HomeMy WebLinkAbout126 Main St - CofO (33)CERTIFICATE OF OCCUPANCY 020 6
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
HUPmNGM BFAO
Business Address i 2 6
Business Owners Name
Business Name
Business Type
(3'd Floor —The Applicant Must Apply In -Person)
Date CA— Z 01 S
Zip Code 41C N 8
Telephone No. S4,Z— 36 s--It1 oa
Bus. Phone
Property Owner Information (required) Tenant/Emergency Contact (required)
Name 7 f; cl c e, Name JAn/
Address 301 171;k si Home Address P q iS-1'-' ,r R,
City t4vn+ n,-1 P)f-c.J,. State/Zip CL ctZCy,? City fl State/Zip !�2Ctlj�
Telephone No. 7 / 4 7 t1f _ O q Z 2- Telephone No. �6 e �d s ` P / Ge
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or IR Existing Building
IS THIS BUILDING FIRE SPRINKLERED? -[� Yes E]No
CHECK ALL THAT APPLY:
IM Change of Business Owner at Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? ❑Yes W No
■ Will operations produce dust/wood shavings or similar material? ❑ Yes ®No
■ Will operations involve the repair or replacement of automobile parts? ❑Yes FRNo If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? ❑ Yes 0 No
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
❑ Yes lB No
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? El Yes 2INo
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑Medical/Dental
❑Warehouse /Manufacturing/Distribution - U&Restaurant/Take-Out Food ❑ Other
■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite?ems
If you answered yes, please proceed to the next question.
• Does your facility currently have a grease control device (i.e. grease trap or grease interceptor)?
Check one: IN Yes ❑ No
For Official Use Only
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Planning Initials • ate:
Conditions of Ap va r Other Notes:
Area:
Area:
Occ Load: I�
Occ Load:
0 No
Area: Occ Load:
No. of Stories: TIF Review: Y/ N
Entitlement #: Zoning: S — Ci
Building Reviewed By Initial4 Date:(` vI l�' 5
I 1
Grease Interceptor Verified Inspected By Initials: Date:
`V_
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • http:// www.agmd.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:
Property Address: I Z 6 /'ham. n sf S41 / 0 It
City: 4 Zip Code: qz cl '
Contact Person: l�-t�,'� Ja�i��� Title: 07w 4•
Type of Business:_ & ��..,�..n� Telephone: e-& -eo-r co
Fax Number: e-mailaddress: :v, �%� �•v'�� Z K
Applicant (print name): Signature: Date:
• 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❑ No=
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
/Xlv6.Cvc'-,
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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