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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020 -
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3'd Floor — Must Apply In -Person)
Business License # A.:+L S% 4- Date
Business Address /Dl ltdci,rl -0-355- Zip Code g2b48
Business Owners Name _-rjnpjQcea j Wn/Iclwidl .4me ?'W.0 LLC_ Telephone No.71,41-Ml
Business Name �� l�I p( q�.( Wa✓lal �E _�4y irk /_.LC Bus. Phone -114 - ye/ - 52a1�
Business Type
Property Owner Information (required) Tenant/Emergency Contact (required)
Name la Ca Name F=:. / .[lam%✓��
Address - I Home Address VV, -ReS4 - Sf 3
City Ach,State/Zip 072[o 4Fg City I LLSfivl. State/Zip L3.29C140
Telephone No. Telephone No,
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or -ffVE xisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner U16hange of Occupant ❑ Change of Use ❑ Additional Occupant
Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes [] No ❑
■ Is the building sprinklered? Ye�k' , Nod
■ Will operations produce dust/wood shavings or similar material? Yes ❑
■ Will operations involve the repair or replacement of automobile parts Yes[] NAe
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes [] N
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes []NO
■ Will there be. storage racks, gondolas, or shelvingexceeding 5feet 9 inches in height? Yes 0No�
■ The following best describes my operation: ffice Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
Other (describe)
For Q fficial Use Only
Occ Group:
Occ Group:��---'-"�
Occ Gro _
Total q Ft O
Bld Permit #
Plnr
Area: a
Area:
Area:
Occ Load:
Occ Load:
Occ Load:
If yes: Describe the
l7 No. of Stories: TIF Review: Y/ N
Entitlement #: Zoning: �7-p S -C
`(Plan Chkr Initials4z—
Date a'�Insp Initials:_ Date: 1pf/
Conditions of Approval or Other Notes:
\�e
V
�—' Inspection Date:
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South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 917654182
Q (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:=nr70Ce0yi Wor1dwido->6n7r-v%ca5, Li c
Property Address: 145OLW /0 / t-10 in 5-L--
City: Harr inQfal a ea ch Zip Code:
Contact Person: S-fkir't- ' RG L:Ly_? ?
Type of Business: a pl vim-Hsi"eir�j
Fax Number: -7114, - $(#1 - 5 33 q-
Applicant (print name): �5� t-K Signature:
Gm,ve z
Date:
Title: (2f � r
Telephone: fly - 0 1 - 5211
66
I e-mail address: eaC1r4iVeZ_G
i✓1v1 pcegn oar�ricas
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® Will the facility have any of the following equipment? Yes ❑ Nog
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[:] Noe
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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