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HomeMy WebLinkAbout15329 Pipeline Ln - CofO (5)L Certificate of Occupan4oNo. 02040 outtZy 0 MR R: 714/536-5271 APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH -- DEPT. OF BUILDING & SAFETY Business License # 4- Z 76 Z�S_ Business Address S 2 / �t e /c, Business Owners Name /' - lie Business Name Business Type 12e«,:/, Name (3'a Floor —Must Apply In Person) Mae-�o City 4 —6- rJ 6 State/Zip G4- Telephone No. 7/ C) 2(Q(Q Date 3 .� Zip Code �i t Telephone No. 7/5' 6/6 -V S-79 Bus. Phone O.0 ­e phiU ��< <( ome Address � 7L 3 / i3 e.-^ I L. - ity / i5 State/Zip _ 1-5- 26T elephone No. 7/0-0 THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or �K Existing Building CHECK ALL THAT APPLY: ❑ Change of Property Owner N' Change of Occupant ❑ Change of Use ❑ Additional Occupant ■ Indicate former type of business ■ Are you requesting that the electricity be turned on? Yes4 ❑No❑ ■ Is the building sprinklered? Yes 'K0 ❑No❑ ■ Will operations produce dust/wood shavings or similar material? Yes❑ ❑Nd;� ■ Will operations involve the repair or replacement of automobile parts Yes ❑ ❑No R If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? Yes ❑ ❑No V ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes ❑ ❑No ■ The following best describes my operation: ❑ Office Only 0 Retail Sales ❑ Medical/Dental ❑ Restaurant/Take Out Food �< Warehouse /Manufacturing/Distribution (describe process and end product) (Le c� �..� a..� s�•re C'� sc-,a cr����,w.•� ❑ Other (describe) For Official Use Only Occ Group: Area: occ Load: 2-- Occ Group: 5�� Area: 114 00 y Occ Load: Occ Group: Area: Occ Load: Total Sq Ft Occupied: No. of Stories: TIF Revie, Y/ Bldg. Permit # Entitlement #: Zoning: L _ Plnr Ini ' s: _HDate Plan Chkr Initials• ' Date's l�Zy/ �a Insp Initials: Date: Condit .on fApprovali or Other Notes: c S D•c.•.c. Cc G 1, 11fi Inspection Date: (G:Building/Forms/document id goes here) r 4,k� 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: Property Address: City: l/1_6� g � C1-1 Zip Code:�i' Contact Person: LC.( /- e w i tr Title: Type of Business: A ,:re ( v K r /,�.-�e4p'GiS"4 Telephone: ( ) 7 tael 61 7/SCE Applicant: (print name) f /- - `� -Signature: ❑ ❑ Will the facility have any of the following equipment? Yes ❑ []No X Charbroiler Dry cleaning machine Spray Booth Printing Press (screen/lithographic/flexographic) Internal combustion engine (greater than 50BP) (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 ❑ ❑ No '� 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 ❑ ❑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 (800) 388-2121.