HomeMy WebLinkAbout10111 Adams Ave - CofO (11)NUNr[vGTON �AO1
Addresa -0-1-F��
Business Name_
Businesgjype , e
APPLICATION FOR CERTIFICATE OF OCCUPANCY
/ Ci"V OF HUNTIN aTON SSACH
"NT OF COMF4UN TY (DEVELOPMENT
/ �eEPl4RTM(?RINT OR TYPE ONLY) DATE
/y D �'l [ 1
/`lf', nY0 5 �` t District
Occ. Group 4 �.
Ob4K M 9WNE MqEj OWNEWANAGER
;Npme �" ��� rlltic�4 CName V `
Address C6P _ t �_G c i 3 �7 Add — • Q
City - 7� 1 / Tel.vz amity n _.Home Tel:
7 y S
THIS USE WOULD BE DESCRIBEDAS:
! J NEWLY COD`STRUCTED BLDG. ❑ CHANGE OF OWNER X CHANGE OF OCCUPANT
L3.1 EYISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
indicate former use, if any_ Y� (J"C� �n} _ $U Occupancy Gr.---Div.
SQUARE FT. OF BUILDING TO BE *OCCUPIED_ ' U
f,DTiCE: 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. N,o electrical service will be released for any existing building until the service has been inspected and
certified safe call applicants for occupancv in an existing building are required to schedule an electrical
'fuse up' inspection in the Department of Community Development at the I'me this application is filed.
3. Change of occupancy or use inspection fee, Whenever it is necessary :^ r.iake inspection of a hustling or
premises in order to determine if a change may be made in the cnaracter of o =pancy or use of the building
or premises which woulo place the building in a different division of the sarne 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 10.2CS requires that building numbers must be a mk,imum of four (41
inches in height with one half (1/z) inch stroke, and of a contrasting color from the background. These
numbers must be posted on your buildingp, 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).
TRAFFIC ICT
DATE PAIL}
AMGU CEIVED
(FOR OFFICE USE ONLYq ZONING Q 'FEZ
OCCUPANCY GROUP YI _ PLAN CHECK NO. NO PARKING SPACES
OCCUPANT LOAD _— Pt=RMIT NO. _ HEALTH DEPT. APPROVAL
j;
NO. OF STO71ES _ — ADMIN ACTION _ UTILITIES RELEASED
l f
-_j=O/CERTIFIGATE OF OCCUPANCY FEE g
APPROVED DATE CHANGE OF USE Oh OCCUPANCY FEE $�—
TOTAL $ i �•
7S-o8HRev. 1/a7 COMM(jNiTY DEVELOPMENT
SUPPLEMENTAL INFORMATION
I A AvL1J l�
1.
BUSINESS ADDRESS __� t -I Yh_<
j
P.
Person to contact in case of emergency —
Telephone number:
3.
Does the building in question have electricity?
Yes
❑ No
(a) If No, are you requesting that the . lectricity be
❑ Yes
turned on?
❑ No
i
4.
The building is sprinklered?
r
Yes1
(� No h
5.
Operations will produce dust/wood shavings or similar
material?
❑ Yes !
No
6.
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
No
E
s
If Ynn _
(a) Describe the components rctpaired or replaced.
(b) Does the operation involve the use of an open flame?
❑ Yes
V No
7.
The business is drinking. dining os assembly use that will
result in an occui ant load of more than 50 persons.
Yes
❑ No
8.
The following best describes my operation;
Offi ,Q nl►
etas Sales
use
Manufacturing / Dist-ibution (describe process and end product) I
i
Restaurant/Take Out Food
B
Medical / Dental
Other (describe) —�
is
SUPPLEMENTAL INFORMATION (Continued)
Does the opc ration ins cIve any, of the following muter!a{s % Q Yes
No
if Yes, indicate quantities:
Material �- —� iOuantity
1. Flai.imable liqu',ds
Class i-A
Class I•-B
Class I-C
2. Combustible YHquids
Glass II
Class Ill -A
3. Combination flarr?-nahle , liquids
4. .Flammable gases _ �-
5. I -Liquefied flammable gates —
6. Flammable fibers - loose -
7,� F;ammable fibers - bal-2d
8. Flammable solids —
9. Unstable materials
10. Corrosive liquids
11. Oxidizing material - geses
12. OxidizinC. material - liquids
13, Oxidizing .materiel - solids —�—�—�---�
14. `Organic peroxides
15. Nitromethane (unstable materials)
16. Ammonium nitrate
17. Ammonium nitra s compound mixtures
containir.g morn than 60% nitrate
by weight
18. Hign!y toxic material and —
poisonous gas
19. Smokeless powder
20. Black sporting powder
I hereby c rtify that above information is true and correct to
the bes y k le qe.
S[gnatur,. Date
zpouth Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PERMIT CHECKLIST
for nonresidential buildings only
ompany Name:!
Location of Property:.-
City:
Contact Person:
Telephone Number:
Type of IndustryBusiness:
6 02 Fax Number:
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing this ^hecklist, please call (800) 388-2121.
YES NO
1. Will the facility have a charoroiler? [ ] W1
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? ]j
5. Will refining of any liquids or solids be done at the facility? [ ]]
6. Will any plating or coating of materiais be done at the facility?
7. Will any combustion equipment rated greater than 2,000,000 BTU/hr;be
operated at the , :ility?
8. Will any acids, ,awvents, or motor fuel be used or stored at the facility? ]
9. Will any organic liquids or gases be reacted or produced? [ ]
10. Will any oven.^, be used to dry or cure products at the facility? [ f}
11. Will any CJ '1C (Freo recy ing machines operate at th ]]
Applicant: _ iJl �/� Signature:
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is PQ heeded 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 (AQM D). Please read the requirements on the back of the checklist.
HMO) 388-2121
ADDITIONAL SUPPLEMENTAL INFORMATION
r