HomeMy WebLinkAbout101 Main St - CofO (35)0
714/536-5271
CERTIFICATE OF OCCUPANCY 020� - U UOa-�2
CITY OF HUNTINGTON BEACH
DEPT. OF PLANNING & BUILDING APPLICATION
(3`d Floor — Must Apply In -Person)
r �
Business License # Date
Business Address 101 Ma i n YeL T Zip Coe *4.b k/ ?
Business Owners Name'&A 01 OC' pwkyt Telephone No.1114 9/,2 • qGq
Business Name 0. 1 no Van V tl o'dwBus. Phone ry/q %b `T - 36,
Business Type '40CLC" i v,
Property Owner Information (required) Tenant/Emergency Contact (required)
Name CCeS s i V 0-nC. aj 2tt-b✓Y-_ Name `?r-'{i,l 1�:Iyrvi
Address 1pl QUn-0t. Home Address _0_6(ol u C_"iulto b v.
City. State/Zip CAL Ct 9, U g 8 City h•? State/Zip
Telephone No. b l!1 63 L9_ Ci thy' Telephone No.
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or r Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner Change of Occu an ElChange of Use ❑ Additional Occupant
■ Indicate former type of business '�IVle�s 0�Z-'L
■ Are you requesting that the electricity be turned on? YesQNo10
■ Is the building sprinklered? Yes 'DNo❑
■ Will operations produce dust/wood shavings or similar material? YesONo.M
■ Will operations involve the repair or replacement of automobile parts Yes 11No'K If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes QNo ,i
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes l7NoA
■ The following best describes my operation: )4 Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/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: rfX Date: f 11 Plan Chkr Initials:
Occ Load:
Occ Load:
Oce Load:
TIF Review: Y
Zoning:{' J�
Date: Insp Initials: Date:
Conditions of Approval or Other Notes:
CMIC 0sE_1b112r1ti7-rLy)' wi(. —W -off l . r 1 G, yr 0, icca!o.
Inspection Date:
(G: Build ing/Forms/document id goes here)