HomeMy WebLinkAbout15321 Pipeline Ln - CofO (2)r'
•
HUNTINGTON BEACH
Business License #
Business Address
Business Owners N
Business Name
Business Type
CERTIFICATE OF OCCUPANCY 020 I - T (Q T.
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
(3`d Floor — The Applicant Must Apply In -Person)
Date/- 5- - % y
Zip Code
Telephone No.
Bus. Phone 0419i.7 37 <7,z er
Prouertv Owner Information (required) Tenant/Emergency Contact (required)
Name r `) e v(��'s� r- Name r �-4 r 6 ' '
Address s S� Home Address ;2 oil i
City /���; %'iliO, State/Zip G. C9 6 4 City ke• ,I r AA-- <.. State/Zip 9�G lG
Telephone No. 6 3 � -,2,- 7 - 02 </Ql) Telephone No. -7-1' -/ q/ -7 -;7 C 'may
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or xistinn Building
IS THIS BUILDING SPRINKLERED? YesC->' No❑
CHECK ALL THAT APPLY: ���
❑ Change of Business Owner Dthange of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes Ndff Will operations produce dust/wood shavings or similar material? Yes l� �PNoO
■ Will operations involve the repair or r placement otomobil parts Ye'If yes: escribe the
components repaired or replaced.2e� eL
■ Does the operation involve the use of weldinlf or open flame? Yes NOD
■ Will the business e a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ❑ No
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yesff No❑
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take-Out Food
■ Will the Food Service Establishment Generate Fats, Oils Greases? Yes❑ No`B_�
■ Does the Facility Have a Grease X4,C-f
ceptor? Yes ElNo�
■ Other (describe) /�,( c, -
ForOfficial Use Only
Occ Group:, �--r
Occ Group:
Occ Group:
Total Sq Ft Occupied: Op
Bldg. Permit #
Planning Initials: 4 . Date: -5-1 .
Area:
Area: I �O
Area:
No. of Stories:
Entitlement #:
Occ Load: 3
Occ Load:
Occ Load:
TIF Review: Y/
Zoning:
Building Reviewed By Initials:�te: Zt7)
+crease interceptor veritiecl Inspected By Initials: Date:
i Voc' `W&
• V 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: ° �� Sv S � ' le -
Property Address
: i 673.)l /UDC /%'e 21 //1IXJ,
City: /1:5 Zip Code: ��2 G e
Contact Person: [7^'� Title:
Type of Business: v�� Telephone:
Fax Number: e-mail address �"Y�j`� % ���Lk t �v x-
Applicant (print name): Signature:
Date: o—
• Will the facility have any of the following equipment? Yes ❑ No ❑/
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).
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