HomeMy WebLinkAbout15319 Pipeline Ln - CofOHUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION
(3rd Floor - The Applicant Must Apply In -Person)
Business Address 6j , S P e I; r Q 1 r` - Date
Business Owners Name C. Zip Code C12Cq0
Business Name V- fA G M Crbo-'S Telephone No. 786110 6
Business Type 4L.Vo bro key' 1 D ea, l --r I t Bus. Phone
Pkoperty Owner Information (required) Tenant/Emergency Contact (required)
Name flwo ►^ A Name FrnmamP Fg-, '
AddresLLL F76 au i c- CGGS-t hwa- Home Address 5635 &iAV16fr" a✓-p-
City j1vn,h vl� kly", gr-cv�>6tate/Zip C-4 ! 11D7g! 2- City L. o✓i � State/Zip Clot R080-'?-
Telephone No. % 14 ) ci b-- - S4 Q � Telephone No. `� 7 67 58 70
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Existing Building
IS THIS BUILDING FIRE SPRINKLERED? ❑ Yes ONO
CHECK ALL THAT APPLY: /
❑ Change of Business Owner El Change of Occupant El Change of Use ® Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? ❑Yes ffNo
■ Will operations produce dust/wood shavings or similar material? ❑ Yes KNo
■ Will operations involve the repair or replacement of automobile parts? ❑Yes M No If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? ❑ Yes No
■ Will the bue' ess be a drinking, dining or assembly use with an occupant load of more than 50 persons?
El Yes C] No
■ Will there be storage racks, gondolas, or shelving�exceeding 5feet 9 inches in height? ❑Yes 1!5<
■ The following best describes my operation: Dffice Only ❑ Retail Sales ❑Medical/Dental
❑Warehouse /Manufacturing/Distribution ❑ Restaurant/Take-Out Food Other Ou4- Qe Q►l-
■ Will any meat products including beef, poultry, and/or fish bee cooked or fried onsite? ❑ Yes No
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 W No
For Official Use Only
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Planning Initials: l� Date:
Area: 14110
Area: 1 (a0
Area:
No. of Stories:
Entitlement #:
Use Permitted:
Y/N
Occ Load: 3
Occ Load: Z .
Occ Load:
TIF Review: I//N
Zoning:
Parking Meets Code (for use): Y / N
Building Reviewed By Initials: -OW Date: 712-5/ 1 T -
Conditions of Approval or Other Notes: W)T wl e! I 09,,9 pgyt,- . Am" I sy S F _
Grease Interceptor Verified Inspected By Initials: Date:
South Coast 13-
a
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
. e ® (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: �Ac- H okv:s
Property Address: 153l e Pl pe 1 i r2. l n .
City: [-t,v-,%►+y 6e) ec.ch Zip Code: a u `4 6(
Contact Person: AM P e_ VQ_, Title: V./n f/-
Type of Business �ed�� rl' it k' gf0 �'r Telephone: 46 z)-7 6& —G 1 d 6
Fax Number: e-mail address: vv*- + 8-0-Z,,A t (O G) 5fO1q00 . corr-\
Applicant (print name): ate- it•.lexkdln- C. Signature: Date:
• Will the facility have any of the following equipment? es ❑ No Rr
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[] Nol ]
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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