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HomeMy WebLinkAbout15052 Springdale St - CofO (16)CERTIFICATE OF OCCUPANCY 0206 - 0 0 CITY OF HUNTINGTON BEACH - DEPT. OF PLANNING & BUILDING APPLICATION Business Address 15052 Springdale Street, Ste. C, FiB, CA 92649 Business Owners Name George Mathis Business Name Hearing Healthcare Recruiters Business Type Staffing agency (3r° Floor — The Applicant Must Apply In -Person) Date 1/13116 Zip Code 92649 Telephone No. 714.580.5951 Bus. Phone 714.680.5961 Property Owner Information (required) Tenant/Emergency Contact (required) Name Dr. Altaf Hudani (Ocean Dental) Name George Mathis Address 15052 Springdale Street Home Address 15082 Sevilla Circle CityHB State/Z1pCA 92649 C1tyHB State/Zip CA 92647 Telephone No. 714.898.0718 Telephone No. 714.892.5313 THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or 1] Existing Building IS THIS BUILDING FIRE SPRINKLERED? ❑ Yes ❑No CHECK ALL THAT APPLY: ❑ Change of Business Owner ❑ Change of Occupant ❑ Change of Use ❑ Additional Occupant ■ Indicate former type of business ■ Are you requesting that the electricity be turned on? ❑Yes © No ■ Will operations produce dust/wood shavings or similar material? ❑Yes ©No ■ Will operations involve the repair or replacement of automobile parts? ❑Yes ®No If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? ❑ Yes 0 No ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? ❑ Yes © No ■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? ❑Yes ©No ■ 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 proceed to the next question. • Does your facility currently have a grease control device (i.e. grease trap or grease interceptor)? Check one: ❑ Yes ❑ No For Official Use Only Occ Group: Area: Occ Load: Occ Group: Area: Occ Load: Occ Group: Area: Occ Load: Total Sq Ft Occupied: No. of Stories: TIF ReviewN Bldg. Permit # Entitlement #: Zoning: Planning Initials: Date: l lam✓ N(j Building Reviewed By Initials: Date: Conditions of Approval or Other Notes: c�- b�- Grease Interceptor Verified Inspected By Initials: Date: South Coast Air Quality Management District -� 21865 Copley Drive, Diamond Bar, CA 91765-4182 P Y '�;wxk- (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 (AQ'VID). Company Name Hearing Healthcare Recruiters Property Address: 15052 Springdale St. Ste. C City: Huntington Beach zip code: 92649 Contact Person: George Mathis Type of Business: Staffing Agency Fax Number: 714.901.0891 Applicant (print name): George Mathis Title: Business owner Telephone: 714.580.5951 e-mail address: Signature: Date: 1 / 13/ 16 • Will the facility have any of the following equipment? Yes ❑ No 0 Charbroiler Dry cleaning machine Spray booth Printing press (screen/lithographic/flexographic) Internal combustion engine greater than 5014P (excluding motor vehicles) Boiler/combustion equipment (greater than I 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❑ No0 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). -2- i d