HomeMy WebLinkAbout15321 Pipeline Ln - CofO (6)• 1p
Ji
HUNTINGTON BEACH
Business License #
Business Address_
Business Owners
Business Name
Business Type _
CERTIFICATE OF OCCUPANCY 02o op(YLZo
CITY OF HUNTINGTON BEACH —
DEPT. OF BUILDING & SAFETY APPLICATION
714/536-5241
AS
(Xd Floor — Must Apply In -Person)
_ Date dl3110
Zip Code 1
Telephone No. _
Bus. Phone I tl„ l 4 Fq- 6066 V
Property Owner Information (required) Tenant/Emergency Contact (required)
Name 1AM %= , _ 11 X rX CI S'% Name 1?A r11e-V7YG✓!1-[/111 ��,/ _
Address e l? /-- Home Address _4e/_YS?2ft ''i16 2Z_id igreC�-
City , State/Zip C%% 9175 City1�✓!��'f°'.,QQ�'lC State/Zip C�/� `�/ 75 �
Telephone No. �Lv , 5;73- &- ��� Telephone No. T 6
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or WExisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner ❑ Change of Occupant ❑ Ch nge of Use Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes W
■ Is the building sprinklered? YesW . No ❑
■ Will operations produce dust/wood shavings or similar material? Yes❑ NoX"
■ Will operations involve the repair or replacement of automobile parts YesX NOD If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame! Yes Q NqK(
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes Q No y
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
;Other (describe) 4crra �&1.04iR., p Ate/ Ply l'.s
For Official Use Onl
Occ Group: h 1 / WTO R o Qn Area: I re o Occ Load:
Occ Group: 13 -, v4�� Area: 100 Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: 1600 No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials: zoate:/-- Alan Chkr Initiatp. IV-.__ Date: 1 (3 v Insp Initials: Date: � I
Conditions of Approval or Other Notes:
Inspection Date:
Ir South Coast
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: plA p—a n lV ` a )1, ca'
Property Address: k� PI pt, f 11n-e
City: !un-Hn ' l Gh Zip Code:
Contact Person: Dura d) Pedr
Type of Business: A-K -v 5C7�
Fax Number:
Applicant (print name): Signature:
?4k r V Date:
q
Title: 01t�3'1 PTV
hone.
e-ma' ad ss:
�' a ra 51cej @ ad -cb),
• Will the facility have any of the following equipment? Yes ❑ NOX
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, 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-