HomeMy WebLinkAbout15061 Springdale St - CofO (41)J1
HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020 0- S D
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION
(3'd Floor — The Applicant Must Apply In -Person)
Business Address 1-9-061 S r2 rJ u_z 2v 2 Date 'I 11+1 1-1
Business Owners Name I Zip Code
Business Name )/,1 NEB '\r CS L -1— Telephone No.(o23-j%n-44-
Business Type G C- 4-42- Yv,,4 . v Bus. Phone
Property Owner Information (required) Tenant/Emergency Contact (required)
Name_C ewoo �90-U , XrZ. Name U •;21� 1�C' a SdN
Address 2S3a e R'll , S,,Oe. 22,' Home Address "LIS l
City S� my, Ara State/Zip Gq 12 9p5 City L� NFGA-4 (-- State/Zip CA °I 11 SO
Telephone No. ` qq, LS o . 71 c o Telephone No. al C -M S % (0'1 O s4�
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or 2(Exi ing Building
IS THIS BUILDING FIRE SPRINKLERED? 9Yes ONO
CHECK ALL THAT APPLY:
❑ Change of Business Owner WChange of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? ❑Yes ffNo I ■ Will operations produce dust/wood shavings or similar material? ❑Yes MNVO
■ Will operations involve the repair or replacement of automobile parts? ❑Yes If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? ❑ Yes 9 No
■ Will the bus}'ness be a drinking, dining or assembly use with an occupant load of more than 50 persons?
El Yes Eff No
■ Will there be storage racks, gondolas, or shelvinexceeding 5feet 9 inches in height? ❑Yes E1No
■ The following best describes my operation: Eice 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 Ef No
If you answered yes, please proceed to the next question.
• Does your facility curren y have a grease control device (i.e. grease trap or grease interceptor)?
Check one: ❑ Yes 9,o
For Official Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied: _
Bldg. Permit #
Planning InitiaM.<N�� Date 1 1
Area:
Area:
Area:
No. of Stories:
Entitlement #:
Use Permitted: Y / N
Occ Load:
Occ Load:
Occ Load:
TIF Rev' YIN
Zoning:
Parking Meets Code (for use): Y / N
Building Reviewed By Initials: Date:
Conditions of Approval or Other Notes: 0 -%� CQ -h c �
Grease Interceptor Verified Inspected By Initials: Date:
South Coast
Air Quality Management District
w21865 Copley Drive, Diamond Bar, CA 91765-4182
m` (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:
iLl r4 C J\^aa 11-S L-C—(�_
Property Address: ) '5o (o l 1
City: VJ V-A) 7 +SG'(�c7� (b�—i�c-A Zip Code:
Contact Person:NV-\1kK Title: If �o
Type of Business: (Z<—�2 N\P4 -i • Telephone:
Fax Number: e-mail address:e�)N�oN���ltSvwi
Applicant (print name): Signature: Date 7j'�
• Will the facility have any of the following equipment? Yes ❑ No Rr
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❑ NO2r
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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