HomeMy WebLinkAbout10069 Adams Ave - CofOAPPLICATION FOR CERTIFICATE OF OCC4iPANCY
CITY OF HUNTINGTON BEACH,— �
` DEPARTMENT OF COMMUNITY DEYFLADP� VgCt- 2'I'
Rurrrurcaw eFwOt (PRINT OR TYPE ONLY) DATE
9 0�
l w.sAddr•�s.; � — District
Business Name 21101 l j4-4-I! C_ S Tel��
Business Type fit- '}'� `� 1 Occ. Group_4
hh BUILDING OWNER BUSINESS OWNER/MANAGER!
Name irrli.w.ev. F �n�+P�v-�iaS Name teaw, IA.
Address b O F 5't 'a �!;, , Home 81 :•i-� 1 f S ra r� Q ZTc e
1 ee � t�+si _ Address—_ _
City cr-!q Ag�.�.t�— i-%���.� Tet .` �
y 9a � oA98
THIS USE 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�f."� �`1-O tie Occupancy Gr.—Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED t I Q 6
NOTICE:
1
1. Occupancy of any building is prohibite, 1 ar,d a business license will not be issued until the building has been
inspected and a certificate of oc rupar y is issued.
2. No electrical szrvice Will be released fo. 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
'fuse up' inspect.on in the Department of Community Development at the time this application I: filed.
3. Chaege ;; cccupancy or use inspection fee. Whenever it is necessary to make inspection of a building or
premises it order to determine it a change may be made in the character of occupancy or use of the building
or premises which wouli place the building in a different division of the same group of occupancy or in a f
different group of occupancy, a change of occupancy inspection fee of $ shall
be paid to the city.
4. Huntington Bea :h Fire Code Section 10." 08 requires that building numbers must be a minimum of four (4)
inches in height with .ne half (/2) inch stroke, and of a-ontre5ting 3olor from the background. These
numoers must be posted on your building in a location that is vb�,ole from the str.at.
5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection ,nd distribution per the
National Fir.; Protection Association pamphlet 10 (see revery ..*ide).
to
TRAFFIC IMPACT FEF
DATC PAID
AMOUNT REt'EIVED
NAME (FOR OFFICE USE ONLY0
ZONING_
OCCUPANCY GROUP PLAN CHECK NO. NO PARKING SPACES '
OCCUPANT LOAD PERMIT NO _ _ HEALTH DEPT APPROVAL
NO. Or STORIES 1 ADMIN. ACTION _ UTILITIES RELEASED _
i I
CERTIFICATE OF OCCUPANCY FEE $ If�'�
APBROVED 9Y DATE CHANGE OF USE OR OCCUPANCY FEE $
TOTAL $
75-039Rev.1/91 COMMUNITY DEVELOPMENT �'`✓1`!
i
.. ��_ __ •, _ _ _ of .: \ _ _ •..� ..:
Y
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS
i
2.
Person to contact in case of
emergencyl'%M� `-" �'�
}
i�4AJ� (f
Telephone number:
g6 8 -zsy
3.
Does the building in 'question
have electricity?
❑ Yes
43—No'
(a) If No, are you requesting
that the electricity be
1;1—lres
turned on?
❑ No
4.
1-he building is sprinklered?
❑ Yes
5.
Operations will produce dust/wood shavings or similar
material?
❑ Yes
8'No
I
6.
Operations will involve the repair
or replacement of
`t Yes Ir
automobile parts?
l
If Yes:
(a) Describe the components
repaired or replaced.
(b) Does the operation involve the use of an open flame? ❑ Yes
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Yes
El -No
8. The following best describes my operation;
Office Only
--T Ret,L -' Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant/Take Out Food
Medical / Dental
Other (describe)
1 . r
SUPPI_EV4E +1TAL INFORMATION (Continued
Does the operation involve any of-`+.Iie� "fbllowir�g "mal,.erial,?
If Yes, indi`ca d -uantltles:
1Vlaterio1- •* ` '_•_ ''` s. Quantity _
1. Flammable liquids
Class 1-/
Class I-B
-Glass I-C
2. Combustible I"c ulds
Class 11
...__Class III -A
3. Combination flammable liquids
4. Flammable gases
5. Liquefied flammable gases
6. Flammable fibers - loose
7. Flammable fibers - baled
8. Flammable solids
9. Unstable materials
10. Corrosive liquids
j71. Oxidizing material -gases
I<: -Oxidizing material - liquids
13. Oxidizing material - solids
14. organic peroxides
15. Nitromethane (unstable materials)
16. -._.Ammon um nitrate
17. Ammonium nitrate compoi,nd m xtures
containing more than 60% nitrate
by weight
n�
18. Highly toxic material and
pot- ous gas
19, Smorceless powder _
20 Slack sporting powder
I hereby certify that the above information is true and correct to
the best of my 'now dge.
Signature Date
t -
South Coast
Air Quality Management District
21865 E. Copley Drive, Diamond Bar, C-,. 91765-4182
(909) 396-3529 - http://%vArw.aqmd.gov
Air Quality Permit Checklist
California State Law Code 65850-9, prohibits cities from issuing an occupancy permit without
clearance from the local air quality agency. This checklist will deters-. ne if you need to obtain
clearance from the South Coast Air Quality Managemen., District i.AQ1�m).
Company Name: D C,-',-k- 5 T-,O-,r Co " C- S
Property Address: I o -o 6 c? Azloo-, 5 A-,r--
City: Zip Code: 9 -A- 6 L( J.
Contact Person: W, w-, Titre: 6)
Type of Business: r Telephone: (7 ty-) c? 6 S-- 1 '7 5" 1
Applicant (print name) Signature:
• Will the facility have any of the following equipment? YES[ NO [,T
Charbroiler
Dry Cleaning Machine
Spray Booth
Printing Press (scre,n/lithographic/flexographic)
Internal Combustion Engine (greater than 50 BP (excluding motor vehicles)
Boiler/Combustion Equipment (greater than 2MM BTU/hr. maximum input)
Abrasive Blasting Cabinets/Roorr.s
Baghouse/Cartridge-Type Dust Filter/Scrubber
Motor Fuel Storage & Dispensing Equipment
• Will any of the following operations be performed? YES j
Application of Paints and Adhesives
Etching, Plating, Casting or Melting of Metals
Plastic Moldiig, Extruding or Curing
Mixing and Blending of Liquids and/or Powders
Storage of Acids Solvents Organic Liquids or Fuels
Production of Fumes, Dust, Smoke or Strong Odors
(f you answered "NO" to both questions, this checklist is your clearance from AQMM. If you
answered "YES" to either question, you must contact the AQMD to determine if air quality
permits ar-- required. If permits are needed, AQIvM will assist you in submitting permit
application(s) and then provide you with a clearance letter. If you have any questions, please gall
AQNM's Small Business Assistance office at (800)-CUT-SMOG, and press 41.
I
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PITY OF HUNTINGTON BEACH
DEPARTMENT OF BUILDING & SAFETY
Prone (714) 536-5677
X-CORRECTION NOTICE
❑ INSPECTION REPORT
❑ STRUCT'URAL ❑ ELECTRICAL ❑ PLUMBING
❑ f\SCHANICAL ❑ OTHER
JOB ADDRESS 0D& rrA���'O 5
PERMIT NO. 0 1 V
3 y�?vteti r a ME 6►4CL
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►�v Y�r<-i-k,f��
16
IF THERE ARE ANYQUESTIONS, P EASE, ALL ME AT:
�✓`o , BETWEEN
TIME iNSP CTOR DATE