HomeMy WebLinkAbout10054 Adams Ave - CofO (2)WO xrqw
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J.4 1� APPLICATION FOR CERTIFICATE OF OCCUPANCY
FID CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPWENT
HUSTON erACR
(PRINT OR TYPE ONLY)
Audress
Business
Business
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Tel .i14--g B U
Orc. Grou, 51
BUILDING OWi R �� BUSINE�SOWNEWMAV'iER
1 D l3 S 1 N `C SS Y` G:?� t� `� �y_ ��Z�1 l�
Name
—� Home l
Addres.•_ Addresst�mmrnwr
City- C A L TeCI City AdrnIII`\ S E41 _Home Te-, Vf_l7S-
THIS USE WOULD BE DESCRIBED AS: �—ff
❑ NEWLY CONSTRUCTED BLDG. n C:IANGE OF OWNER � CHANGE OF OCCUPANT
i
EXISTING BUILDING ❑ CHANG( OF USE ❑ ADDITIONAL OCCUPANT ?
Indicate former use, if any Occupancy Gr.--Div.--
SQUARE FT. OF BUILDING TO BE OCCUPIED___
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NOTICE: 1. Occupancy of any building is prohioited and a business license will not be issued until the building has been f
inspected and a certificate of occupancy is issued.
2.
3.
4,
5.
No electrical service will be released for any existing building until thu 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 Cc,mmunity Development at the time this application is filed.
Change of occupancy or use inspection fee. Whenever it i; necessary to make InsaPction of a building or
premises in order to determine if a change maybe made in the character of occupancy c,r use of the building
or premises which would place the building in a different division of the same group of r,ccupancy or In a
different group of occupancy, a change of occupancy inspection lee of $ _ shall
be paid to the city.
Huntlpgtan Beach Fire Code Section 10.208 requires that building numbers must be a min mum of four(-}?
inches in height with one half (1/2) inch stroke, and of a contrasting color fror„ the b,.ckgr¢und. These
numbers must be po aed on your building in a location that is visible from the street. 1
Huntington Beach Fire Code Section 10.301 requires fire u4inguisher selection a 11 dlstribut'it-n per the 1
National Fire Protection Association pamphlet 10 (see ~everse side).
TRAFFIC IMPACT FEE
DATE P41D
AMOUNT RECEIVED
NAME _
(FOR 7FFICE USE ONLY)
OCCUPANCY GROUP PLAN CHEC1' NO.
OCCUPANT LOAD �' PERMIT NO
NO. OF STORIES —% ADMIN. ACTION_
ZONING �0��_-
_. NO PARKING SPACES
HEALTH DEPT AI?KiOVAL
UTILITIES RELEASED —.
CF iTIFICATE OF OCCUPANCY FEE $
Ap�itj'tjVED BV ' 0 C /DATE CH ANGI: OF USE OP. OCCUPANCY FEE $
U TOTAL
5-C39 Rev. UF7 COMMUNITY DEVELOPMENT
t:
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESSftAamS•Q-
2.
Person to contact in case of emergency -
Telephone number: 71 - -l75- -7:516� 714 _56 Py272-
3.
Does the building in question have electricity?
Yes
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
u
4.
The building is sprinklered?
❑ Yes
❑ No i
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 or replaced.
d
(b) Does the operation involve the use of an open fume?
❑ Yes
❑ No
7.
The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
❑ Yes
No
8.
The following best describes .my operation;
Office Only
Detail Sales
Warehouse
Manufacturing / Distribution (describe process and ena product)
Restaurant/Take Out Food
Medical / Dental
Other (describe)
I i
SUPPLEMENTAL INFORMATION
"
South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PERMIT CHECKLIST
for nonresidential buildings only
Company Name: M 1Vl Is Tay' 11- Sl�p a
Location of Property: 100 4 -8-Jatyis AV-p—
City; e� ,n�� r, 4 i� ��n _ Qa �Cn Zip Code: Cf} 9 Z 6, 4
Contact Person: 4U & 1 'R Pr N Title:. (2,j.rV\-
Telephone Number: �1 ! 14. -- 9 h 8- 9 2 72-_ Fax Numbe-:
Type of Industry/Business:
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.
1.
Will the facility have a charbroiler?
[ ] [
2.
Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)?
3.
Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings?
[ ] r']
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 F : U/ht 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 reacu: d 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?
[ ] [
Applicant: 4U tac N I P-A- ij Signature:
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is LiQt 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.
(£ 00)1388-2121
ADDITIONAL SUPPLEMENTAL INFORMATION