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HUNTINGTON BEACH
Business License #
Business Address_
Business Owners N
Business Name, �
Business Type'
CERTIFICATE OF OCCUPANCY 020 13 - DD 5e655
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3`d Floor - Must Apply In -Person)
Date q — l3
Zip Code
Telephone N . 1
Bus. Phone
Provertv Owner Information (required) Tenant/Emer2encv Contact (required)
Name o En L. Name •L
Address 16e, Home Address Ib -9- (01
City I j State/Zip('-- q0M - City State/Zip ___q2(oq-1
Telephone No. (�go)_:�1- 93gg Telephone No. N-) ?1-76 -QQcW
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or `Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner ❑(Mange of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes O No
■ Is the building sprinklered? Yes , Non
■ Will operations produce dust/wood shavings or similar material? Yes ❑ N
■ Will operations involve the repair or replacement of automobile parts Yes N If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? YesO NO)K,
■ 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 shelvi eeding 5feet 9 inches in height? YesNNo ❑
■ K
following best describes my operation: c Only ❑ Retail Sales ❑ Medical/Dental
arehouse /Manufacturing/Distribution urant/Take Out Food
cribe process and end product)
Other (describe)
For Official Use Only
Occ Group: $ ^ Area: Z O� 7 (0_ Occ Load: �'�' �-2-
Occ Group:
f_R Area: 1 TT9.�', Occ Load:' �- /,��
p: Area: Occ Load:
Total Sq Ft Occupied: 6-7 1 No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials Date: lan Chkr Initials:��Date: b Insp Initials: Date: 5 2 %
Conditions of Approval or Other Notes:
Inspection Date: Cl 2 e-- 2,
�y South Coast
Air Quality Management District
P21865 Copley Drive, Diamond Bar, CA 91765-4182
' O �` (909) 396-3529 • http:// www.aqmd.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:0 -�L ljmu."
Property A dress:
City: Zip Code: (?A e
Contact Person: 4na��c�_ Title: f-fz GG
Type of Business: F"L&LA)x 1(1(SR— Prt( . Telephone: -c
Fax Number: 'I t q &A R Aq (-) �e-mailadd�ress.:J�j��&r�PQrv�qq
App 'cant (print name): Signature: J
F1� �VI�IIV��C% Date: �--�A
• 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 HP (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❑ NOX
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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GENERAL NOTES
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OCCUPANT LOAD TABULATIONS
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