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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020 / - QD
CITY OF HUNTINGTON BEACH -
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3'd Floor - Must Apply In -Person)
Business License # A -2, -Z y Date
Business Address 15Z 1 — 2i Jv6�4LG s_ +(9 _ C4 Zip Code G Z 6 4- is
Business Owners Name --Iq q t,.j E�—F S tZy E2 5f V--- 1V Telephone No. � � � �s et.-,-
Business Name A GSoc-u-TF,- L-V F:jq-63 u L.O u S Bus. Phone 7
Business Type (ZG i'�A1 t_ SYt=4C U S !=�
Property Owner Information (required) Tenant/Emergency Contact (required)
Name V d" `-3;;,GJZ A-4-i r Name Ly r Va 1 t'7
AddressZ�., Ly L-t-o Lr4A-j►AE�AZ7oHome Address 6t_r—
City MisSjz*-+ VIP -To State/Zip C-A- tq26c(t City L_ 3 State/Zip e--A qCG.2e I S—
Telephone No.e-(Lr 9 :3 4-PS C(A 9Z) Telephone No. S6 Z Sit 2 1 S"
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner 'SChange of Occupant []Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes El NoX
■ Is the building sprinklered? Ye?5( , No❑
■ Will operations produce dust/wood shavings or similar material? Yes❑ No,
■ Will operations involve the repair or replacement of automobile parts Yes 0 NoX If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes[ Now
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONOX
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? YesX. No ❑
■ T wmgbest escn a tion: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
Warehouse /Man ufacturing/Distrib ion ❑ Restaurant/Take Out Food
(describe process and end pro
For Official Use Only
Occ Group: �"� Area: j2 Occ Load:
Occ Group: Area: tro Occ Load:
Occ Group: Area: Oce Load`.
Total Sq Ft Occupied: '� 2 No. of Stories: T TIF Rev'gw: Y/
Bldg. Permit # Entitlement #: / Zoning: l-
Plnr Initials: Date Plan Chkr Initials: �G_Date: �/ I Insp Initials: Date: J i
Inspection Date: / / S
Property Address: i S Z ( 3 —
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 e 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: � (�s'oLv i �.L`% ��U L.o uS
ft5 P2► Klnr-j-�,A-LS—::: S-7 _,
City: `%A r-K. Zip Code:
4 26 LF&
Contact Person:`%>t>RV.C— St� Title: c3wk3C—,/Z
Type of Business: (Zl=` }1 �- S'te 24. WAf'Lf`14ou5EE, Telephone: % 1- �s5Lt-Z
Fax Number: '7 0 Lt' S1{2 1&2_8� e-mail address:c�e.c•o��`'-�,�
Applicant (print name): Signature: _�-� 1
Date: G —
Will the facility have any of the following equipment? Yes ❑ NoK
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❑ No)K
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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