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HUNTINGTON BEACF
CERTIFICATE OF OCCUPANCY 020
CITY OF HUNTINGTON BEACH —
DEPT. OF COMMUNITY DEVELOPMENT APPLICATION
(3'd Floor - The Applicant Must Apply In -Person)
Business Address Lln
Business Owners Name
Business Name
Business Type pekSO 11 j L ST0 rx_
Date S- II- "
Zip Code
Telephone No. 14cr' IaZ' I4jj
Bus. Phone
Tenant/Emergency Contact (required)
Jame G 11�' C er jT ILO
-Tome Address +1"Lf�-State/Zip
5'Cityce✓,Zk-t u 2(�
Telephone No. Telephone No.
THIS USE WOULD BE DESCRIBED AS:
O Newly Constructed Building or /Ejxsting Building
IS THIS BUILDING FIRE SPRINKLERED? es ONo
CHECK ALL THAT APPLY:
❑ Change of Business Owner ❑ Change of Occupant ❑ C ange
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? ❑Yes 12f No
■ Will operations produce dust/wood shavings or similar material? ❑ Ye!
■ Will operations involve the repair or replacement of automobile parts?
of Use ; ❑ Additional Occupant
X
❑Yes QNo If yes: Describe the
components repaired or replaced.
■ Does the opera ion involve the use of welding or open flame? ❑ Yes No
■ Will the busi ss be a drinking, dining or assembly use with an occupant load of more than 50 person .
El o
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? ❑Yes o
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑Medical/Dental
Warehouse/Manufacturing/Distribution ❑ Restaurant/Take-Out Food ❑ Other
■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite? ❑ Yes ❑ No
If you answered yes, please roceed to the next question.
• Does your facility curren have a grease control device (i.e. grease trap or grease interceptor)?
Check one: El o
For O[Eicial Use Only
Occ Group: 1
Occ Group:
Occ Group:
Total Sq Ft Occupied: �(2
Bldg. Permit #
Planning Initials Date: ( 2-11 &
Conditions of Approval or Other Notes:
Area: WID
Area:
Area: Ic
No. of Stories:
Entitlement #:
Occ Load:
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning: --
Building Reviewed By Initia
Grease Interceptor Verified Inspected By Initials: Date:
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: U1 �<
Property Address: 1-7
City: U I1
_)SA
S R.6
t1tV
Zip Code:
Contact Person: M I 'r SO `7 Title:
Type of Business: b2,L S'rTTelephone:
Fax Number: -77e-mail addres : 6 '� y� 2 C cs T to zd Jy po-,)-t
, Cb
Applicant (print name): C4 4 0,, CR ET RV Signature: Date:
• 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[:] No2/
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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