HomeMy WebLinkAbout15329 Pipeline Ln - CofO (6)1 Certificate of
No. 02W5 0 0
714/536-5241
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING &
(3rd Floor — Must Apply In -Person)
Business License # ��(�O�C� JDate 41, 2511 0 9 v
Business Address /632 ,(Ji�a� /ice it'd , G 2 Zip Code 77& Y6,
Business Owners Name .,,, �C� z� s Telephone No. ?/y 713-4/SS3
Business Name t c S b�-- Bus. Phone x
Business Type Aa ,r f I t a�-�'� ��,•,i c pt .awk ( v v� +r
Property Owner Information (required) Tenant/Emergency Contact (required)
Name _� /�1�1,,,�, Name
Address ��o Home Address y Z2 <<
City State/Zip City H6 State/Zip C -9
Telephone No. / 4(f �0d - `/ z / 3 Telephone No. 71�Z CP 03 --30 Y 7-
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or rUxisting Building
CHECK ALL THAT APPLY:
0 Change of Property Owner °6-- Change of Occupant
■ Indicate former type of business ? OFf1�/MAilc,
❑ Change of Use ❑ Additional Occupant
■ Are you requesting that the electricity be turned on? YesgNoO
■ Is the building sprinklered? Yes INNo❑
• Will operations produce dust/wood shavings or similar material?.Yes QNo9
■ Will operations involve the repair or replacement of automobile parts Yes ONo W If yes: - Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ONo [�
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes DNo 14
■ The following best describes my o eration: 0 Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food ' Warehouse /Manufacturing/Distribution
(describe process and end prod ct)
❑ Other (describe) Gt-t fv
For Official Use Only,
Occ Group:_
Occ Group:
l(21
Occ Group: _
Total Sq Ft Occupied: I&G?
Bldg. Permit #
Area: 2--00 _
Area: ( t400
Occ Load:.
Occ Load:
Z
13
Area: Occ Load:
No. of Stories: TIF Review: YA�D
Entitlement #: Zoning: ..
Plnr Initials: Date: t'{ Plan Chkr Initials:R Date: V sp Initials: Date: /
Conditions of Approval or Other Notes:
ofrite a 6!�o0 of ez /1/000 WAz-1toe-� ) ' Ko to /�'r�Af ly' pxc & �T1
—✓V O r au! t W } ti� M 4S 1 (p-
Inspection Date: T 7
(G: Building/Forrns/PennitAppl ication/CofO2006)
I
w
of
SOURCOast •
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: /o 5 , -/ �/ S
Property Address: / 53Z'2
City: 116 Zip Code:
Contact Person: I& h
Type of Business: ,�(.c ✓�� �f
�r✓r ce
q2 & t((.l
Title: DU'�
Telephone: TO ? ( 5 - 4 03�5
Fax Number: -71y- nz - /b v e-mail address: Qtoc as �
Applicant (print name): _&e" m?c.&)Signature:
Date: 2�
• 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 BP (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 [�L
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-
Revised June2005