HomeMy WebLinkAbout15039 Goldenwest St - CofO (4)—S
C RTIFICATE OF OCCUPANCY
020
CITY OF HUNTINGTON BEACH -
DEPT. OF PLANNING & BUILDING APPLICATION
(3`d Floor — The Applicant Must Apply In -Person)
Business License #
Business Addre;
Business Owner
Date 1(i 14
Zip Code -7
Telephone No. '?fib 3 ai53T�
Business Name Bus. Phone:-7.l4 <r3qLI `07 `�60
Business. Type A21 l>ll JAM RAJ fd11C6 ' CA I CE=k) i E&
Property Owner Information (required) Tenant/Emergency Contact (re uired)
Name. i3U5j AlESS Ao -x' Name i 1
Address �F,3t _ Home Address I I 5-P'00K IZd
City _- _ City W4'5-j-M i,mS 1 State/Zip CN Gj L 6 AO �2
Telephone No.. 0 O Telephone No.--) 11-1 ts:� l�
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or WXisting Building
IS THIS BUILDING SPRINKLERED? Yes)( No
CHECK ALL THAT APPLY-
0 Change of Business Owner - k�Change of Occupant Mange of Use [Edditional Occupant
■ Indicate former type of business ,.I S:V G 16*E4-j25V,
■ Are you requesting that the electricity be turned on? Yes0 No '5/'ffQ ii q' r ��4,<Cr
�p
■ Will operations produce dust/wood shavings or similar material? Yes 7.Q< o
■ Will operations involve the repair or replacement of automobile parts Yes 0 No�(If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes 0 N
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
YesO Nox
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes 0 4K
The following best describes my operation: ❑ Office Only ❑ Retail Sales A1—Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food & G r"Yt) at=- j �`rZ
Will the Food Service Establishment Process Fats, Oils Greases? YesO NqE�-
Does the Facility Have a Grease Interceptor? Yes 0 No. /
• Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yeso No;X
• 0 Other (describe) .
For Official Use Only
Occ Group: Kj
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area: 5-3 8 0
Area:
Area:
No. of Stories:
Entitlement #:
Occ Load:
Occ Load:
Occ Load:
TIF Revi Y/ N
Zoning:
6o 0
Plnr Initi� Date - VI 3 �q Plan Chkr Initials:_J�ate: 19�' /f
als: Iasp Initials: Date:
Conditions of Approval or Other Notes:
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • http:// www.agmd.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: T,5 STr- 9-1m.6 avra- C I
Property Address:
City: 1 >J 6 i VJ Zip Code: q2 6(I%
Contact Person: wt_b v� ,J "-� Title: OAVI-6�
Type of Business: A'M1,J� �jk& ((I GJ Telephoner/ (,3 IV/
ax umber: e-mail address:• So� 100
F N � �Q
Applicant (print name): J/ Signature: V yAqtV0-
Date: -A _110�^ J
• 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 B? (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).
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