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HUNTINGTON BEACH
Business License #
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CERTIFICATE OF OCCUPANCY 020�- S 5?j
�. CITY OF HUNTINGTON BEACH —
F DEPT. OF PLANNING& BUILDING APPLICATION
714/536-5241
Business Address_I
Business Owners Name
Business Name
Business Type
Name 1)
Address
City M
Telephone No.
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(3`d Floor —Must Apply In -Person)
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v 4 Date a\ t t Z
✓' S & Zip Code (o
Telephone No.
o Bus. Phone 2 O 1 /0
(required) Tenant/Emer enc
S I C Name 0l y,
d C, a Hom Address 1 S
% `� City h Ht7 -\
Telephone No.
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THIS USE WOULD BE DESCRIBED AS:
O Newly Constructed Building or Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner FrChange of Occupant 0 Change of Use ❑Additional Occupant
• Indicate former type of business
■ Are you requesting that the electricity be turned on? YesK No ❑
■ Is the building sprinklered? YesO . N�
■ Will operations produce dust/wood shavings or similar material? Yes❑ NoE(
• Will operations involve the repair or replacement of automobile parts YesO NoCL If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes Now
■ Will the business be a drinking, dining or assembly use with'an occupant load of more than 50 persons?
Yes QNo
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes ONO
■ The following best describes my operation: O Office Only ❑ Retail Sales ❑ Medical/Dental
O Warehouse /Manufacturing/Distribution O Restaurant/Take Out Food
(describe process and endproduct)
R Other (describe)
For Official Use Only rr
Occ Group: ` Area: b6�0 Occ Load:
Occ Group: Area: Occ Load:
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: 0 A No. of Stories: 1 TIF Review: Y/
Bldg. Permit # Entitlement #• Zo
Plnr Initials:_►
Wing.
DatePlan Chkr InitialslvS CDate: �1 \� IZlfisp Initials: Date: 7-614
Conditions of Approval or Other Notes:
CQmrrLiMc.E►Tw fgciLM 1 vOQgyn =
Inspection Date: A L-\-,
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South Coast
Air Quality- Management District
21865 Copley Drive, Diamond% Bar, CA 91765-4182
(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:
Property Address:
City: Zip Code:
Contact Person: Title:
Type of Business: Telephone:
Fax Number: e-mail address:
Applicant (print name): Signature:
Date:
• Will the facility have any of the following equipment? Yes ❑ No ❑
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? Yesn Non
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-
South Coast
Air Quality Management District
21865 E. Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 - htpp://www.agmd.gov
Air Quality Permit Checklist
California Government 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: R(Ct TY�ii p
Property Address: I S S^ YY'rl�, ,S i��ZZAWF
City: Zip Code: 1 2 6 t, Q
Contact Person: Title:
Type of Business: 1"�( l��i )W W S4L ST Telephone:'() - ( Lj 22 4 O -}
Fax Number: email address: sv2(Gi i SlviiiO�L'
Applicant: (print name) J00 r0 H V(D (��ignature:
Date:
Will the facility have any of the following equipment? Yes El No I�I
Charbroiler
Dry cleaning machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal combustion engine greater than 50HP (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 0 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, AQNID 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).