HomeMy WebLinkAbout15313 Pipeline Ln - CofO (3)e �
HUNTINGTON BEACH
Business License #
Business Address_
Business Owners N
Business Name]
Business Type J
CERTIFICATE OF OCCUPANCY 0200 (S-}-
CITY OF HUNTINGTON BEACH —
DEPT. OF BUILDING & SAFETY APPLICATION
714/536-5241
(3`d Floor — Must Apply In -Person)
Date q-16"0
Zip Code 7 ;T_
Telephone No.
Bus. Phone ,�/Y- OR&%
Prol)ertv Owner Information (required) Tenant/Emer enc Contact (required)
Name Name of P_
Address e A��� Home Address
City Irc S i /Zip 5 City Lei Pi�(a r a State/Zip
Telephone No. r 0 Telephone No.
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or WExisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner khange of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes_ NOD
■ Is the building sprinklered? Yesp . No❑
■ Will operations produce dust/wood shavings or similar material? Yes ❑ Na4_
■ Will operations involve the repair or replacement of a t obile parts Yes N� If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or ope flame? Yes Q NoK
■ Will the bilsmess be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo-P
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
Warehouse /Manufacturing/DXstribIj ii . . Res t/Take O Food
(describe process and end product) u tJ iJ
❑ Other (describe) Ij
For Official Use Only
Occ Group: Area: 13 5-0 Occ Load: 3
Occ Group: 8 Area: Z50 Occ Load: 3
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: 1(ew No. of Stories: I TIF Review: Y/
Bldg. Permit # Zoning: - _.. _ .........__ _.. .
Plnr Initials: Dater Plan Chkr Initials: ,Date: fv ory Insp initials: _ Date:
Inspection Date:
(G:BuildingAdnun/WebDocumentdCertificateofOccupancy)
lSouth Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909)'396-3529• http:HwwwAgmd.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 Iopal 'air quality agency. This checklist will determine if you
need to obtain clearance froin. the South Coast Air Quality Management District. (AQMD).
Company Name:
Property Address: 1.-�j 1(P7.1 N
City: o Zip Code:
n:
Title: Contact Perso
Type of Business: C 0(,k) tQ sc Telephone -
Fax
Fax Number: ( � �� 22 e- 1 ad s: j) ` ( od (cm
Applicant (printname): Sign a LAC iJ
AeG in ALL Date: q-ffo 63
• Will the facility have any of the following equipment? Yes n 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[ No
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, AOMD will assist.: you in submitting permit
oi;
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 June 2005