HomeMy WebLinkAbout116 Main St - CofO (19)16
714/536-5271
CERTIFICATE OF OCCUPANCY 020// - 0 a 3 SS'- S
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(3'd Floor - Must Apply In -Person)
Business License Date
Business Address t I Lo 11-2, V\A Pv-i A3 'SA' Zip Code U6
Business Owners Name [oS O Telephone No. 7A Q j - i2(¢&
Business Name D Bus. Phone t c
Business Type
PropertyOwner Information (required) Tenant/Emergency Contact (required)
Name pt A N e% S LO t vN Name G 4r- LOS
Address IM mccf1 Home Address ti�
City \V5 State/Zip C& 0 2kdrlb City iJ P wP6,r 9 C State/Zip
Telephone No. 714 - s3t0-79003 Telephone No. C44'0- 01?A-116,7
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Existing Building
CHECK ALL THAT APPLY: /�
El Change of Property Owner lIChange of Occupant( ❑ Change of Use
■ Indicate former type of business 1A0,ACt 0 P O tj oee ' 490;
■ Are you requesting that the electricity e turned on? Yes0No
■ Is the building sprinklered? Yes 1. ❑
■ Will operations produce dust/wood shavings or similar material? Yes0Noe_11*/
■ Will operations involve the repair or replacement of automobile parts Yes ONo Q If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes E]No
■ Will the busJi ass be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo C
■ The following best describes my operation: ❑ Office Only CYRetail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Only
Occ Group: Jam(
Occ Group:
Occ Group:
Total Sq Ft Occupied: �p
Bldg. Permit #
Area: I F0
Area:
❑� Addit;onal Occupant
Occ Load:
Occ Load:
Occ Load:
vr'
TIF Review: Y/ N
Zoning: �—j f 757 �
Plnr Initials-q Date: Plan Chkr Initials: Date: Insp Initials: _ Date:
Conditions of Approval or Other Notes:
7-
Inspection Date:
Area:
No. of Stories:
Entitlement #:
/% (G:Building/Forms/document id goes here) �Q S
11'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:
Type of Business:
Applicant: (print name)
0,7
Zip Code: R?iL9 T9
Title: O,,�w
Telephone �j ' q '-?1167
Signature:
0 Will the facility have any of the following equipment? Yes 0 No N�
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 ^�
0 Will any of the following operations be performed? Yes []No 17
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
01f you 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.