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CERTIFICATE OF OCCUPANCY 020.,ff,- Ab 92 5'3
J� CITY OF HUNTINGTON BEACH -
.� DEPT. OF COMMUNITY DEVELOPMENT APPLICATION
HUNTINGTON BEACF (3'" Floor — The Applicant Must Apply In -Person)
Business Addre
Business Owne
Business Name
Business Type '
Date
Zip Code 92-6V9
Telephone No S * -8i 2 2 //B
Bus. Phone Z S8' GLX(f9
ProMtv Owner Information required) Tenant/Emer enc Contact (required)
Name OV) I— vnY a Name
Address c A Home Address O
City l o+ G� State/Zip �.?_b9 / City State/Zip
Telephone No. l L� ����5 ' %�'JO Telephone No. %GO
THIS USE WOULD BE DESCRIBED AS: 7&cl %) / 5
ONewly Constructed Building or ,Existing Building
IS THIS BUILDING FIRE SPRINKLERED? eYes ONo
CHECK ALL THAT APPLY:
0 Change of Business Owner AftChange of Occupant OChange of Use Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Oyes &No
■ Will operations produce dust/wood shavings or similar material? OYes @No
■ Will operations involve the repair or replacement of automobile parts? OYes 19No If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? 0 Yes &NNo
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
OYes PNo
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? OYes l No
■ The following best describes my operation: ffice Only ORetail Sales OMedical/Dental
Warehouse /Manufacturing/Distribution ORestaurant/Take-Out Food OOther
■ Will any meat products. including beef, poultry, and/or fish bee cooked or fried onsite? Oyes qNo
If you answered yes, please proceed to the next question.
• Does your facility currently have a grease control device (i.e. grease trap or grease interceptor)?
Check one: 0Yes 0 No
For Official Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Planning Initial4L—Date: / /y /4
Area:
Area:
Area:
No. of Stories: '
Entitlement #:
Conditions of Approval or Other Notes: C,.SC-- eq1C-_
Occ Load: !I
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning:
Building Reviewed By Initials: P4J Date:_ 6
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:
A
Property Address: r' S Z 3 g T2�t,/1SI S;xry_
City:JIMZip Code: Z
Contact Person: Title:
Type of Business: iN I V C6.1 QYZ�Telephone: % 1 G/ ' Z S4 —���/��►
Fax Number: e-mail address: (s4� z
Applicant (print name): z- Signature: Datef
• 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❑ Norp"''
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). 1
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