HomeMy WebLinkAbout10084 Adams Ave - CofO (2)we 1111111""WA
/, �� APPLICATION FOR CERTIFICATE OF OCCUPANCY t -" 74
CITY OF HUNTINGTON BEACH ` /
DEPARTMENT OF BUILDING & SAFETYJ��
HUNTIMGTON '- - ' (PRINT OR TYPE ONLY)
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,n�1I r
Address I QMI 14'r> � District
Business Name i +, �_� " xkj::,' Tel.714 • �4,� 475-7 Business Tyoe 2e5M:�ItZA T— Occ. Group f r A: _` �
BUILDING OWNER BUSINESS OWNER/MANAGER
�I � �s*A nK;P_o C>Namelye N�%v
Name ��w
'3 ��.-�, �� ��l Home lt¢
Address Address ' L
City tayu'k � Tel �C `-q°�r�l�-a ty Tz 4A4 /'f i 1hf ��7 5� Home Tel 3LI
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG.
><XjSTING BUILDING
Indicate former use, if any
SQUARE FT. OF BUILDING TO BE OCCU
CHANGE OF OWNER
CHANGE OF USE
RANGE OF OCCUPANT
F"DDITIONAL OCCUPANT
Occupancy Gr Div
1=--Ar'f_ F -�u- (Ss.e ntet l 1se�� Panc y �.e'vk Z-LD 1`a+" 01- S3 P .runs or rV1'0rf.
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 ut..il the service has been inspected and
certified safe. All applicants for occupancy in an existing building are required to schedule an electrical
'€use up� inspection in the Department of Community Development at the time this application is filed.
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
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 heiyi., with one half (1/2) inch stroke, and of a contrasting color from the background. These
numbe s must be posted on your building in a location that is visible from the street.
5 Huntington Beach Firo Cods Section ')''01 require fire extinguisher seleciion and distribution per the
National 're Protection Association pamphlet 10 (see reverse e).
OCCUPANCY GROUP' A 73q�_
OCCUPANT Lb;`D —
NO f TOIES
17, [0 Z'
AP"P'MOVP BY Ilk DATE
(FOR OFFICE USE ONLY)
ZONING
PLAN CHECK NO. NO PARKING SPACES —
PERMIT NO HEALTH DEPT APPROVAL
ADMIN. ACTION, UTILITIES RELEASED —
CEP IFICATE OF OCCUPANCY FEE
CHANGE OF USE OR OCCUPANCY FEE
TOTAL
FORM 75.039 REV 2102 REORDERSAND )OLLHR71n-842•1148 6f ILVIN Q. ? ,i,,;�" T ,' Y Q V � rz_ � ? 2�3
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS WM> t�
i
2. Person to contact in case of emergency—*
j Telephone number: `� 14 I(e3—�?573
3. Does the building in question have aitictrici° v n Yes
❑ No
(a) If No, are you requesting that the electricity be ❑ Yes
turned on? ❑ No
4. The building is sp;inklered? ❑ Yes
01` No
5. Operations will produce dust/wood shavings or similar
material? ❑ Yes
P9 No
6. Operations will involve the repair or replacement of ❑ Yes
automobile parts? No
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame? ❑ Yes
No
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. � Yes
❑ Na
8. The following best describes my operation;
Office On►y
V-Retali Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
estaur a Out Food
Medical / Dental
Other (des: ribe)
SUPPLEMENTAL INFORMAT104 (.-_.ontinued)
Does the operation involve any of the following materials? Yes
VLL, N o
If Yes, '(FidiCater quantities:
iOaterial Quantity
1. Flammabile liquids
Clas4, I -A
Class I-C
2. Combustible liquids
Class 11
Class 111-A
S. Combination flammable liquids
T Flammable --gases
5 r . Liqfjefied flammable 'gaseL
6. Flammable fibers - loose
7. Flammable fibers -baled
2. Flammable solids
9
Unstable materials
1
Crjrroslve
i"lquids
12.
Oxidizing
Oxidizing
material - gases
material - liquids
13.
Oxidizinq
material - solids
14.
Organic per
15.
Wltromp_,hane (uns�able materials)
16.
Ammonium
nitrate
17,
Ammonium
containing
by weight
nitrate compound mixtures
more than 60% nitrate:
18,
19.
Highly toxic material and
poisonous gas
Smokeless powder
20, -Black sporting powder
I hereby certify that the above information is true and correct to
the est oMiknowledge.
7 S 2-
ignature pate
Company Name:
South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY FZRMIT CM CI LIST
fork .zesidential buildings only
N
Location of Property: kWyj
City:_ ¢a'" Zip Code: r2
Contact Person: Title: \)
T!ephone Number: � l(Q' 75—] /- _ Fax Number:
Type of Industry/Business:��A+'� l
To apply for a nonresidential building permit, you must complete this checklist. If you have any
q, estions about completi! o this checklist, please call (800) 388-2121.
YES NO
I.
WiV the facility have a charbroiler?
[ ] [X ]
2.
Will any internal combustion engine with greater than 50 horsepower
operate at the facility (f=ludirig motor vehicles)?
[ ] [JC]
3.
Will oper_:tions at the racility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings?
[ ] [yG]
4.
Will dust or smoke be generated at the facility?
5.
Will refusing of any liquids or solids be done at the facility?
[ ] [l
6.
Will any plating or coating of materials be done at the facility?
[ ] [n]
7.
Will any combustion equipment rated greater than 2,000,000 BTU/hr be
.,perated at the facia*--J?
[ ] [A]
8.
Will any acids, sol•:t Ls, or motor fuel be used or stored at the facility?
[ ] [ 1j
9.
Will any organic r. ...ids or gases be reacted or produced?
[ ] 1?9
1,1.
Will any ovens be used to dry or cure products at the fa ty?
[ ] [�]
11.
Will any CFC (Freon) recycling machines operate at e f ili ��
fa
[ ] [T]
Applicant: GI "WR---- _ Signature:
Trint name clearly)
If you have marked "NO" in all the boxes, an air quality permit is nQt 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
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