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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY � ®�® L --fjo ` ,
CITY OF ]H UNTINGTON BEACH —
DEPT. OF BUILDING & SAFETY APPLICATION
714/536-5241
(3'd Floor - Must Apply In -Person)
Business License # AZ'1 Z-7 4 < Date 2-1-7 2-C-9
Business Address 1 2-2 dA-kc L9 s-, Azz- r Zip Code 9
Business Owners Name R>6t3 hkbYCS tF_ Telephone No. '7t 4 Si 4 iL26 S
Business Name Mooqiam Gelaio Bus. Phone 714 5 3� 536�
� �� Business Type tC,n �c•a �-
Property Owner Information (required) Tenant/Emergency Contact (required)
Name 6C_�s j oc Name ?56S
Address 3& to WiLSk-t xc * 9 1 i Home Address k'16 41
City Lei fie-,. g. State/Zip Ck- 4Cz I o city SeAcotate/Zip CA 92-64 €�
Telephone No. 7 t 4 i Cob 2;141 Telephone No. -71 + S 14- (,-, 2- /o S
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or )(Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occupant ❑Change of Use ❑Additional Occupant
13 Indicate former type of business
El Are you requesting that the electricity be turned on? Yes D No�
13 Is the building sprinklered? Yes ❑ , Nok
13 Will operations produce dust/wood shavings or similar material? Yes[] . No,?q
13 Will operations involve the repair or replacement of automobile parts Yes 0 N6)0 If yes: Describe the
components repaired or replaced.
13 Does the operation involve the use of welding or open flame? Yes[ Nolp
13 Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes EjNo V
13 The following best describes my operation: ❑ Office Only PRetail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
❑ Other (describe)
For Official Use OnLy 014-1
c
Occ Group: X Area: Occ Load: ` r
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occu`pi V41k 41 No. of Stories: TIF Review: Y/
Bldg. Permit # = 147� Entitlement #: Zoning: 5PS DSt[IiCT 3 - 027
Plnr Initials: _ D an Chkr Initialsc�D_ :-7 oe Insp Initials:_ Date: G� 30 • CA
Conditions of Approval or Other Notes:
'r
Inspection Date:
(G:BuildingAdnun/WebDocuments/CertificateofOccupancy)
Q = South Coast
Air Quality management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
p (909) 396-3529 o http:// www.aqmd.gov
Air Qu agi ty Permit CheekRist
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: ZZ Ml�►�� i
City: Zip Code:
Contact Person:
Type of Business: T2-,f7A Fax Number:
Applicant (print name): 5bg 1keXSvc Signature:
Date:
G Z(,4 `b
Title:
Telephone:
e-mail address:
7iq St41-7i�S
=KSti= C' AOt_ , 00-,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 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❑ NoW
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 AQNM. 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).
Revised June 2005