HomeMy WebLinkAbout10041 Adams Ave - CofO (2)CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
Da! -
Address
District
Business Name
LJ !`b.'
Tel.
Business Type
Occ. Group
BUILDING OWNER
BUSINESS OWNER/MANAGER
jL. . 1.1 V 1
Name
Name
Address v
Home
Address
ti j,
L
L
U
i. i. L Home
City
Tel.
city
Tel.
Corietruction
No. of Stories
Occupant Load
Sprinklers
CONDITION-,- OF APPROVAL
This Certificate of Occupancy
SNAIL BE posted in a conspicuous place an the
premises and shaft not be iemoved except by the
Building Official.
DEPARTMENT OF COMMUNITY DEVELOPMENT
by
COMMUNITY DEVELOPMENT
AP L.I I N FOR CERTIFICATE OF 0,.,CUPANCY q
CITY OF HUNTINGTON BEACH /
f'+� An R:!AENT OF COMMUNITY DEVELOPMENT a ���`Y/�7
HUNTE7raoN eFwoi �(PRINT OR TYPE ONLY' DATE
.dress %r0//l Aged_-ns A District
Business Name 411W k-We 1c. o.D. K LI i , eY.+'YIa4,1SPA'! e.,D- Tel �lOa—�377 _
Business _ ype __ i i2lw_ -)cc. Grcup
BUILDING OWNER BUSINESS OWNERIMIs 'AVER
Name ✓C P (�nWli,`.1 /&,16110' CY/f �'o ? S Name t2l//iL
Address%U. o� •�V� Sf • cSr('- a��� Home
Address
City_ 4fP ] 612 / (Ar . *B)k Te 96121 City pu�/ll VQ//ell C!<E- Home Tel. 9/� !
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. CHANGE OF OWNER ��-�'. ❑ CHANGE OF OCLUPANT
XISTING BUILDING ❑CHANGE OF USE ❑ ADDiT'7N ;L OCCUPANT
Indicate former use, if any �t`� Occupancy Gr. —Div._
SQUARE FT. OF BUILDING TO BE OCCUPIED ��oa
NOTICE: 1. Occupancy of any building is prohibited and a business licens3 will not be issued until the building has been
in -�pect3d and a certificate of occuoancy is issued.
2. No e,ectricaf service will be released for any existing bLilding until the service has been inspected and
certified safe. All applicot ;ts for cccupancy in an existing building are required to schedule an electrical
'fuse ups' inspection in the Department of Community Development at the time this application is filed.
3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection or a building or
premises in order to determin- if a change may be made the character of occupancy or ua4) of the building
or premises which would place the building in a different division of the same group of occupancy or in a
different group of occupancy, a change of occupancy inspection fee of $ _ shall
be paid to the city.
4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum L, four (4)
inc,.es in height with one half (1/2) inch stroke, and of a contrasting color from the hackground. These
numbers must be posted on your building in a location that is visib's from the street.
5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see rever a side).
�J �rr�aZ 7
TRAFFIC IMPACT FEE_
DATE PAID
AMOUNT RECEIVED
5. . qAIL
NAME
r
_
(FOR OFF*4CE USE ONLY)
a�_
SUPPLEMENTAL lNFORMA''!ON
ZONING_
OCCUPANCY GROUP
PLAN CHECK NO
NO PARKING SPACES
OCCUPANT LOAD
PERMIT NO
HEALTH DEPT APPROVAL
NO. OF STORIES T—
ADMIN. ACTION _
UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE
APPROVED BY
DATE CHAh GE OF USE OR OCCUPANCY FEE
$
TOTAL
$ r_
75-039 Rev.1197
COMMUNITY DEVCLOPMFIdT
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS A0341
J
2. Person to contact in case of emergency*���/�
Telephone number:
3.
Does the building in question have electricity?
W Yes
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ "o
4.
The building is sprinklered?
❑ Yes
f� No
5.
Operations will produce dust/wood shavings or similar
material?
❑ Yes
No
6.
operations will involve the repair or replacement of
❑ Yes
automobile parts?
No
If Yes:
(a) Describe the components repaired of replaced.
,b) Does the operation involve the use of an open flame?
H
❑ Yes
❑ No
7.
The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
L; Yes
No
8.
The following best describes my operation;
Office Only
Retail Sale,,
Warehouse
Manutacturing / Distribution (describe process and end product)
,estaurant / Take Out Food
r
cfi Dental
Other (describe)
;
SUPPLEMENTAL I`VFUtiA+fATION
60
i
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following
materials? ❑ Yec
P�No
If
Yes, indicate quantities:
Material Quantity
1.
Flammable liquids
_
Class I -A
Class I-B
Class i-C
2.
Combustible liquids
Class 11
l
Class III -A
3.
Combination flammable liquids
4.
Flammable gases^
5.
Liquefied flammable gases
6.
Flammable fibers - loose
7.
Flammable fibers - baled
i
8.
Flammable solids
9.
Unstable materials
10.
Corrosive liquids
11.
Oxidizing material - gases
12.
Oxidizing material - liquids
13.
Oxidizing material - solids
14.
Organic peroxides
15.
Nitrornethane (unstable materials)
�^
i6.
Ammonium nitrate
'
17.
Ammonium nitrate compound mixtures
containing more than 6011,`e nitrate
by weight
"8.
Highly toxic material and
poisonous gas
19.
Smokeless powder_
20.
Black sporting powder
I hereby certify that the above information
is true and correct to
the best of my knowledge.
Signature
Date
Sout►l Coast
AR QUALITY MANAGEMENT DISTRICT
1z) 2186:: E. Cooley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR Q1UAI,IT`x 7PERTMIT CHECKLIST
for rion. lential buildings only
Company Name: l%J-)d! AeV1 a
Loc;�:tion of Property: /v0`f/
City: 1,41tc 2LIr6 f7Y1 &X&I� OW- Zip Code:
Contact Person: &C L rt Title: _/
Telephone Number: (/!y) 6,-z—g377 Fax Number. _
Type of IndustryBusiness: „ 2�
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about conipleiing this checklist, please call (800) 388-2121.
YES
NO
1. Will the facilit- have a charbroiler? [ ]
(�(]
2. Will any internal combustion engine wridi greater than 50 horsepower
operate at the facility (excluding motor vehicles)?
3. Will operations at the facility involve mixing, blending, or pr.�cessing of
solvents, adhesives, paints or coatings?
4. Will dust or smoke be generated at the facility'!
5. Will refining of any liquids or solids be done at the facility?
6. Will any plating or coating of materials be done at the facility? [ ]
7. Will any combustion equipment rated greater than 2,000,000 BTU; ,ir be
operated at the facility?
8. Will any acids, solve.ats, or motor fuel be used or stored at the facility? [ ]
9. Will any organic ligrdds or gases be reacted or pro - weed? [ ]
10. Will any ovens be used to dry or cure products at the facility? [ ]
�A
11. Will any CFC (Freon.) recycling mac: aes operate at the facility?
Applicant: Lind! 14-'!/PGIti Signature:
(Print name clearly,i
If you have marked "NO" in all the boxes, an air quality permit is not needed at this time,
and this checklist is your written release.
If you marked "YES" in any of the boxes, you must contact the South Coast Air Quality
Management District (AQMD). Please read the requirements on the back of the checklist
(s00) 388-2121
ADDITIONAL SUPPLEMENTAL INFORMATION