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HUNTINGTON BEACH
Business License #
CERTIFICATE OF OCCUPANCY /0200(L - Q.
CITY OF HUNTINGTON BEACH -
DEPT. OF BUILDING & SAFETY APPLICATION
714/536-5241
Business Address S�
Business Owners Name
Business Name. X)e
Business Type J
2 LIT
(3'd Floor - Must Apply In -Person)
Date 0-/3`e) 7
Zip Code O2
Telephone No.71762' 7 7'
Bus. Phone _J iq -12 - ItO t J
Property Owner Information (required) Tenant/Emergency Contact (required)
Name X fL A to, l 4-y c. I Name - P a. , I •5....r -1
Address I s Home Address to n Y R PG •� ° AM °- Jl %� c
City D .Atate/Zip c_� 4 -)-(- `e s City liK•;+%K� giate/Zip c 9 A L Y
Telephone No. 7 l y' Q- 7 • 0 o .3 1!
Telephone No. �'714. 3 17 y- f 7 Y-?
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or ,Existing Building
CHECK ALL THAT APPLY:
Change of Property Owner ❑Change of Occupant ❑Change of Use ❑Additional Occupant
• Indicate former type of business Gt) flCC-2,
• Are you requesting that the electricity be turned on? Yes Noll
• Is the building sprinklered? Yes� Non
• Will operations produce dust/wood shavings or similar material? Yes❑ NoX
• Will operations involve the repair or replacement of automobile parts Yes 0 NoX 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 ONo x
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product) WAlf1" Sias; 61,4OMu6,r,
❑ Other (describe)
For Official Use Only
Occ Group:%e
Occ Group:
cc Group: -gatnt,4,6A
Total Sq Ft Occu
Bldg. PermitIL
Area: cf 2- �
Area: d� _ n
Area: q 4-
No. of Stories: 2—
Entitlement #:
Occ Load: 53
Occ Load: S9
Occ Load: .fit ,�► �
TIF Review: Y/ N
Zoning:
Plnr Initials: Date: Plan Chla Initials: Date: Insp Initials: jr, k - Date:
Inspection Date:
..i`
(G:BuildingAdmin/WebDocuments/CertificateofOccupancy)
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • http:// www.agmd.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: x R, j_ L e-
Property Address: /f I 4
City: N�tia s 4_- IV 64- -` L Zip Code: _
Contact Person: 1P
Type of Business:
Fax Number: 7 14 ' Q' 7 c N /
Applicant (print name):. f,,,t1 Signature:
Date:
Title: L F '0
Telephone: -7 I y' 9"'J -(' 3 y
e-mail address:
jo/ ) Je
• Will the facility have any of the following equipment? Yes ❑ No"P<
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❑ Not�r
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 June 2005