HomeMy WebLinkAbout10088 Adams Ave - CofO (2)®� ION FOR CERTIFICATE OF OCCUPANCY
J J� aA APPL IC rrr�
CITY OF HUNTINGTON BEACH
DEPARTMENT OF BUILDING & SAFETY
HUNTHNGTON S ACH (PRINT OR TYPE ONLY) DATE
Address 14909? "-4—"S.1 zlaN J—.j!�'my e-4 t ""''-'f4 District 9L2 (A'��77
Business Name UV5e"11&V50Aj OfTymo`41S% Tel`
Business Type _ 19F7ZW4-1W — �' - _ _ _ Occ. Group 22
BUILDING OWNER BUSINESS OWNERIMANAGER
Name 15usmfP -S flu
i IP/C1�/E S Name A':G/lk 6V4 0/r..1JO.i(NHome
Address
T 7 ��, �d y� I i�� Address
d�
City I;Lt I� l L- 4 % F7� Tel. Ciiy�C,��'Jp! � _Home Tel.
THIS USE WOULD BE DESCRIBED AS:
(❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
lG+�" EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any eC7'-)" - 5'1^6P Occupancy Gr. Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED- /—'?/T S' '
NOTICE:
1. Occupancy of 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 an,
certified safe. All applicants for occupancy in an existing buildinC ie required to schedule an electric.
`fuse up' inspection in the Department of Community Development at the time this application is file
3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a buildim.
premises in order to determine if a change may be made in the character of occupancy or use of the buildu g
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 BeacN 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 background. These
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),
FIVtlt"a�ld.{~t L�
1); r; f 's''a i9,
OCCUPANCY GROUP
OCCUPANT LOAD iI
NO. OF STORIES
�t6ki (—, L
h1b
(FOR OFFICE USE V.1LY)
PLAN CHECK t&0
PERMIT NO
ADMIN. ACTION
ZONING 0
NO PARKING SPACES
HEALTH DEPT APPROVAL
UTILITIES RELEASED
�`� n \� ( k Cc7 ERTIFICATE OF OCCUPANCY FEE $
APPROVED BY c DATT CHANGE OF USE OR OCCUPANCY FEE $
TOTAL $ _
FORM. 75.039 REV, 2/02 RE -ORDER SAND DOLLAR 714.842.1148
SUPPLEMENTAL INFOkMATION
1. BUSINESS
ADDRESS
/10t5 4%�lS A,-'U 177A)C=A)
2. Person to
contact in
case of emergency-tZP�ellfilE
IV
Telephone
number:�`�-faZ=�3�-
_
3. Does the
building in
question have electricity?
Yes
❑ No
(a) If No,
are you
requesting that the electricity be
❑ Yes
turned on?
❑ No
4. The building is sprinklered? Z Yes
❑ No
5. Operations will produce dust/wood shavings or similar
material? ❑ Yes
JR No
6. Operations will involve the repair or replacement of ❑ Yes
automobile parts? tom+ No
7
A
If Yes:
(a) Describe the components repaired or replaced.
(b) Does th , operation involve the use of an open flame? ❑ Yes
Na
-1ne business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. Q Yes
No
The following best describes my operation;
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
r &ance, Zna 2-0 &
t / Take Out Food
4er
ica Dental
(describe)
SUPPL,'�-'MMHITAL
�-iv V (I a n v e.;-� t P �z g
es, indicatr) cA a 6t i t i
I. F- I am m oblo o
Class 1-,A
class
--d I —as s i-C,
2. Combustibie Hquids
Class H
Class Ill -A
3. Combination. flammable
4. Flammable gases
5. Liquefied I fia mmable gases
6. Flamm F)i;- —fibers - loose
7. Flammable fibers - baled
8. -T—Iam`mable so-1—ids
9. Unstable materials
10.
Corrosive
liquids
11.
Oxidizing
material - gases
12.
Oxidizing
material - liquids
13.
Oxidizing
material - solids
14.
Organic
peroxides
15.
Nitromethane (unstable materials)
16.
Ammonium nitrate
17. Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight
18. Highly toxic material and
pcisonous gas
)9. Smokeless powder
20. Black sporting powder
I hereby certify that the above information is true and correct to
the best of my knowledge.
h
I g
gnature, Date
South Coast
AIR QL ° LITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
ATYs QL: tLITY PERMIT CHECKLIST
fc nonresidential buildings only
Company Name: ke (,// aU
L oeation of Property: ZOOM SWAM-M— I
city:_z-6,AAtz t Aj ap /U lie4-r - Zip Code: Q7a 41k
Contact Person: k;5111 t% O°I�J''IUAUIJS6AI Title: mo 641)A.PeiZ
Telephone Number: &!V - 9 2, — 93 7�� Pam Number:
Type of Industry.Tusiness: _ CFI'' Q . 6PE0,P—MY7'.
To apply for a now esidential building permit, you must uomplete 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 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?
4. Will dust or smoke be generated at the facility? [ ]]
5. Will refuting 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 BTU/hr be
operated at the facility? ( ]
[}c]
8. WiIl 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? [ ]
[}c]
11. Will any CFC (Freon) recycling machines operate at the facility? [ ]
[
Applicant: I Uv Signature:
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is not needed st t}•is time,
and this checklist is your written release.
If you marked "YES" in any of ti2e 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
OVI UMMTF'NT' COME. U_ ,j SQ 2, T ��6 55
t
Callforn:,a Sta%- T --v, rZI, sOn 6
BiYYl'ti?�' Popartinc',,ts Erom
I ity agency are
issuing a fim,-', u s S --n 1cca.1, aL- qual IL�,OUIP�M-1 ts 11
met. All applica,litfar?"C ;,'!, ii r +'•'; ip'.: _ '3a;....,qjality
(0- P T;7TIM2,---r"r,,r-n;t or -r! �jj
I , :", 117 -
designed to ai"; IN If -SV, er to, . JC
the qu.;-stions L, -YIES," t4 BeYding TX: :-1ai-un-,-' must clotinawrit'c,,£e l o5c },-om the local au,
quality a-enc— -v-rff�-ifno, -chat tl appli6:am- is iii aonrp'xance,
buildii7,� � pann, i's MU: : C 7on, tl,�Sch-cklist.
All T, z a,. 11 W
2. if tlie anssven: to g A - 11 .
LI quz�-s-'.iorls tlil- Bi6lEa�g L)�--, zrtn*,�;.,m clin �ccept the ch -cki'.ist
as the wiitlen release.
3. 11' any que.st4,ns .-ze "YFS" tli1--- a'.-ij-,iicani Trust contact ttlw AQ-Nff) by calling
(800) 388-2-12,'1 to determine wh--their L-11 q-aality permits are iequ*Ted for any equipment
which may be operated at the site. If the AQTNID determines that air awdity per-mits are
not required that all requiremeets hay e been met, a written relea,-�e will be issued.
4. If air quality per n;ts are requi--,-ed arid applications have not been submitted, the applicant
must sulirnit 'che necessary pe-,,,Tni* applica-zlonts) and appropriate fees before a vv-ilaen
release will be issued.
AQNM is conrited to expediting all clexiaiice letter requests. However, it may take several
weeks to veri& compliance with all requiremle-zits, Therefore, you are advised to c-ritact AQTMD
immediately after applying f(;r building permits.
(800) 388-2121
revised M5