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HUNTINGTON BEACH
CERTIFICATE OF OCCUPANCY 020L -
CITY OF HUNTINGTON BEACH -
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
Business License # 2� 3
Business Address 15 23 T04';15 Tog. I. VE R ,B d • RZ6 91
Business Owners Name Cl AP -IS WE
Business Name Ckx5 VG-Wa -S Ica
Business Type DFsi6ifJ
(3'd Floor - Must Apply In -Person)
Date 12 - 2 -13
Zip Code 'Z(64q
Telephone No. -I14 `i% 5'18
Bus. Phone S4�L
Pro er Owner Information (required) Tenant/Emergency Contact (required)
Name G4 EL_ . Re Name pJwt
Address Z644e �AumjM () A 571: 27o Home Address I7511 661ZWN 96 [ANE
Cityt,;6icr1 io State/Zip g269 CA. City )_ ,3, State/Zip 6A y26g7
Telephone No. �I�iq � � - 96 70 Telephone No. ET � _Sys
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or 7Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner 9(Change of Occupant
■ Indicate former type of business StofhG E
■ Are you requesting that the electricity be turned on? Yes 0 No�W
■ Is the building sprinklered? Yes No❑
■ Will operations produce dust/wood shavings or similar material? Yes ❑ Nox
■ Will operations involve the repair or replacement of automobile parts Yes El Noy If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? YesO No)(
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo X
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes ONo R
■ The following best describes my operation: 4FOffice Only ❑ Retail Sales ❑ Medical/Dental
XWarehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product) Of�<140 Of
Other (describe)
❑Change of Use ❑Additional Occupant
For Official Use Only
Occ Group: Area: Occ Load: 7_
Occ Group: l Area: C� SC7 Occ Load : 3
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: No. of Stories: TIF Review/ N
Bldg. Permit # Entitlement #: Zoning: [_
G
Plnr Initials: Date:r%.-?- 1 Plan Chkr InitialsDate:Insp Initials: Date:
Conditions of Approval or th Notes: -t
D� % O U ��' �P%S O(LI (' 17c f�I� r) r,
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: C JS "F-
Property Address: 1S236 TeA`j"%STz> 9- "Ur
City: H - -6• Zip Code:
Contact Person: GRrl'S NoWE;--- Title: +erwcr t'AL-
Type of Business: 17c'siG�/ Fa -xi
Fax Number:
Applicant (print name): G-NRIS HbtwE Signature:
Telephone: `711
e-mail address:
G�
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? YesV 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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