HomeMy WebLinkAbout15323 Pipeline Ln - CofO (3)Business Licen
Business Addrt
Business Owne
Business Name
Business Type
V CERTIFICATE OF OCCUPANCY 020 - 00 !
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(3`d Floor — Must Apply In -Person)
Date
Zip Code f'
Telephone No.562.-g2elg.-1
Bus. Phone
Property Owner Information (required) Tenant/Emergency Contact (required)
Name z&dewa M r` l j .:Gr t--S Name . da
Address 94 '5 v. 44&e ry) '4ye , Home Address 1i� :9 1E) 4kdonoa K uo-,
CityA -jC� fret f ffirK State/Zip CA of �7� City Cely'j' {State/Zip (,A- !�07e�j
Telephone No. ��a�2 j'7Telephone No.
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or 1JZ Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner .0 Ch nge of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business_ --�r
■ Are you requesting that the electricity be turned on? Yesi. No❑
■ Is the building sprinklered? Yes qNo ❑
■ Will operations produce dust/wood shavings or similar material? YesONoJi.
■ Will operations involve the repair or replacement of automobile parts Yes ONo)9 If yes: Describe the
components repaired or replaced.
Does the operation involve the use of welding or open flame? Yes QNo ;K
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo 9
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product)
Other (describe)'? (' bra-t�'I1��
For Official Official Use Only
Occ Group:_ Area: Occ Load:
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: 1+0 No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitlement #: Zoning: IL
Plnr Initials: , Dater % Plan Chkr Initials�Date: MOP Insp Initials: `Q.C-. Date: �
Conditions of Approval or Other Notes:
�1/&04AP\ cowwl'A 0-3e-'(7eeJ W/6 6 P
S �"• .P
(3 P� ,
ection Date:
X(G:Building/Forms/document id goes here)
ig
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:
Contact Person:
Type of Business:
Applicant: (print nam
Zip Code:
Title: T1-.2. WtC
Telephone: () S62 gK«
Signature:
[.]Will the facility have any of the following equipment? Yes UNo,
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
0 Will any of the following operations be performed? Yes U Noy
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
0If you answered "No" to both questions, this checklist is your clearance from AQMD.
DIf 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.