HomeMy WebLinkAbout15315 Pipeline Ln - CofO (2)0
714/536-5271
Certificate of Occupancy No. 020C(M
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY
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Business License # N-,'—)-14?a5 __ _ Date
Business Address lb-�-Act', CA Zip Codeg2k��A
Business Owners Name Telephone No.
Business Name ���,� F�sz;,,� �u ��.c1QS�lCS Bus. Phone
Business Typesc�.w�na�a05� ScoC,c
Property Owner Information (required) Tenant/Emergency Contact (required)
Name TrAt--,tL.N4 Z'e.U,ST Name V—E'0*
Address Home Address 1524, `�zk2oomry1 Nw
City;Q?.tzk- State/Zip cA c nS"3 City t %gA,y\QW,(\ State/Zip
Telephone No. Leu.-x�—t5_uS1y Telephone No. gpr�•�4�-25?,�1
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner '7�, Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business Es roa A ti op CVMtQ-
■ Are you requesting that the electricity be turned on? Ye No ❑
■ Is the building sprinklered? YesATNo❑
■ Will operations produce dust/wood shavings or similar material? YesONX
■ Will operations involve the repair or replacement of automobile parts Yes Jlio ❑ If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ❑No,'
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo`RI/
■ The following best describes my o eration: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
Restaurant/Take Out Food Warehouse /Manufaetufi Distribution
(describe process and end product)
❑ Other (describe)
For Of.f cial Use OnIY ,
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area: Occ Load: , S
Area: I jc� Occ Load:
0 2
Area: Occ Load:
No. of Stories: TIF Rev' w: Y/
l / j Entitlement #: / / Zoning: �,,._
Plnr I tials. V > Date" �i Plan Chkr Initials: ' Date: 1( i7 c' I Insp Initials: Date:
Conditions of Approval or Other Notes:
Inspection Date:
(UBuilding/Forms/document id goes here)
South Coast
Air Quality Management District
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp://www.agmd.gov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate of Occupancy 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: 7tV �c,,,�AA�
Property Address: n, \S Q�P��--► LAcvq,
City: Zip Code: '3 cam%. Po n
Contact Person:Title: der
Type of Business:Telephone:
Applicant: (print name)- �T �,� > Signa
OWill the facility have any of the following equipment? Yes []No 7
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine (greater than 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 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 11NOA
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
QIf you answered "No" to both questions, this checklist is your clearance from AQMD.
QIf 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 (800) 388-2121.