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Home My WebLink About6041 Bolsa Ave - CofO (35)J HUNTINGTON BEACH Business Add Business Owr CERTIFICATE OF OCCUPANCY 020- iJlf CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION Business Name Ka, ��c►, Business Type nJ (3rd Floor - The Applicant Must Apply In -Person) Date t 103l ac)km Zip Code 1� a W-1 Telephone No. -714 �Q4 - 11_28 Bus. Phone ^ f U 9Q 4 - 9120 Property Owner Information (required) Tenant/Emergency Contact (required) Name C- Name 'SLfvA Mtd CL. Address 064a'L CGjlkaNcS Home Address 41755 6%9ec \ Age City Lrf" A. �t� State/Zip C D S City a (�`atftc , State/Zip CA k7pa> Telephone No. 3(b - CS - 3-71� Telephone No. �(QL- 32[- I (,$3 THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or [`Existing Building IS THIS BUILDING FIRE SPRINKLERED? ❑ Yes [RrNo CHECK ALL THAT APPLY: 1il Change of Business Owner ❑ Change of Occupant ❑ Change of Use ❑ Additional Occupant • Indicate former type of business Re,-,knmaPA { a4fi 'F.,J • Are you requesting that the electricity be turned on? ❑Yes ❑ No • Will operations produce dust/wood shavings or similar material? ❑ Yes 561NO • Will operations involve the repair or replacement of automobile parts? ❑Yes p'No If yes: Describe the components repaired or replaced. • Does the operation involve the use of welding or open flame? ❑ Yes Ef No • Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? ❑ Yes Eallo • Will there be storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? ❑Yes dNo • The following best describes my operation: ❑office Only ❑ Retail Sales ❑ Medical/Dental ❑ Warehouse/Manufacturing/Distribution [ZRestaurant/Take-Out Food ❑ Other • Will any meat products including beef, poultry, and/or fish be cooked or fried onsite? g Yes ❑ 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: E4'Yes ❑No Grease Interceptor Verified For Official Use Only Occ Group: g Occ Group: Occ Group: Total Sq Ft Occupied: Bldg. Permit # ` Planning Initials: Dater Inspected By Initials: Date: Area: l UO Occ Load: 2- Area: Occ Load: Area: Occ Load: No. of Stories: TIF Review- Entitlement #: Zoning Use Permitted: Y / N Parking Meets Code (for use): Y / N Building Reviewed By Initials: _Date: l / ,o Conditions of Approval or Other Notes n/k-a v19.1 ..L x South Coast ti Air Quality Management District , 21865 Copley Drive, Diamond Bar, CA 91765-4182 Phone Number (909) 396-3529 http://www.agmd.gov fQ& p ' 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: kDM Vy-A,%(x Age, 4-3 City: 6A,L, ^c W-o-dc\ Zip Code: - - qa.0-7 Contact Person: it" &k Title: QED Type of Business: "kxum Telephone: Fax Number: E-mail Address: CD Applicant (print name): Sz (%kt) � Signature: Date:1 1. Will the facility release air pollutants, including but not limited to, dust fumes, gas, mist, odors, smoke, vapor, or a combination of these to the atmosphere? ❑Yes 2to 2. Will the facility res It of fuel -burning equipment including, but not limited to, boilers, generators, and internal combustion engines? ❑Yes WNo 3. Will the facility result of hazardous materia s, including but not limited to, chemical, plastics, rubber, resins, solvents, paints, and other parts cleaners? ❑Yes NNo 4. Will the facility have use of above or underground storage tank? ❑Yes 5?'N"o 5. Will the facility consist of manufacturing, fabrications, finishing, or treatment of wood, metal or plastic products? ❑Yes Ev No 6. Will the facility result in the use of the equipment listed below? ❑Yes ❑No (Select all that apply) ❑Abrasive Blasting Cabinet/Room ❑Internal Combustion Engine (rated > 50 bhp; e.g. back-up generator) Air Conditioning System (containing > 50 Ibs of refrigerant) ❑Mixing/Blending of Liquids and/or Powders ❑Application of Paints/Adhesive/Resins ❑Baghouse/Dust Collector ❑Bakery Oven (gas fired) ❑Molding /Extruding/Curing of Plastic ❑ Pharmaceutical/N utraceutical ❑Plasma/Laser Cutter 91boiler/Water Heater (max. heat input = or > 1 million BTU/hr) ❑Printing/Coating/Drying ' Uv Charbroiler/Smoker ❑ Pr duction of Fumes/Dust/Smoke/Odors ❑Coffee Roaster/Afterbunner efrigeration Systems (containing > 50 Ibs of refrigeration Veep 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). 0jq- ouT youth. 'Coast Air Quality Management - DIS"trict 21865 Copley ON6, Diamond Bar, CA'94765-4182 Air '''Quality Perm -it'd .,hecklist Small BusinessAssisfanee of tmallbizassist.ance@aqmd.gov WWW:aqMd.gw California Government Code Section 65850.2.pkohibits cities from issuing a Certificate of''O&UPancy to a business without clearance from the local air quality ag6ftdy. South Coast Air Quality Management District (SCA QI�M) developed this.Air Quality Checklist as a screen evaluation.tool the clearance d screening in process require, pursuant*to Section 651.50' Please provide a response to all questions this checklist., provi ons on s If you have .any 'questioh or need assistance completing this ehecklist, please contac'-t.fhe� SCA'QMD's'Small Business Assistance Office, and a representative will help you complete the, inkrmation.in the checklist. NOTE- If there are any demolition or renovation activities that may distiirb' building materials„ please contact the Asbestos Hotline at K W5 IS X" P T 1 Business Xaine6. 2. Address: CA 4A41 S . treet City zip 3. Contact Name: SvW(A-. Rtvj CkAc> Telephone Number: Title: Email: r, :S t-kv CK00 M k COM Please ;provide a detailed description of th.e business operations to be performed and equipment to be used at this location: . Vioaa . . . . . . . . . . . . . . Please'respond to all questions as it relates to the. business activities to be performed at this location. business ,.Will. L. Result 'in -the release. of airpollutarits, including butnotlimiited to, dust, fbines'ga$1 018t"'0dorg, smoke, vapor, or a combinadon:4 these tothe atmosphere? Yes (go 2. -Result ffi the use of fuel burning equipment itcludirig,:butnot limited.'to . , boikrs- generators,. and iniemal combustion engines? yes No I Result in the use of l t & hazardQu,maerias, including but notIlmited to, chemicals; . . . -emi plastics, rubl er. resins, solvents, �� pai .and parts cleaners?. -PtSi Yes (A Rev. 6-6-17 6ilo Coco Page 1 of 2 C'>! 1- 6 <<7 I 00 Sti�lboti��he�'��clt�t t�uiesiio�lr�a�� or�#ita�le+�� > �, �fi..�ry�� 4 , � ,�• °�� . �- 3 � � -�� f , ''*a'tR,�ry�,..„pa'�, j '�t..p+"�J .:.::fs� r: •(' .�=��. Pam. iP ':t9a S' Ci'.:"'c "�'4. +-g.n.�i(,.'..xi �ft�.:rr "bm� ,i•.�".Y'm�t�� i�..� ..'-3.: 4. Result in the use of an above or underground storage tank? Yes 5. Consist of manufacturing, fabrication, finishing, or treatment of wood, metal or plastic products: Yes Q b. Result in the use of any of the equipment listed below: Yes No (Select all that apply) I� Abrasive Blasting Cabinet/Room ❑ Soldering Oven Air Conditianirig Systems (containing > 501bs of refrigerant) ❑ Spray Booth ❑ Application of Paints/Adhesives/Resins 0 Storage of Acids/Solvents/Organic ❑ Baghouse/Dust Collector .Liquids/Fuels . . ❑ Bakery Oven (gas4ired) ❑ Storage Silos (sugar, flour, etc.) ❑ Boiler/Water Heater (max. heat input = or > 1 million. BTU/bf) l' Charbroiler/Smoker ED Coffee Roaster/Afterburner C� Deep Fryer (excluding equipment located at eating establishments) Dry Cleaning Equipment - El Electrostatic Precipitator ❑ Etchuig/Plating/Casting/Melting/Forging/Grinding/Cutting of Metals ❑ Fermentation ❑ Gasoline Storage & Dispensing Equipment ❑ Internal Combustion Engine (rated >- 50 blip; e.g. back-up generator) ❑ Mixing/Blending of Liquids and/or Powders Molding/Extruding/Curing of Plastics ❑ Pliarmaceutical/Nutraceutical Plasma/Laser Cutter ❑ Printing/Coating/Drying ❑ Production of Fumes/Dust/Smoke/Odors ❑ Refrigeration Systems (containing > 50 lbs of refrigerant) :r �s w r7 �'� •�"f 'r ro�- Faa -as .t v-- ._,., i't h rs' a y'at-< r s r e: - V. eioB�tftess�s ife tii#�oth^*;,�at ,. r� e+•,,j " `aJ' � ppuu11 7 ,yt. f �" 7. Preparer: Svc M1N Ckb Title: CEU Signature: Date: Telephone Number: of o aot,q �-.3� t- bg33 .l herehy certify by my signature above that, I am a duly authorized representative of the above -named business, and that all information contained herein is true and correct. Equipment: rD Clearance Issued ❑ Applicant has permit(s) from the SCAQNID: ❑ Applicant has filed for perrnit(s) with the SC;ACMD: d W4 ❑.Applicant is exempt from permit requirements: APPROVED a Applicant has complied xN th filing requirements of R?22: NOTE: This clearance is not Based on the infornzAticn provided, no equipment/process requiring ai.rQMDConstruct m Coast a Registration or Permit to /Operate. quality permit or registration. Page 2 of 2 Rev. 6-6-17 C71q -01 ij s! Department of Planning & Building u2000 Main Street Hntington Beach, CA 92648 Phone: (714) 536-5241 Fax: (714) 374-1647 Occupancy Application 6041 Bolsa Ave 3 HENDIFAR PAUL E & SHAHNAZ 6041 -- APN 195-053-17 Application Binder Num Street Unit Bldg Job Address 6041 Bolsa Ave 3 1 1 APN 195-053-17 RD 2812 Zoning CG Lot 10 Tract S0005 Block 11 File Number CofO? 02008-005444 Yes E2008-005533 No C2008-006575 No 62009-002138 No E2009-002140 No 02009-006784 Yes 02010-000053 Yes B2010-000347 No E2010-000645 No P2010-000655 No M2010-000684 No 02010-002674 Yes Entered By Moreno, David Date Entered 05/18/2010 u� Default Inspector Kirby, Kevin Status Expired Permit Type Certificate of Occupancy Issue Permit? ! Date 07/01/2010 Origin Counter Issued By Chuor, Phillip Building Use - City Planner Arabe, Jill Ann Building Use - County iF: New Building? Plan Checker I Kwak, Jason Description I'"*CALIFORNIS TERIYAKI GRILL -- Internal Notes CofO Number ICO2010-0026741 Choose Print Alt CofO Type Permanent Fees and Payments Sheets to Issue --- --= Issued By Chuor, Phillip Single C/O CofO Status Issued Inspections CofO Date Issued 97/01/2010 Temp. CofO Issued Date Printed Utility Release Date Temp. COFO Expiration 07/01/2010 License Number A276879 Business Name CALIFORNIA TERIYAKI GRILL Business Type Retail Business Phone (714) 894-9120 Proposed Use Former Use Conditions FOOD RESTAURANT 12 SEATS- TAKE OUT RESTAURANT Click the « button to copy the Business License information into the Certificate of Occupancy. Business Licenses Business Name 156254 ISUPREME DONUT 148778 EEOCOPY2 RAGONS PALACE 181256 RAGON PALACE CHINESE 155734 Approved Occupied Area (Sq Ft) 11,100.00 # of StoriesF1 D! Change of Owner? Elec. Available? ❑ Drinking / Dining > 50 Occupants? 01 Change of Use? Want Electricity On? Welling IF Open Flame? �j Change of Occupant? Sprinklered? Automobile Repairs? Additional Occupant? � Dust /Wood? Auto Parts Desc. • a.d Grniin Descrintion Area Construction TvDe Occuoancv Load B RESTAURANT 1100 23 B RESTAURANT 1100 23 Group Definitio Business Use - Building or structure, or a portion thereof, used for office, professional or service -type transactions, ,....L ,.4fnn nin rnnn of rnnnriic. onrl onnn„n4c -