HomeMy WebLinkAbout10090 Adams Ave - CofO (2)�f -zz
APPLICATION FOR CERTIFICATE OF OCCUPANC 4
CITY OF HUNTINGTON BEACiH
DEPARTMENT OF COMMUNITY DEVELOPMENT
iPRINT OR TYPE ONLY)
q�''�
ATE
Addresu y,, - District
Business Name Herd
•i. r.: rU z���c _ Tel
Business Type fir _ Occ. Group
BUILDING OWNER SUSINES3 OWNEWMANAGER
Name rtnS 4. 'l sfiz:Asel Name l uS+�� SS-C,or,4:
_ —1—
Home
Address 0 4/li 1 F"r' -_ Address_ 063 1_
irydv G `11`-i Tel ity°ne:A a(! HomeTeo`i't �17�1-8
T IS ISE WOULD BE DESCRIBED AS:
it I
El NEWLY CONSTRUCTED BLDG. � CHANGE "F CWNER CHANGE'OF OCCUPANT I
' EXISTING BUILDING ❑ CHANGE OF USE Q ADDITIONAL OCCUPANT
Indleeke former use, if any °" Occupancy Gr Div..._,;,
SQUARE FT. OF BUILDING TO BE OCCUPIED
NOTICE:
1, Occupancy of any building is prohibited and a business license will not be issued until ithe bu?lding has been
'inspected and a certificate of occupancy is issued.
2. No eie-t,;cal ser;ca will be released for any existing building until the service has been inspected and i!
ce-iified safe, All aF: rots for occupancy in an existing building are required to schedule an elentrical f
'fuse up' inspection in the Department of Community Development at `he time this application is filed. t
3. Change of occupancy or use inspection fee. Whenever it is necessary to male inspection of a, building or i
premises in order to determine if a change may be made in the character of occupancy or use of the building
or premises which would place the building in a different divisor, of the same group of occupancy or in a
different group of occupancy, a change of occupancy inspection fee of ro shall
he paid to the city, i
4. Huntington Beach Fire Code Secti..h 10.208 requir s that building numbers must be a minimum of four (4)
inches in height with oite half (1/2) inch utrol .„ and of a contrasting color from the background. These
numbers must be posted on your building in a IOGaTIOn that is visible from the. street.
5, HunUngton Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fir Protection Association pamp'71et 10 (see reverse side).
TRAFFIC i%3�WT _ f
DATE PAID
('FOR OFFICE (ISE ONLY)
ZONING
OCCUPANCY GRO>r'�' pr ; 1 t", PLAN CHC:^. : C3 a�� NO PARKING SPACES
OCCUPANT LOAD _ -. PERMIT NO e) HFALTH DEP:' APPROVAL
NO OF STORIES _ k—,—w -- --- AQMIN ACTION UTILITIES IiELEAwEL'
r'•ERTIFICATE 0;� OCC.u;'r VC Y FEE $ _
APPROVED BY DATE CHANGE OF USE OR OC`. ,,PANCY FEE g _
TOTAL
n 7� tt3p Rm 1/97 t^,C'li'/IMUNITY DEVELOPMENT
tUPPLIENIENTA1L 1NF RMAT110t1
yy,,
1.
BUSINESS ADDRESS ) 6 r ' .S y LIZ. � r
2.
Person to cotNtact in case of
Telephone number: Y) 44-' —
3.
Does the building in question have electricity?
Yes
0 No
(a) If No, are you requesting that in. electricity be
Yes
Turned on?
❑ No
4.
The building is sprinkleredry
0' Yes
i No
,
5.
Operations wil produce dust l woad shavings or similar
material
Yes
N-
,t
6.
Operations wid involve the repair or replacement of
C Yes
;..
automobile parts? -
No
If Yes.
(a) Doscribe the components repaired or replaced.
(b) Does the operation ijivolve they use of air open flame?
�-' Yes
-
No
v3
z
7.
The business is drinking, dining or assembly use that uk .4
result in an occupant load of more than 50 persons.
Q Yes
n
No
8.
The following best describes my operation;
Off ice Only
Sales�s
Warehouse
Manufacturing distribution (describe process and end-
-
c�product)
Restaurant/Take Out Food
"
Medical / Dental
Other (describe)
SUPPLEPAEW L INFORMATION
SUPPLEMENTAL. INFORMATION (Continued)
Does the. operation in)tolve any of Uie fs hawing materials 7 Yes
No
If Yes, indicate quantities:
l Material Quantity
1. Flammable liqu'fds
Class ] -A
,
Class l - S
Class l-C
2, Combustible liquids �..��...-�...�....�.._..... ..�.
Class #,l
Mass M-A-
3. Combination flammable liquids: .�,....�,�.�__._.._.�.,....�..�.....�..,,��.�..�__ '.
"Flammable gases
5, Liquefied flammable g ses
, 6. Flammable fibers -• l: ase ..�.,.___...�-.......�.,�. ,.�.
T Flammable fiber-- : bales
£#. Flammable solids�0. .._..._,..._,.�... .._�.o...�.-..�..�.�,.._......-,
9. Llnstabfe materials
10, Corrosive liquids
T,, Oxidizing material oases
`f2, Oxidizing material - liquids
13. Cn di7iitrg materlat solids
14, Organic peroxides
5. N tromethane (unstable- maierials
16. Ammonium nitrate
`t7'. Ammoniumr�iirate compound MIa� res
containing more t'aan 60% nitrate
by weight
18. Highly toxic ena$orial and
po sonoos pas
19, Smokeless powder
2. Black sporting powder
1 hereby certify that the above information is true and correct to
the best of my knowledge.
'e'
,ftv
n 1ti1 re
Date
South Coast
,, SIR QUALIrf MANAGEMENT DISTRICT
a
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PELT CHECKLIST
for nonresidential buildings only
CompmiyName: �7-46,1
Location of ]property: k4z,
j
City: �9.' 7eM X+ .Zh) Code: Yt�;
Contact person: _ 144111V 116144y Title:
Telephone Number: ��1�� �C��-l� �/�i Fax Number:
f
Scru SS e.�t
Type of lhdustxyrB-asiness: _j /
To apply for a nonresidential building permit, you must complete this checklist. Ifyou have any
questions about completing this checkdist, pleme call (300) 3 88- 3121.
'SAES
NO
1. Wl the facility have a charbroiler?
2. Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)? j ]
[
3. Will operations at the facility involve mixing, ble ridir 5, 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 fa4 lity?
7. Will any combustion equipment rate" greater than 2,000,000 L : T TIt- he
operated at the facility? [ ]
[
8. Will any acids, solvent-, or motor fuel be used or stored at the facility?
9. Will an- organic liquids or gases be reacted or produced? [ ]
[
10. Will any ovens be used to dry or cure products at the facility? [ ]
]
t
11. Will any CFC (Freon) recycling machines operate at the facility?
` e-k4
Applicant: s .� � 4� y _ Signature: .111"
riot name clearly)
If you have marked "Nth" in all the boxes, an air quality permit is n4L nee.- r two +;rae,
and this checklist is your written release.
If you marked "YES" in any of the boxes, you must contact the SoertL Coast Aix, Quality
Management District (AQMD)_ Please read the requirements on the back of the checklist,
(800) MR-2121
ADDITIONAL, SUPPLEMENTAL 114FORMATION
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CIT"VOF HUNTEM �,,'ON BEACH - DEPARTMENT OF B UILDING & SAFETY
(Yd -Floor —.1 hist Apptr In -Person)
Business License —T Date
13usincssName-/z.TA&4 rxw- T '�71
lk-4 7I
13 lasiness Type A I
1.41)
Name p
Addre"', I lonle Add.-e, q
Ile 71
I is Usf. WOCIA) BE DESCIZ1131-:1)AS:
JNc%%I% Con,tructvd Baddim�, o:
CIIECK.ALIA HAT "UTI.)
'ilJ NoJ
J No
NoA
"'I'v. III i;-,. oi% c OIL: n.:Jmll ,'l J 'lira 4_
IL uper, IT I I Q I It: I tv t No
1 IQ IT I: X t 1": rad
f �1
IA
Il Dental JRC,tlaaan! I'skeou(I't-md J%%i4leiloue
(kc Oroup: Occ 1-4twE
4-
J IF Re,, i-v.: Y' N Anit PaidS:
P,IaJ hi I Ir I IT!, P�,
11mlihic Pelim't
Comments:
Plamiet I III Oak
HAZARDOUS MATERIALS DISCLOSURE INFORMATION
Huntington Beach Dire Department
California Health and Safety Code requires the Fire Department to regulate businesses that handle hazardous
materials. Motor oil, hydraulic fluids, gasoline, dry cleaning fluid, etc., are considered hr.ardous materials and
must be disclr»ed. If you use, handle or store hazardous materials or waste materials equal to or in excess of
the following basic, gTiancities, your are required to disclose:
• 55 gallons of liquid
+ 500 pounds cif solid
200 cubic feet of compressed gas
Any amount of radioactive material,,
# Any amount of Class A explosive
Aiiv amount of chernicals known to cau:n-c cancer
• Any amount ref conin-jercial pesticide-,
Reportable quantity of any clivinical t:n LTA Vxtrtfr elz llazaado,as NIA aieriai4 Si,b<aric:. I.i`;t
Di,,t .lure is not required for the follvcvin`l.:
I. Ila"ardou`, sfrb;tanties contained in food, drab,, ctasmvtic or tt.oacco products.
'. i :p,ln approtal of the Fins Chief, hrazardons materials contained Sol -1y in contunaer products packaged
for use by and distributed to the general public. However, pesticides, herbicides, and ammonium
nitrate fertilizers over ih,: required disclosure amounts are not e)xnapt from disclosure.
The transportation 6 laazardoos n.,aerials accompanied by shipping papers preprired in acccattiance with
the proi, isions of 49 Code cot` 1:edzral Regulations.
4. ectious ovaste venratcd by health care facilities that are regulated under'! itle 22 of the ('11ifornia
nimistrative Code.
deck ove ttfth, tt)llt%',cina?:
No chemicals are used, handled or stared at this business.
Chernica's are used, handled or stored at this business, but do not meet the requirements for disclosure
_-- C lie*nicals axe u_-ed, i andled or stored at this business. Disclosaare forms rvill be sent to 3,ott.
Amounts a ill lie er fied by the Dire Department during annual inspections. It is unlawful for any person to
kneowing':y violate any provision of this ordinance.
I certify, under the penalty of perjury, that the above infornation is true and correct to the best of my
knowledve.
Daty
Ilorne
!'lease call 7,14-536-5676 with questions rgarding the Aaaardous,11averials Program.
Suuth Coast
Air Quality TManagement District
21865 R. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp :`A"vNv.agmd.�*ov
Air Qualitti Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate ofOccu fancy I- a business
without clearance from the local urr gu dity agency. This checklist will determine if ou ,_iced to obtain
clearance from the South Coast Air Quality Management District (AQ%1D).
Company N. me: �!ftfi%�J1t'�7v!G.. e' -,. tt� taC-liu'T;'.
_ i � � 13.���
Property Yddress:Ijir�.__.__�
Cr,rtact Person: /?YtfaA. _ _.
Title: _ L7
•Type ofl3tstilfir
r
f
" )p rant: (Print Ilaliie) y t l Kt ' . _ .
Si llau«4. t�.
NY'ill the fa •ility have any Cif`tlie fiillimin- equipment''
Yes ❑ :tit)
Charbroiler
DrS' cicarimx`. machine
Printing Pres-., t'14riCri lltii ``idl?lt.!' t:t:?�r 3p11IC)
Internal Combustion etit?III;', (grealcr than 50111') (excludi n, motor' chicl :s)
BoileCconibustion equipment (greater than 2 million BTU;1ir. mammuni input)
Abrasive; blasting cabiriet-room
13a -house cartridge type dust fi)'.er scrubber
.Mo!or fuel stora-.;e and 'iswr ,ilia; equipment
• Will any. of the fallowing •.aperations be per%rived`'
Yes ❑ INJ
Appiicat;on of paints or adhesives
I tchiag, plating, casting, or melting of metals
Moldink and blending of liquids andor powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organ. c liquids, or fuels
Production of fumes, dust, smoke or strong odors
• If you answered "No" to both question , this checklist is your clearance from AQM.D.
• If you ansNvc:red "Yes" to either question, you must contact AQMD to determine if air quality pen -nits are
required. If permits are needed, AQ:r11) wall assist you in submitting permit application(F) and then provide you
', I° .i t l arance letter. You can call.tQ D at their small Business Assistance Office at (800) 388-2121.
Jul 15 04 12:14p City Of Huntington Beach 714 374 1647
p.l
.00* 1- c-4 `J nsp e2
K
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPARTM NT OF BUILDLNG & SAFETY
(3`d Floor -Must Apply rn Person.)
Business License # A25 �b Date,
Address ld t) ive. 8Vniin frin CA 124-IL
Business Name NB v _�:,solo:, Telephone6i
Business Type 2,Du jA�j SzanlW � ,5gq/aM
Property Owner Information Business Owner
Name Ztl.SJyESs T o,, - zT,rS C�wN mN P S1*7--1 Name 2-oh W. I-ce
Address /73/ F/)z�q Home Address _ _ Z;",xr �iFCt�jy�
City /RviN� Tel. jW_jiL44jo City ai16 Cirf' Tel.
THIS USE WOULD BE DESCRIBED AS: et137
❑Newly Constructed Building or OExisting Building
CHECK ALL THAT APPLY:
3Change of Owner ®Change of Occupant DChange of Use ❑Additional Occupant
Indicate former use, if any
Does the building have electricity? Yes 2 No❑
If No, are you requesting that the electricity be turned on;? Yes ❑ No ❑
The building is sprinklered? Yes ❑ NdZ
Operations will producF4ust/wood shavings or similar material? Yes ❑ NO 0
Operations tiyill involve the repair or replacement of automobile parts Yes ❑ No EL
If yes: Describe the components repaired or replaced.
Does the operation involve the use of welding or open flame? Yes ❑ No E-
Thc asiness is drinking, dining or a55mhlv tts - that will result in an occupant load
of more than 50 persons. Yes U No ❑
The following best describes my operation:
❑Office Only URetail Sales ❑Medical/Dental ❑Restau,,mtT,1.c Out + Warehouse
❑Manufacturing/Distribution (describe p Rcp and end product)
_R <�_hk _ t\ �, P RV `3( 10
❑ Other (describe; A L
,S1A JhJ_ e*-- 0 ;' <;tlW(.Y 7W_PV (7_S
Office Use Only. l
Zoning: �/ /,I _ Sq Ft Occupied: L, 65� Occ Group: N Occ Load:— 1
`\o. Dj
A Stories: Parking Spaces: TIF Review: Y/ N Amt PaidS:
Paid BEFORE Final Inspection
Building Permit 9 Entitlement 4:
Comments: `"G trs L t. ,�.mot,____ ( f J
Planrier Initals• Date. , sC 0-t Plar- Checker I itials:�_.r,r.Date: -)/ _ _ COfO
.Jul 15 04 12: 15p
City ',Of Huntington Beach 714 374 1647 p.3
Certificate of Occupancy —Information Sheet
1. Occupancy of any building is prohibited ui1d1 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. V
3. Huntington Beach Fire Code 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 i:-om the
background. These numbers must be posted on your building in a location that is visible
from the street.
4. Huntington Beach Fire Co.ie requires fire extinguisher selection and distribution per the
National Fire Protection Association pamplilet 10:
a. Apartment Buildings (5 or more units): One (1) 2A rated extinguisher, to be located on
each floor level so as not to exceed 100 feet of travel. Two or less anartrnent units on
an upper level may be serviced by the extinguisher on the next lower level
b. Industrial and Commercial Buildings.-
0 Light Hazard (May include offices, schoolrooms, churches, assembly halls,
telephone exchanges, etc) — One (1) 2A rated extinguisher is required for each
6,000 square feet of floor area, or a portion thereon
• Ordinary Hazard — (May include ,,,ercantile storage and display, auto
showrooms, parking garages, Iight manufacturing, warehouses not classified as
extra hazard, school shop areas, etc.) — One ?A rated extinguisher is required for
each 3,000 square feet of floor area or a portion thereof.
• Extra Hazard (May include woodworking, auto repair, aircraft servicing,
warehouses with high -piled (over 15 feet in solid piles, over 12 feet in piles that
contain horizontal channels) combustibles, and processes such as flammable
liquid handling, painting, dipping, etc.) — One (1) 3A rated extinguisher :s
required for each 3,000 square feet of floor area, or a portion thereon Certain
extra hazardous uses and/or processes may require additional fire protection
systems. An on site inspection will be required to make the determination.
c. Service Stations: Are required to maintain one (1) 1 OBC rated extinguisher within 75
feet of travel of the dispenser cabinets, and one (1) 2A rated extinguisher on the
premises.
d. Fire extinguishers for cornet ::rcial and industrial buildings are to be located so as to
maintain a maximum distance .,f travel of 75 feet.
e. Occupancies having a potential for fires involving combustible cooking media
(vegetable or animal oils and fats) shall provide a Class K fire extinguisher within 30
feet of the hazard.
IMPORTANT: PLEASE READ THE FOLLOWING CAREFULLY
You may purchase this extinguisher at any hardware store and a nlunber of department or discount
stores, or you may purchase your extinguisher from an extinguisher service company, which may be
found under `Fire Extinguishers" in the yellow pages of your phone book. The extinguisher is
requiad to be serviced when new and annually thereafter. The hardware, department and discount
stores usual:y are not licenses to service extinguishers. Therefore, you should expect an additional
expense to have your new extinguisher certified by an extinguisher service company if you purchase it
from one of these stores.
If you have any questions regarding the inspection or fire extinguisher requirements, please feel free to
contact the Huntington Beach Fire Department Fire Prevention Bureau at (714) 536-5411.
CERTIFICATE OF OCCUPANCY EVALUATION FORM
GENERA! BU(LD1NG INFORMATION
OWnername: Address andtor suite ft;
f Ziti05;5� OW6095
Emergency contact; Phone number.
j Occupancy Class - primary use(s) & sq. ft.: Occupant load:
"t
i Occupancy Class - second use(s) & sq, ft.:
Type of constructuon:
Stories Hetght(ft)
Sprinkling used?
CStory increase
CCity Ordinance
❑Unllmited area
❑onn hour construction
OAtria
t
CArea increase
LICha ter 9
( Area allowed:
I
Basic; Yard;
Area separation;
I Sprinkling:
Y
ror mumh mrwu anurrm ea u5a aaarn a Separate WOrK sneet or InciuOe In SKeICn area
Attach work sheets by Planning or Fire if provided
F*-*-'-'-'-*- `{ARDT
KRONEN
YARD 3
41
YARD 1 WMING VIINNVic; RM I
4. p y E to%r
n PARKING
1` ID
SAMPLE -ASSEMBLY USE
N
a PA� Kl G� _j 1
0
to
STREF-T NAME
G:I3UILD1NGIFORM51Cert o(OccupancylCofO Evatulalion.DOC
1
May 3, 2004