HomeMy WebLinkAbout10110 Adams Ave - CofOAPPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPA WMIENT OF BUILDING & SAFETY
(Y"' 11oor - MustApp[j, In.-Pervoit)
Business License #
Address /01/0 'TD-11;74T
Date,_
BusinessName 0Ccrag -?,r6F V telephone
Business Type Re I-,q I I -r _-t.
-61 T
Business Owner 'N-�V �voerCq-±Mact,", �4..4�4 t - Name at
Address biome Addre-s
City 9 City 10List Tel, z
THIS USE WOULD BE DESCRIBED AS:
QNev.ly Constructed Puilding or WE%isting Building
CHECK ALL THAT APPLY:
QChangeofOwner Whangeof Occupant Whangeof-Use ElAdditior-I Occupant
Indicate fbrmer use, ifanyLlcjL
Du
es the building have electricity, 9 I,.esW NoQ
If No, are you requesting that the electricity ba turned on'? ves 0
'Die building is sprinklered? Yes Q NoQ
Operations will produce dustlwoad sbavings or similar niatt.6al? Yes Cl No 0
Operations will inwlve the mpair or replat.enient ol'automobile parts Yes Ll No 0
If ves: Describe the components repaired or replaced.
Does the, operation invAve i4e use ot'Nvelding or open flame? Yes 0 No
The businetrs is drinking, diwing or as,.zmbly use V it Neill result in an Occupant load
of more than 50 persons. Yeas C1 No (A
.fie fo 11owing best dcser: bcs my operation.
001'rice Only ORctail Sales , UNTedicallDental Q!kestaurantTake Out P',jod UWarehouse
Q Manufacturing,/Distribution (describe process ar*. I end produco
0 Other (describe)
Office V:ve On13,.-
70nitig: Sq Vt Occupied: '*2 ix Oc; Group, �jl Oce Load: 67
ft, Stories: Parking Spaces:, TIF Review: '.8 N Atrit
Paid MTGRE Final laslirawn
Building Permit A- Entitlement
Planner fnit6ls.,,_ BldgfFilan Checker initials: Cofo 9
Ms"
i
HAZARDOUS MATERIALS DISCL+t3SUP;E INFORMATION
Huntington Beach Fire Department
California Health and SaFety Code requires the Eire Department to regulate businesses that handle hazardous
materials. Motor oil, hydraulic fluids, gasoline, dry cleaning fluid, etc., art considered hazardous rrmaterirds and
must be disclosed. If you use, handle or store hazardous materials or waste materials equ- to or in excess of
the following basic. quantities, your are required tv, disclose:
'Y
• 55 galloixs of liquid
• 500 pounds of solid
• 200 cubic feet of compressed gas
• Any arnount of radioactive materials
• Any amount of Class A explosive
• Any amount of chemicals known to cause cancer
• Any amount of commercial pesticides
• Reportable quantity of any chemical on EPA Extremely Hazardous Materials Substance List
Disclosure is not required for the follawirtg:
1. Hazardous substances contained its food, drug, cosmetic or tobacco products.
2. Upon approval of the Fire Chief, hazardous materials con-Lkned solely in consumer products packaged
for use by and distributed to the general public. However, pesticides, herbicides, and ammonium
nitrate fertilizers over the required disclosure amounts are not exempt from. disclosure.
3. The transportation of hazardous rmaterials accompanied by shippiur, papers prepared in accordance v6th
the provisions of 49 Code of Federal Regulations.
4, Infectious waste generated by health care facilities that are regulated under Title 22 of the California
Administr;:'�ve Code.
Check one ofthe following:
No chemicals are used, handled or stored at this business,
Chemicals are used, handled or stored at this l; 'liness, but do not meet the r-:quirements for disclosure
Chemicals are used, handled or stored at this business. Disclosurefor►ws will be sent to you.
Amounts xill bc verified by the fire Department during annual inspections. It is unlawful for any person to
knowingly violate "y provision of this ordinance.
I certify, ender the penalty of perjury, that the above information is true, and Correct to the best of my
knowledge. /
Signature :f� t �, J �°- Date ! I r G
Home Phone -71 T; i"�/ 6 « 01- l
P'leease call 7I4-536--5676 whit questions regvrduxg lire Razardoks Alaterials Ptogram.
r
._.I South Coast
.Air Quality Management District
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
(909) 396-3529 htpp://www.aq�-cd.gov
Air Quality Permit Checklist
Ca'itbrnia Government Code 65850,2 prohibits cities from issuing a Certificate of( ccupancy to a business
without clearance from the local air o_iality agency. This checklist will determine .if you need to obtain
clearance from the South. Coast Air Quality Management Distric^. (AQMJ')).
Company Name: Ocrwtl �C_"r
Property Address: j o c; 14 0 i4 r w s 14 v r . tt r r �-, IV c� 7' 11 1. � ric to
City: d.c ra r^ x b a rt c; Pr Zip Code: 1.11 66 _
Contact person: l/ I,V(",I4. 17itle: t-' t; ";! LL
Type of Business: (? rt t . r C 5__ Telephone: () 7 i4,) 132,1
Appt,icant: (pritstnani--), € d Ifr 1Jv 'rx --Signature:
• Vr ill the facility have any of the Io,.awing equipment? Yes No
Charbroiler
Dry cleaning machine
l; pray Booth
PrintiaFg Press (scrag n/lithograpliic/liexographic)
lnternal combr: ition engine (greater than 50HP) (excluding motor vehicles).
Hailer/co mbttstion. equipment (greater than 2 million BTU/hr. maximum input)
Abrasive blasting cabinet'.room
Bagltouse%rrtridge type d!ist filter/soribber
LA"otor fuel storage and disprensing equipment
• Will. any of the following operations be performed? Yes No
Application of paints or adhesives
Et6hing, plating, casting, or melting of Metals
Molding and blending of liquid i and/or powders
Storage of acids, solvents, organic liquids or fuels
Production of acids, solvents, organic liquids, or fuels
Production of hones, dust, srnoke or strong odors
• 1f you answered. "No" to both questions, this checklist is your clearance from AQMD.
# If you answered "Yea" to either question, you must contact AQMDto determine: ifair quality permits are
required. if permits are needed, AQMDwill assist you in submitting permit applications) and then provide you
with a clearancc letter, You can call AQMD at their Small O►usiness Assistauce Office at (800) 388 2121.