HomeMy WebLinkAbout101 Main St - CofO (33)i 7
Certificate of OccuiDa ev No. O2®0gt9n-q604_q.
1
714/536-5271
Business Licen
Business Addr(
Business Owne
Business Name
Business Type
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF H>IJ1®17[ IN GTON BEACH - DEPT. OF BUILDING & SAFETY
/ 1� 1 &7—72�
(P Floor — ]Must Apply In -Person)
Date
Zip Code
Telephone No.`71�f V N
Bus. Phone
PrRperty Owner I formation (re iced) Tenant/EmergencyContact (required)
Name & �� Name q
Address 101 UAS� Home A dri ss Z�- 6
City State/Zip 949W City State/ZipC& %-7Z (�yV
Telephone No. Telephone No. 72/ L/' 717 - Sro I I
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or "PC- 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 electricit be turned on? YesONd%
• Is the building sprinklered`? Yes JNo❑
• Will operations produce dust/wood shavings or similar material? YesON011fic
® Will operations involve the repair or replacement of automobile parts Yes [.]No 14 If yes: Describe the
components repaired or replaced.
• Does the operation involve the use of welding or open flame? Yes ONO
13 Will the business be a drinking, dining or assembl use with an occupant load of more than 50 persons?
Yes ONo` 6 la The following best describes my operatio CAOffice Only ❑ Retail Sales ❑ Medical/Dental
[IRestaurant/Take Out Food ❑ Wareho Manufac ng/Distribution
(describe process and end product)
❑ Other (describe)
For Official Use Only
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area:
Area:
Area:
No. of Stories:
Entitlement #:
Plnr Initials: Dater Plan Chkr Initials:
Conditions of Approval or Other Notes:
Occ Load:
Occ Load:
Occ Load:
TIF Review: Y/
Zoning:
Date: Insp Initials: Date:
R'—j Cc L*o
Inspection Date:
(G:Building/Forms/document id goes here)