HomeMy WebLinkAbout123 Main St - CofO (9)CERTIFICATE OF OCCUPANCY 020 I2. - o611
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
Floor - Must Apply In -Person)
Business License #
Business Address I
Business Name
Business Type.
Date
Zip Code
Telephone No. S -,
Bus. Phone
Pronertv Owner Information (required) Tenant/Emer ency Contact (required)
Name 1A1$ on/ Name PAOIl
Address _ 14. A 'SSL4• f i u 1 Home Address /3 STG / a04 C
City H L"t) 'A'J ,n State/Zip 6 A Citys#/,/ �ieQ � State/Zip 19 q)130
Telephone No. -Z - Sq� - //0) Telephone No'� S 73 Cl -0 3
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or EY Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner R"*ZC hange of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business COA-A
■ Are you requesting that the electricity be turned on? Yes 0NoET'
■ Is the building sprinklered? Yes P�No ❑
■ Will operations produce dust/wood shavings or similar material? YesoNoE'
■ Will operations involve the repair or replacement of automobile parts Yes QNo E' If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ONo R,
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo B/
■ The following best describes my operation: ❑ Office Only C3*Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product) do
❑ Other (describe)
For Official Use Only
Occ Group: M
Occ Group: S
Occ Group: f
Total'Sq Ft Occupied:
Bldg. -'Pen -nit #
'i
Area: i501jt;7 Occ Load
Area: j p 1 p Occ Load
Area:
No. of Stories:
Entitlement #:
Plnr Initials: Date: 117-111., Plan Chkr Initials: �—Date: ` �- 1 CI I
-
Conditions of Approval or Other Notes:
Inspection Date:
-M
RA
Occ Load:
TIF Review: Y/ N
Zoning: '5PG-G-F1-
Insp Initials: Date: ' 3' Q
235, 56
Q Will any of the following operations be performed?
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
' 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: ,19soo Aeq u CCI-�'aA)C 1
Property Address: 1a3 , n �y�.� .5� / /c� 1
City: 1' nh j(, Y, j�& Zip Code: V 6- L1
Contact Person: a—(, r'6 >(vA - Title:
Type of Business: c (I �h Telephone: O)
Applicant: (print name) S f fiA o,✓ 2d&cam T < Signature: !z.,,�..
Q Will the facility have any of the following equipment? Yes O 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
Yes []No ax
Q If you answered "No" to both questions, this checklist is your clearance from AQMD.
D 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 (800) 388-2121.