HomeMy WebLinkAbout117 Main St - CofO (22)I05-S*(,-,
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714/536-5271
CERTIFICATE OF OCCUPANCY 020LL_ - (o !
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(3rd Floor - Must Apply In -Person)
Business License # -1 9 53-7 Date / l //" if 0,
Business Address -7 MAKI A/ ST, v I 1 Zd Zip Code 9 Lb q
Business Owners Name /11 W UULt,15 ( 4Cam/ S� . Telephone No.71 y- Z Vo - S
Business Name W 1 A- S TV gyp/ a S Bus. Phone — SA�E—
Business Type BL5 o-6 so►-rp ey',,e % 6 0 NV S V c4-1 Al
Property Owner Information (required) A, Tenant/Emergency Contact (required)
o< Name 117 /-t efl IJ 14 13 / L L G Name P_44171J ^i
Address 110 60 X 1 u 7 9 Home Address - 2 S wt'Me G(i/L-
City 1 iLV 1 N f State/Zip 6-0� Ii ZG 1 5 City C)SV Pr 1-167J -Ci' State/Zip 2
Telephone No. `1 ,11' 77 Z- Z 6 C) Telephone No. SO ' 7s- b - 7-2 % 0
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or X Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner ❑ Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you. requesting that the electricit be turned on? YesONo❑
■ Is the building sprinklered? Yes WN00
■ Will operations produce dust/wood shavings or similar material? YesON04_
■ Will operations involve the repair or replacement of automobile parts Yes 0. No If yes: Describe the
components repaired or replaced.
Does the operation involve the use of welding or open flame? Yes ONo
Will the business be a drinking, dining or assembly use with an occupant loa,
Yes ONo
The following best describes my operation: Office Only etai
l Sales
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturi g/Distribution
(describe process and end product)
❑ Other (describe)
For O(ficial Use Only
Occ Group: 1
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area:/ .
Area:
Area:
No. of Stories:
Entitlement #:
of more than 50 persons?
❑ Medical/Dental
Occ Load:
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning:
Plnr Initials: Date:ilnomo Plan Chkr Initials:,% Date: 1 In 0 Insp Initials: 'tZC_ Date: �p L
Conditions of Approval or Other Notes:
Inspection Date: St IL
/�'$uilding/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:
Property Address:
City:
Contact Person:
III s l . sye Tg Zol
' AW,4 ApoelKWW"
Type of Business: w SV W _ 40 �ONSV L �-
Applicant: (print name) Gc 4,64
Zip Code:
Title:
Telephone.l(� Z Yf ' 3
Signature:
4s=-
Q 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 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
O Will any of the following operations be performed? Yes []No
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
U If you answered "No" to both questions, this checklist is your clearance from AQMD.
DIf 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.