HomeMy WebLinkAbout15059 Goldenwest St - CofOO
AJ
714/536-5271
CERTIFICATE OF OCCUPANCY 020L-L - tbrbS
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(3TdFloor—Must Apply In Person)
Business License # � O 0
Business Address 6OLI.J�r%Sr ► -
Business Owners Name aS,Er-b / til 6Gs9r%G
Business Name d K t/
Business Type �ES�i�'ilR?rJ�
Date >-V / -I--
Zip Cod
Telephone No.7l4- S 7-7.7
Bus. Phone :Z1*jF fTt4it
Propgqy Owner Information (required) Tenant/Emergency Contact (required)
Namega5m/✓ T Av&2f0S pe v - Goo - Narndo 5�e hvA1GA;14 i
Address 6 cH Home Address tSfO/ AhzZ-,E7%
City = le/, Yy State/Zip C�#- I City �'%� State/Zip 7it'3G%
Telephone No. % 11. K f j iP Telephone No. ]/!I Me -1,77
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or ,Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner eChange of Occupant ❑ Change of Use ❑
■ Indicate former type of business ,J A'", 0'-
■ Are you requesting that the electricity be turned on? YeNo ❑
■ Is the building sprinklered? Yes,tj`N' 0X ,
■ Will operations produce dust/wood shavings or similar material? Yesolq
■ Will operations involve the repair or replacement of automobile parts Yes QNo 2�
Additional Occupant
If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ONo
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNoe
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
X Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Only
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area:
Area:
Area:
No. of Stories:
Entitlement #:
Plnr Initials: Date: '30 (Z Plan Chkr Initials: Date:
Conditions of Approval or Other Notes:
— Aft AT wXT02 �i A
Occ Load: G--
Occ Load:
Occ Load:
TIF Review- Y/ N
Zoning:
Insp Initials:�Date: 2 t Z
South 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). p
Company Name: -el 1e � i ///� 5�/ 14s- �
Property Address: / SD ff
City: f Zip Code: gZz 7
Contact Person: oJ�—Fo 0W/1,41"J6/ Title: ��%�✓��
Type of Business: 0 0 ' 1 2A Telephone: Z 717
Applicant: (print name) �6,S d %� %L,4 Signature:
0 Will the facility have any of the following equipment? Yes 0 No�"
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 5011P) (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
0 Will any of the following operations be performed? Yes El No
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.
OIf 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.