HomeMy WebLinkAbout15131 Triton Ln - CofO (103)/D - 3 7.3
Certificate of Occupancy No. 020010 000 3"Z
714/536-5271
Business Licen
Business Addri
Business Owne
Business Name
Business Type
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPT. OF BUILDING & SAFETY
(3'd Floor — Must Apply In -Person)
Prmerty Owner Information (reyu) n' f Tenant/Emer e.
Name ' LSC .ASS ('E K.-� Name
Addre s :5�(.4aHom dress
City State/Zip City
Telephone NoEl l — 02� hAOL Telephone No.
C-r I y
Date 01 / �
Zip Code _
Telephone T
Bus. Phone
THIS USE WOULD BE DESCRIBED AS:
D Newly Constructed Building or Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occupant ❑ Change of Use ❑ Additional Occupant
■ Indicate former type of business
■ Are you requesting that the eiectnclw be turned on? Yes ONOX
■ Is the building sprinklered? Ye o❑
■ Will operations produce dust/wood havings or similar material? YesONo�S
■ Will operations involve the repair or replacement of automobile parts Yes ON04 If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ONo
■ Will the b siness be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes DNo
■ The folio 'ng best describes my o eration: D Office Only D Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out FoodWarehouse /Manufacturing/Distribution
(describe process and end product)
D Other (describe)
For Official Use Only
Occ Group: s--�
Occ Group:
Occ Group:
Total Sq Ft Occupied: 13 V2 J: -
Bldg. Permit #
Occ Load: lz�
Occ Load: 2
Occ Load:
TIF Review: Y/
Zoning: IL
Plnr Initials: ( Date: 1 — j0 Plan Chkr Initials: (f�-"�ate: d Insp Initials: 2C— Date: LD
�P)
Conditions of Approval or Other Notes:
Area: n J`.
Area: rM _n 4 .
Area:
No. of Stories: l
Entitlement #:
Inspection Date:
(G:Building/Forms/document id goes here)
r
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 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: t
City:
Contact Person:
Type of Business:
Applicant: (print naYr
Q Will the facility have any of the following equipment?
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
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
Zip Code: Q .1
Title:
Zelep]
Signal
QIf you answered "No" to both questions, this checklist is your clearance from AQMD.
QIf 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.