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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020L!�_ - /)p 6 S 7Z__,
CITY OF HUNTINGTON BEACH -
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3`d Floor - Must Apply In -Person)
Business License#-�—~�?S Date 8 . /Z —
Business Address 4 6 Tj2 aoS'i.c is 2 L qn-e Zip Code ` 2—L t/ 9
Business Owners Name khq leQ1 ok[ q' i Telephone No.7// V6y0
Business Name CIO &„ e r Bus. Phone -7 t q -
Business Type ee-it", e. A-C _f
Property Owner Information (required) Tenant/Emergency Contact (required)
Name It^ A Name iGh�, i�_ r1 c9bg g i
Address' 31,51 pAq.._ {may A' !yid T: ' Home Address 7 / / p C-ff #' 313
City._ State/Zip>[ City 1-113 State/Zip 9? GV
Telephone No7° Telephone No. %/ %- - % (/ 2 7 P'Zr
THIS USE WOULD BE DESCRIBED AS:
❑.Newly Constructed Building or "'tS Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner kChange of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes N6N
■ Is the building sprinklered? Ye'se. No❑
■ Will operations produce dust/wood shavings or similar material? Yes , T�K
■ Will operations involve the repair or replacement of automobile parts Yes 0 Nob If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? YesEl No
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes QNo`61
■ The following best describes my operation: office Only ❑ Retail Sales ❑ Medical/Dental
"*'&Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
Other (describe)
For Official Use Only
Occ Group: - or Area: /j0Occ Load:
Occ Group: 7� Area: Occ Load
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: No. of Stories: TIF Review: Y/ N
Bldg. Permit # Entitlement #: Zoning:
Plnr Initials: f�� Date: 11-0-4) Plan Chkr Initials:lf�- Date: I 1 !y Insp Initials: Date:
�L
Conditions of Approval or Other Notes:
Inspection Date:
i
NIr-v to CA, cc' o
South Coast
Air Quality Management District
21865 Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • 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: - { v, CE C& t^, ` 67LA-) 6os-�" X GCS
Property Address: 7_�_c,7 S % 5 /or -
City: 0 %3 Zip Code: 9 2- 0 5
Contact Person: D b 5--+ Title: Owkxje-
Type of Business: 4., S A, �AQJ
Fax Number: 21q 9 J—
Applicant (print name):
rho, le 01 p1b�-J�'
Telephone: N2 -- 932 6
e-mail address: key (j�,Q
Signature: �-
Date: 1 1 i2 Z v j V
• Will the facility have any of the following equipment? Yes ❑ No-S
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
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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