HomeMy WebLinkAbout15049 Goldenwest St - CofO (2)CERTIFICATE OF OCCUPANCY 020L - IS
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(3`d Floor — Must Apply In -Person)
Business License # 1
Business Address I t:�D1
Business Owners Name
Business Name
Business Type
Date 7 L77 / j Z
Zip Code 92- 6 4—j
Telephone No.
Bus. Phone -114)
Property Owner Information (required) Tenant/Emergency Contact (required)
Name Wgmam (,QOV Name -6011
Address 11 1 N01 Home Address N 1 f10 Mile
City I ryl Yl State/Zip CA 1 CjZ 61 Y City HViAf nQ j-pn a Ch State/Zip Q}- , q Z l.j —1
Telephone No. 9 qq) 0 4 — NVO Telephone No.
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or X Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner ❑/`Change of Occupant
■ Indicate former type of business 'TGI (Of , Alti "T/1f1V'
❑ Change of Use ❑ Additional Occupant
• Are you requesting that the electricity be turned on? Yes O No 9k
Is the building sprinklered? Yes XNo ❑
Will operations produce dust/wood shavings or similar material? YesQ No)(
■ Will operations involve the repair or replacement of automobile parts Yes ❑ No 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 ONO X
■ Will there by storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? Yes ❑ l o
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
Y Other (describe) A'1t]EjA.-on ,gi10�
For Off cial Use Only
Occ Group: ej
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area: 1 Occ Load:
Area: Occ Load:
Area:
No. of Stories:
Entitlement #:
Occ Load:
TIF Review: Y/ N
Zoning: C &
Plnr Initials:_ Date:? Z7 12 Plan Chkr Initial�� Date?�3 2 Insp Initials: Date:
Conditions of Approval or Other Notes:
\Inspection Date:
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 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: NO; K r fet 1 h'
Property Address: ISM Golden wKf S+.
City: Nu�fio n BeoOA Zip Code: 9 Z b 4-i
Contact Person: �P�VlM C110 Title: DID ner
Type of Business: J600y- / 6i17P-t bA Telephone: () 5Z) — Vg —9 411
Fax Number: email address: HenrjAXCk o 0,9MAj(-(VM
Applicant: (print name) H"n61 cl%o Signature:
Date: 112-, 1 1 Z
Will the facility have any of the following equipment? Yes 0 NO X
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 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 NO �]
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).
APRLI'C1(i��N'`�1�`°i't'lZl''T`�'Y�AfiE '6F,��Gi�Y'
/3
`rit �fif'HO�ti toff `Beach Deioh t(Wiit 6f bdV6lVPifiWt Seiv'icf.
FOR= L;l CANT TO FILL IN (Mfit•or type 6nly) DATE _
Wdeyllftblf6 a 'Ce f 1c_aie of Oct'v'9y''fGh'A*
OcM'A'6Y: 'Gr.
DesCP�t e" BUsdiless 9e 1
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US: Y `So
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ame: ress Pi ty zip o'
rftnSE V(06b WE" ESCR`Y$'Eb1AS
� Wly Cafis$i icted'Mil0k: E Cha)ii b`ef'O P [� Cha11 ''of `Occlf�a t
1
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tie' fiftbr Use' if flj, b'c Gh. biV.
a'�tly'uf"•any-1 is g b to =fa -a°` �ls itiess icpfl e'i�ill n t e ssUd
cop
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2.
ih'speCt� i1 i0yt�ie bapAVVt. t.46f 5'11�dYli � Yd° Cb1 Tt i£y beVel�pPifdYit at the t'f ie
thls a0p14 tion is filed
,!'l`�'1 Wd$ilTs1iZei c�'tiI�fi*6ftae ^b1Pi.1'g "�1' pN'. :n ceS'tb"miKei 3Aftit is
issbt�dde may,
b�e (mhde- flhe 61'f oCC se thNU r�emises uffeh m�'e h' ih a ose 'cl'f"accilpp�h y
oh ih a. diffi l'd► t 6i ibf"15cc``fiis` iiy," a cf dYltje of 'occtlp�fir y 11S ctibfiT `fee of
$30 ,00 shall be paid 'to't%e City.
(012"OFFICE"USE "Ol)
J SI���I.`�i�'L tNK07t6'�I'
I S _.ft: of bC(11�� j // 7 T� Pla�i L`fie k No.
odd, iO%ry Grp Permit Nb
`Occ�ititi'L$d. At • Aggi iiSPP .
'No Of StOi�ies ' No Pi'Kii�Cj S 'es
t Hedl th DdVt ,A"F`al
'T3Y-- 1 DATc" Utilities Released —
C TIFICATE br'. COP-A.(V FEE $ 6:06
OWEOF OCCUP ROTOR USE INSPECTION FEE
TOTAL T--
(N�5
F
CERTIFICATE OF OCCUPANCY 020L - IS
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(3`d Floor — Must Apply In -Person)
Business License # 1
Business Address I t:�D1
Business Owners Name
Business Name
Business Type
Date 7 L77 / j Z
Zip Code 92- 6 4—j
Telephone No.
Bus. Phone -114)
Property Owner Information (required) Tenant/Emergency Contact (required)
Name Wgmam (,QOV Name -6011
Address 11 1 N01 Home Address N 1 f10 Mile
City I ryl Yl State/Zip CA 1 CjZ 61 Y City HViAf nQ j-pn a Ch State/Zip Q}- , q Z l.j —1
Telephone No. 9 qq) 0 4 — NVO Telephone No.
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or X Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner ❑/`Change of Occupant
■ Indicate former type of business 'TGI (Of , Alti "T/1f1V'
❑ Change of Use ❑ Additional Occupant
• Are you requesting that the electricity be turned on? Yes O No 9k
Is the building sprinklered? Yes XNo ❑
Will operations produce dust/wood shavings or similar material? YesQ No)(
■ Will operations involve the repair or replacement of automobile parts Yes ❑ No 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 ONO X
■ Will there by storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? Yes ❑ l o
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
Y Other (describe) A'1t]EjA.-on ,gi10�
For Off cial Use Only
Occ Group: ej
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area: 1 Occ Load:
Area: Occ Load:
Area:
No. of Stories:
Entitlement #:
Occ Load:
TIF Review: Y/ N
Zoning: C &
Plnr Initials:_ Date:? Z7 12 Plan Chkr Initial�� Date?�3 2 Insp Initials: Date:
Conditions of Approval or Other Notes:
\Inspection Date:
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 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: NO; K r fet 1 h'
Property Address: ISM Golden wKf S+.
City: Nu�fio n BeoOA Zip Code: 9 Z b 4-i
Contact Person: �P�VlM C110 Title: DID ner
Type of Business: J600y- / 6i17P-t bA Telephone: () 5Z) — Vg —9 411
Fax Number: email address: HenrjAXCk o 0,9MAj(-(VM
Applicant: (print name) H"n61 cl%o Signature:
Date: 112-, 1 1 Z
Will the facility have any of the following equipment? Yes 0 NO X
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 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 NO �]
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).
APRLI'C1(i��N'`�1�`°i't'lZl''T`�'Y�AfiE '6F,��Gi�Y'
/3
`rit �fif'HO�ti toff `Beach Deioh t(Wiit 6f bdV6lVPifiWt Seiv'icf.
FOR= L;l CANT TO FILL IN (Mfit•or type 6nly) DATE _
Wdeyllftblf6 a 'Ce f 1c_aie of Oct'v'9y''fGh'A*
OcM'A'6Y: 'Gr.
DesCP�t e" BUsdiless 9e 1
fobe knownvas: �:: /i
:r4amesof,'uus1T1bfs Lo 1
;Lbcated at
US: Y `So
Na 4 ; BUSTIN S OAt ER es a F23s Cl ty P ':
BUsiita;ss/lce
ame: ress Pi ty zip o'
rftnSE V(06b WE" ESCR`Y$'Eb1AS
� Wly Cafis$i icted'Mil0k: E Cha)ii b`ef'O P [� Cha11 ''of `Occlf�a t
1
[� E 'i'stif '�iO itl'� liiij''• Cha'je `of Uh E Ali MA rotdOAt
tie' fiftbr Use' if flj, b'c Gh. biV.
a'�tly'uf"•any-1 is g b to =fa -a°` �ls itiess icpfl e'i�ill n t e ssUd
cop
• ..y,.�., .,.cY,: �•crfyral�aATixF...�:-..�k•.attire:....+.;.�,.�•i�`�.�-�:�re�Kas���+o,nf{�t��ithar�'r'tr_ c iecTib21..
2.
ih'speCt� i1 i0yt�ie bapAVVt. t.46f 5'11�dYli � Yd° Cb1 Tt i£y beVel�pPifdYit at the t'f ie
thls a0p14 tion is filed
,!'l`�'1 Wd$ilTs1iZei c�'tiI�fi*6ftae ^b1Pi.1'g "�1' pN'. :n ceS'tb"miKei 3Aftit is
issbt�dde may,
b�e (mhde- flhe 61'f oCC se thNU r�emises uffeh m�'e h' ih a ose 'cl'f"accilpp�h y
oh ih a. diffi l'd► t 6i ibf"15cc``fiis` iiy," a cf dYltje of 'occtlp�fir y 11S ctibfiT `fee of
$30 ,00 shall be paid 'to't%e City.
(012"OFFICE"USE "Ol)
J SI���I.`�i�'L tNK07t6'�I'
I S _.ft: of bC(11�� j // 7 T� Pla�i L`fie k No.
odd, iO%ry Grp Permit Nb
`Occ�ititi'L$d. At • Aggi iiSPP .
'No Of StOi�ies ' No Pi'Kii�Cj S 'es
t Hedl th DdVt ,A"F`al
'T3Y-- 1 DATc" Utilities Released —
C TIFICATE br'. COP-A.(V FEE $ 6:06
OWEOF OCCUP ROTOR USE INSPECTION FEE
TOTAL T--
(N�5
F