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Business
CERTIFICATE OF OCCUPANCY 020il'o-'?- 1 v'5
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
A k;*
Business Name ('v„wr,,,;
Business Type PCs
(3`d Floor - The Applicant Must Apply In -Person)
Date
Zip Code 9Z& Y77
Telephone No. X y 4!;69ZO
Bus. Phone 7iY 862 /0 LiA
Property Owner Information (required) Tenant/Emergency_Contact (required)
Name LZ-C 41GW Name 0b*r`•
Address 5 - Si" Home Address !.57/ Z/ Alh-y 49 f rL F�v
City c_ State/ ip %1 /lO 6 So (a 2 City /V 3 State/Zip 9 Z-6 e,19
Telephone No. 6 `j (, Z S_�" Zl `f' O Telephone No. �4i `f 3 Z � /G Z&
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or AKExisting Building
IS THIS BUILDING FIRE SPRINKLERED? MYes []No
CHECK ALL THAT APPLY:
❑ Change of Business Owner ,?.Chan e of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business VA-,--
■ Are you requesting that the electricity be turned on? Mes ❑ No
■ Will operations produce dust/wood shavings or similar material? ❑ Yes 1510
■ Will operations involve the repair or replacement of automobile parts? ❑ Yes �gNo If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? ❑ Yes X5 No
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
❑ Yes )�l-No
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes ❑No
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑Medical/Dental
_93warehouse /Manufacturing/Distribution ❑ Restaurant/Take-Out Food ❑ Other
■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite? ❑ Yes 1�rNo
If you answered yes, please proceed to the next question.
• Does your facility currently have a grease control device (i.e. grease trap or grease interceptor)?
Check one: ❑ Yes Flo
For Official Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Planning Initials: 6Date: 10 - t - IS
Conditions of Approval or Other Notes:
Area:
Area: _
Area: L *-V V
No. of Stories:
Entitlement #:
Occ Load:
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning: X L—
Building Reviewed By Initials: Date:
Grease Interceptor Verified Inspected By Initials: Date:
South Coast
Air Quality Management District
J 21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • http:// www.agmd.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: LTA, -LTA,
Property Address: At
City: Zip Code:
Contact Person: IA Title: c-a—,j l
Type of Business: Telephone: —I`1 1-2
c
Fax Number: N6 e-mail address:
Applicant (print name): 3 L'#N jkj (_j,2 Signature:- �/, Date: �Q.-/— _0, .�
• Will the facility have any of the following equipment? Yes ❑ Nc�K
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❑ Nob,
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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