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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020Ii - G Z Q 7
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3'd Floor— Must Apply In -Person)
Business License # Q'Rcn--� (�Q �� (' Date 7 —_
Business Address 12-1 �'►'AIAl s•7y2E. T Zip Code cf ?
Na Business Owners me '� I,�- ���L .� . Telephone N� %'6 7
Business Name a. a'_ Bus. Phone ,
Business Type , , /> ,� uc. y,, �,o
14
Property Owner Information (required) Tenant/Emergency Contact (r wired)
Name e-'l Name to Tea �4 V q R f
Addres T���p�C- t a - , � Home Address
City State/Zips City _ �T—State/Zip
Telephone No. -�i/ V- ?�: 1,4 4 C! Telephone No.
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or [-Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner k•,,Change of Occupant ❑ Change of Use 0 Additional Occupant
■ Indicate former type of business_ �� � .Ye� T� ,
■ Are you requesting that the electricity be turned on? s � No
■ Is the building sprinklered? Yes❑ NoB---
■ Will operations produce dust/wood shavings or similar material? Yes❑ , N9,9.
■ Will operations involve the repair or replacement of automobile parts Yes O N4 If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes Q N
■ Will the business be a drinking, dining or assembly use with an occupan load of more than 50 persons?
Yes ❑No
I
Will thestorage racks, gondolas, or shelving exceeding 5feet 9 inches in* height? Yes ON014
■ The following best describes my operation: ❑ Office Only etail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/T e Out Food
(describe process and end product)
❑ Other (describe)
For Official Use Only
Oce Group: Area: WM47 Occ Load:
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: ,Z-2,� No. of Stories: TIF Review: /
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials: Dater2tl 1 Plan Chkr Initials: Date:�6.1_� �nsp Initials: Date: ZZ L
Conditions of Approval or Other Notes:
WAIL- 10n2eW TOO Nb 0AAW6Z of U�hb OSI; r(40Vh 1P VhWf-,
Inspection Date:
-.
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(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:
V^
Property Address: i�.�0.� k-
J
City: a lR
ContactPerson:
Type of Business:.
Fax Number: `7f ,q— YJ ,( 7�
Applicant (print name):
Zip Code:
�6
Title:. QLJGI 6L /` 7
Telephone: � — Li4,- 0
e-mail address: nL�s',�'
Signature: LUZf
Date: ::7 f--
• Will the facility have any of the following equipment? Yes ❑ No
K.
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❑ No�l
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).
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