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HomeMy WebLinkAbout10109 Adams Ave - CofO6 J'd CERTIFICATE OF OCCUPANCY Mew� 1 ;,gr3g CITY OF HUNTING 7N BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT Date HLM7tNGTON M04 Address 10109 AekwFtB Axe. Distr'ct Business Name ARTISTIC O-L'r.,. 4TmS Tel.._j.T et962—r536 Business Type C ANFP Occ.Group _n"2 BUILDING OWNER BUSINESS OWNER/MANAGER Name _ Name =' #mg In beu?c Address Address me 9961 ll tb S-" r n� City Tel. City Garden Grove,, CA Home Tel, 531-41503 � Construction_ No, of Stores Occupant Load, 3:Sprinklered II This Certificate of Occupancy DEPARTMENT OF COMMUNITY DEVELOPMENT SHALL BE posted in a conspi ,ious place on the premises and shall not be removed ex- cept by the Building Official by _ APPLICATION FOR CERt'FICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH DEFAR'rMENENT OF DEVELOPMENT SERVICES V HUNMGTON BEACH iFRINT OR TYNt OM.Yy DATE Address Business Business Type BU" `)ING OWNER Name — Address City. _ Disjjtrict f Tef _/V L — Occ. Group BUSINESS OWNERIMANAGER Name— Home Address — 5 City U MHome Tel. O �� THIS USE WOULD BE DESCRIBED AS: ❑ NEWLY CONSTRUCTED BLDG. RANGE OF OWNER TV CHANGE OF OCCUPANT EXISTINC- BUILDING ❑ CHANGE OF USE 46ADDITIONAL OCCUPANT Indica!e former use, if a ty__CZ124A ry —Occupancy (~*,_ ._, Div. SQUARE FT. OF BUILDING TO BE r1CCUFIED _ z d � NOTICE: 1. Occupancy of any building is prohibited and a business hcernse will rot 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 buil6ing 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' it 3pection in the Department of Development Services at the time this application is filed. 3. Change of occupancy or use inspectio;r fee. Whenever it is necessary tc nit.ke inspection of a building or premises in order to determine if a change may be made in the charac.er 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 grOL,a of occupancy, a ch, ,nge of cc--upancy inspection fee o $_ sriall be paid to the city. 4. Huntington Beach Fire Code Section 10.208 regwres that building numbers must be a minimum of four (4) inches in height With one, half (V2) inch stroke, and of a cOitTasting color from the backg,ound. These numbers must be posted on your building in a locution that is visihle from the street. 5. Huntington Beach Fire Cade Section 10.301 requires fire extinguishes selection and distribution per t the National Fire Prctaction Association pamphlet 10 (see reverse side). (FOR OFFICE USE ONLY) ZC 'iNG SUPPLEMENTAL INFORMATION OCCUPANCY GROUP 7 PLAN CHECK NO. NO. PARKING SPACES OCCUPANT LOAD _ PERMIT NO. _ HEALTH DEPT. APPROVAL NO. OF STORIES — ADMIN ACTION — UTIUT,ES REiEf.SED r •--- �! •" CL CERTIFICATE OF OCCUPANCY FEE' $ APPROVE Y DATE CHA!4GE OF USF OR OCCUPANCY' FEE $ TOTAL $ 7 —•� _ 75-039REv. DEVELOPMENT SERVICES • — �' SUPPLEMENTAL, INFORMATION 1. BUSINESS ADDRESS _ 1010 ,Li njr(ffn� L, 9.2(1Q_ 1. Person to contact in case of emergency: - Telephone number: 3. Does the `.z.i--Lding in question have electricity? taYes ❑No a. if No, are you requesting that the electricity be ❑Yes turned on? L No 4. The building is sprinklered? 5. Operations will produce dust/wood shavings or similar material? O Yes "o 6. Operations will involves? the repair or replacement of byes automobile parts? �No 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. Dyer �Na 8. The fo�'.owing best describes my operation: Office Only R:-Lail Sales Warehouse Manufacturina/Distribution (describe procass and ei8: product) Restaurant Ta e Out Foo Vf Medical/Dental / �3 other ( descrio, (0562D) (12/8/86) SUPPLEMENTAL INFORMATION (Continued) Does the operation involve any of the following materials? Wes 0 If Yes, in icate quantities: Material Quantity 1. Flammable liquids Class I --A Class I-B Class I-C 2. Combustible Liquids Class II Class III -A 3. Comk-inat:on flammable liquids 4. Flammable gases 5. Licruefied flammable gases 6. Flammable fibers —loose 7. Flammable fibers - baled B. Flammable solids 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 poisonous gas 19. Smokeless powder 20. Black sportiing 2owder I hereby certify khat the above information is true and correct to the best of my kpowledge. Signature " Date (0562D) (12/6/86) •) CERTIFICATE OF OCCUPANCY CI iY OF HUNTINGTON BEACH 10/pif90 Date Address �iGi @ 9 '�T:= District Business flame A 47 T '�1'a -C; r r ±. n D'r.. 1j. Q Tel. rf r = c: Business Type r,1-y ('r r n: `�•,� Occ. Croup 4 BUILDING OWNER BUSINESS OWNER/MANAGER Name Name fis Pv E'[,hf' EIS LIZ 1 IAA LEE Home Address Address-.,+ r� r Zti r n x r r x. n r•2a CityTel. � Home _ City r ye^t*as r rt x c Tel. ri t • i� : Construction , No. of Stories 4 Occupant Load t F Sprnklers CONDITIONS OF APPROVAL DEPARTMENT OF COMMUNITY DEVELOPMENT This Cet-tificate of Occupancy SHALL BE posted in a conspicuous place on the pr9mises and shall not be removed' except by the by } Building Official. COh1MLtNITY REVEL ..?MENT 2 0 APPLICATION FOR CERTIFICATE OF OCCUPAN Y CITY OF HUNTINIGTON BEACH DEPARTMENT Ot= COMMUNITY DEVELOPMENT f F,UNnN(,Totd REACH (PRINT OR TYPE ONLY) DATE Address D��� ! 6 - District Business Ne, e � ��- ��� Tel._J.'l!._ Business Type '✓_�-''a'�°`� Occ. Group BUILDING OWNER N c, BUSINESS O1WrNERIMIA"N..AGER Name Name 1 1 ✓� sit - vv�.I Home Address_ Address— City —Tel. City _Home Tel. THIS USE WOULD BE DESCRIBED AS: j❑ NEWLY CONSTRUCTED BLUG. X CHANGE OF OWNER ❑ CHANGE OF OCCUPANT L� EXISTING BUILDING. ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT Indicate former use, if any— _ _Occupancy Gr. Div. SQUARE FT. OF BUILDING TO BE OCC'JPIED / rfi�7-0 NOTICE: 1. Occupancy of any building is prchibitL 1 and a business license will not be issued until the building has been inspected and a certificate of oecupar, y is issued. 2. No electrical service will be released fo, any existing building until the service has been inspected and certified safe. All applicants for occupancy in an existing buiiaing are regUired to schedule an electrical 'fuse up` inspection in the Department of Community Development at the time this application is filed. 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 may be made in the character of c-cupancy or use of the building or premises which would pic ce the building in a different div lion cf 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 f Iat huiiding numbers must be a minimum of four (4) inches in neicht 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 f om the street. 5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distributior per the National Fire Frotection Association pamphlet 10 (see reverse side). U.0 /re (FOR OFFICE USE ONLY) SUPPLEMENTAL INFORMATION f OCCUPANCY GROUP --,-.-PLAN CHECK NO. _ OCCUPANT LOAD CIL_ PERMIT NO. NO. OF STORIES ADMIN. ACTION- 1 ! / b I t76 CERTIFICATE OF OCCI IPANC`t FEE APPROVED ATE CHANGE OF USE OR OCCUPgNCY FEE TOTAL ZONING NO. PARKING SPACES — HEALT-I DF.PT APPROVAL UTILITIES RELEASED — $ 75-039 Re, 6166 COMMUNITY DEVELP. u ,_<06 acr SUPP& MENTAL IRTPORMATION 1. BUSINESS ADDRG:;S I JY�C7�.� 2. �Ierso„r to contact in case of emergency: � Y Telephone number:: 3. Does the buildings in question have electricity? ( Yes ONO a. If No® are you requesting that -he electricity be Dyes turned on? ONO 4. The building is sprinklered? s W 5. Operations will produce dust/wood shavings or similar material? C eos 0 K. Operations will involve the repair or replacement of OYe automobile parts? C o if yes: (a) Describe tte components repaired or replamed. (b) Doer the operation involve the use of en open f1&fie? 0,e s ONO ?, The business is drinking, dining or assembly use that will result in an occupant load of more than 50 persons. C1s 0 8. The following best describes my operation: Office Only Retail Sales warehouse manufacturing/Distribution (describe process and end prcoduct)----- e a u r aA n a e u oo Medical/Dental � Other (describe) t`YL t-I_P t v► p� I L ` SUPPLEMENTAL INFORMATION (Continued) Does the operation involve any of the following materiels? 0b�- CM0 ems- a FET—Ica t e q u a n rT i s Materiral Quantit:L 1. Flammable liquids Classy I -A Class I-B Class I-C 2. Combustible liquids Class II Class III -A 3. Combination flammable liquids _ 4. Flammable eases 5. Liquefied flammable gases 6. Flammable fibers — loose 7. Flammable fibers - baled 8. Flammable solids 9. Unstable materials 10. Corrosive liquids 11 ox.idi_.i_n5 material gaffes 12. oxidizing material - ],lg(uids 13, oxidizing mater,;.al - solids 14. organic peroxides - 15. Nitromethane (unstable materials) 115. Ammonium nitrate + ® 17. Ammonium nitrate compound mixtures containing mo:e than 60% nit -rate by weight 18. Highly toxic material and --� poisonous gas 19._ smokeless powder ® 20. Black sporting powder i I hereby certify that the above information is true and correct to the best of my knowledge. i' % E South Coast AIR C{UAL;-N MANAGEMENT DISTRICT 9150 FLAIR DRIVE, EL MONTE, CA 91731 !81 !�► 572-6200 DATE: March 8, 1990 TO: Anytown Building Department FROM: Arthur Lawler, Air Quality Engineer SUBJECT: BUILDING PERMITTING UNDER AB3205, WATERS BILL Regarding PLAN CHECK #: 90-12345 VOCATION: Joan Doe Inc. 12345 Main St. Anytown S A M P L E S A M P L E: S A M P L E S A M P L E This .-<,te has met or is meeting 'the requirements of Section 42303 of, the Health am Safety Code and the requirements for a permit to construct and operate for the South Coast Air Quality Management District . APPLICANT HAS ALL REQUIRED PERMITS FROM THE SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT FOR THIS SITE AND/OR PLAN CHECK ONLY. APPLICANT HAS FILED FOR PERMITS TO CONSTRUCT EQUIPMENT WITH THE SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT. APPLICANT IS EXEMPT FROM PERMIT REQUIREMENTS AT THIS SITE AND/OR PLAN CHECK ONLY. REVISED 7/13/89 u Assembly Bill 3205 requires L%G Building Departments not to issue the final certificate of occupancy unless the applicant has met or is meeting the requirements of the District. The Building Department must obtain a written release from the District to show the applicant has complied with this law. The attached check list is designed to he'p the applicant and the building departments to meet these requirements. 1. The applicant ( the same person applies ,permits from the Building Department) must fill the check list which can be obtained either at the Building Department or at the District. 2. If all boxes in the list are checked "no", the Building Department can accept the check list as the release. 3. If there are any "yes" answers in the list, the applicant must contact a District engineer by calling (818-572 6406, 818-572 6111,.818-572 6261 ) to find out whether air permits arty required for the proposed construction project. 4. If air permits are not required, the applicant will obtain a written release. from the District engineer. 5. If ai� permits are required, t.ho a, )plicant must submit the necessary permit applications before the releaf3e can be issued. A sample copy of the release is attached. Because of the time it may take for the District engineer to go through above procedures, the applicant is advised to contact the District immediately after applying for Building permits. myl/al AB3205ID E SOUTH COAST AI ' QUALITY 19,NAGEMENT DISTRICT (Nonresidential Buildings Only) Location of Subject Property: (d(� `► C � H " �'/ / � Property Owner name: H6UA 5e� L.IZ. k/l aqc— Phone %� ""6✓ 8 Name of the Person Preparing this form in print anc signature Name HaK- signature The person preparing this form must be the same person applying for building permits. Please answer the following questions _regarding your proposed occupancy of the subject building. IF YOU DO NOT KNOW THE ANSWER TO A QUESTION MARK IN' THE "YES" COLUMN: S AQMD P'ERYTITTING CHECKLIST YES NO 1.. Does your facility use any internal combustion engines greater than 50-HP? 2. Does your facility involve mixing, blending, or processing any solvents, adhesives, paints or coatings? 3. Does your facility create any dusts or smoke? 4. Does your facility refine any liquids or solids? I= { Reclaim any metals? LJ 5. Does your facility plate or coat anything? 6. Does your facility have any combustion equipment i.e. boiler, furnaces, broiler, baking ovens, etc.) rated greater than 2,000,000 BTU/HR? 7. Does your facility handle or store solvents or mo'..or fuel? I A 1 8. Do yen use or store any acids? 9. Do you use any chemical process? 10. Do you i- 3e any solvents for clean-up? � 3.1. Are you a dry cleaner, restaurant with a charbviler, body whop, gasoline station, printer, or part coater? 12. Is the subject building located wi'.:hin one thousand (1,000) feet of any school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12. If you have marked "NO" in all columns, you do not need an Air Quality permit at this time. If you have marked any questions in the "YES" Column you must contact the South Coast Air Onality Management District located at: 9150 FLAIR DRIVE, EL MONTE, CA 51731 Pleaso call these offices: Plan Check (818) 572-6406 (818) 572-6111, (818) 572-6261 D•AL00603 0 i Ell CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH Date Address District Business Name Tel. Business Type E !arty F L Occ. Grou p BUILD114G OWNER BUSINESS OWNERIMANAGER 1v Name Name Address U Home Address k. 1' Z C L. j F- city Te City f, V 5 'Home —tic j Tel. Constructicn No. or Stories, Occupant Load Spnnklers CONDITIONS OF APPROVAL DEPAIRTMENT OF COMMUNITY' D':-:VELOPMENT This Carlifficate of Occupar.--y SHALL BE posted in a conspicuous place on the premises and shi-] not be reniG-.ad except by the by, 1 iL Bu0ding Otticial. COMMUNITY DEVELOPMENT 'A d WKS APPLICATION FOR CEATIrICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT HUNTINMON WAdi (PRINT OR TYPE ONLY) Address L -5�'l Q 7 Ac!�li�/q.S A4 H.R. , --CA _ Business Name 14 P-T / 5? IC- C L 4SR Business Type _ Axx BUILDING OWNER Name 4-p6ed ,I e, `lr i" —. Address 21,�O �-:�G max•_ � _ City_ Lo _14 r-4 Tel._,/ti74)- 'n THIS USE WOULD BE DESCRIBED AS: " b Z DATE District Tel :I /t) f X;Z — Z;r,3,4 Occ. GrouF BUSINES,, QWNERtMANAGER Name�°�d�S.?' Home q G Address 14COaD PR, City__ ("• _ Home Tel ❑ EWL`r" CONSTRUCTED BLDG. X CHANGE OF OWNER ❑ CHANGE OF OCCUPANT EXISTING BUILDING ❑ CHAN:-GGE OF USE ❑ ADDITIONAL OCCUPANT Indicate former use, if any _—_ Occunancy Gr.— Div. SQUARE FT. OF BUILDING TO BE OCCUPIED_1--emC2fEz 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 OCCUoancy is issued. 2. No electrical service %.11 be released for any existing building Until the service has been inspected and certified safe. All app!icarts for occupancy in an existing building are required to schedule an electrical 'fuse up' inspection in'? e 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 mLy be made in the character of occupancy or use of the building or premises which would place the bui}aing 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 ^at 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 distr ution per the National Fire Protection Association pamphlet 10 (see reverse side �r .� �K V *--% -11-q ) (FOR OFFICE USE ONLY) SU''PLEMENTAL INFORMATIO OCCUPANCY GROUP l PLAN CHECK NO. OCCUPANT t_OAD PERMIT NO. NO. OF STORIES ADMIN ACTION fry / , tun ,cj r 7 C/ " ZONING_ NO. PARKING SPACES — __ HEALTH DEPT APPROVAL UTILITIES REL&SED — U// _ CERTIFICATE OF OCCUPANCY FEE $ L APPRO ED {, ATE _ CHANGE OF USE OR OCCUPANCY FEE g TOTAL 66/,P6�' 75-039 Rev, 11 /90 COMMUNITY DEVELOPMENT .v_1 SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS .�F•®i �o%�_. e. r � : 1�'% - 2, `��' U 2. Person to contact In ease of emergency�i ,eXMrX Telephone number: �, ?. 22o — 3. Does the building in question have electricity? (a) If No, are you requesting that the electricity be turned on? 4. The building is sprinklered? 5. Operations will p� orluce dust/wood shavings or similar material? F. Operations will involve the repair or replacement of automobile parts? 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 ass-ibly use that will result in an occupant load of more than 50 persons. 8. The following best describes, my operation; Office Oniy etail Sales Were ouse Manufacturing / Distribution (describe process and end product) Restaurant/Take Out food Medical / Dental Other (describe) A Yes ❑ No El Yes ❑ No ❑ —Yes No ❑ Yes No El Yes R No ❑ Yes ❑ No i17 Yes Z,No 0 'Al JNJC 0,AAATlrlh/ SUPPLEMENTAL 1114FOf; RATION (Continued) Does- the oberation',' involve 'any of' the following materials? El Yes ,. No if Y"es, indicate-• quantifies: _ Material _ Quantity 1. 1=lammable liquids a Class 1-A Class I-B Class l -C 2. Combustible liquids Class 11 Class Ill-N 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 11. Oxidizing material - gases 12. Oxidizing material liquids 13. Oxidizing material - solids 14. Organic peroxides 15. Nitromethano (unstable materials) 16. Ammonium nitrate _ 17. Ammonium nitrate compound mixtures -w containifig more than, 60% nitrate 18 19. 20. by rveight Highly toxic materia; and poisIonous gas Smokeless powder Black sporting powder I hereby certify that the above information is true and correct to the best of my knowledge Signature Date ' SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT (Nonresidential Buildings Only) Location of Subject Property: ,/a/a���xt���. Property owner name:&,le � Cvo s{l� -1. 6p r>rj � Phone # Name of the Person Preparing this form in print and signature Names un .-L.lef�✓t Signature__ The person prepa;cing this form must be the Same son applying for building pe-rmits. Please answer the following gnestion.s regarding your proposed occupancy, of the subject building. IF YOU DO NOT KNOW THE ANSWER TO A QUESTION M,?1RK IN THE "YES" COLUMN: SCAQMD PERMITTING CHECKLIST YES 17O I. Dc,es your facility use any internal combustion engines greater than 50-HP? 2. Does your facility involve mixing, blending, or processing, ai:,y solvents, adhesives, paints `E or coatings? 3. Does your facility create any dusts or smoke? r--, 4. Does your facility refine any liquids or solids? El�—�--a� Reclaim any petals? 5. Does your facility plate or coat anything? 6. Does your facility have any combustion equipment i.e. moiler, furnaces, broiler, baking ovens, etc.) rated greater than 2,000,000 BTU/Hk 7. Does your facility liandle or store solvents or motor] fuel? 8. Do you use or store any acids? 9. Do you use any chemical process? ..-- 10. Do you use any solvents for clean-up? 11. are you a dry cleaner, restaurant w4.th a charbroiler, ✓, body shop, gasoline station, printer, or part coater? 12. Is the subject building located within one thousand (3,000) feet of any school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12. If you have marked "NO" in all columns, you do not reed. an Air Quality permit at this time. if you have marked any questions in the "YES" column you must contact the Sout1i Coast Air Quality Management District located at: 0150 FLAIR DRIVE, EL MONTE, CA 91.731 Please call these offices: Plan Check (818) 572-6406 D:ALO0603 (818) 572-6111, (818) 572-6261 This Certificate of Occupancy SHALL BE posted in a conspicuous place on, the premise-, and shall not be removed except by the Building Official. DEPARTMENT OF COMMUNITY DEVELOPMENT by ---- -- _Iee'l COMMUNITY DEVELOPMENT r m APPL),CATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH 4/, ?,,` g� DEPARTMENT OF COMMUNITY DEVELOPMENT HUNTIWSjON MACH DATE (PRINT OR TYPE ONLY) Address 11010 AMAIS AU6 hfad/7/H 41 gem`otGC�C7 District /J BuBusiness Name BEST G4Z--AV&a5 Tel 2// �62_ S3G ✓ Business Type L�}N��''�S Occ. Group BUILDING OWNER >Gsp fZi% f4140 BUSINESS OWNER/MANAGER I/N'a me /Name Z ° `, ome /Address S7tfTt 2cfl �: g / dress XW C/4 612LSo rhe / �y Tel. City____-��/ ti� lN✓ 13PLL- Home Tel.;S�r C 6 31.) y90 - 00 HIS USE WOULD BE DESCRIBED AS: ❑ NEWLY CONSTRUCTED BLDG. CHANGE OF OWNER ❑ CHANGE OF OCCUPANT EXISTING BUILDING ❑,�rCHANGE OF USE ❑ ADDITIONAL OCCUPAN ndicate former use, if any C J�-�ly _—_Occupancy Gr Div SQUARE F7. OF BUILDI G O BE O CUPIED IeO f S r— no VaCant_ bwg, NO ICE: 1. Occupancy of any building is prohibited and a business li, •anse w I no be sued until the building has been c 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 r" I certified safe. All applicants for occupancy in all existing building are required to schedule an electrical 'fuse up' inspection in the Department of Community Development at the time this application is filed. O 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 may be made ;n the character ipancy or use of the building ✓�\I or premises which would place the building in a different division of the same group of occupancy or in a different group of occupanc,• 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 background. These numbers must be posted on ycur 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 j� National Fire Protection Association pamphlet 10 (see reverse side). SUPPLEMENTAL INFORMATION Q (FOR OFFICE USE ONLY) OCCUPANCY GROUP JJJJ __ PLAN CHECK NO. NO. PARKING SPACES OCCUPANT LOAD j PERMIT NO. _ HEALTH DEPT APPROVAL NO. OF STO IE" ADMIN..ACTION_" _ UTILITIES F,cLEASED ` VI/14 CERTIFICATE OF OCCUPANCY FEE s �� ) OVED DAfE CHANGE OF USE OR OCCUPANCY FEE $ TOTAL �c— S (t, 35-039 Rev. 11190 SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS _Zv/09 Aye-' 2. Person to contact in case of emerge. cy- VW N Che�,V . AQ-esnf- C-A Telephone number: 7L,41 MI—SVkr _ . Does the building in question have electricity? J Yes ❑ No (a) If No, are you requesting that the electricity be ❑ Yes turned on? ❑ No 4. The building is sprinklered? ❑ Yes ,' No 5. Operations will produce dust/wood shavings or similar material? ❑ Yes 0 No 6. Operations will involve the repair or replacement of ❑ Yes automobile parts? Z 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 .r No 8. The following best describes my operation Office Only tail Sale -� i�f�'�LL��^1Z'72s Warehouse Manufacturing / Distribution (describe process and end product) �a CLf-C--K1ty - Restaurant/Take Out Food Medical / Dental Other (describe) _, SUPPLEMENTAL INFORMATION (Continued) Does the operation involve �any of the following materiels? 'Yes No If Yes, indicate quantities: Materir; Quantity 1. Flammable liquids Class I -A Cass I-B Class I-C _ _._...__- 2. Combustible liquids Class it 'Class II( -A 3. Ccmbination flammable liquids , 4. Flammable gases 5. Ligl tefied flammable gases 6. Flammable fibers - loose 7. i=iammat>!e fibers - baled __.. _ _.... 8. ~� Flammable solids 9. Unstable materials 10. Corrosive liquids 11. Oxidizing material - gases 12. Oxidizing material - liquids 13. Oxidizing material - solids 147 Organic peroxides 15. Nitromethane (unstable materials) _ 16. Ammonium nitrate 17. ,ammonium nitrate compound mixtures containing more than 600/6 nitrate by weight 16. Highly toxic material and poisonous gas 19. Smokeless powder, i 20. Black sporting powder 1 hereby certify that the above information is true and correct to the best of my knowledge. taature Date 1 d s APPLICATION FOR PERMIT TO CONSTRUCT AND PERMIT TO OPEWE SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT P.O. BOX 4944 FORM 400A Diamond Bar, California 91765-0944 1� N t"NVY N urvlbtF1_ 1 COMPANY INFORMATION INFORMATION INSPECTOR SECTOR —�'— 21 ISSUE DATE - iLEGAL NAME OF APPL CANT ❑ IRS OR ❑S.S. NUMBER - i PERMIT TO BE ISSUED TO: (SEE INSTRUCTIONS) t ( = BUSINESS MAILING ADDRESS I xl .:J } / S '!Z I�j� _ : / f „1 Ct r• _ �'.L'i<. ( j I 7r� ri i I • TYPE E OF ORGANIZATION ' C3 CORFORATION ❑ LIMITED PARTNERSHIP ED GOVERNMENT ENTITY 0 INDIVIDUAL ❑ GENERAL PARTNERSHIP q OTHER ARE YOU A SMALL BUSINESS? (SEE INSTRUCTIONS) I AVERAGE ANNUAL GROSS RECEIPTS: IS YOUR BUSINESS 51 PERCENT OR MORE WOMAN; YES ❑ NO (I NUMBER OF EMPLOYEES: .--� irV MINORITY OWNED? (OPTIONAL) ❑ YES A NO !` ARE ALL FACILITIES UNDER SAME OWNERSHIP IN CALIFORNIA IN COMPLI %NCE WITH FEDERAL, STATE AND LOCAL AIR POLLUTION CONTROL RULES? G YES ❑ NO ARE YOU THE OWNER OF THE UNDER THIS APPLICATION? ❑ NO. ❑IRS O�S. NUMBER E OWNER `DYES F NO, ENTER LEGAL NAME OF OWNERENT FACILITY INFORMATION EQUIPMENT ADDRESS!LOCATION NUMBER: STREET 1 CONTACT PERSON AND TITLE TYPE OF BUSINESS AT THIS FACILITY BU EQUIPMENT :`_'FORMATION iJ c/41 f •-ri! 6 I FACILITY NAME I FACILITY ID NUMBER (SEE INSTRUCTIONS) ZIP CODE CONTACT TELEPHONE NUMBER NUMBER OF EMPLOYEES AT THIS FACILITY: St MESS E (SEE INSTRUCTIONS) I IS THERE A SCHOOL WITHIN 1,000 FEET OF YOUR PROPERTI YES p NO [.:) EQUIPMENT DESCRIPTION (SEE INSTRUCTIONS) APPLICATION FOR:. (SEE INSTRUCTIONS) ARE YOU SUBMITTING MULTIPLE APPLICATIONS FOR ❑ NEW CONSTRUCTION ❑ MODIFICATION ❑ CHANGE OF LOCATION EQUIPMENT IDENTICAL TO THAT DESCRIBED ABOVE? EXISTING EOUIPMENT OPERATING WITHOUT PERMIT 'L:`) CHANGE OF PERMITTEE ❑ CHANGE OF PERMIT CONDITION s` ❑YES ❑' NO EXISTING EQUIPMENT WITH EXPIRED PERMIT r HAVE YOU BEEN ISSUED A. NOTICE TO COMPLY (NC) OR A NOTICE OF VIOLATION (NOV) FOR THIS EQUIPMENT? ❑ YES Q NO NUMBER OF EMPLOYEES NEEDED TO OPERATE THIS EQUIPMENT: I NC NUMBER: NOV NUMBER: NOTICE ISSUE DATE: ' IF THE EQUIPMENT HAS A PREVIOUS WRITTEN PERMIT, STATE NAME OF PERMITTEE: - PERMIT NUMBER: - FOR NEW CONSTRUCTION OR MODIFICATION, ENTER ESTIMATED COST OF: BASIC EQUIPMENT S AIR POLLUTION CONTROL zNT S FOP NEW CONSTRUCTION OR MODIFICATION, ENTER ESTIMATED START DATE: ESTIMATED COMPLETION DATE: FOR CHANGE OF PERMITTEE, LOCATION OR FOR EXISTING EQUIPMENT IN OPERATION WITHOUT CONDITION, ENTER DATE OF OCCURRENCE: f r7 r?��� f j �) PRIOR PEr .� , ENTER INITIAL OPERATION DATE: FOR THIS PROJECT, HAS A CALIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) DOCUMENT BEEN REQUIRED BY ANOTHER GOVERNMENTAL AGENCY? ❑ YES p' NO IF YES, ENTER NAME: AND SUBMIT A COPY IF APPROVED DO YOU CLAIM CONFIDENTIALITY OF DATA ? (SEE INSTRUCTIONS) ❑ YES [�' NO I HEREBY CERTIFY, UNDER PENALTY OF PERJURY, THAT ALL INFORMATION CONTAINED HEREIN AN/DI INFORMATION SUBMITTED WITH THIS APPLICATION ARE TRUE AND CORRECT OFFICIAL TITLE OF SIGNER • SIGNATURE TYPE OR PRINT NAME OF SIGNER TELEPHONE NUMBER DATE :{ V foi { i•;t? 1'L 1 i�Jt;) rl���_ r''_; ?,� ! - �j C,/y/ APPLICATION NUMBER TYPE EQUIPMENT CATEGORY NUMBER n ASSIGNMENT CLASS ENF. "Mwa E C 0 1 UNIT, ENGINEER I III IV SECT. ENGR. c, •� ENGR. FEE SCHEDULE S VALIDATION / CHECK OR MONEY ORDER NUMBER AMOUNT A -. 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'��.: B r ° s City of Huntington Beach 2000 MAIN STREET CALIFORNIA 92648 DEPARTMENT OF COMMUNITY DEVV.')PMENT Bulld!ng 536-5241 Planning 536-5211 dousing 536-5271 Government Code Section 65850-.2(b) requires the: City of Huntington Beach Building Division not tq issue the final certificate of occupancy unless the applicant has met or is meeting the requirements of the; South.Coast Air Quality Management District (AQMD). The Building Division must obtain a written release from AQMD to show .the applicant has complied with this law. The check list on the reverse side is designed to help .the applicant and the building division to meet these requirements. 1. The applicant (the same person who applies for permits frorr► the Building Division) must complete the check list which can be obtained either at the Building Division or at AQV:D. 2. If all boxes in the list are checked "no", the Building Division can accept the check list as the release. j '3. I£ there are any "yes" answers in the list, the applicant must contact an AQMD engineer by calling (714) 396-2000 to find out whether air permits are requa^ed for the proposed construction project. 4. If air permits are not required, the applicant will obtain a written release from AQMD. 5. If air permits are required, the applicant must submit the nece:,sary permit applications before the release can be issued. Because of the time'it may take for AQMD to go through the above procedures. the applicant is advised to contact AQMD immediately after applying for Building permits. (1360D) C SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT ' (Nonresidential Buildings Only) Location of Subject Property:_ ,210 -7/UI Property Owner Name: Phone # 96.5'36 Name of the 7erson Freparing this form in print and signature Name: � %' i g n a t u r e s�1 �, r�-y.v.-- !a.� �•u�- The person preparing this form must be the same person applying for building permits. Please answer the following questions regarding your proposed occupancy of the subject building. IF YOU DO NOT KNOW THE ANSWER O A QUESTION MARK IN THE "YES" COLUMN: AQMD PERMITTING CHECKLIST YES NO 1. Does your facility use any internal combustion engines greater than 50--HP? 2. Does your facility involve mixing, blending, or processing any solvents, adhesives, paints or. coatings? 3. Does. your facility create any dusts or smoke? 4. Does you. facility refine any liquids or solids or reclaim any metals? 5. Does your facility plate or coat anything? 6. Does your facility have any combustion equipment i.e. boiler, furnaces, broiler, baking ovens, X etc.) rated greater than 2,000,000 BTU/HR? 7. Does your facility handle or store solvents or motor fuel?� 8. Do you use or store any acids? 9. Do you use any chemical process? — X 10. Do you use any solvents for clean-up? 14 11. Are you a dry cleaner, restaurant with a - charbr_oiler, body shop, gasoline station, printer, or part coater? X 12. is the subject building located within one thousand (1,000) feet of any school? _ PROPERTY LINE TO PROPERTY LINE. GRADES K-12. If you have marked "NO" in all columns, you,do'not need an Air Quality permit at this time. If you have marked any questions in the "YES" Column you must contact the South Coast Air Quality Management District located at: 21865 E. Copley Drive f C,.K ml n�o p ciz 93 j Diamond Bar, CA 91765-4182 Please call: Plan Check ) 396-2000 Uq , (1360D-2) CERTIFICATE OF OCCUPANCY' CITY OF HUNTINGTON BEACH 1; 1 ! t 4 Date Address 1 n o C.9 IrJ.r_,.,•c District Business Name PFS'i CT T.'66tF'T~ Tel. or Business Type C E3 Y C: T. F A AE F R F Occ. Group o BUILDING OWNER BUSINESS OWNER/MANAGER Name CCI+ GIL,i.kt,4.zrCRli,K "_-LLL1 Namd.F'I:Y�it Horne Address L;1!7 h cu T n c z. m r Address Home City t f' A' ( rlvtirt Tel. ? r. _ 1 C .. frT, c s _ City T �` �; ; _ Tel. Construction No. of Stories Occupant Load 12 Sprinklers CONDITIONS OF APPROVAL Ccrner,ts: i'O CUTS11iL SIULL E; DEPARTMENT OF COMMUNITY DEVELOPMENT This Certificate of Occupancy f SHALL ?E posted in a conspicuous place on the prem'^es and shall not be removed except by the by t! Building Official. (, COMMUNITY DEVELOPMENT APPLICATION FOR CERTIFICATE OF OCCL'?ANCY CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT HUNTINGTON BEACH DATE (PRINT OR TYPE ONLY) Address—_�/y/o9 A�/ AYS A15 %7`0VZ'1//AIM©A% �2,"41 C� �of�L�G District -Business Name_ �5C-ST CLEI/ V&PZS Tel 214 6F2- e<5_M ✓ Business Type 1)R! lL��'s Occ. Group r BUILDING OWNER �OrTH Cofill�rtL> �t'f I� ySl�� o BUSINESS OWNERIMANAGER "Name ,s %�a. /+9AMi W �ame——lJR�i/�n! /�I GfTo/tiGl be I yI'ne /Address �` �� �2 n �co ecrAv�pdodress ��S`ul C4 C ��s- /,Irfi2 �iy cr 0vabb ity Tel S City. , /.l v�lry�i w,/ AR-a'L- Home Tel. 9, `,' cab 31 �) q90 - 00 9$ �1 IaA HIS USE WOULD BE DESCRIBED AS: ❑ NEWLY CONSTRUCTED BLDG CHANGE O- oWNEP.4' �e­ ❑ CHANGE OF OCCUPANT EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPAN ndicete former use, d any Orcupa ,cy Gr Div SOIJARE FT. OF BUILDI G O BE O CUPIED �i78o n5 1 NO ICE: 1. Occupancy of any building is prohibited and a business license will ri be suea until the building has been c inspecteo 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 fuse up' inspection in the Department of Community Development at the time this application is filed. O 3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a building or A premises in order to determine if a change maybe m,.de in the character of occupancy or use or the bUilaing \, or premises which would place the Iuilding in a d,fferen! 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, I 4, Huntington Beach Fire Code Section 10.2011 requires that building numbers must be a minimum of four(4) inches in height wish one half (1/2) inch stroke, and e: a contrasting color from the background. l nese I` numberr must be posted on you - building in a location that is visible from the street. ' 5. Huntirgton Beach Fire Code Section 10.301 reouires fire extinguisher selection and distribution per the National Fire Protection Associatio, pamphlet 10 (see reverse side). a, (FOR OFFICE �, SIE ONLY) SUPPLEMENTAL INFORMATION 8 OCCUPANCY GROUP PLAN CHECK NO OCCUPANT LOAD — PERMIT NO. _ NO. OF STO E % s ADMIN ACTION 7M ` �10� CERTIFICATE OF OCCUPANCY FEE P-P( OVED / D E CHANGE OF USE OR OCCUPANCY FEE TOTAL 75.039 Rev. 11/90 COMMU UI.VELOPMENT ZONING NO PARKING SPACES — HEALTH DEPT APPROVAL UTILITIES RELEASED y SUPPLEMENTAL INFORMA aON 1. BUSINESS ADDRESS l0/ All- f/U.t�l 7W 12,1 6-4 9-26t/� 2. Person to contact in case of emergency' Telephone number: �i) 3. Does the building in question have electricity? -1 Yes ❑ No (a) If No, are you requesting that the electricity be ❑ Yes turned on? ❑ No 4. The building is sprinklered? ❑ Yes ,JR No 5. Operations will prodice dust/wood shavings or similar material? ❑ Yes �9 No 6. Operations will involve the repair or replacement of ❑ Yes automobile parts? PSl No If Yes: (a) Describe the components repaired or replaced. (b) Does the operation involve the use of an open flame? ❑ Yes No 7. Thy business is drinking, dining or assembly use that will result in an occupant load of more than 50 persons.. ❑ Yes T IJo 8. —he following best describes my operation; Office Only ta!! Sale ^ PJ2z'Z� Warehouse Manufacturing / Distribution (describe process and end product) �f� .b IZs� c c erm i n•L Restaurant/Take Out Food Medical / Dental Other (describe) SUPPLIMENTAL INFORMATION r 1 a i SUPPLEMENTAL NFORMATION (Continued) Does the operation involve any of the following .naiorials? ❑ Yes No If Yes, indicate quantities: Material _ Quantity ?. Flammable _liquids -_-- Class I -A Class 1-6 --- Class I-C 2, Co, pbustible liquids Class 11 Ciass ill -A 3. Comhinatior, —flammable liquids Fiammabi s gases — 5. Liquefier fiamrnable gases G. Flammable fibers - loose Flammable fibers - baled Flamrzabie solids �— ___..-Unssttaa-_---_ble___.__ ___materials____ y. s 10. ::onosive liquids ------- 11.-Oxid's.zing --material - g�:st;s 12. Oxidizing material - liquids 13. Oxidizing material - solids Organic peroxides 15. - Nitromethane (unstable materials) 16. Ammonium nitrate 17. Ammonium nitrate compcund mixtures contairning more than 60% nitrate by weight 18. Highly toxic material and poisonous gas 19 Smokeless powder 20. Black sporting powder I hereby certify that the above informatio.-i is true and c-rrect to the best of my knowledge. atu re Date 0 APPLICATION FOR PERMIT TO CONSTRUCT AND PERMIT TO OPERATE SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT P.O. BOX 4944 FORM 400A c� Diamond Bar, California 91765-0944 NC NOV NUMBER COMPANY INFORMATION INSPECTOR SECTOR ELATE I I LEGAL NAME OF APPL CANT G IRS OR 1 � PERMIT TO BE ISSUED TO: (SEE INSTRUCTIONS) BUSINESS MAILING ADDRESS TYPE OF ORGANIZATION - CI CORPORATION C LIMITED PARTNERSHIP El GOVERNMENT ENTITY INDIVIDUAL ❑ GENERAL PARTNERSHIP ❑ OTHER ARE YOU A SMALL BUSINESS? (SEE INSTRUCTIONS) I AVERAGE ANNUAL GROSS RECEIPTS: _� IS YOUR BUSINESS 51 PERCENT OR MORE WOMAN' YES NO ' NUMBER OF EMPLOYEES: '/ / ❑ MINORITY OWNED? (OPTIONAL) ❑ YES g NO I ARE ALL FACILITIES UNDER SAME OWNERSHIP IN CALIFORNIA IN COMPLIANCE WITH FEDERAL, STATE AND LOCAL AIR POLLUTION CONTROL RULES? El YES ❑ NO ARE YOU THE OWNER OF THE EQUIPMENT UNDER THIS APPLICATION? OYES j NO ❑ IRS OR ❑ S.S. NUMBER OF THE OWNER IF NO, ENTER LEGAL NAME OF OWNER �rn :r IWrunma I lum EOULPMENTADDRESS'LOCATION i • `,�.r !+'a b I FACILITY NAME NUMBER. STREET f FACILITY ID NUMBER (SEE INSTRUCTIONS) ��( I CITY OR COMMUNITY CA I FITT 1 I 1 ZIP CODE ! CONTACT PERSON AND TIT LE CONTACT TELEPHONE NUMBER NUMBER OF EMPLOYEES AT TYIS FACILITY: TYPE OF BUSINESS AT THIS FACILITY BUSINESS TYPE CODE (SEE` INSTRUCTIONS) IS THERE A SCHOOL WITHIN 1,000 rEET Or YOUR PROPERTY? i YES ❑ NO .0 FOUIPMENT 114?0.4IMATIGN EQUIPMENT DESCRIPTION (SEE INSTRUCTIONS) APPLICATION FOR: (SEE INSTRUCTIONS) ,.HE YOU SUBMITT%.NG VjJLTIPLE tiPPLICATIONS FOR ❑ NEW CONSTRUCTION, MODIFICATION DESCRIBED ABOVE ❑ CHANGE OF LOCATION EQUIPMENT IDENTICAL TO THAT'? [� EXISTING EQUIPMENT OPERATING WITHOUT PERMIT CHANGE OF PERUIITTEE 0 CHANGE OF PERMIT CONDITION ❑ YES ❑ NO EXISTING EQUIPMENT WITH EXPIRED PERMIT , HAVE YOU BEEN ISSUED A NOTICE TO COMPLY (NC) OR A NOTICE OF VIOLATION (NOV) FOR THIS EQUIPMENT? ❑ YES ❑ NO NUMBER OF EMPLOYEE'S NEEDED TO OPERATE THIS EQUIPMENT: NC NUMBER: NO" NUMBER: NOTICE ISSUE DATE: IF THE EQUIPMENT HAS A PREVIOUS WRITTEN PERMIT, STATE NAME OF PERMITTEE: PREVIOUS PERMIT NUMBER: FOR NEW CONSTRUCTION OR MODIFICATION, EN7-R ESTIMATED COST OF: BASIC EJUIPMENTS AIR POLLUTION CONTROL EQUIPMENT S FOR NEW CONSTRUCTION OR MODIFICATIOR., ENTER ESTIMATED START DATE: ESTIMATED COMPLETION DATE: FOR CHANGE OF PERMITTEE, LOCATION OR FOR EXISTING EQUIPMENT IN OPERATION WITHOUT CONDITION. ENTER DATE OF OCCURRENCE: ��r� /i r;,J� �/ PRIOR PERMIT, ENTER INITIAL OPERATION DATE: I Fr.R THIS PROJECT, HAS A Cf.LIFORNIA ENVIRONMENTAL QUALITY ACT (CEQA) DOCUMENT BEEN REGUIRED BY ANOTHER GOVEFINMENTAL AGENCY? ❑ YES Ci.7• NO IF YES, ENTER NAME: AND SUBMIT A COPY IF APPROVED 00 YOU CLAIM CONFIDENTIALITY OF DATA? (SEE INSTRUCTIONS) ❑ YES T3 NO 1 HEREBY CERTIFY, UNDER PENALTY OF PERJURY, THAT ALL INFORMATION CONTAINED HEREIN AN) INFORMATION SUBMITTED WITH THIS APPLICATION ARE TRUE AND CORRECT OFFICIAL TITLE OF SIGNER 1 SIGNATURE TYPE OR PRINT NAME OF SIGNER TELEPHONE NUMBER DATE i-: L` I -1 i1 j t ,' IY:C,I Oh; nrl.�_ S 3 APPLICATION NUMBER TYPE EQUIPMENT CATEGORY NUMBER ASSIGNMENT CLASS ENF. W �. B C 0 _ _ _ _ _ _ _ I_ _ UNR .:L. ENGINEER I III IV SECT. V 7 fl N ENCR. ENGR. FEE SCHEDULE S ' VALIDATION l CHECK OR MONEY ORDER NUMBER AMOUNT // A R DATE IN AL A R DATE INITIAL. J` �I� f� � -cr 1,�r 3 �/(i-�' J TIICTPIRIITInu _II.,wi— curluccclun —1.1 •nr.r,n — n City ®f Huntington Beach 2G,�i MAIN STREET CALI FORNIA 92648 DEPARTMENT OF COMMUNITY DEVELOPMENT Building SSS-5241 Planning 636-5271 Housing 536-5271 Government c:)de Seci•ion 65850,2(b) requires the City of Huntington Beach Build,-. Division not to issue the final certificate of occupancy uriless the applicant has met or is meeting the requirements of the South Coast Air Quality Management District (AQMD). The building Division must obtain a written releasg from AQMD to show the applicant has complied with this law. The check list on the reverse side is designed to help the applicant and the building division to meet these requirements. 1. The applicant (the same person who applies for Permits from the Building Division) must complete the check list which can be obtained either at the Build:ng Division or at AQMD. 2. If all bo),;ri in the list are checked "no", the Building Division can accept the check list as the release. •3. If there are any "yes" answers in the list, the applicant must contact an AQMD engineer by calling (714) 396-2000 to find out whether air permits are required for the proposed construction i>roject. 4. If air permits are not required, the applicant will obtain a written release from AQMD. 5. Ii a'_r permits are required, the applicant must submit the necessary permit a-,plications before the release can be issued. Because of the time it may take for AQMD to go through the above procedures, the applicant is advized to contact AQMD immediately aft3r applying for Building permits. (1360D) b SOUTH COAST AIR QUALITY MANAGEMENT D] TRIC1' a.. (Nonresidential Buildings Only)" Location of Subject Property: /0/0 9 ZLt Iys' t411e-- r�yy7�a/3�-k �� 9aSyG Property Owner Name: /3e'�rAi✓ P1 6^ Phone Name of the Person Preparing this form in print and. signature Name:__ 1151e� /11 C#-NL/ .ignatu e �O5? Cam . x The person preparing t"is form must be the same person applying for building permits. Please answer the following questions regarding your proposed occupancy of the subject building. IF YOU DO NOT KNGTa THE ANSWER TO A QU'ZF:TIUN MARK IN THE "YE ES ' COLUMN: AQMD PERMITTING CHECKLIST YES NO 1. Does your facility use: any internal combustion engines greater thEa 50-HP? 2. Does your facility involve mixing, blending, or processing any solvents, adhesives, paints or coatings? _ 3. Does your facility create any dusts or :Hoke? 4. Does your facility refine any Liquids or solids or reclaim any metals? Se' 5. Does your facility plate or coat anything? Ye_ 6. Does ,your facility have any combustion eq,,::.J.pment i.e. boiler, furnaces, broiler, baking ovens, _ etc.) rated greater than 2,000,000 BTU/HR? 7. Does your facility handle or store solvents or motor fuel? 8. Do you use ,-)r store any acids? 9. Lo you use any chemical process? 10. Do you use any solvents for clean-i<p?_ _ 11. Are you a dry cleaner, restaurant with a charbroiler; body shop, gasoline station, printer, or paic coater? 12. Is the subject building located within one thousand (1,000) feet of any school? PROPERTY 'LINE TO PROPERTY LINE. GRADES K-12. If you have markE:d "NO" in all colur-.s, you do not need an Air Quality permit at this time. If you have marked any querstions in the "YES" Column you must contact the South Coast Air Quality Management District located at: 21865 E. Copley Drive yp itL ff3 j Diamond Bar, CA 91765-4182 Please call: Plan Check ) 3.96-2000 r ClO> (1360D-2) a �PLICATI01VO:i CI TIFI ATE OF OCCUPANCY t�tf : HtitdT{NGTON BEACH DEPARTMENT OF 6bFAMUNITY DEVELOPMEN. a+urmrrcToN BEACH (fiilNlaOR TYPE ON.I") tddress ti Business Name Business Type — �. Ci ATE District Tel. Occ. Group, T2 pBUILDING OWNER � BUSINESS OWNER/MANAGER coL l Namr_ �{/� t c oCA�� t � ` — Name_�� lh 1J gC,Li�� Address_ O -s. �ftiA6- S r �'2,00 Home 7 O 5/_F-� �0�A, s ,_�� s � Address GCS � City � cth f� —.�. �• b G� 7e1 2 ' Ci U ' �' Home gay oi�i THIS USE WOULD BE DESCRIBED AS: ❑ NEWLY CONSTRUCTED BLDG. NICHANGE OF OWNER ❑ CHANGE OF OCCUPANT ❑ EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT Indicate former use, if any =52� 4--- Occupancy Gr Div. SQUARE FT. OF BUILDING TO BE OCCUPIED NOTICE: 1. Occupancy of an, } jilding 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 'fuse 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 may be 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. Huntingtor 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 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). I a a-a:+�ra•a�,- :an�r..,, a-e-s. __.------- -• AMOUNT RECEIVED ---- ._--------- NAME _ _-. ._ _.__._ - _ (FOR OFFICE USE ONLY) OCCUPANCY GROUP PLAN CHECV NC OCCUPANT LOAD _ FERMIT NO — NO. OF STORIES I ADMIN ACTION_ ZONING. NO PARKING SPACES — HEALTH DEPT APPROVAL UTILITIES RELEASED — & CERTIFICATE OF OCCUPANCY FEE $ RCV BY DATE CHANGE OF USE OR OCCUPANCY FEE $ TOTAL u 75.039 Rev.1/97 4-• C0M,i,1UNITY [',FVE4 0I1%1C-1':T SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS L 0 �—� 2. Person to contact in case of emergency•—�l -U N _ Telephone number: 1 r 3. Does the building in question have. electricity? C`Y Yes ❑ No (a) If No, are you requesting that the electricity be ❑ Yes turned on? ❑ No 4. The building is sprinklered? ❑yes No 5. Operations will produce dust / wood shavings or similar material? �❑ es Imo' N o 6. Operations will involve the repair or replacement of es automobile parts? No If Yes: (a) Describe the components epaired 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. O yes No 8. The following best describes my operation; Pffice Only Retail Sales Warehouse Manufacturing / Distribution (describe process and end product) Restaurant/Take Out Food Medical / Dental Other (describe) S 1PPLEVENTAL INFORNIAT! �N SUPPLEMENTAL INFORMATION (Continued) Does the operation involve any of the following materials? ❑}Te5 jg' No If Yes, indicate quantities: Material Quantity 1. Flammable liquids Class I -A Class I-B ti Class I-C 2. Combustible liquids - Class II Class III -A 3. Combination flammable liquids 4. Flammable gases 5. Liquefied flammable gases 6. Flammable fibers - lode 7. Flammable fibers - baled 8. Flammable solids 9. Unstable materials 10. Corrosive liquids 11. Oxidizing material - gases "r 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 sxic material and poisonous gas 19. Smokeless po.vwler 20. Black sporting powder I hereby certify that the above information is true and correct to the best of my knowle ge. Sig on-u--r4 Date i (D South Coast AIR QUALITY MANAtGEMENT 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 Property: 0 0 &1)6 . City: ZiI, Code: 2 6 iG Contact Person:y1. IJ Title: 4V,614n,P-.- Telephone Number: `� �— a G Z �� Fax Number: Type of Industry/Business: To apply for a nonresidential building permit, you must complete this checklist. If you h�.ve 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)? [ ] [ V] 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 2,000,000 BTU/hr be operated at the facility? [ ] [ 8. Will ny acids, solvents, or motor fuel be used or stored at the facility? [ ] [ t 9. Will any organic liquids or gases be reacted or produced? [ ] [ V] 10. Will any ovens be used to dry or pure products at the facility? [ ] [ t 11. Will any CFC (Freon) recycling machines operate at the facility? [ ] [ Applicant: LL N Signature: a (Prin name clearly) If you have marked "NO" in all the boxes, an air quality permit is ngat 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 (AQIIIID). Please read the requirements on the back of the checklist. (800) 388-2121 ADF ITIONIA. ",UPPLc_MENTAL INPOBMATiCllq