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CERTIFICATE OF OCCUPANCY 020 1 - --6 lr t .-_�
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5271 (3rd Floor - Must Apply In -Person)
Business License # A D, Date
Business Address I D& MA,a c-,Jr 4 to'3 Zip Code Qa( 4:>
Business Owners Name Telephone No. S= 4SS(ooSS
Business Name Q ADS ;.}-gip Bus. Phone
Business Type E���,�rto,a ►c.s
PropeLly Owner Information (required) Tenant/Emergency Contact (required)
Name o n, ' DFlwJ Name M%c.,,+4eA Sl�ort�-�►
Address Zoo (Y1 A,r'� S f 04ft to Home Address aoo fnA, a Sk
City 9b State/Zip CA cl di ,qp City �,� State/Zip GA 9QCA6
Telephone No. -j 14 3OE5 3 ,ri Telephone No. SmtASS 609b
-- I
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or (.Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner 9Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes ❑ Ndl5-
■ Is the building sprinklered? Yes ;6-❑ ❑No ❑
■ Will operations produce dust/wood shavings or similar material? Yes❑ ❑ Nol�-
• Will operations involve the repair or replacement of automobile parts Yes ❑ No 19- If yes: Describe the
components repaired or replaced.
• Does the operation involve the use of welding or open flame? Yes ❑ ❑Now
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ❑ ❑NoCK
■ Will there by storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? Yes ❑ No:®- .
■ The following best describes my operation: ❑ Office Only Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
❑ Other (describe)
For Official Use OnI
Occ Group: ✓A
Occ Group:
Occ Group:
Total Sq Ft Occupied: 3
Bldg. Permit #
Occ Load: 12-
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning:
Plnr Initials: Date: II Plan Chkr Initial Date: Insp Initials: Date: .2/
Conditions of Approval or Other Notes:
Area: 3"�O
Area:
Area:
No. of Stories:
Entitlement #:
I
❑ Will any of the following operations be performed? Yes ❑ ❑
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
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 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: �o) (E t p
Property Address: (a Y31 p., a S-�{O�
City: Zip Code: cla(a I b
Contact Person: - O.3 Le— Title: &p
Type of Business: t � G1 et -Vacs t Telephone: () 800 Lk S �o-un
Fax Number: R q9 A001 1 S61 email address:
Applicant: (print name)Signature:
Date: t o 0 t
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 50HP (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
Nox
If you answered "No" to both questions, this checklist is your clearance from AQMR 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).