HomeMy WebLinkAbout10056 Adams Ave - CofOs
CERTIFICATE OF OCCUPANCY
7/ 17 y 9 9
j
CITY OF HUNTINGTON BEACH
Date
Address 10056
A DAMP
District
ROYAL
DONUTS
714--378—OSI�0
Business Name
Tel.
DONUT
SALES
i
Business Type
Occ. Group _
BUILDING OWNER
BUSINESS OWNER/MANAGER
CAROLYN WHITE—UTASING
PANGS KOUGH
u
Name
Name
176-0 FITCH
A mess 16476 j•J_TNDCREST
Address
IRVINE
714--474-6900 FONTANA Home
909-.353-12)7
City
TeL
City TeL
1
31
Construction No. of Stories
Occupant Load Sprinklers
CONDITIONS OF APPROVAL
i
a �
F DEPARTMENT OF COMMUNITY DEVELOPMENT a
1 1
'R This Certificate of Occupancy
SHALL 8E posted in a conspicuous place on the f
premises and shall not be removed except by the by
Building Official.
COMMUNITY DEVELOPMENT f
A CATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
'' Ip DE RTMENT OF COMMUNITY DEVELOPMENT Ch
�rVINGR' KAGH j� DATE
V(PRINT OR TYPE ONLY)
Business Name _ Tel.
Business Type Occ. Gr-up
BUILDING �GOOWNER BUSINESS OWNLh,MANAGER
Name��-� G Ly N 1�. LR)LEAS i N6 NameHal
Address �� Lr�- f Address l i� �/i'V! -rP 4 ,
City�YVL12�T1 �1 ___I"el/ 6cCityT231A CAR =3 3 Home Tel �`^ i2'q
THIS US. WOULD BE DESCRIBED AS: ��
❑ NEWLY CONSTRUCTED BLDG. & CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
❑ EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any 5/�AE, Occupancy CI. __Div,
� 2
SQUARE FT. OF BUILDING TO BE OCCUPIED /` `�1n "+ S O
NOTICE: 1. Occupancyof 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 released for any existing building until the service has been inspected and
certified safe. All applicants for occupancy in an existing building are required to schedule an electrical s
'fuse up' inspection in the Department of Community Development at the time this application is filed. a
3, Change 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 3
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 of four(4)
inches in height with one half (1/2) inch stroke, and of a contrasting color from the backgrcund. These v
numbers must be posted on your building 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
National Fire Protection Association pamphlet 10 (see reverse side).
Pg
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TRAFFIC IMPACT FEE
DATE PAID
AMOUNT RECEIVED
NAME (FOR OFFICE USE ONLY) ZONING--
SUPPLEMENTAL INFORMATIONZONING—
OCCUPANCY GROUP PLAN CHECK NO. NO. PARKING SPACES
OCCUPANT LOAD PERMIT NO. HEALTH DEPT. APPROVAL -
NO. OF STORIES ADMIN. ACTION UTILITIES RELEASED —
7
CERTIFICATE OF OCCUPANCY FEE $
APPR VE Y DATE CHANGE 1W USE OR OCCUPANCY FEE $
TOTAL $ar
75.039 Rev.1/97 COMMUNITY DEVELOPMEPR
SUPPLEMENTAL INFORMATION
I:
1.
BUSINESS ADDRESS )-Qc)5-6 AJA m-n /P� H B CA
M 1
IJ
2.
Person to contact in case of emergency _
is
Telephone number:
h
i
3.
Does the building in question have electricity?
Yes
0 No
(a) If No, are you requesting that the electricity be
❑ Yes}
i!
turned on?
❑ No
4.
The building is sprinklered?
O es
i
5
Operations will produce dust/wood shavings or similar
r� o
material?
es
6.
Operations will involve the repair or replacement of
No
❑ Yes
automobile parts?
ErNo
If Yes:
(a) Describe the components repaired or replaced.
i
(b) Does the operation involve the use of an open flame? CJ Yes
❑ No
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Xes
No
8. The following best describes my operation;
O e Only
etail Safes
Warehouse
Manufacturing / distribution (describe process and end product)
r�
Restaurant I ake Out Food
Medical / Dental
Other (describe)
)
t
i
{
SUPPLEWNTAL INFORM A'i ON
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials? Yes
.l1'No
If
Yes, indicate quantities,
Material Quantity
1.
Flammable liquids
Ciass I -A
Class I-B
Class I-C
2.
Combustible liquids
Class 11
Class ill -A
3.
Combination flammable liquids
4.
Flammable gases
5.
Liquefied flammable gases
6.
Flammable fibers - loose
7.
8.
Flammable fibers - baled
Flammable solids
9.
Unstable materials
10.
Corrosive liquids
11.
Oxidizing material - gases
12.
Oxidizing material - liquids
13.
Oxidizing material - solids
14.
Organ'^. peroxides
15.
Nitron,ethane (unstable materials)
16.
17.
Ammonium nitrate
Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight
16.
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. �J
Sig ature -- Date
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South Cow
AIR QUA[ ITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PERMIT CHECKLIST
for nonresidential buildings only
Company Name:
Location of Prope
City: atAl vl4SY-� 8��J,_ ? Zip Code:
U
Contact Person: Title: `D 0,JG1,a'
Telephone Number: Q i lj KS -_'97 Fax Number:
Type of Indust—y/Business: �rUT'p�y� lC 4
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
1. Will the facility have a charbroiler?
2. Will any internal combustion engine with greater than 50 horsepo Yver
operate at the facility (excluding motor vehicles)?
3. Will operations at the facility involve nixing, blending, or processing of
solvents, adhesives, paints or coatings?
4. Will dust or smoke be generated at the facility?
5. Will refining of any liquids or solids L,e 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/hr 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?
Applicant: _ G � Q d C4 Signature: �'r�i 4
��—
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is not needed at thi: ume,
and this cheel-list 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
e
�d
Nurrrrr+cTOH riErai
APPLICATION FOR C�_ RTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF CC)MMUNtTY DEVELOPMENT
IPRINT OR TYPE ONLY?
Address _1ZL U - 4> rr . � ... �_�_.1<
Business Name - --A ��k�-2lrx
Business Type:
BUILDING OWNER
Name
Address 1-7� '_=_
City '>,- 2 r _ TP1 ���
e&lv 76, G-7 .° : _
THIS USE WOULD BE DESCRIBEb ASS:
r r ( �02-
IYATE
Occ Group,.
BUSINESS OWNEWMANAGER
Name_• kA!LG._._
Hom
Add essz'e 1 44
City rx� Home Tel -
f
NEWLY
NEWLY CONSTRUCTED BLUG CHANGE OF OWNER CH^NNGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USr ❑ i DOITIONAL CCCUpANT
Indicate former use, if any.ul'incy (;r _D,v
SQUARE FT. OF BUILDING TO BE OCCUPIED r, , - ` �t✓� � r < �
1. Occupancy of any building is pronibited and a business license will not be issued until tfie building has been
inspected and a certificate of occupancy is issued.
?. No electrical service will be released for any existing building until the service halt, been inspected and
certified safe All applicants for occupancy in an existing building are required to !,rhedule an electrical
'fuse up' inspection in the Def artment c' ommunity Development at the time this application is filer!.
3. Change 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 rray be made in the character of occupancy or use of the building
.ir premises which would place the building in a different division of the same groin,) of occupancy or it a
different g oup of occupancy, a change of occupancy inspection fee of $ _ __ _ shai
be paid to the city.
€. Huntington Beach Fire Code Section 10.28 requires that building numbers must bia a minimum of four (4)
inches in height with one half ('%t) inch stroke, and of a contrasting color from tie background. These
numbers must be posted on your building in a location that is visi)le from the street.
i 'Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection a;^d distril:ution perthe
National Fire Protection Association pamphlet 10 (see reverse side~.
OATsw-ANN)L�a RECEIVED
(FOR OFFICE USE ONLY)
OCCU AIICY GHOLIP _e_._.. ___ P=�AN CHECr NO
OCCUPANT t.OAO N
O OF STD' I -8
NO _ _ _ _ . _ ;L'MtN
1A/ � ? _ r - ��: ej "W,1F11 AT-" OF 000JPAN' Y FEE
A R6V1=, r MATE ,HANC,E OF USE OR OL ` jPANt." "r E,E
TOTAL
NO l'AFK'NG SPACES —
HCALTH PEP7 APPROVAL
i}TILME: RELJ:ASED .._ -
COMMUN!TY DZVELOPMENT
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS
q
2.
Person to
contact in Lase of emer,*,nc
AAA1
Telephone
number:
3.
Does the
building in question have
electricity?
❑ Yes
.No
(a) If No,
are you requesting that
the electricity be
0 Yes
turned on?
❑ No
4,
The building is sprinklerea?
>? ,Yes
El No
5.
Operations
will produce dust/wood
shavings or similar
material?
C7 Yes
�
o
5.
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?
7, The business is drinking, dining or assembly use, that will
result in an occupant toad of more than 50 persons.
LA
❑ Yes
)KNO
Yes
11TIVO
The following best describes my operation;
Office Only
retail Sales
Warehouse
Manufacturing / Distribution (describe process and end produ t
Restaurant /take Out Food
Medical / Dental
Other (describe) S
SUPPLEMENTAL iNFOEiWTION
SUPPLEMENTAL MWORY[KrION tContinuvd)
Dow �Jpern�,.fion involve any c;.' ti'i(;
Uj Yes
Hammable fiquids
Ckls3 I -A
O"ars 1-6
Ofas's, I-C
(50r6�Y_Ztible Ile, iC;
Class Ifl..A
gases
ifs able fibers - loose
T
- _ba1ed____,___,
-6--
_Unsi,_,Tdilrt fd 9. .. ... .... ..
f—jqv,
€� matedcll gases
r Fnr - liquids
c
Oxg fk i material - solids
)M, Khanc, (unstable mate, s,!
if.
Annipay' orJun--., n1traitle
4
m9' c,-0uj,,, nitrate compound
t,ortsin�-ig more, "than 600E
I&
1`lW,1!y '"Icxic material and
palsoncAus gas
povvld�%
20,
Mac!, sport�vg powder
I pertify 'hat ibe above
the best" /,of,, my knowledge.
I -' Signature
is "-.,e and correct to
Date
South Coast
AIR QUALM! MANAGEMENT D. ISTRIcr
21865 E. Copley hrive, Qiamona Bar, CA 91765.41 £2 '909) 396-2000
x'QUAL FY ]PERMIT CHECKLIST
for nonresidential buildings only
Company Namk.:�.=— - --
Location. of Property: —lo e, 3 6 -4-) A N(< Ave —
City:
ti t -..g. � -- , �_ t Zip Code: ` 2-
Contact Person: _ fL��., ,,, Title: 0 ij
Telephone Number:��.`f-) 7 - 0 '1 J 0 Fax Number:
Tyne of Industry,Business: p., rC
To apply for a nonresidential building permit, you must corapietL this checklist. If you nave .0 y
questions about; completing this checklist, please call (800) S 88-2121.
YES
NO
1. Will the facility ha, e a ch�dbroile:r?
2. Will any internal combustion engine with greater than 50 hor seg ors er
operate at the facility (excl ceding motor vehicles)?
[ ]
(A
3. Will operations at the f4ci?ity iuvolve mi-+mg, blending, or pToc -�ssing of
solvents, adhesives, pRdnt-z or coatings?
j ]
j
4. Will dust or smoke be guteruted at the facility".
[ )
Dq
5. Will refining of any liquids +zr solids be clone at the facility?
6. Will rn_y plating or coating of materials be done at the facility?
7. Will any combustion egrapment rated greater than 2,000,000 BTUIhr b,e
. - . ted at the facility?
8. Wni any acids; solvents, or motor fuel be used or stored at the facility?
r ]
9. `Will any organic liquids or gases be reacted or produced?
[ j
10. Will any ovens be used to dry or cure products at the facility?
j
�q
11. Will any CFC (Freon)) recycling machines operate at the fa,,cili
f
7i;
lti. 51 Sz a ure:7
Applicant:
e
(Prinz name clear43)
If you have marked "NO" in aII the bores, an air quality permit is n9t nee&d 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 (A.QMD). Please read the requirements on the back of the checklist.
(800) 388-2I21
South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA a1765-4182 (909) 396-2000
,UR QUALITY PERMIT CBECILIST
for nonresidential buildings only
Company Name:
Location of Prop(
City 4tUA--1 vt01TbA f�,fkr-C' _ Zip Code: T
Contact. Person: a?,�Cl.�i� Title: Q W Lj �,^
Telephone Number: Fax Number:
Type of Industry/Lusiness: R a6� - 4
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
1. Will the facility have a charbroiler? [ ]
[�
2. Will any internal combustion engine with greater than 50 horsepow—r
operate at the facility (excluding motor vehicles)?
3. Will operations at the facility involve mixing, blending, or processing 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 2,000,090 BTU/hr 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?
Applicant: j_PN�9E —)
A C kC-4 Signature: fE24nQg.!—
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is not needed at this f rae,
and this checklist is your written release.
If you marked "YES" in any of the bowies, you mast contact the South Coast Air QuaRy
Management District (AQMD). Please read the requirements on the back of the checklist.
(800) 388-2121
ADD17IONIAL SUPPLEMENTAL IPWORMATION
1