HomeMy WebLinkAbout15217 Springdale St - CofO714/536-5271
' CERTIFICATE OF OCCUPANCY 020� - va3
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(3`d Floor - Must Apply In -Person)
Business License # � ::I a L4 Date
Business Address fS2--7 Zip Code 9zeyp
Business Owners Name j)„t, r S,c v�.�esres w Telephone No. wel Saz t` o 9;
Business Name ,4455*d4e-r0% Y 15�,JV 4.10 ' Phone •206 /11e4-
Business Type _ j7w eAoe-
Property Owner Information (required) Tenant/Emergency Contact (required)
Name welD�v lieu �,Sr .a c>.�v�,cr Name P,*A,,r �arriilsr�.a
AddremzA!y-� Home Address G q9 8 S.¢.00�� �'>•c
City 11"is6.n0 Vzlf,}"7, State/Zip 6f City Le'a Air State/Zip so eid-
Telephone No. q eI g :yG 9Gyo Telephone No. SZ 2- 4�y as .7_ ems'
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or O Existing Building
CHECK ALL THAT APPLY:
El Change of Property Owner ❑ Change of Occupant 0 Change of Use ❑ Additional Occupant
■ Indicate former type of business
Are you requesting that the electricity be turned on? Yes.RNo❑
■ Is the building sprinklered? Yes ZNo❑
■ Will operations produce dust/Wood shavings or similar material? YesONo'
■ Will operations involve the repair or replacement of automobile parts Yes ONo .0' If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ONo B'
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo
■ The following best describes my operati Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food L�( ='s6-'Rr
(describe process and end product)
'Other (describe) s'm�lMer
For Official Use Only
Occ Group: S'r- Area: �9
Occ Group: _ Area: 6 6:1: J"..1`
Occ Group: Area:
Total Sq Ft Occupied: Z No. of Stories:
Bldg. Permit # Entitlement #:
Plnr Initi s: V Dater 1 1 Plan Chkr Initials: ____.mate: �� /b
Conditions of Approval or Other Notes: , 1
Inspection Date:
Oce Load: -
Oec Load_: mil`
Oce Load:
TIF Revie �Y/ N
Zoning:
Insp Initials: k.<Z.LDate: ll
R6LV
(G:Building/Forms/document id goes here)
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: A3SOG V r",�tcracd&s-
Property Address: 0 7 " A4:Ld Ae ec
City: Of Zip Code:
Contact Person: Title: Ocvic�-�
Type of Business: Sty- Telephone: ) 71
y L9Y2- /60 C
Applicant: (print name) Signature: ,wl�
Q Will the facility have any of the following equipment? Yes U No K
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
OWill any of the following operations be performed? Yes []No
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding and blending_of_liquids_and/_or povwders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
Xlf you answered "No" to both questions, this checklist is your clearance from AQMD.
QIf 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.