HomeMy WebLinkAbout10044 Adams Ave - CofO (6))
J� 059
APPLICATION FOR CERTIFICATE OF OCCd1PAN -------�_
c1 CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT +gGj
f -0 U _
HUNTVIGTON �` ' (P'IINT OR TYPE ONLY) p G M
DATE
0 YV
' Address 1 ��4 (j G�y'�1, �~� ,1l�G1"� "I wr' ��,r-r"��� ,r-'' (��. � �District� 1 �} r 'Business Name f (�� Q_-C2,t� r(AJV_!_rr C�V'►i�Uv1 V� Gi7`�- _T�. 4) l3'- J500
IIn _ Occ. Grcup%
i ! ,BUSINESS OWNER)MANAGER
•Name
Address V ✓fir: •� L��~ ��l `x�
City',t�f' �!� Home Tel.LTQ L
`Business Type
BUILDING OWNER
Name
Address-0-7if '�t
City'=t="
THiS USE WOULD BE DESCRIBED AS:
El NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER � CHANGE OF OCCUPANT
JEXISTING BUILDING /�, ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use. if any_Occupancy Gr Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED 1 Q100
NOTICE: 1. Occupancy c ^y budding is prohibilad and a business license will not be issued until the building has been
inspected at,., a certificate of occupancy is issued.
2. No electrical service wlii be released for any ex:, ting building until the service has been inspected and
,e,ufied safe. All applicants for occupancy In an existing building are required to schedule an electrical
'fuse up' inspection in the Department ;,I Community Development at the time this application is filed.
3. Change of occupancy ar use inspection rne. Wherever 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 thebuilding
or prefnises 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 10208 requires that building numbers must be a minimum of four (4)
inches in height with one half (112) ir�ch s`roke, and of a contrasting color from the background. These
numbers must be posted on your building in a location that is visible from the street.
5. Huntim-ton Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
-�Pd Pj t A /oz—
gE
FIC IMPACT FFE
PAID _
,)�G" , ECEIVED _ ._"_-_
(FOR OFFi(aE USE ONLY) tt6— ,
ZONING _
OCCUPANCY GROUP _. PLAN CHECK NO _ _ _ NO PARKING SPACES
OCCU; ANT LOAD PLP1,01T NO HEALTH D PT Ar?ROVAL
110 F TOR ES ADMIN ACTION__— UTILITIES RE
f J�� r- CERTIFICATE OF OCCUPANCY FEE $
A 0V D BY DATE CHANGE OF USE OR OCCUPANCY FEE $ �
' TQTAL $
75-039 Rev. 1197 COMMUNITY DEVELOPMENT
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS jCDq'-4 PXWI�?
q,,;� (�o4
2. Person to contact in case of emergency- 1 � J MeMA
Telephone number:
3. Does the building in quest,un have electricity? , Yes
❑ No
(a) If No, are you requesting that the electricity be ❑ Yos
turned on? ❑ No
4. The building is sprinklered? ❑ Yes
No
5. Operations will pi* oduce dust /wood shavings or similar
material? ❑ Yes
�1 140
F. Operations will involve the repair or replacement of ❑ Yes
automobile parts? 0 No
If Yes:
(a) Descr�ibe the components repaired or replaced.
c
�_R
(b) Does the operation involve the use of an open flame? ❑ Yes
0 No
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Yes
N,No
8. The foli_best describes my operation;
Office Only
etail 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 inv,^ve any of tne following matehatm? 0Yes
n�"
)��vw
If Yea. ind---icate-'-- -- -----
Material {] ' 1. Fl80ol8tA8 liquids
C}|aa$ (-A
class |-B
- - ------- ----
C|aaa !-C
Combustible liquids
LJ>asa If
Class 111-A
- ---------- --------------''
3. Combination oaFDmob[e hqUid3
-
Flammab!e gases
19. Liquefied flammable gases
6. F|a[nma�)|a fibers - loose
7. F|a0n1ib|e fibers - �,,.aled
B. F|arnrnabig ooUdm
______
Si U�stabie materials
10.
11.
[;Orrosiv 8
Oxidizing
liquids
material - gases
12.
Oxidizing
nlateri8! - liquids
/D.
Ox/diz`ng
material - solids
T.
Organic penJxideG
---
15.
NitiOr0e|/l@ne (unstable materials)
__-___-_-___-____________-__�_-____-__�_-.__--__-
16.
/\[nmoA!Urn
Dl1y2t8
IT A0muniu0 nitrate compound mixtures
containinq more than 8046 nitrate
by
ht
18. Highly toxic material a/td
poisonous gas
19. Smokeless Smok lesspowder
20Black sportin6 powder
I hers --.by certify that the information is true and correct to
the of my knowledge,
-r-~---\_� Signature Date
South Coast
AIR Ql .ALITY MANAGEMENT DISTRICT
21865 E. Ccoley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY JP'ERl<�^.'�:T CHECKLIST
,,11 for nonresidential buildings only
Company Name: �'1 ay 0 % G
Location. of Property: ! 0o,` 4 Op � r? ,
City:'NT1�1�� 6pAw4 QA Zip Cade:
Contact Person: 1�%L E- Title: N I'��'
Teleohone Number: j�'� �"� �� Fax Number: -7/`F"
Type of Industrv/Business: ( yC-N-fb /�L ' POCY�L- E� rT&�.
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing this checklist, pleas-, call (800) 388-2121.
YES
N�O,
1. Will the facility` have a charbroiler? [ ]
V �
2. Will any internal combustion engine with greater than 50 horsepower
olpe*ate at the facility (excluding motor vehicles)? [ ]
11A
3. Wi'., aperations at the facility involve mining, blending, or processing of
solvents, adhesive:, paints or coatings? ( ]
4. Will dust or smoke be generated at the facility?
5. W I refusing o F any liquids or solids be done at the facility9 ( ]
5. Witt any elating or coating of materials be done at the facility? ( ]
7. Will any combustion equipment rater cTeater than 2,000,000 BTU/hrbe
operated at the facility?
8. Wi,3 any acids, solvents, or motor fuel be used or stored at the facility? L ]
D :.I
9. Will any organic liquids or gases be reacted cr produced": [ ]
1
10. WilI any ovens bs used to dry or cure products at the facility? ( ]
( ]
11. Will my CFC (Freon) recycling machines operate at th facility: ��,`l�, ( ]
�V
(-
i�'I Applicant: _ - N C, Au - `Signal ,r, �lLl'L
--
(Print name clearly)--" `-
If ou have marked "NO" in III the boxes, an air quality permit is not needed at this time,
and this checUst is your written release.
If you marked "YES" in any of the boxes, you must contact the South Coast Air Quality
Map agement District (,AQMD). Please read the requirements on the back of the checklist.
(800) 388-2121
__ ADDITIONAL SUPPLEMENTAL NFORMAT(""