Loading...
HomeMy WebLinkAbout10128 Adams Ave - CofO (5)• JA CERTIFICATE OF OCCUPANCY 020 - CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION HUNTINGTON BEACH (3rd Floor — The Applicant Must Aprply In -Person) Business Address 1012-bn A S Y,7, Date 1012'�t( Business Owners Name ' LLG Zip Code 9 ZG 4 to Business Name �� v �p Telephone No.d 14 717"77163 Business Type P-Pa�a via f2A r dA M et& Bus. Phone Property Owner Information (required) 1 Tenant/Emergency Contact (required) Name-8 "k'yte- ss Qrb!p,— , -, &AneYSluP Name ri Ik> Address 1425 CoLAg►cyyc,L Ss Y-re+ foi{,- 46crc Home Address l.��FZZ City SowL -PrLlAZG .c-o State/Zip CA 014 104 City tfiAAd1 V1 13�LC�_ State/Zip CA 9M47 Telephone Nob 1440 505 — 4 \ cm Telephone No. al 4) 79-7 9-76-5 THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or Existing Building IS THIS BUILDING FIRE SPRINKLERED? NYes ❑ No CHECK ALL THAT APPLY: TV Change of Business Owner ❑ Change of Occupant CChange of Use ❑ Additional Occupant • Indicate former type of business ` c C-0 • Are you requesting that the electricity be turned on? ❑Yes ®No • Will operations produce dust/wood shavings or similar material? ❑ Yes gNo • Will operations involve the repair or replacement of automobile parts? ❑Yes $No If yes: Describe the components repaired or replaced. • Does the operation involve the use of welding or open flame? ❑ Yes X No • Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? ❑ Yes )4 No • Will there be storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? []Yes XNo • The following best describes my operation: `❑ Office Only ❑ Retail Sales ❑ Medical/Dental ❑ Warehouse/Manufacturing/Distribution ❑ Restaurant/Take-Out Food N Othere:✓tn�k • Will any meat products including beef, poultry, and/or fish be cooked or fried onsite? ❑ Yes g No 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: ❑ Yes 15Po Grease Interceptor Verified Inspected By Initials: Date: For Official Use On/y Occ Group: Occ Group: Occ Group: Total Sq Ft Occupied: �© 5 Bldg. Permit # F21 6 Planning Initials Date: IV .:7A. 1eE), Conditions of Approval or Other Notes: Area: 4045 Area: Area: No. of Stories: i Entitlement #: KIP> 15 5 nI (p Use Permitted: N Occ Load: 2:1 Occ Load: Occ Load: TIF Revievy:�Y/ N Zoning: M Parking Meets Code (for use)&Y N Building,Reviewed By Initials:�ate: South Coast `, 0, Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182 - - Phone Number (909) 396-3529 http://www.agmd.gov f C 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: Property Address: City: ,,n {l rc, y. Q Zip Code: `j Z61? ro Contact Person: iA0 Title: AAa V1_a: ►' Type of Business: Telephone: MQ2 q- — 9-762 Fax Number: _ E-mail Address: Ti-Va -1 v.-torivNr c2:vL�e,r. corn) Applicant (print name):_ rl bo Signature: � y C�o V Date: _10i zc1 ) F 1. Will the facility release air pollutants, including but not_limited to, dust fumes, gas, mist, odors, smoke, vapor, or a corrfbination of these to the atmosphere? ❑Yes P4No 2. Will the facility result of fuel -burning equipment including, but not limited to, boilers, generators, and internal combustion engines? ❑Yes XNo 3. Will the facility result of hazardous materials, including but not limited to, chemical, plastics, rubber, resins, solvents, paints, and other parts cleaners? ❑Yes 5�No 4. Will the facility have use of above or underground storage tank? ❑Yes MNo yy 5. Will the facility consist of manufacturing, fabrications, finishing, or treatment of wood, metal or plastic products? ❑Yes 0No 6. Will the facility result in the use of the equipment listed below? ❑Yes JNo (Select all that apply) ❑Abrasive Blasting Cabinet/Room ❑Air Conditioning System (containing > 50 Ibs of refrigerant) ❑Application of Paints/Adhesive/Resins ❑Baghouse/Dust Collector ❑Bakery Oven (gas fired) ❑Boiler/Water Heater (max. heat input = or > 1 million BTU/hr) ❑Charbroiler/Smoker ❑Internal Combustion Engine (rated > 50 bhp; e.g. back-up generator) ❑Mixing/Blending of Liquids and/or Powders ❑Molding /Extruding/Curing of Plastic ❑ Pharmaceutical/N utraceutical ❑Plasma/Laser Cutter ❑ Printing/Coating/Drying ❑ Production of Fumes/Dust/Smoke/Odors ❑Coffee Roaster/Afterbunner []Refrigeration Systems (containing > 50 Ibs of refrigeration ❑Deep Fryer (excluding equipment located�at eating establishment) ❑Soldering Oven ❑Dry Cleaning Equipment ❑Spray Booth ❑Electrostatic Precipitator ❑Storage of Acids/Solvents/Organics Liquids/Fuels ❑Fermentation ❑Storage Silos (sugar, flour, etc.) ❑Gasoline Storage & Dispensing Equipment If you answered "No" to any of the above questions and your facility will not have the following equipment listed, 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).