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HUNTINGTON BEACH
Business Licen
Business Addr(
Business Owne
Business Name
Business Type
CERTIFICATE OF OCCUPANCY
020
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241 (3'd Floor — Must Apply In -Person)
Date It IS611
Zip Code
Telephone No.
Bus. Phone
• Property Owner Information (required) *Tenant/Emerizenev Contact (required)
Name A96 Sid &-r LLA , I -LC Name a@n m-e kn r 4 ti i45
Address 126 Home Address 4,zV) Ake
City f�rAn fr�ACity j-�. State/Zip �� ,dState/Zip
Telephone No. 7/V 6S 5 -770 Telephone No. (eS S-7742
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or 'k Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner 'XChange of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes 0 NoT,6
■ Is the building sprinklered? Yes ❑ Now
■ Will operations produce dust/wood shavings or similar material? Yes ❑ Nd;6
■ Will operations involve the repair or replacement of automobile parts Yes NoJ4 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 ONo4
■ Will there be storage racks, gondolas, ors ing ex et 9 inches in height? Yes ONo
■ The following best describes my operati Office ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
Other (describe)
For Official Use Only
Occ Group:
Occ Group:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: No. of Stories: TIF Review: Y
Bldg. Permit # En ' ement #: Zoning: C-s
( ni .
Plur Initials: Date: ll jL ! Plan Chkr Initials: Date:\ 2sp Initials: Date: /
ions of Approval or Other Notes:
Area: ?�?
Area:
Occ Load:
Occ Load:
Inspection Date:
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: 50n w C!s -t &01fy
Property Address: JZQ 19aciAr- 6,-a5t gf-5kv l"-
City: �i��l%1� -t�i.�/ I,z'��� ,Z/ip Code: 7
Contact Person: cao�* �G�G� Title: /
Type of Business: & / O�L,, cz Telephone:
Fax Number: TV-90-�33� e-mail address: f'bW6veriva?fPmv®
mc6o yckou. «,.
Applicant (print name):] -4- 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[:] Nol
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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