HomeMy WebLinkAbout126 Main St - CofO (16)CERTIFICATE OF OCCUPANCY 020 -
CITY OF HUNTINGTON BEACH
• DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5271 (3`d Floor - Must Apply In -Person)
Xsiness License # i\X1 QcQQ'7 Date 5 / 1 &1 / 1 c
Business Address taro M,_;„, 5� . 5�� tom, Nv..i; ram ►.. �e�L4 c_Ft Zip Code n exLoyse
Business Owners Name A,,,d„e„y 1-ta,r,d� �,, Telephone Nogug.35o -agg 1
Business Name N,.1. _�� ,,.,a Bus. Phone _
Business Type k
Property Owner Information (required) Tenant/Emergency Contact (required)
Name ;d ., P►�cr�e✓1i�S Name AvNAe-e_ .) I_kA.vdS4
Address Lail 0544" Ave- US01 Home Address t2co N\ , s�• , SVCA03
City 6c%v . pi o State/Zip C.A /,oj2.jpj City Fk Aj,, State/Zip e.p,
Telephone No. -11 y - -1 y (e - oy as Telephone No. q y q • 5 So - 2.R of
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or xisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Ca' Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity bb turned on? Yes❑No
■ Is the building sprinklered? Yes �No❑ /
■ Will operations produce dust/wood shavings or similar material? YesoNo&�
■ Will operations involve the repair or replacement of automobile parts Yes ONo Fj*'-"-If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ONo
■ Will the busine be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ❑No
■ The following best describes my operation: ❑ Office Only Retail Sale ❑ Medical/Dental
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Only t
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied: � L
Bldg. Permit
Plnr Initials: Dater • IU Plan Chkr
Fs -of Approval or Other Notes:
tr S s V4-c- K-yw
Inspection Date:
Area: "�-
Area:
Area:
No. of Stories:
Entitlement #:
Occ Load: /
Occ Load_:
Occ Load:
TIF Rev�w• Y/
Zoning: eS7 -
itials: Date k� s&sp Initials: `-C.L- Date: _tp
(G:Building/Forms/document id goes here)
•
South Coast
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 Management District (AQMD).
Company Name: \cA1mwooeA 140LA \--0V1r,aC_
Property Address: _121v f\A m;,,, Sk 1o3
City:yv,�ri�n lyv, 9iCeAch ,c-A Zip Code: ga(a4Ij
�
Contact Person: A,<"Inww W e,1 i S Title:
Type of Business: Telephone: O g1-1,1 - t►lq- y1-10
Applicant: (print name) Signature: /
❑ Will the facility have any of the following equipment? Yes 0 No h�
Charbroiler `
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
QWill any of the following operations be performed? Yes []No LrJ�
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding..and blending_of.liquids.and/or_povwders_
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
Vely"Ou answered "No" to both questions, this checklist is your clearance from AQMD.
QIf 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.