HomeMy WebLinkAbout15121 Graham St - CofO (22)CERTIFICATE OF OCCUPANCY 020 -�
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5271 � (3'd Floor - Must Apply In -Person)
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Business License # �� `7 Date q
Business Address -It to r 15 Zip Cod _
Business Ownerskvami Telephone T
Business Name S e� 5_Nc Bus. Phone
Business Type
RroDerty O ner Information (required) T ant/Emer enc Contact (required)
Name L Name 1 ' tir
Address lotj F-0, � 5�;�� 1' - \'�i� Home A ress 0 n vWw t
City`\t,J vV� �. _; State/ Zip'Ll,_s\a_City State/ p C
Telephone No. C M) 3Q\ - Telephone No. - �1 VAN -I %33-SMI
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THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or.=,-- xxisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner ❑ Change of Occupant ❑ Change of Us Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electric`ity�e turned on? YesQN9)<
■ Is the building sprinklered? Yes%kNo❑
■ Will operations produce dust/wood shavings or similar material? Yes QNob�-
■ Will operations involve the repair or replacement of automobile parts Yes QNo7 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 QNol,
■ The following best describes my operation: I Office Only EYRetail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product)
❑ -Other (describe)
For Official Use Only
Occ Group:
Occ Group: S`
Occ Group:
Total Sq Ft Occupied: ZZ21
Bldg. Permit #
Area: Am 10 dtl �p Occ Load: k-0
Area: , ((�� Occ Load:
Area: Occ Load:
No. of Stories: TIF Review: Y/ N
Entitlement #: Zoning: j L
Plnr Initials:"ate: !-1/ Plan Chkr Initials�''7C„ Date
Conditions of Approval or Other Notes:
Inspection Date:
Insp Initials:'/ Date:
(QBuilding/Forms/document id goes here)
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 anagement District (AQMD). 55w:,
Company Name: ��-
Property Address:
City:
Contact Person:
Type of Business:
Applicant: (print name
Q Will the facility have
Charbroiler
Zip Code:
Title: ()>Nt4A
Telephone: ( )
Signature:
Yes QNo
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 []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
QIfyou answered "No" to both questions, this checklist is your clearance from AQMD.
DIf 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.