HomeMy WebLinkAbout101 Main St - CofO (101)1 Cerd Cate of Occupancy No. 02007�00q' gS� -.1
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714/536-5241
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY
Business License #
Business Address 10 (Y1 Ri TO
Business Owners Name "i"ka �
(P Floor -Must Apply In Person)
Business Name _/A(:Lt.Ni ` i�Cl. S
Business Type _ _ Ci) i 1 /�-
Date / Z
/7/� 7
Zip Code ' r9 L 6
Telephone No. '71 tl - z ? '"7 -1510 7�,
Bus. Phone '711-1 •- Z7-'/-go,15` '
Pro pertyOwner Information (required) Tenant/Emergency Contact (required)
Name _ N) C. Name :`(LC- Qe-L NCiJC �
Address i 01 M R hJ :ST- Home Address •
City A 6 State/Zip c p, 3 z6y L City 1 B State/Zip ` 2- 6 4 9
Telephone No. NjLl) 51�,- 656 % Telephone No. 212,7 9 0117 s-
THIS USE WOULD BE DESCRIBED AS:
0 Newly Constructed Building or VZxisting Building
CHECK ALL THAT APPLY:
0 Change of Property Owner Z- Change of Occupant 0 Change of Use 0 Additional Occupant
■ Indicate former type of business th02c A6C- 5
■ Are you requesting that the electricity be turned on? YesQNo�
■ Is the building sprinklered? Yes'ONoD
■ Will operations produce dust/wood shavings or similar material?. .YesQNoM.-.
■ Will operations involve. the repair or replacement of automobile parts Yes dNo If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or,open flame? Yes QNo .Ch
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo 'Vf
■ The following best describes my operation: -0 Office Only 0 Retail Sales 0 Medical/Dental
0 Restaurant/take Out Food 0 Warehouse /Manufacturing/Distribution
(describe process and end product)
0 Other (describe)
For Official Use Ong
Occ Group:j
Occ Group:
Area: -1
Area:
Occ Group: gqLt 0 Area:
Total Sq Ft Occupied: =-%� - r't No. of Stol
Bldg. Permit # i / � _ � Enttiitlemen
. V ` Plnr Initial Date: Plan Chkr Initials-ik
Conditions of Approval or Other Notes:
Inspection Date:
Occ Load: -31
Occ Load:
Occ Load: 1-1
es: TIF Review: Y/ !y
#: Zoning: S 2
Date: 7 67Wsp Initials: / Date:
(G:Building/Forms/Permi(Apptication/CofO2006)
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:
Property Address: ► 0( M r\► .,) 6 Ti zJ- 0
City: J CEO
Contact Person: 'Ti'LUE2 �UcS
Type of Business: IZCC(Lo i ieA.S_
Fax Number. (7 f q) 596,. 0'7 3y
Applicant (print name):S60H-m A51410
Zip Code:6 S
Title:
Telephone: -ai L4) 5 y 6 - O-' Ott
e-mail address: VJWUJ ACCUN %t-C4Nic&,
cup
Signature:
Date: / - 0% 77
• Will the facility have any of the following equipment? Yes ❑ Now
Charbroiler
Dry cleaning machine
Spray booth
Printing press(screen/lithographic/flexographic)
Internal combustion engine greater than 50 BF (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).
-2-
Revised June 2005