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Certificate of Occuvancv No. 0200 1
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH — DEPT. OF BUILDING & SAFETY
Business License # EV / 11,
Business Address ►()1 A f
Business Owners Namej�
Business Name 0t\r-e-Z-Vti-e
(3`d Floor - Must Apply In -Person)
Date 2 10
-,6e Zb�- ,�, a2(o f'� Zip Code a
v cl— Telephone No. :71 4 - L� 1-qq
X , Bus. Phone -11 Q - (A.41-1 13
Business Type C u I + L`��
Property Owner Information (required) Tenant/Emer enc Contact (required)
Name / %1e l�uald � 2 vci CO . Name L
Address Home Address 02
City vk _�` �ln _.State/Zip 192C,t0 City 9- 3 State/Zip
i elephone No. 714 � 2"1►-t - 04.9 7"� Telephone No. 1�-Q - %�� " J`� � O
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occupant ❑ Change of Use 0 Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity turned on? Yes 0No
■ Is the building sprinklered? Yes VNo❑
■ Will operations produce dust/wood shavings or similar material? YesONop--*,
■ Will operations involve the repair or replacement of automobile parts Yes ONo If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes ONO
■ Will the bus' ss be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ❑No
■ The following best describes my operati4�
Office Onl Retail Sales ❑ Medical/Dental
ElRestaurant/Take Out Food ❑ Warehouse anufacturing/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: Occ Load:.
Area: Occ Load:
Area:
No. of Stories:
Entitlement #:
Plnr Initials: Dat` 16 Plan Chkr Initials: Date:
Conditions of Approval or Other Notes:
Inspection Date:
Occ Load:
TIF Review: Y/&
Zoning: gtS — (.-2-.
Insp Initials: Date:
(G:BuildingTorms/document id goes here)