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Home My WebLink About101 Main St - CofO (28)CERTIFICATE OF OCCUPANCY 020 1 -� CITY OF HUNTINGTON BEACH - DEPT. OF PLANNING & BUILDING APPLICATION 714/536-5241 (3'd Floor — Must Apply :In -Person) Business License# ,r1' a7(,, /.2 Date Business Address 16 G<rr� �230 , i1 hlllt 2)/ ea(- Zip Code Business Owners Name/ e l) IS • Ik P. IJ619 Telephone No.'7/ &R,7�?a' Business Name i ICE C 2a(t,tt c A Bus. Phone Business Type C' . n� es Cyr a �re. S ec� -Si wit c ro Owner Information (re uired) Tenant/Emergency Contact (required) Name t; P tU t/2 D dl e✓) �'v Name j et ll `Address r7- /l o C .!'/LG Homej Address r7 uL. State/Zip C/f- �je2� �/� City/�tJi1/7' c State/Zip Telephone No. 1 `['" a %�%— b(a % % Telephone No. '7 / `�" qLq THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or xisti.ng Building CHECK ALL THAT APPLY: ❑ Change of Property Owner ❑Change of Occupant ❑Change of Use ®Additional Occupant ■ Indicate former type of business Ala) buS/n en ■ Are you requesting that the electricity be turned on? YesO Nou,-- ■ Is the building sprinklered? Yes No❑ ■ Will operations produce dust/wood shavings or similar material? Yes❑ NoE�-� ■ Will operations involve the repair or replacement of automobile parts YesO No Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? YesEl No ■ Will the busine be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes ONO � ■ The following best describes my operation: 9-0ffice Only ❑ Retail Sales ❑ Medical/Dental ❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and etr)4 product) Other (describe) (4e 1b C 6-0) t./ For Official Use Onl Occ Group: Occ Group: Occ Group: Total Sq Ft Occupied:. Bldg. Permit # Area: Area: Area: No. of Stories: Entitlement #: Occ Load:. Occ Load Occ Load: TIF Review: Y/ N Zoning: S? S —G 2-- Pinr Initials: Date: Z pPlan Chkr Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: C.6!5� 'lip C.%/ge— Inspection Date: CERTIFICATE OF OCCUPANCY 020 - CITY OF HUNTINGTON BEACH - DEPT. OF PLANNING & BUHDING APPLICATION 714/536-5241 Floor- Mast Apply In -Person) Business License # Business Address i n % Main Z seo - Business Own( Business Name 'Business Type ProR= Owner Information (required) Tenant(1 Name l"-*A taxiopmeft Qn. Name Address %-..P^ F:- -,),,,A x+ . # PmIA Home Address City Lcj6A ecoa n State/Zip CA. 9=2b City Telephone NoTelephone. No. Date. io& Aa Zip.Coder'` Telephone No. Bus. Phone bib -VM -Ca46 THIS USE WOULD BE DESCRIBED AS: 0 Newly Constructed Building or 1%_ Existing Building CHECK ALL THAT APPLY: ❑ Change of Property Owner 'Change of Occupant ❑ Change of Use ❑Additional Occupant ■ Indicate former type of business .rA-i,nQ - ■ Are you requesting that the electricity be turned on% TesQ NoVr ■ Is the'building sprinklered? YesV No0 Will operations produce dust/wood shavings or similar material? Yes❑ Noll ■ Will operations involve the repair or replacement of automobile parts YesO No'9 Ifyes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? YesQ Nd¢t ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes QNo ■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes QNo V ■ ,- -The following best describes my operation: IffOffice Only ❑ Retail Sales ❑ Medical/Dental ❑ Warehouse /Manufacturing/Distribution 0 Restaurant/Take Out Food (describe process and end product) Other (describe) For Official Use Onl Occ Group: Area: Occ Load: Occ Group: Area: Occ Load Occ Group: Area: Occ Load: Total Sq Ft Occupied No. of Stories, TIF Review: Y/N Bldg. Permit # Entitlement #: Zoning: >L)— Plnr Initials:- Date: i Flan Chkr Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: Inspection Date: CERTIFICATE OF OCCUPANCY* 020\ CITY OF HUNTINGTON BEACH — -DEPT. OF PLANNING & BUILDING. APPLICATION 714/536-5241 h-arl(,1?� [COB. HUNTINGTON BEACH Business License # Business Addres8J Business Owners N Business Name k Business Type 40 Telephone No. q 14- a 7`{- �!o % ri Telephone No. (3n4 Floor —Must Apply In -Person) Date d • i✓�l _� Zip Code �W Telephone No. - (o /v?�c� Bus. Phone / - "` . THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or ' "'Xi Building CHECK ALL THAT APPLY: ❑ Change of Property Owner ❑Change 9f Occupant ❑Change of Use ❑Additional Occupant ■ Indicate former type of business Alew V asm e d'S ■ Are you requesting that the electricity be turned on? YesQ NoB� ■ Is the building sprinklered? Yes l�, Noll ■ . Will operations produce dust/wood shavings or similar material? Yes❑ , Nob—' ■ Will operations.involve the repair or replacement of automobile parts YesQ Noyes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? YesQ No ■. Will the busineess-be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes QNo 1T � / ■ The following best describes my operation: 1�'Office Only ❑ Retail Sales. 0 Medical/Dental Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and aNe-&C64 roduct) Other (describe) a2 t f For Official Use Onl Occ Group: Area: Occ Load: Occ Group: Area:. Occ Load Occ Group.' Area: Occ Load: Total Sq Ft Occupied: No. of Stories: TIF Review: WN Bldg. Permit # Entitlement #: Zoning: SAS —G Z Plnr Initials:. Date: t a o Plan Chkr Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: C' 22 C6�1 cge Inspection Date: RT", South boast NZ Air Quality Management ,District 21865 Copley Drive, Diamond Bar, CA 91765-4182 * r (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:,�itA.� Property Address: to% tAoav—% 4�sk • *SW City: becKAI Contact Person:-XC Type of Business:V�C�h`�.� Fax Number. '"�1 -a11� • -yam V • •F r • Applicant (print name):" 1pri signature: JJ Date: Title: CW Telephone: ft-WrO-O* '� ��.Fro I . 40IN ' "Al - - • Will the facility have any of the following equipment? Yes ❑ No V Charbroiler Dry cleaning machine Spray booth Printing press (screen/lithographic/flexographic) Internal combustion engine greater than 50 BP (excluding motor vehicles) Boiler/combustion equipment (greater than 1 million BTU/hrmaximum 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? YesO No(V 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-- HUNTINGTON BEACH FIRE DEPARTMENT HAZARDOUS MATERIALS DISCLOSURE OFFICE 2000MAIN STREET • HUNTINGTON BEACH, CA 92648 S (714) 536-5676 • FAX (714) 374-1551 HAZARDOUS MATERIALS DISCLOSURE INFORMATION MANDATORY REPLY REQUIRED PRIOR TO ISSUANCE OF BUSINESS LICENSE Complete aad refirn to the Business`LicenseDlvison PLEASE PRINT RD#/: Business Name: lb Phone: Business Address: XO% Nnoct% ! _ G1'dLAb Number Street Unit Zip Code Owner/Manager.. 0 Date Business Will Start Operation: Description of Business: California's emergency response network requires all businesses to notify their local emergency response agency if they store or use hazardous materials above certain threshold quantities. In the City of Huntington Beach, the emergency response agency is the Fire Department, and the method of notification is by fling a Hazardous Materials Disclosure Package with the Fire Department's Hazardous Materials Disclosure Program office. Types of hazardous materials that must be disclosed include: oils, solvents, paints and coating materials, gases (compressed or cryogenic), fuels, and hazardous wastes. You are required to submit a Hazardous Materials Disclosure Package if you store or use hazardous materials in quantities equal to or greater than the following amounts: ➢ 500 pounds of a hazardous solid' ➢ 55 gallons of a hazardous liquid ➢ 200 cubic feet of a gas (or the compressed or liquefied equivalent) ➢ Extremely hazardous materials that exceed the threshold amounts listed in 40 CFR 355 Appendix. A ➢ Radioactive materials that exceed.the amounts listed in 10 CFR sections 30,40 or 70 ➢ Hazardous wastes that exceed any of the thresholds amounts listed above ➢ Other materials determined to pose a significant hazard to human health and safety; or the environment Disclosure is NOT required for the following types of hazardous materials: e ➢ . When contained in a food, drug, cosmetic or tobacco product ➢ When packaged for direct distribution to consumers (retail products). ➢ When the materials are stored, used, or handled at a facility for less than 30 days. ➢ Infectious waste generated by health care facilities. Please indicate which category most appropriately describes your business: No hazardous materials are, or will be, used, handled or stored at the above location, - Hazardous materials are present, but in quantities less that the amounts listed above. ❑ Hazardous materials are used, handled, and/or stored at or above the amounts listed above. A Fire Department representative will contact you -at a later date to verify the above information and determine if you need to file a Hazardous Materials Disclosure Package., If you have any questions about the Hazardous Materials. Disclosure Program, please call (714) 536-5469 or (714) 536-5676. You can also obtain additional information on the City's website. at www.surfcity-hb.org in the Fire Department page under the section Fire Prevention. I certify, under the pen above information is true and correct to the best of my knowledge. Signature: :!H e PhoneDate: -3- 1� HUNTINGTON BEACH Business Licen Business Addy+ Business Own( Business Nam( Business Type CERTIFICATE OF OCCUPANCY 1 020 — CITY OF HUNTINGTON BEACH — DEPT. OF PLANNING & BUILDING APPLICATION 7141536-5241 (3ro Floor -Must Apply In -Person) Date Ala Zip Code gggQg0 Telephone No. Bus. Phone ftl b - t�c�5 —tA�Ei Property Owner Information (required) Tenant/Emergency Contact (required) Name Name ' Address E550 le, it Home Address City 142TO bwr-tn State/Zip CA. GC CQ5 City Pate/Zip CA A ail0 Ili 1-j Telephone No. Telephone No. �jt$-tlzp6 -C 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 • Indicate former type of business 'C Y ' 1nQ ■ Are you requesting that the electricity be turned on. YesO NoVr ■ Is the building sprinklered? Yesl No❑ ■ Will operations produce dust/wood shavings or similar material? Yes❑ , No) ■ Will operations involve the repair or replacement of automobile parts Yes 0 NoV If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? YesQ NdZ • Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes ONo V • Will there be storage racks, gondolas, or shelving exceeding Sfeet 9 inches in height? Yes ONo V • The following best describes my operation: Office Only ❑ Retail Sales ❑ Medical/Dental ❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and end product) Other (describe) For Oflicial Use Onl Occ Group: Area: Occ Load: Occ Group: Area: Occ Load: Occ Group: Area: Occ Load: Total Sq Ft Occupied: No. of Stories: TIF Review: Y/ N Bldg. Permit # Entitlement #: Zoning: >tR5-- cm— Plnr Initials:�-� Date:LZLI--1 flan Chkr Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: Inspection Date: South Coast f - ` Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182 c) (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: tdla� Property Address: 1C)% VA iY1 4�'=k - *SW City: }� '�rta�ktx� bECkr-" Contact Person: —Vo= �� VE"� Type of Business: ��1�'t1 Fax Number: -1%A4-O(A-A;AW Zip Code: 9&9!! b Applicant (print name) TQri l5ignature: Date: Title: C W Telephone: M-Loar- "OW46 • Will the facility have any of the following equipment? Yes ❑ No E7 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? YesQ NoV 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- HUNTINGTON BEACH FIRE DEPARTMENT HAZARDOUS MATERIALS DISCLOSURE OFFICE 2000 MAIN STREET • HUNTINGTON BEACH, CA 92648 (714) 536-5676 • FAX (714) 374-1551 HAZARDOUS MATERIALS DISCLOSURE INFORMATION MANDATORY REPLY REQUIRED PRIOR TO ISSUANCE OF BUSINESS LICENSE Complete and return to the Business License Division PLEASE PRINT RD#: Business Name: ,)�jp Oedia .�ir1L• Phone: ��-t�05'{ •� Business Address: Xo—% Y�i0.�lY1 Q� O�V Number Street Unit Zip Code Date Business Will Start Operation: Description of Business: California's emergency response network requires all businesses to notify their local emergency response agency if they store or use hazardous materials above certain threshold quantities. In the City of Huntington Beach, the emergency response agency is the Fire Department, and the method of notification is by filing a Hazardous Materials Disclosure Package with the Fire Department's Hazardous Materials Disclosure Program office. Types of hazardous materials that must be disclosed include: oils, solvents, paints and coating materials, gases (compressed or cryogenic), fuels, and hazardous wastes. You are required to submit a Hazardous Materials Disclosure Package if you store or use hazardous materials in quantities equal to or greater than the following amounts: ➢ 500 pounds of a hazardous solid ➢ 55 gallons of a hazardous liquid ➢ 200 cubic feet of a gas (or the compressed or liquefied equivalent) ➢ Extremely hazardous materials that exceed the threshold amounts listed in 40 CFR 355 Appendix A ➢ Radioactive materials that exceed the amounts listed in 10 CFR sections 30,40 or 70 ➢ Hazardous wastes that exceed any of the thresholds amounts listed above ➢ Other materials determined to pose a significant hazard to human health and safety, or the environment Disclosure is NOT required for the following types of hazardous materials: ➢ When contained in a food, drug, cosmetic or tobacco product. ➢ When packaged for direct distribution to consumers (retail products). ➢ When the materials are stored, used, or handled at a facility for less than 30 days. ➢ Infectious waste generated by health care facilities. Please indicate which category most appropriately describes your business: No hazardous materials are, or will be, used, handled or stored at the above location. Hazardous materials are present, but in quantities Iess that the amounts listed above. ❑ Hazardous materials are used, handled, and/or stored at or above the amounts listed above. A Fire Department representative will contact you at a later date to verify the above information and determine if you need to file a Hazardous Materials Disclosure Package. If you have any questions about the Hazardous Materials Disclosure Program, please call (714) 536-5469 or (714) 536-5676. You can also obtain additional information on the City's website. at www.surfciiy-hb.org in the Fire Department page under the section Fire Prevention. I certify, under the pen f jm jup ; above information is true and correct to the best of my knowledge. Signature: :5Ho a Phone: 615-{jr Date: -3- J� HUNTINGTON BEACH Business License Business Address Business Owners Business Name l Business Type C Name ft `Address City CERTIFICATE OF OCCUPANCY' 020 CITY OF HUNTINGTON BEACH — -DEPT.. OF PLANNING & BUILDING. APPLICATION 714/536-5241 (Td Floor— Must Apply In -Person) , - a17/.,11 P Date Zip Code —26 Telephone No.'7/ (, la-1 aT Bus. Phone / - `` i Telephone No. /Lt' a 77'% Telephone No. 7 / c/ yqg " n THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or xisting Building ,. CHECK ALL THAT APPLY: ❑ Change of Property Owner ❑Change 9f Occupant ❑Change of Use C1Additional Occupant ■ Indicate former type of business Mew V asin exi ■ Are you requesting that the electricity be turned on? YesQ NoBL,-- ■ Is the building sprinklered? Yes No❑ ■ . Will operations produce dust/wood shavings or similar material? Yes❑ , NoE� ■ Will operations involve the repair or replacement of automobile parts YesQ Noyes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? YesQ No ■ Will the business -be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes QNo ■ ZT- The following best describes my operation: fl1Office Only ❑ Retail Sales.. ❑ Medical/Dental 0 Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and eggd�� product) Other (describe) `' le IU*C 6-1 a tc� For Official Use Only Occ Group: Occ Group: Occ Group: Total Sq Ft Occupied: Bldg. Permit # Area: Area: Area: No. of Stories: Entitlement #: Occ Load: Occ Load: Occ Load: TIF Review: Y/ N Zoning: 51.5 --G Pinr Initials: Date: Z ,- 6Plan Chia• Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: Inspection Date: CERTIFICATE OF OCCUPANCY 020 - CITY OF HUNTINGTON BEACH - DEPT. OF PLANNING & BUHDING APPLICATION 714/536-5241 Floor- Mast Apply In -Person) Business License # Business Address i n % Main Z seo - Business Own( Business Name 'Business Type ProR= Owner Information (required) Tenant(1 Name l"-*A taxiopmeft Qn. Name Address %-..P^ F:- -,),,,A x+ . # PmIA Home Address City Lcj6A ecoa n State/Zip CA. 9=2b City Telephone NoTelephone. No. Date. io& Aa Zip.Coder'` Telephone No. Bus. Phone bib -VM -Ca46 THIS USE WOULD BE DESCRIBED AS: 0 Newly Constructed Building or 1%_ Existing Building CHECK ALL THAT APPLY: ❑ Change of Property Owner 'Change of Occupant ❑ Change of Use ❑Additional Occupant ■ Indicate former type of business .rA-i,nQ - ■ Are you requesting that the electricity be turned on% TesQ NoVr ■ Is the'building sprinklered? YesV No0 Will operations produce dust/wood shavings or similar material? Yes❑ Noll ■ Will operations involve the repair or replacement of automobile parts YesO No'9 Ifyes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? YesQ Nd¢t ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes QNo ■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes QNo V ■ ,- -The following best describes my operation: IffOffice Only ❑ Retail Sales ❑ Medical/Dental ❑ Warehouse /Manufacturing/Distribution 0 Restaurant/Take Out Food (describe process and end product) Other (describe) For Official Use Onl Occ Group: Area: Occ Load: Occ Group: Area: Occ Load Occ Group: Area: Occ Load: Total Sq Ft Occupied No. of Stories, TIF Review: Y/N Bldg. Permit # Entitlement #: Zoning: >L)— Plnr Initials:- Date: i Flan Chkr Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: Inspection Date: CERTIFICATE OF OCCUPANCY* 020\ CITY OF HUNTINGTON BEACH — -DEPT. OF PLANNING & BUILDING. APPLICATION 714/536-5241 h-arl(,1?� [COB. HUNTINGTON BEACH Business License # Business Addres8J Business Owners N Business Name k Business Type 40 Telephone No. q 14- a 7`{- �!o % ri Telephone No. (3n4 Floor —Must Apply In -Person) Date d • i✓�l _� Zip Code �W Telephone No. - (o /v?�c� Bus. Phone / - "` . THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or ' "'Xi Building CHECK ALL THAT APPLY: ❑ Change of Property Owner ❑Change 9f Occupant ❑Change of Use ❑Additional Occupant ■ Indicate former type of business Alew V asm e d'S ■ Are you requesting that the electricity be turned on? YesQ NoB� ■ Is the building sprinklered? Yes l�, Noll ■ . Will operations produce dust/wood shavings or similar material? Yes❑ , Nob—' ■ Will operations.involve the repair or replacement of automobile parts YesQ Noyes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? YesQ No ■. Will the busineess-be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes QNo 1T � / ■ The following best describes my operation: 1�'Office Only ❑ Retail Sales. 0 Medical/Dental Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and aNe-&C64 roduct) Other (describe) a2 t f For Official Use Onl Occ Group: Area: Occ Load: Occ Group: Area:. Occ Load Occ Group.' Area: Occ Load: Total Sq Ft Occupied: No. of Stories: TIF Review: WN Bldg. Permit # Entitlement #: Zoning: SAS —G Z Plnr Initials:. Date: t a o Plan Chkr Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: C' 22 C6�1 cge Inspection Date: RT", South boast NZ Air Quality Management ,District 21865 Copley Drive, Diamond Bar, CA 91765-4182 * r (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:,�itA.� Property Address: to% tAoav—% 4�sk • *SW City: becKAI Contact Person:-XC Type of Business:V�C�h`�.� Fax Number. '"�1 -a11� • -yam V • •F r • Applicant (print name):" 1pri signature: JJ Date: Title: CW Telephone: ft-WrO-O* '� ��.Fro I . 40IN ' "Al - - • Will the facility have any of the following equipment? Yes ❑ No V Charbroiler Dry cleaning machine Spray booth Printing press (screen/lithographic/flexographic) Internal combustion engine greater than 50 BP (excluding motor vehicles) Boiler/combustion equipment (greater than 1 million BTU/hrmaximum 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? YesO No(V 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-- HUNTINGTON BEACH FIRE DEPARTMENT HAZARDOUS MATERIALS DISCLOSURE OFFICE 2000MAIN STREET • HUNTINGTON BEACH, CA 92648 S (714) 536-5676 • FAX (714) 374-1551 HAZARDOUS MATERIALS DISCLOSURE INFORMATION MANDATORY REPLY REQUIRED PRIOR TO ISSUANCE OF BUSINESS LICENSE Complete aad refirn to the Business`LicenseDlvison PLEASE PRINT RD#/: Business Name: lb Phone: Business Address: XO% Nnoct% ! _ G1'dLAb Number Street Unit Zip Code Owner/Manager.. 0 Date Business Will Start Operation: Description of Business: California's emergency response network requires all businesses to notify their local emergency response agency if they store or use hazardous materials above certain threshold quantities. In the City of Huntington Beach, the emergency response agency is the Fire Department, and the method of notification is by fling a Hazardous Materials Disclosure Package with the Fire Department's Hazardous Materials Disclosure Program office. Types of hazardous materials that must be disclosed include: oils, solvents, paints and coating materials, gases (compressed or cryogenic), fuels, and hazardous wastes. You are required to submit a Hazardous Materials Disclosure Package if you store or use hazardous materials in quantities equal to or greater than the following amounts: ➢ 500 pounds of a hazardous solid' ➢ 55 gallons of a hazardous liquid ➢ 200 cubic feet of a gas (or the compressed or liquefied equivalent) ➢ Extremely hazardous materials that exceed the threshold amounts listed in 40 CFR 355 Appendix. A ➢ Radioactive materials that exceed.the amounts listed in 10 CFR sections 30,40 or 70 ➢ Hazardous wastes that exceed any of the thresholds amounts listed above ➢ Other materials determined to pose a significant hazard to human health and safety; or the environment Disclosure is NOT required for the following types of hazardous materials: e ➢ . When contained in a food, drug, cosmetic or tobacco product ➢ When packaged for direct distribution to consumers (retail products). ➢ When the materials are stored, used, or handled at a facility for less than 30 days. ➢ Infectious waste generated by health care facilities. Please indicate which category most appropriately describes your business: No hazardous materials are, or will be, used, handled or stored at the above location, - Hazardous materials are present, but in quantities less that the amounts listed above. ❑ Hazardous materials are used, handled, and/or stored at or above the amounts listed above. A Fire Department representative will contact you -at a later date to verify the above information and determine if you need to file a Hazardous Materials Disclosure Package., If you have any questions about the Hazardous Materials. Disclosure Program, please call (714) 536-5469 or (714) 536-5676. You can also obtain additional information on the City's website. at www.surfcity-hb.org in the Fire Department page under the section Fire Prevention. I certify, under the pen above information is true and correct to the best of my knowledge. Signature: :!H e PhoneDate: -3- 1� HUNTINGTON BEACH Business Licen Business Addy+ Business Own( Business Nam( Business Type CERTIFICATE OF OCCUPANCY 1 020 — CITY OF HUNTINGTON BEACH — DEPT. OF PLANNING & BUILDING APPLICATION 7141536-5241 (3ro Floor -Must Apply In -Person) Date Ala Zip Code gggQg0 Telephone No. Bus. Phone ftl b - t�c�5 —tA�Ei Property Owner Information (required) Tenant/Emergency Contact (required) Name Name ' Address E550 le, it Home Address City 142TO bwr-tn State/Zip CA. GC CQ5 City Pate/Zip CA A ail0 Ili 1-j Telephone No. Telephone No. �jt$-tlzp6 -C 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 • Indicate former type of business 'C Y ' 1nQ ■ Are you requesting that the electricity be turned on. YesO NoVr ■ Is the building sprinklered? Yesl No❑ ■ Will operations produce dust/wood shavings or similar material? Yes❑ , No) ■ Will operations involve the repair or replacement of automobile parts Yes 0 NoV If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? YesQ NdZ • Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes ONo V • Will there be storage racks, gondolas, or shelving exceeding Sfeet 9 inches in height? Yes ONo V • The following best describes my operation: Office Only ❑ Retail Sales ❑ Medical/Dental ❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and end product) Other (describe) For Oflicial Use Onl Occ Group: Area: Occ Load: Occ Group: Area: Occ Load: Occ Group: Area: Occ Load: Total Sq Ft Occupied: No. of Stories: TIF Review: Y/ N Bldg. Permit # Entitlement #: Zoning: >tR5-- cm— Plnr Initials:�-� Date:LZLI--1 flan Chkr Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: Inspection Date: South Coast f - ` Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182 c) (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: tdla� Property Address: 1C)% VA iY1 4�'=k - *SW City: }� '�rta�ktx� bECkr-" Contact Person: —Vo= �� VE"� Type of Business: ��1�'t1 Fax Number: -1%A4-O(A-A;AW Zip Code: 9&9!! b Applicant (print name) TQri l5ignature: Date: Title: C W Telephone: M-Loar- "OW46 • Will the facility have any of the following equipment? Yes ❑ No E7 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? YesQ NoV 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- HUNTINGTON BEACH FIRE DEPARTMENT HAZARDOUS MATERIALS DISCLOSURE OFFICE 2000 MAIN STREET • HUNTINGTON BEACH, CA 92648 (714) 536-5676 • FAX (714) 374-1551 HAZARDOUS MATERIALS DISCLOSURE INFORMATION MANDATORY REPLY REQUIRED PRIOR TO ISSUANCE OF BUSINESS LICENSE Complete and return to the Business License Division PLEASE PRINT RD#: Business Name: ,)�jp Oedia .�ir1L• Phone: ��-t�05'{ •� Business Address: Xo—% Y�i0.�lY1 Q� O�V Number Street Unit Zip Code Date Business Will Start Operation: Description of Business: California's emergency response network requires all businesses to notify their local emergency response agency if they store or use hazardous materials above certain threshold quantities. In the City of Huntington Beach, the emergency response agency is the Fire Department, and the method of notification is by filing a Hazardous Materials Disclosure Package with the Fire Department's Hazardous Materials Disclosure Program office. Types of hazardous materials that must be disclosed include: oils, solvents, paints and coating materials, gases (compressed or cryogenic), fuels, and hazardous wastes. You are required to submit a Hazardous Materials Disclosure Package if you store or use hazardous materials in quantities equal to or greater than the following amounts: ➢ 500 pounds of a hazardous solid ➢ 55 gallons of a hazardous liquid ➢ 200 cubic feet of a gas (or the compressed or liquefied equivalent) ➢ Extremely hazardous materials that exceed the threshold amounts listed in 40 CFR 355 Appendix A ➢ Radioactive materials that exceed the amounts listed in 10 CFR sections 30,40 or 70 ➢ Hazardous wastes that exceed any of the thresholds amounts listed above ➢ Other materials determined to pose a significant hazard to human health and safety, or the environment Disclosure is NOT required for the following types of hazardous materials: ➢ When contained in a food, drug, cosmetic or tobacco product. ➢ When packaged for direct distribution to consumers (retail products). ➢ When the materials are stored, used, or handled at a facility for less than 30 days. ➢ Infectious waste generated by health care facilities. Please indicate which category most appropriately describes your business: No hazardous materials are, or will be, used, handled or stored at the above location. Hazardous materials are present, but in quantities Iess that the amounts listed above. ❑ Hazardous materials are used, handled, and/or stored at or above the amounts listed above. A Fire Department representative will contact you at a later date to verify the above information and determine if you need to file a Hazardous Materials Disclosure Package. If you have any questions about the Hazardous Materials Disclosure Program, please call (714) 536-5469 or (714) 536-5676. You can also obtain additional information on the City's website. at www.surfciiy-hb.org in the Fire Department page under the section Fire Prevention. I certify, under the pen f jm jup ; above information is true and correct to the best of my knowledge. Signature: :5Ho a Phone: 615-{jr Date: -3- J� HUNTINGTON BEACH Business License Business Address Business Owners Business Name l Business Type C Name ft `Address City CERTIFICATE OF OCCUPANCY' 020 CITY OF HUNTINGTON BEACH — -DEPT.. OF PLANNING & BUILDING. APPLICATION 714/536-5241 (Td Floor— Must Apply In -Person) , - a17/.,11 P Date Zip Code —26 Telephone No.'7/ (, la-1 aT Bus. Phone / - `` i Telephone No. /Lt' a 77'% Telephone No. 7 / c/ yqg " n THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or xisting Building ,. CHECK ALL THAT APPLY: ❑ Change of Property Owner ❑Change 9f Occupant ❑Change of Use C1Additional Occupant ■ Indicate former type of business Mew V asin exi ■ Are you requesting that the electricity be turned on? YesQ NoBL,-- ■ Is the building sprinklered? Yes No❑ ■ . Will operations produce dust/wood shavings or similar material? Yes❑ , NoE� ■ Will operations involve the repair or replacement of automobile parts YesQ Noyes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? YesQ No ■ Will the business -be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes QNo ■ ZT- The following best describes my operation: fl1Office Only ❑ Retail Sales.. ❑ Medical/Dental 0 Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and eggd�� product) Other (describe) `' le IU*C 6-1 a tc� For Official Use Only Occ Group: Occ Group: Occ Group: Total Sq Ft Occupied: Bldg. Permit # Area: Area: Area: No. of Stories: Entitlement #: Occ Load: Occ Load: Occ Load: TIF Review: Y/ N Zoning: 51.5 --G Pinr Initials: Date: Z ,- 6Plan Chia• Initials: Date: Insp Initials: Date: Conditions of Approval or Other Notes: Inspection Date: