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15061 Springdale St - CofO (63)
J� HUNTINGTON BEACF CERTIFICATE OF OCCUPANCY 020IG - CITY OF HUNTINGTON BEACH - DEPT. OF COMMUNITY DEVELOPMENT APPLICATION Business Address__1_5 Business Owners Name Business Nami Business Type A M (3`d Floor - The Applicant Must Apply In -Person) Date Z ' I _ t (o Zip Code ' l 2, (o y Fj Telephone No. '7 14 $q `1 ' 3&D Bus. Phone Property Owner Information (required) Tenant/Emergency Contact (required) Name 5�*Jw3 Inc► &MAIQS Name 5 Address 253o Wga M',11 A.-ae Sic 0 22S Home Address 4 , er City somm &a State/Zip Ch q2-1 oS City ` ate/Zip Telephone No. IR4q . 2S0 • 91100 Telephone No. (D 2-(e 5 S — Q 4 Q THIS USE WOULD BE DESCRIBED AS: O Newly Constructed Building or )<Ex' ting Building IS THIS BUILDING FIRE SPRINKLERED? kyles 0No 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 l d No ■ Will operations produce dust/wood shavings or similar material? ❑ Yes MNo ■ Will operations involve the repair or replacement of automobile parts? ❑Yes C�No If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? ❑ Yes i�rNo ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? ❑ Yes MNo ■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? ❑Yes [ 9No ■ 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 IgNo 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 09 No For Official Use Onl Occ Group: Occ Group: Occ Group: Total Sq Ft Occupied: _ Bldg. Permit # Planning Initials: �Date:2��-G Area: ddC� Area: Area: No. of Stories: Entitlement #: Occ Load: /4::�' Occ Load: Occ Load: TIF Review: Y/ N Zoning: Building Reviewed By Initialsrate: (e Conditions of Approval or Other Notes: Off l c,-. j'O ( �i Grease Interceptor Verified Inspected By Initials: Date: South Coast b16 Y g Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182 P Y .�� (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: � j \ O bc4A KnJD! t Lk Property Address: �`� G / _ City: ZZ8 J416- # Zip Code: !Z2.� Y i Contact Person:JOln Title: C EO Type of Business:km'�relephone: Fax Number: l U — S OO 7_ e-mail address: O�/� �to Sfet o�rOC C d ^'� Applicant (print name):©hrnn�� Signature Date: I �/ 1� • Will the facility have any of the following equipment . s ❑ No I 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❑ Nog 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-