HomeMy WebLinkAbout10042 Adams Ave - CofO (4)5T -No r I')
Al t� PLICATION FOUR CE11TIFIC4TE OF OCCUPANCY
CITY OF HUNTINGTON BEACH �b4� ✓,��
�45
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNrPK,7ON BFACM , (PRINT OR TYPE ONLY) DATE
T )
Address
Business Na;,,
Business Type
Soo Yce-
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District
TeI.SF?, 33/.
Occ. Group.����
BUILDING OWNER BUSINESS OWNER/MANAGER
Name �-�3 L!)'j�L �❑ 7 Name •� �'� , ) uh �!'J�1
Address 7 t 3 / : Home // � v- 7 25 !
L Aodresso x�
City ) l,, h b - S" r- let �� � City t Z Y ar `�. �t `' %O 3 Home Tet.J'-z;z.
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THIS USE WOULD BE DESCRIBED AG:
❑ NEWLY CONSTRUCTED BLDG CHANGE OF OWNER G CHANGE OF OCCUPANT
VNEXISTING BUILDING %C% / ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, it any LICK Q?' j a Ci?"e,-Q Occupancy Gr Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED_L_� /J S 4 • (4-60 lz:�Siz-ytc, -5-00
NOTICE: 1. Occupancy of any building is prohibited and a business license will not be issued until the building has been
inspected and a certificate of occupancy is issued.
2. No electrical service will be rele.lsed for any existing building until Ike service has been inspected and
certified safe. All applicants for occupancy in an existing building are required to schedule an electrical
'fuse up' inspection in the Department of Community Development at the time this ,,Ilcation is filed.
3. Cha:,ge of occupancy or use inspection fee. Whenever it is necessary to make inspection of a building or
premises in order to determine if a change maybe made in the character of occupancy or use 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 a shall
be paid to the city.
4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum of four (4)
inches in height with one half (1/2) inch stroke, and of a contrasting color from the background. These
numbers must be posted on your Duilding in a location that is visible from the street.
5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
Nat'-nal Fire Protection Association pamphlet 10 (see reverse side).
it>•I f -
TRAFFIC IMPACT fiEi
_ _-
Dec OUK 85CEIVEP�
NAME.,` �.—..._—
OCCUPANCY GROUP
OCCUPANT LOAD
NO. Or ST I
V
A I
BY DATE
(FOR OFFICE USE ONLY)
PLAN CHECK NO
PERMIT NO
ADMIN ACTION _
CERTIFICATE OF OCCUPANCY FEE
CHANGE OF USE OR OCCUP\NCY FEE
TOTAL
75.039 Ray. 1/97 COMMUNITY DEVELOPMENT
ZONING 9
NO PARKING SPACES
HEALTH DEP-rAPPROVAL
UTILITIES RELEASED
$ `
SUPPLEMENTAL INFORMATION
BUSINESS ADDRESS
2. Person to contact in case of emergency'
Telephone number:
3. Does the building in question have electricity? L'' Yes
f2'No
(a) If No, are you requesting that the electricity be ❑ files
turned on? p No
4. The building is sprinMered? �❑ Yes
�r`N o
5. Operations will produce dust/wood shavings or similar_
material? ❑ Yes
0
6. Operations will involve the repair or replacement of ❑ Yes
automobile parts? o
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame? ❑ des
r, N o
7. The business is drinking, dining or assembly use that will f
result in an occupart load of more than 50 persons. E Yes
❑ No
8. The following best describes my operation;
Office Only
f Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant / Take Out Food
Medical / Dental
Other (describe)
SUPPLEMENTAL INFORMATION
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of *Lhe foi'sowing materials?
If Yes, indicate quantities;
^" _^Material i - Quantity - y-
1. Flammable liquids
Class i-A
—`—.- Class" 1-B
Class (-C ___
2. Combustible hquids�__ --
Class if
3. Combination flarnmable liquids -
4. Flammable gases_-
5 Liquefied Yflammable gases —
6. Flammabiti fibers - loose
7. Flammable fibers - bated
8. Flammable so, ris
9. instable rnateri 3is _
10. Corrosive Iiquid4
'11. Oxidizing materiiai - gases
12. Oxidizing materiai - liquids --v
13. -._ Oxidizing material - solids
14. _ Organic peroxides
15.� Nitromethane (unstable materials)
16. _ Ammonium nitrate
i7. Ammonium nitrate compound rr+ixti es
containing more than 60% nitrate,
by weight
18. Highly toxic material end
poisonous gas
19. Smokeless powder
20. Black sporting powder
I hereby certify that the above information
the best of my knowledge.
l/ Signature
is true and correct to
, Date
(D South Coast
AIR QUALITY MANAGEMENT ®[STRICT
21865 E. Copley Drive, Diamond Bar, CA' 1765-4182 (909) 396-2000
AIR QUALITY PE1Zl.Y11T CHEC--J IST
fbrr�nonresidential buildings only
Company Name:
Location of Property-/e' %`" da --r /�-, , 5�q
City: 44.is i1�U q Zip Code:, �-
Contact Person: L eJc-- ,t� Li h/A Title: i'-Q
Telephone Niim er:6-/ 3 ` -> 7� r S' Fax Number:
Type of IndustryBusiness:
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing this checklist, please call (800) 388-2121.
YES NO
I. Will the facility have a charbroiler?
[ } M
2. Will any internal combustion engine with greater than 50 horsepower
`
operate at the facility (excluding motor vehicles)?
j ] [ j
3. Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings?
4. Wili ist or smoke be generated at the facility?
[ ] [1
5. Wi' 'ring of any liquids or solids be done at the facility?
[ ] [
6. Will an, plating or coating of m -terials be done at the facility?
[ W/
7. Will any combustion equipment fated greater than 2,000,00013TU/%-- be
operated at the facility? [ ]
8. Will any acids, solvents, or motor fuel be used or stored at the facility? [ ]
9. Will any organic liquids or gases be reacted or produced? [ ]
10. Will any ovens be used to dry or cure products at the facility? [ ]
11. Will any CFC (Freon) recycling machines operate at the facility? [ ] [ ]J
Applicant: G(1�LI I 1 &( �--L--E Signature s �--
-----
(Print name clearly)
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.
(800) 388 -2121
ADDITIONAL SUPPLEMENTAL INFORMATION