HomeMy WebLinkAbout15321 Pipeline Ln - CofO (4)Certificate of Occupancy No. 0200 ?
714/536-5271
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY
(3'd Floor - Must Apply In -Person)
Business License # cj
Business Address hpell -
Business Owne
Business Name
Business Type
Date /;)- 3 -2;)d4
Zip Code
Telephone
Bus. Phone 6�90 93= YS/D
Property Owner Information (required) Tenant/Emergency Contact (required)
Name "7, N,6701VA d9fitzelzS Name &TEll my W. ftodl /74,_.
Address 3 410 S, Home Address -Iq 3 S mph m,r✓m Ave -
City M/M rf'4 q Ptak State/Zip City Myn j �, UAM/,- State/Zip a4
Telephone No. �, , 38D" � 3 Telephone No. ?,(. 6 ��2- W%�-
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or )<Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner hange of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business 1911 TO && SMP % Rep,11;0-
■ Are you requesting that the electricity be turned on? YesONo)<
■ Is the building sprinklered? Yes>a'�o❑
■ Will operations produce dust/wood shavings or similar material? YesONoX/
■ Will operations involve the repair or replacement of automobile parts Yes No ❑ If yes: Describe the
components repaired or replaced. I- nde/15, �L�10P � TJril�ii�S i �
■ Does the operation involve the use of welding or open flame? Yes ONoX
■ Will the busi ess be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ON
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food Warehouse /Manufacturing/Distribution
(describe process and end product) 09V20 &Del jePe�f//y�'�l Q
❑ Other (describe)
For Official Use Only
Occ Group: rl �� �t�' Area: Jam, z 0". 4--� Occ Load:
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: lj',f, No. of Stories: t TIF Review: Y/
Bldg. Permit # Entitlement #: Zoning: 1 L _
Plnr Initials: A(X Date: MIS 01 Plan Chkr Initials:_g::;&Z--Date: �30 Insp Initials: Date: / d
Conditions of Approval or Other Notes:
IISIy PLIMITU ViA 11z 70KV6 bts'►2Lm W ONE AUTO W AllL f 6l N1F-S5 jg 1 N 10*60 •-15 SQ
N•GE '. NO WrSfloe Sty4AGC- ,
Inspection Date:
(G:Building/Forms/document id goes here) i 3—
�p
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: Vega woi re &TFALLOVD
/0;//)0 , MCI
Property Address: 16 3 01 PiPef w e jj"
e
City: h- . Mi` �A R iSt� {4
Zip Code: %v1,I-I i
,� "
Contact Person: fin -,A an GJ. "-e !?o--
F-7
Title: Rl eSIdW7—
Type of Business: t-(,{` V
?O1 �54e')P _
Telephone: () 0d (;
Applicant: (print name) n-erjY tiAU Gt7 . r'►'1 red I 44t-
Signature: �� A
0 Will the facility have any of the following equipment?
Yes 1jNo,%19'
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
Q Will any of the following operations be performed?
Yes ONO(
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 fames, dust, smoke or strong odors
QIf you answered "No" to both questions, this checklist is your clearance from AQMD.
UIf 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. '