HomeMy WebLinkAbout15131 Triton Ln - CofO (69)Certificate of Occupancy No�02001• do AS.4 a
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPT. OF BUILDING & SAFETY
(3'd Floor - Must Apply In -Person)
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Business License #`'l Date
Business Address AG/3/ ZAn1v /", C4- 9&4s Zip Code 9' 49gq
Business Owners Name Telephone No. (71y E'w2 7,?9A
Business Name �"��i-S��ii` %c�',�.crr`�3teti' /�/�, Bus. Phone — ��—
Business Type
Property Owner Information (required) Tenant/Emergency Contact (required)
Name 150ee-Ar Name C
Address SA92 gocd7,t— /4-VE Home Address 367Q
City fterl � Z&W/State/Zip (VA-V2649 City ftr,, ,7NYI-uk) d tate/Zip �-- �Z'G�g
Telephone No. l`19) &Jg -2791 Telephone No. r7/9) 6Q 2 -37-eq' 6
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or W Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner 9"Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? Yes ONo ❑
■ Is the building sprinklered? Yes CNo❑ �
■ Will operations produce dust/wood shavings or similar material? Yes`�,JNo Wo
Will operations involve the repair or replacement of automobile parts Yes C❑ If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes flNo Ref
■ Will the bus. ess be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo
■ The following best describes my operation: ❑ Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food ewarehouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Only
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied: v+y S.
Bldg. Permit #
Area: or�
Area: y Po
Occ Load:.
Occ Load:
Occ Load:
TIF Review: Y/ N
Zoning:
Plnr Initials: Dater Plan Chkr Initials: y_I2ate: 1 n`�Insp Initials: Date: 2J og
Conditions of Approval or Other Notes:
Inspection Date:
Area:
No. of Stories:
Entitlement #:
(G:Building/Forms/document id goes here)
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 a Certificate of Occupancy 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:
Contact Person:
CZAss 72�I,'wl-lt6l-Fs IA,C7.
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Zip Code: 72 C f q
60belJ 427-W-L Title: %46T72Jr-;'Vi
Type of Business: �j�� �1 %�� �'�'� Telephone: ej 6q2 7J'Q0
Applicant: (print name) Signature: 4rc
0 Will the facility have any of the following equipment? Yes 0 No MY
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 2 million BTU/hr. maximum input)
Abrasive blasting cabinet/room
Baghouse/cartridge type dust filter/scrubber
Motor fuel storage and dispensing equipment �/
Q Will any of the following operations be performed? Yes []No LK
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
C If you answered "No" to both questions, this checklist is your clearance from AQMD.
Q 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 (800) 388-2121.