ca
L (3rd Floor — Must Apply In -Person)
Date 4kq1 I 1
Zip Code S L 4 '1 _
Telephone No. `► I_L{--S 3rx g S ac>
Bus. Phone
0 U Ltndblbrq
Property Owner Information (required) Tenant/Emergency Contact (required)
Name ' C � Name 1%(Ckhn-e-
Address G 5 l ' Ac:lne_ 6fcle- Home Address b 33 Vy'-yyr� -. ��a �-
City cy-d�tin'tol State/ZipC-0 eo 1)1 CityC&-' �p_ l�j State/ZipC'� . ' O104-- 17F5
Telephone No. W �,) -] 99 — I%L{.5-(D Telephone No. _ —1 -2-0 : JM — 3 13 �
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Listing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner CdChange of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes , NOD
■ Is the building sprinklered? Yes❑ , Nov
■ Will operations produce dust/wood shavings or similar material? Yesv NOD
■ Will operations involve the repair or replacement of automobile parts YesD Nod If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? YesQ NOD
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo /
■ Will there be storage racks, gondolas, or shelving exceeding ee ncfies ierhei ht? Yes ®No ❑
■ The following best describes my operation: ❑ Office Only Atail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Takeood
(d cribe process and end product)
Other (describe) 'W7' �, - C'G=fj'-f� r�
For Official Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Plnr Initials: Date
Area: / yo 3
Area:
Area:
Occ Load: /
Occ Load:
Occ Load:
No. of Stories: TIF Review: Y/ N
Entitlement #: .Zoning:
Plan Chkr Initials: <�ate: �� J 1 Insp Initials: Date:
Conditions of Approval or Other Notes:
` Inspection Date:
V
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: S ;m G cs U- -��` C&or rol G2n:1
Property Address: Gokden v->--- fir- S+,
City: Zip Code: 0% 9-t. 14
Contact Person:
Type of Business:
Title:
Telephone:
Fax Number: n�,}�,,_ e ail address:
Applicant (print name):,__`-`Signature:aV.,,j,,
Aw
R-axn,U u Date: �j l �' (►1
Will the facility have any of the following equipment? Yes ❑ No [;K
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? Yes[] No[V
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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