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CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
12/ Q 9 / 9 j
Date
Aadress 75??Ll TPANST-qTOR
District
Business Name MIDEO SYST1;NIS. rj; C�
TeL
7 i 11 -RLt _ Fc t1
"Business Type VIDEO MICROSCOPY
- Occ. Group 13��
BUILDING OWNER
BUSINESS OWNER/MANAGER
VGN DER AHE PARTNERS
Name
Name GARY CRAWFORD
Address 26440 LA A
Home
af:CAddress ignl AA;ITTt-ONA
i:>`f
City MISSION'VIEJO Tel. 14-•'�4P-Q6 tl Home
r` City 14t" A
11 '7
Tel.
b _ C r; ft h (17
Construction No. of Stories
Occupant Load, Sprinklers
CONDITIONS OF APPROVAL
DEPARTMENT OF COMMUNITY
DEVELOPMENT
This Certificate of Occupancy
SHALL BE posted in a conspicuous place on the
premises and shall not be removed except by the
Building Official.
b�
y
COMMUNITY'. DEVELOPMENT
i
—4,
APPLICATION FOR CrMTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
HUNDNG.ON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT
(PRINT OR TYPE ONLY) _ DATE
1
Address �/f} /✓J�/S �O%� f.�}/f.�L
District _ }
Business Name D
Business Type
Occ. Group
BUILDING OWNER
,/ _ BUSINESS OWNERIMANAGER
Name f�a11/_Dr,�'�� C� Name
Address—.,-)(,. 41(A6 CC w F Home
o2lrU Address
City
el. (city %t� Home Tel, 4,0,
%Z 9 o
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. (�
CHANGE OF OWNER CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE El ADDITIONAL OCCUPANT
Indicate former use, if anq,
Occupancy Gr. Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED _
SUPPLEMENTAL IINIFORMATON
.
BUSINESS ADDRESS
2.
Person to contact in case of emergency- 4,
.j
Telephone number. -
Does the bu► ,. -,g in question have electricity?
04- Yes
.. NO
(a) If No, are you requesting that the electricity be
Yes
turned on?
❑ No
4.
The building is sprinklered?
X,Yes;
El rd o
5.
Operations will produce ' dust / wood shavings or similar
material
❑ Yids
;k No
6.
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
/6,No
If Yes:
(a) Describe _ the components repaired or replaced.
"
(b) Does the operation involve the use of un open flame? ❑ Yes
gNo
7.
The business is drinking, dining or assembly use that
will
result : in an occupant load of more than 50 persons.
❑ Yes
'Er Nc
8.
The following best describes ►,ny operation;
O f.
�" arI Sales
W re us
Manufacturing / Distribution:(�escribe process and end
product)
Restaurant/Take Out Food
Medical i Dental'
Other (describe)
w
SUPPLIMENTAL INFORMATION
SOUTH COAST ,SIR QUALITY MANAGEMENT DISTRICT
(Nonresidentiaf Buildings Only)
Location of SubjectProperty:
Praoorty Qwr;cr Name:, " - l�-ety Phone #: -lo 0
Name of the person preparing this form in print and sfgnai ve;
r Name: LF� �� !�/,'
$i gr�ature,
i
S.
The person preparing this form must be the same,,person applying for building
followinguestions regarding
q ;, g g proposed ouci�pancy of the subject building,
permits nPfease.answer the
IF YQII DO �iQ
,your T 1C1�3Q1�!
�� ,� 1 g,
THE ANSWER TO A'QUESTION MARK IN I TWA - YES " COLUMN.
AQIVID PERMITTING CHECKLIST
* .
'DES 'NO
1. noes your facility case any internal combustion engines greater'than 5" OHP?2.
�-
Does your facility involve mixing, blending, or processing any solvents, ..
adhesive., paints or coatings?
-
3. Dues your facility croate any dusts or smoke?
E
i 4. Does your facility refine any liquidsorsolids or reclaim any metals?`
5. Does your facility plate of`coat anything? TM,X
6. hoes your facility have any combustion 6qugpmant (Le. boiler, furnaeps;
broiler, baking ovens, etc.) rating greater than 2,000,000 BTU/HR? '
7.Does faci(l
Y ty hsndie o
our l'stor , solv`eriteitir motorfuel?
S. Do you use or store any acids?
l%
t
9. Do you use ah��*clieffif«ai process?
�— '-
10. Do you use any solvents for clean-up?
11. Are you a dry cleaner, res gui°ant.with a:charbroilpr, body shop, gasoline
�a
„,-
station, printer, or part ooker?
12. Is the subject building located within one thousand (1,oflo) feet of any
school? PROPERTY LINE
TO PROPERTY LIMB GRADES K-12.
If you have marled "NO" in all columns, you do not reed an Air Quality permit at
� any :.lucstions in the"YES" column you must contact the South Coast Air Quality Management
this time. It you have marked
District located
at;
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
Please call: Plan Check (909) 396-Z000
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