HomeMy WebLinkAbout1118 Pacific Coast Hwy - CofO (8)CERTIFICATE OF OCCUPANCY 020
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION
HUNTINGTON BEACH (3`d Floor - The Applicant Must Apply In -Person)
Business Address Ott pyir-le_ - Its Date C;/ TG/ I
Business Owners Name a ba tjAi6b ftNi te�6 Zip Code 011,644
Business Name FN lt:�j b CDf i>A'7,"-^-l041 Telephone No. 601"SU -ZyJ91
Business Type Bus. Phone t`
Property Owner Information (required) Tenant/Emergency Contact (required)
Name :Z iy- h-.kj 0YL4Xj S Name IX ti "
Address It I'd Cow.ctIfcC- Cow—�W j Home Address + R ra '
City �-1 State/Zip ! Z� City �1 (� State/Zip
Telephone No.1.6 114- 3 3 ( :;. � 3' 1-6 Telephone No, '116 -S(G 6 Z- G 7
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or N'Existing Building
IS THIS BUILDING FIRE SPRINKLERED? ❑ Yes ❑No
CHECK ALL THAT APPLY:
Change of Business Owner
■ Indicate former type of busine
,e of Occupant ❑ Change of Use ❑ Additional Occupant
■ Are you requesting that the electricity be turned on? ❑Yes kNo
■ Will operations produce dust/wood shavings or similar material? ❑ Yes 4No
■ Will operations involve the repair or replacement of automobile parts? ❑Yes,&IFAo If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? ❑ Yes No
■ Will the bus' ss 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 shelving -exceeding 5feet 9 inches in height? ❑Yes k5o
■ The following best describes my operation: KOffice Only ❑ Retail Sales ❑Medical/Dental
❑Warehouse /Manufacturing/Distribution ❑ Restaurant/Take-Out Food ❑ Other
■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite? ❑ Yes Qo
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: ❑ Yes -V No
For Official Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied: _
Bldg. Permit #
Planning Initials j ate:
Conditions of Approval or Other Notes:
Area:
Occ Load:
Area:
Occ Load:
Area:
Occ Load:
No. of Stories:
Entitlement #:
Use Permitted:
Y/N
TIF Review: Y/ N
Zoning:
Parking Meets Code (for use): Y / N
Building Reviewed By Initials: Date:
Grease Interceptor Verified Inspected By Initials: Date:
South Coast
k 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: Fey 1&o
Property Address: ) I t� FCJA W Wt-L <5,
City: 446 Zip Code
071r.gS6
Contact Person: CC (t:�J(- Title: Cj� 0
Type of Business: Pbl,)4C, tSF4-%- Telephone: 6 I of 7-6 Z-� 5 6
Fax Number: e-mailaddress:
Applicant (print name): tZAALP iW tCA6 Signature:L- Date: ��/Jo
• Will the facility have any of the following equipment? Yes ❑ Nat5
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❑
jff---
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).
-2-
J ,
,APPLICATION FOR CERTIFICATE OF OCCUPANCY
' CITY OF R-UNTINGTON BEACH - DEPA.RTAIENT OF BUILDING & SAFETY
Y
c r-,(3rd.Floor-MtstApplyIh-Persan) 0
C
Business License #
r Adr 1-11 C,, 16.,, P", A -
Date
BusinessN<<ti • _ s'g f6y' sp c -ruy — _ Telephone 111 944t77
Business Type Pusittessyy ca_-P6�' str+ibr-dtJ z#_g Ass is-6ne L_KT,,rr4 Se�v'`�
Property Owner Information Business Owner
Name - -1-6 eLs r. P ktdre r S dame S em+ya
Address I )i& Pic. e-6a 4- Htv . Home Address M ttco Rat an4 R40-P
City 01&xki! -has sa& City 0ewttri- T& %rh 04. Tel, t i 1) Lsd - 4-4.r4
THIS TJSFWOtJLDBE DESCRIBED AS;
❑Newly Constructed Building or OFxisting Building
CHECK ALL THAT APPLY:
❑Change of, Owner Whaage of Occupant ❑Change of Use OAdditional Occupa it
Indicate former use, ifany-
Does the building have electricity? Yes El NOD
If No, are you requesting that the electricity be turned on? -Yes ❑ - No ❑
'lie building is sprinklered? Yes ❑ No
Operations willproduct dustiwood shavings or similar material? Yes ❑ No
Opetations will involve the repair or replacement of automobile parts Yes ❑ No 91
If yes: Describe the components repaired or replaced.
Dues the operation involve the use of welding or open flame? Yes ❑ No 0
The buLkiess is drinking, dining or assembly use that will result in an occupant load
of more than 50 persons. Yes ❑ No W
The following best describes my operation:
®Office Only ❑Retail Sales ❑Medkal/Dental ❑Pestaurant/Tan.e Out Food' ' ❑Warehouse
❑Mantufaeturing/Distribution (describe process and end product)
❑ Other (describe)
r E
ngcaC:$ �2-C
Sql+t Occupied:
Occ Group. Occ Load:
I
i
ll u Stories;
rr
Parking Spaces:
o p
OF Review: Y/ N Amt PaidS,
Building Permit
�� PaIdBEForEFinalimptccjon
',F,�titlement#� _
_ _
Comments:
_'Io
SibN i ' 30 -
t . ,
Pla;uier T'mt�alsi��t�►A•
v 1 Ch@Cher II]it131$; Cof0 #
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