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HUNTINGTON BEACH
Business License #
Business Address
Business Owners 1\
Business Name
Business Type fbi
CERTIFICATE OF OCCUPANCY 020_L'$ 7 1" L
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
90R7-7
(3`d Floor — The Applicant Must Apply In -Person)
Date /0�/`%4"4(
Zip Code q2G#q
Telephone No. g114-339 170
Bus. Phone V- #/7--7620
Property Owner Information (required) Tenant/Emer enc Contact (required)
Name t/aH Ar 4hL Name
Address /,�/ re /1 Home Address S, .
City. �H State/Zip City tate/Zip Z
Telephone Ieo. �—q— Q�2z� Telephone No.
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or KExisting Building
IS THIS BUILDING SPRINKLERED? Yes ❑ N06
CHECK ALL THAT APPLY:
❑ Change of Business Owner Change of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes❑ No❑
■ Will operations produce dust/wood shavings or similar material? Yes El NoX
■ Will operations involve the repair or replacement of automobile parts Yes El Na)J If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes❑ Ng•V
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ❑ No)D
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes El NdK1
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
Warehouse /Manufacturing/Distribution ❑ Restaurant/Take-Out Food
■ Will the Food Service Establishment Generate Fats, Oils Greases? Yes❑ NX
■ Does the Facility Have a Grease Interceptor? Yes❑ No)C
■ Other (describe)
For Official Use Only
Occ Group: T2 Area: -C;;o Occ Load:
Occ Group: Area: I &c::;C7 jb Occ Load: 3
Occ Group: Area: Occ Load:
Total Sq Ft Occupied: No. of Stories: TIF Rev* w: Y/ _ .
Bldg. Permit # Entitlement #: Zoning: L - 1
Planning Initials: Al L2 Datel t N• Building Reviewed By Initials:' Datel1 `21 11y
Conditions of Approval or Other Notes:
F-C/j%--OFAqVSN&e_. IVC S '�
L
Grease Interceptor Verified Inspected By Initials: Date:
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:
Ll�k � eff�x fiv-
• Property Address: 1,5-14D Tr-ansIs�r GH-
City: [ n A Zi�pf Code: q20'
Contact Perso 'nar Yd&kj,0*,W Title:
Type of Business: C,hRUt�� /j' �fj/jX Telephone: 9� 33g / �Dtl
Fax Number: e-mail addre s:
Applicant (print name): Signature:
Date: M7/Y4?��
• 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? Yes❑ Noo
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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