HomeMy WebLinkAbout10122 Adams Ave - CofO (4)B APPLICATION FOR CERTIFbCATE OF OGCUP^NCY
.- CITY OF HUNTING T ON BEACH
DEPAR T NiEFi T O b'UiLDif'G 8 SAFETY v
HUNT4n.G1ON WAGi (PRINT Cl? TYFE ONLY) DATE
Address _ 1 �� + T"L t'� �� _ District —
Business Name vN .tirt�-b� � -A � ;, t=T� yet 3
Business Type L�� is - K� ;it�� -_ Occ. Groups
BUILDING OWNER BUSINESS OWN(RlMANAGER
Name DU —PA w cs S PR0161L Il 7A4,GAQtsiyP plc r f Name—?c a +,� c� i p,Home
n
Addre-ssTn('3 (0 3 kl-rr-t Address
City J. V E Tel�lR9ooCiry+* s s . �t�'-� r ` _Home Tel9`F 3 45' 12�7
THIS USE WOULD BE ]DESCRIBED AS'
0 NEWLY CONSTRUCTED BLDG. ` J CHANGE OF VNER CHANGE OF OCCUPANT
9 EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any GIA-5 FLe `_Occupancy G. Div _
SQUARE FT. OF BUILDING TO BE OCCUPIED•44'15- Sip. P, i ��IV
NOTICE:
1. Occupancy of any building is prohioited and a business license will not be issued until the building has been
inspected and a certificate of c=,cupancy is issued.
2. No electrical service will be rei -.sed for any existing building until the service has been inspected and
certified safe. All applicants for occupancy in art existing buildinq a,e .equired to schedule an electrical
'fuse up' inspection in the Department of Community Development at they time this applicator, is filed.
3. Change of occupancy or use insnection fee. Whenever it is necessary to make inspection of a huiidfig or
premises in order to determine if a change rn q be made in the character of occupancy r r use of the building
or premises which would place the building in a different division of (K.; rime group of occupancy or in a
different group fr o, cupancy, a change of occupancy inspaction fee of $ _ __ shall
be paid to the cite.
4. Huntington Beach Fire Code Section 1 O.rO8 requires that building numbers must be a minimum of four (4)
inches in height with one half (`'l2) inch stroRp., 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 Brach .Fire Code Section 10'_i01 requires fire extinguisher selectior and distribution per the
Nct,onal Fire Protection Association pamphi)t 10 (sec reverse -ide). 11
. ) uo k - . . ___ V
a �. .... , (FOR OFFICE USE . LY)
OCCUPANCY GROU/�,,_T
NO. STORIES
ROVED BY i GATE
PLAN CHECK NO
PER:`vtlT NO __
ADMIN. ACTION_
CERTIFICATE OF OCCUPANCY FEE
CHANGE OF USE OR OCCUPANCY FEE
TOTAL
ZONING �
NO PARKING SPACES
HEALTH DEPT APPROVAL
UTILITIES RELEASED
FORM- 75.0:0 REV 2102 11E-ORDER. SAND DOLLAF( 71&012-1140
SUPPLEMENTAL INFORMATION
1. ,`9'U9INESS ADDRESS 401-s (,-a
2. Person to
contact in caso of
emergency, 'Je-VE—t— Is''
L-`r"S��
Telephone
number:
rYs i 9--7
3. Does the
building in qutis*ion
have electricity?
15
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
14 N o
6. Operations will involve the repair or replacement of ❑ Yes
automobile parts? ®. 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 busir ass is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Yes
No
8. The following best describes my operation;
Office Only
F�etail Sale
Warehouse
Manufacturing l Distribution (describe process and end product)
Restaurant/Take Out Food
Medical / Dental A f
Other (describe) �y
SUPPLEMENTAL INFORMATION
�`,voive- any of tle- loliovnng
Quantity
Fl-arnnnatke
Class I- 4,t
Class
,
C oj
dcl
tiblc I yids
Class !I
Class 111-A
Comb-'r-ation flammable liquids
— —gases
767 Flarnmable -fibers - oose
materials
-iu, ----- - - —6,;rr—osi'v—e
g material - cases
—2 Ox�tiiing material ---flg-i—,tds
13. Oxidizing material - solicis
1 61 rganic peroxides
15. Nitromethane (un terials)
16. ;Grr�ciniurn nitrate
17. Ammonium nitrate compound mixtures
containing riore 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 information is true and correct to
the best of my knowledge.
y'j
Signature Date
South Coast
AIR QUALITY WNAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AI]R. QIUAEITY PERAH'T CHECKLIST
for nonresidential buildings only
Company Name: — (-r,N �-�-a� •,��Y.
Location of Property: I p I --;, -2— AS) A M s IN Jie
City: �N r. �� c�x� c Iq Zip Code:. `� 11-44-
Contact Person: P , -cisaA Title:
Telephone Number: -711 9 (� 3 o o -314 Fax Number:
Type of Ii-dustry/Business:
To apply for a nonreside* tial_ building permit, you must complete this checklist. If you have any
questions aboLt compL...ng this checklist, please call (800) 388-2121.
YES
NO
1. Will the iacility have a charbroiler?
2. Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)? [ ]
[xJ
3. Will operations at tb:, 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 k ,f any liquids or solids be done at the facility?
6. Will any plating or coating of materials be done at the facility? [ ]
[111-3
7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be
operated at the facility? [ j
8. Will any acids, solvents, or motor fuel be used or stored at the facility? [ J
[54
9. Will any organic liquids or gases be reacted or produced? [ J
10. Will any ovens be used to dry or cure products at the facility? [ ]
P-1
11. Will any CFC (Freon) recycling machines operate at the facility? [ ]
[}
Applicant: ant:�VU 6-- A� " Sign ature:''-/' R_
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is riot 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 (AQML`). Please read the requirements on the back of the checlk ist.
(800) 388--212I
'OTICE OF RE'QUIREMENTS
SECT10- i 65850.201020--�)
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Complete th;-� v
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Huil"imi- DcPartm.c., , , -, - I I Lix
T', - , # ) b"- i 7 1 - r Must Cortal, t"'K
a�l permits are reqvid fbr ain
5 L-Ch, bc- eporatcd at the site. It' fh� AQ,'YID &tennirvs that, air 4ualit�y jlerl*Tl"t,4 Zrf,
:-u*rcmt:n*,,s: been tnc�, a written releasc be ssuc not ze,. I I d.
aiv q";Ji,-, rer - arc wit -I al-plicatioris have not been Yabmittc,-,', Lht.- a.
and appropriat,- fees befo applicat: re NIII-IEt=
rele
V"N be
AC,NID is comnitted to expediting. all clearance letter requests. However, it may take several
weeks to veripv, conlpjixlc;, with 0 requirements. -flierefore, you are advised to cor%acAQN11D
inimedfiately after applying for building permits.
(800)388-2121
rev!$cd 8,*95