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CERTIFICATE OF OCCUPANCY 020 -
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(3`d Floor - Must Apply In -Person)
Business License # A-,�,"M-71
Business Address IS I Sl -T-K-k-rpt-1 1 l
Business Owners Name 41-t -VA-,,Z4jL-f
Business Name
-N- Business Type.
im
Date e�11
Zip Code eJ2�1/%l/
Telephone No. - c
Bus. Phone
Property Owner Inform ion (required) Tenant/Emergency Contact (required)
Name - S iz IL Lame AlI ! o z-/" f
AddressS - 10 Home Address 1' �, t-->U..c e-
City State/Zip q 2_ �, City2 _ f f State/Zip c .--
Telephone No.� I6 ':S�l !) '. 7--) 9 Telephone No.
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or xisting Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner �angeOccupant ❑ 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 E]No❑
■ Will operations produce dust/wood shavings or similar material? Yes0No❑
■ Will operations involve the repair or replacement of automobile parts Yes DNo ❑ If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ONo ❑
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes E]No ❑
■ The following best describes m o - El Retail Sales ❑Medical/Dental
❑ Restaurant/Take Out Foo are ouse /Manufacturing/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Onl
Occ Group: - Orr-
Occ Group:�_r k' occ
Occ Group:
Total Sq Ft Occupied: 600
Bldg. Permit
Area: 1 ! -o Occ Load: 2-
Area: :7 Co Occ Load: 3
Area:
No. of Stories:
Entitlement #:
Plnr Initials: Date: • B Plan Chkr Initials: Date: `1/1 //a
itions of Approval or Other Notes:
(� Inspection Date: \
��' (G:Building/Forms/document id goes here)
_ Occ Load:
TIF Review: Y/
Zoning:
Insp Initials:-]�r` Date: 2 l�
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).
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Company Name: Z:-,/-& SL9- 1, p a� S m,61 j
�7r v�
Property Address:
City: �� Zip Code: C�li
Contact Person: e�vl 5DzK5_241f Title: ,r D4& j,/
Type of Business: C _ Telephone:
Applicant: (print name) -.7ignature:
Q 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 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 U 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
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.