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HomeMy WebLinkAbout17822 Beach Blvd - CofO (105)HUNTINGTON BEACH CERTIFICATE OF OCCUPANCY 020 - 0 CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT APPLICATION (3rd Floor - The Applicant Must Apply In -Person) Business Address V1$11 &,—V, Q>UA . Su�ke. 342 AAAS CA � Business Owners Name 1 wAl 34n Business Nam( Business Type Date 12 - 2(0 - 2018 Zip Code go1(o�"1 Telephone No. Bus. Phone 11q S41- (o04q Property Owner Information (required) Tenant/Emergency Contact (required) Name- Vllwaxwy Asecci t 6s Name Address O� C— Pact Aw SLdt 24"a Home Address t1 E I 9)vv-n2l� C�( City State/Zip PA d10 �01( City I. L State/Zip CA 1 L'69t Telephone No. 5(Pl ` qV ,yo©2 Telephone No. CM " �Lo '� THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or XExisting Building IS THIS BUILDING FIRE SPRINKLERED? ❑ Yes ❑ No CHECK ALL THAT APPLY: A Change of Business Owner�"" ❑ Change of Occupant ❑ Change of Use ❑ Additional Occupant • Indicate former type of business r30� tM CAf kyy\ ppS An (A" ►►OR0.cAA • Are you requesting that the electricity be turned on? ❑Yes ;j No • Will operations produce dust/wood shavings or similar material? ❑ Yes JXNo • Will operations involve the repair or replacement of automobile parts? ❑Yes JWNo 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 C'f No • Will there be storage racks, gondolas, or shelving exceeding 5 feet 9 inches in height? []Yes KNo • The following best describes my operation: ❑ Office Only ❑ Retail Sales )q Medical/Dental ❑ Warehouse/Manufacturing/Distribution ❑ Restaurant/Take-Out Food ❑ Other • Will any meat products including beef, poultry, and/or fish be cooked or fried onsite? ❑ Yes Dd 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 141No Grease Interceptor Verified Inspected By Initials: Date: For Official Use Only Occ Group: (� Occ Group: Occ Group: Total Sq Ft Occupied: 1400 Bldg. Permit # Planning Initialsi—bl—Datet..1 - Iq Conditions of Approval or Other Notes: Area: 1400 Area: Area: No. of Stories: L+ Entitlement M Use Permitted: / N Occ Load: Occ Load: Occ Load: TIF Review: Y/ Zoning: T'r 4 Parking Meets Code (for use)6/ N Building Reviewed By Initials:__fAJ Date:11 2 btq-002t South Coast Air Quality Management District 21865 Copley Drive, Diamond Bar, CA 91765-4182 Phone Number (909) 396-3529 http://www.agmd.gov 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: )UY 11A �,V k c la Q Property Address: 17 2 a. 2 - ?5CGtCL G (U- u.0 Ve- �; y 2" ` City: Zip Code: �1 a V4-7 Contact Person: Title: QYe S� Type of Business: SLA r Telephone: `1 f `� kq 7- ZjOVY Fax Number: E-mail Address: � Y) J S " . //� Applicant (print name): �4C t IUIY eC *wY� Signature: - 1c fwr��ate: i 2, ej 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? ❑t Yes No 2. Will the facility result of fuel -burning equipment including, but not limited to, boilers, generators, and internal combustion engines? ❑Yes J�JNo 3. Will the facility result of hazardous matelials, including but not limited to, chemical, plastics, rubber, resins, solvents, paints, and other parts cleaners? ❑Yes No 4. Will the facility have use of above or underground storage tank? ❑Yes ;KNo 5. Will the facility consist of manufacturing, fabrications, finishing, or treatment of wood, metal or plastic products? ❑Yes XNo 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) ❑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 ❑Coffee Roaster/Afterbunner ❑Mixing/Blending of Liquids and/or Powders ❑Molding /Extruding/Curing of Plastic ❑Pharmaceutical/Nutraceutical ❑Plasma/Laser Cutter ❑Printing/Coating/Drying ❑ Production of Fumes/Dust/Smoke/Odors ❑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 ❑Gasoline Storage & Dispensing Equipment ❑Storage Silos (sugar, flour, etc.) 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). Dfq-002A� i y j J M ! m U C u u.r M 3 W Q( O? a v G = w z _ c' =LLIJ O - cu 2 e!.{. U — 1 �) x! � = i G N O O ;- { —# ` { z c c enZIT O G c p fro oil - oo 2,t .�-: +1:'a.�-dYl� ' -:r y?«;i r..01 ;•,+, ;: y:� .+, ��._ . J. t�, .. _rn-,`. '.+1s.-',!71?i"'�z• a., ..- 'Application For yj �.��yO, Certificate of. Occupancy ;I City of Huntington BLJch, California Date JUlY 'i 4 -/ �is �n hereby made for a Certificate of Occupancy for a:Apolleation mddioal praotioe f)escr.ibe bus_ine�ss Use To be known as John P. Morey, M• D, Name of Business Located at 1?822 Beaoh Blvd, Ouite_342 _ Business Address Amerioan Medibbrp, Bala Cynwyd, Pa. _ Nance: BUILDING OWNER Address City 7.tp Phone No. This use would be described as: Eiew Building@Existiti Hulldind:]Change of Use❑Change of Ownerahange of Occupant Indicate former use if any _ _ Jothh P. Mor6j, M.D. 2919 Ellesmere. Costa Mesa, Ca, 9262E Name: BUSINESS OWNER Residence Address City .Zip Phone No. - Business: 8424491 _ kesidence: _^557-_ 2' 243` ICE: 1. Occupancy of airy building is prohibited by law and a business license will not be issued until the building tins been inspected and a Certifie'ete of Occupancy is issued. 2. No e'+.ectrical service will be released for any existing building until the service has been inspe,:xed and certified safe. All applicants for occupancy in an existing building are required to schedule an electrical "fuse up" inspection in the Department of Building and Cc•mmunity Development at the time this application is filed. Ot:FICE USE ONLY (below this line DEPARMIENTAL APPROVALS RECEIVED: ci 1. Bu,ilding Department 4. Public Works Department. ��+z Name Date Name Date 2. P), 4ning Department S. H p th Depart ent �O -- > - 7 V _ k , ,(j )a` � 3 Naive Datr. Name D to t 4.,Fire Depart ant (` ' t N. irie Date SUPPLEMENTAL INFO .MAIVION rut , .Lulu, ft. of buildin i Sq. g SJ Plan C3 hec No. Occupancy Group -'Z Permit No. �_ + Occupant Load _ Admin. Action _ No. of Stories No. Parking Spaces 074-009) Utilities Released _ fu U2 0 . i. +•_!+•,...,a at+Tr •. p::"._,., J.,s.�r.};.:-., �,:. �... .. <..._<a�..... .,, �. -:.y-. .,-ri ♦��.: s.�.�,- it?t +`.±::':'7=;'�.; °.. e_. :a'?7��, 'F �wai: .d.q,'��"�7•.- q.. f h� r � t :t . "{: �i; -a . -:%' rr;.i�`,/r r a$�, . �p.: Application For Certificate of OCCupBncy City of Huntington Beach, California Ivl. U 1911. Xp l..ication is hereby made *for a Certificate of Occupancy f P M,60cal-Offi-ce Describe use 'To be known as Stanley Rosenblatt, M.U._& Leo F. 3tock, M.D. - Internists - suite 342 Name of business Located at 11$12 Beach Md., Hutiti446r< Beach, C81if. 92641 Address I;y Nii iti'nk 'i i�'n 'Assbci ates , -41992 2682 Michel son St., Suite 201, N : B. 83338353 6-14-71 'Owner of Building Address Phone No. Date This use would be described as: New BuildingED Existing Building L--jjChAnge of UseE:]Change of Owner` Indicate fortaer use if a>>y_Management Firm _ PERSON TO NOTIFY IN CASE OF EMERGENCY: Stanley RotOhb'latt, M:D. or Leo F. Stock, 14.9. 178?-2 Beach Blvd.., 842-4491 Name BUSINESS OWTER Address Phone No. NOTE: A business license will not be issued until the building has been inspected and a Certificate of Occupancy is issued. OFFICE USE ONLY DEPARTMENTAL APPROVALS: 1. Vlanni.ng Department Name Date 2. Fire Department Name Date 3, Biti ldi.ng Department Date .4. HealLh Department. Name - - Date SUPPLEMENTAL INFORMATION Sq.ft. of building n) /V Oceupancy.Group Occupant Load ` �? Remarks: a Remarks: Remarks: �s Remarks : ____ _— C No. Parking spaces C. E. or U.P. No. Utility Release , Permit No. 41, !2,; . _: W, . <