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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020_L�7 - OF1
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3'd Floor — Must Apply In -Person)
Business License # N a9 2- (.0 j l' Date :7 - 9 -/.:?
Business Address /16 New ,-L Sig & /O S Zip Code 9 21549
Business Owners Name ,l,''o0 140 )"'1 W, Telephone No.
Business Name (aP'r Bus. Phone
Business Type geLai f
Property Owner Information (required) Tenant/Emergency Contact (required)
Name �% p�j-�1% �,P.� T( S Name 5� D R0 il-f
Address Home Address Zy6-3 3 S . j/e.No ti / - (
City fj/_IN� r N j�z-�tate/Zip C.4— City 7VAgWNd4C- State/Zip KA., -7 0"2-
Telephone No. ,7 /V 960 •-f/ r-5 Telephone No. 0-`3 �4i/
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or I/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 electricity be turned on? Yes D No
■ Is the building sprinklered? YesV No❑
■ Will operations produce dust/wood shavings or similar material? Yes❑ Nor
■ Will operations involve the repair or replacement of automobile parts Yes Nofr If yes: 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 ❑No d
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes ONO
■ The following best describes my operation: ❑ Office Only KRetail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ 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: 310 No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitlement #: Zoning: alp t;- "�C�
Plnr Initials: Date?�? Plan Chkr Initials: Date: 12 Insp InitialsDate: �� 2
Conditions of Approval or Other Notes:
y Inspection Date: / / Z /1 /tA
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: - W-5
Property Address: /,24 W,1" S STi—i 02>
City: •&UAG TI V1'J H Zip Code:
Contact Person: A �`- 4_00 140 �" 1 Title: O wi�C(z-
Type of Business: R-E 774IL 647S S7DP�0 Telephone: �2/3'v2/qI - `% llr�'
Fax Number: e-mail address: _
Applicant (print name): -!t� feo 1f�4 Signature:
Date: 2 — 9' — / z
• 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 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❑ Nod
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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