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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020
CITY OF HUNTINGTON BEACH -
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3rd Floor — Must Apply In -Person)
Business License # Al 07,E Date a2//l/W
Business Address A,�57V560V Cr/,E'e � I 5?-'N'WL Zip Code (�
Business Owners Name � iN� /lr'�P��� fi Telephone No. %/ ,'
Business Name Bus. Phone . 3 (, 7197
Business Type
Property Owner Information (required) Tenant/Emergency Contact (required)
Name %T4Fe_Ikl Cf/,9 LII,61;,TAJ _ _ _ Name a 116e ,-Uk
Addrqs,s 1290 K0l4f)e1l> S7� Home ddress (f,4r%
City 1« ih6 g# State/Zip 0i4 92& V% City State/Zip 60 9211W
Telephone No. Telephone No. �V3 '04-71W
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or XExisting 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 Nog
■ Is the building sprinklered? Yesy' . No❑
■ Will operations produce dust/wood shavings or similar material? Yes❑ . No)q/
■ Will operations involve the repair or replacement of automobile parts YesQ NoJZ If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yeso NOY
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo W
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes QNo
■ The following best describes my operation:S:qDffice Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
Other (describe)
For O, f •facial Use OnIY O�
Occ Group: Area: 17�p Occ Load:
Occ Group: —1 Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: -O No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials: Date:,-q Plan Chkr Initials: D �/ � t Insp Initials�-��. Date: ' fb
Conditions of Approval or Other Les, rr�� rr
—j rn I 'A � n r,h Al ,1W U +, —� U 1� a, ONO v I ua) � t� otn011 r o mA G �
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: Cc/E57` /'�fANAG�7�t�1 fit �:
Property Address:
City: IhMli)GfD19 � Cti Zip Code:
Contact Person: 8 ed 4f q IM--Vc nAt# Title: &5-1,0�7-
TypeofBusiness J v/l �Ci�� Kl il'�K ��Cnf�etffs Telephoner��-%/g�
Fax Number: - it address:
Applicant (print name) 4,1N I Signat
' klf tWl - Date: /
Will the facility have any of the following equipment? Yes ❑ No R
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❑ N Z
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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