HomeMy WebLinkAbout15237 Springdale St - CofO (9)Certificate of Occupancy No. 0200 b
I
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY
(3`d Floor - Must Apply In -Person)
Business License # Date 4- JL 1 ~0 ?
Business Address /s"Z3? S oe ri H ct Ag3 JULN Zip Code ?2-LVI
Business Owners Name tJ; (c a e-e-S 2.1 Telephone No. 7ly -
Business Name Ka Bus. Phone
Business Type S �P—e V'i c.¢-
Property Owner Information (re uired) Tenant/Emergency Contact (required)
Name Von r M le- Name Koresre..!
Address ?1 V V-0 t * o Home Address 42oi A7or-6Yco
CityPt .S.S10 + i e l d State/Zip C& ' 9 ;Z! ?/ City qJ3 State/Zip (?,a?A G c( 8
Telephone No. Q q9 -3 `�B - �6 .`%o Telephone No.
THIS USE WOULD BE DESCRIBED AS: -
❑ Newly Constructed Building or R Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner .r Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? YesQNoVT,
■ Is the building sprinklered? Yes 6 Vo❑
® Will operations produce dust/wood shavings or similar material? YesON04
■ Will operations involve the repair or replacement of automobile parts Yes ONo 6 If yes: Describe the
components repaired or replaced.
® Does the operation involve the use of welding or open flame? Yes I]No l�
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes O No ;g.
■ The following best describes my operation: kKOffice Only ❑ Retail Sales
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Only S 1
Occ Group:
Occ Group: lQ,
Occ Group:
❑ Medical/Dental
Occ Load: I--
Occ Load: ?/
Occ Load:
Total Sq Ft Occupied: �A No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitlement #• 'n Zoning: j li
V
Plnr Initials: Date:4 Plan Chkr Initi wAr ate: _ Insp Initials: 'fiZL Date: "2cri
Conditions of Approval or Other N s:t
Area: ()0
Area: \ ?in 6
Area:
Inspection Date:
(G:Building/Forms/document id goes here)
7
° South Coast
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: K��ye5 /1l►'o�n.S
Property Address: l Sz 3 S r� ✓� c p(p�t�
City: }-) Zip Code: ` ,2 OV 7
Contact Person: Title: /ire-S 1 aa"�
Type of Business: ,S P-rVi c— Telephone:() 71 `-/— 6 06 -33�/S
Applicant: (print name) ,&%/ / /�o o�—SS�� Signature:
❑ Will the facility have any of the following equipment? Yes o ,
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
Will any of the following operations be performed? Yes E]No R.
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
❑If you answered "No" to both questions, this checklist is your clearance from AQMD.
Ulf 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.