HomeMy WebLinkAbout10126 Adams Ave - CofO (4)APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINOTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
I ON FEA61 (PRINT Ofl TYPE ONLY) DATE
r ss_ � 2sJ 1 ve,
Business Name �/ 5
Business Type O z56
/-{12-% 8 ILDIIJ OWNER
� 1. �
Occ. Group
BUSINESS OWNERJMANAGER
Name- :��'%7�'s Name—�
/ Home Yy)_= ' Address �- -1�(3 Addr/es/s) / 1 �� ��veP
City—,. rL V lVE, f el�4 City! ���T /v/ EEC. ('.,K. tme�Tel`i
THIS USE WOULD BE DESCRIBED AS: I" -
❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER CHANGE OF OCCUPANT
IFTING BUILDING 'CHANGE OF USE ❑ FDDITIONAL OCCUPANT
� 1
Indicate former use, it any p�
SQUARE FT. OF BUILDING TO BE OCCUPIED��?/�
I,
ri
r
TRAFFIC IMPACT F-EE 1
DATE PAID
AMOUNT RECEIVED - (FOR OFFICE USE ONLY)ZONING_—� NAME �_.
OCCUPANCY GROUP `', PLAN CHECK NO. NO PARKING SPACES
OCCUPANT LOAD �u PERMIT NO. HEALTH DEPT. APPROVAL
NO. OF STORIES ADMIN. ACTION__ UTILITIES RELEASED
9n30 � CERTIFICATE OF OCCUPANCY FEE $ _ ("
PPROV BY DATE CHANGE OF USr= OR OCCUPANCY FEE $
OTAL $
i5•039Ray. ;ie7 CCnOMUNITY DEVELOPMENT
SUPPLEMENTAL
INFORMATION
1. BUSINESS ADDRESS
2. Person to in
contact case of emergenc
��
a
Telephone number:
r71
3. Does the building in question have
electricity?
Yes
f
❑ 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 simile,
material?
❑ Yes
.ErNo
6. Operations will involve the repair or
repiacernant
of
❑ Yes
automobile parts?
n .
If Yes:
(a) Describe the component repaired or replaced.
A
E t
(b) Does the operation involve the rise of an open flame? ❑ Yes
❑ No
7. The business is drink;ng, . dining or assen>aly use that will
result in an occupant load of more ;than 50 persons. ❑ Yes
,WNo ,{
8. The following best describes ►n;.� operation; {
Office nl .
etaii Sales_'
are ouse j
Manufacturing / Distribution (describe process and end product)
�)UPPL,EMEN`fAL INFORll A71ON (Continued)
Does the operation involve any of the following materials?
If Yes, indicate quantities:
Material _ Quantity
1. Flammable liquids
Class I -A
Class I-B -- +
Class I-C - -
2. Combustible liquids
C.dss 11
Class III -A
3. ~Combination flammable liquids
4, Fiariniable gases
S�Liquetied flammal*le gases '
6. Flammable fib^rs - loose
7. Flammable fibers - baled
8. Flammable solids
9. Unstable materials
10. Corrosive liquids
11. Oxidizing material gases
12. _ - U idizing-materi.-1 11qu'fd
13. Oxidizing materiai - solids
14. Or;janc peroxides _ l
15. Nitromethane (unstable materials)
16. Ammonium nitrate _
17. Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight „
18. Highly to .',c material and
poisonotas gas
19. Smokeless powder
20. Mack sporting powder
I- hereby certify that the -above information is true and correct to
thst of my n IedgG�.
ignat r date'
i
South Coast
AIR QUALITY .MNAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AM QUALITY PERMIT CHECKLIST
for nonresidential buildings only
Company Name:
ocation of Property: — t
City:_ -
Contact P�^rson: 14,
Telephone Numbe�
Type of IndustryiBusiness:
J "—�► Zip Code: gam- (046n
Title:
4(&'0 Fax Number:
nn , 0
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing this checklist, please call (800)388-2121.
YES NO
1. Will the facility ba«e a charbroiler^ [ ] r '
2. Will any internal combustion engine with greaOr than 50 horsepower
operate at the facility /,excluding motor vehicles)? [ ]
3. Wal 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 BTUr11r be-
'
operated at the facility?
8. Will any acids, solvents, or motor fuel be used or stored at f; a facility? ( ]
9. Will any organic liquids or gases be reacted or produced? [ ]
10. Will any ovens be used to dry or cure products at the facility?
11. Wil CFC (Freon) rec cling machines operate at ..ty? [ ]
Applicant: Signa --
(Pant', name clearly)
If you have m- ked "NO" in all the boxes, as air quality pernut is ng-t needed at this time,
and this checklist is your wilitten release.
If you marked "'YES" in any of the boxes, you roust contact the South Coast Air Quality
Management District (A.QMD). Please read the requirements on the back of the checklist.
(800) 388-2121
J� APPLICATION FOR CERTIFICATE OF OCCUPANCY
l CITY of HUNTINGTON SEACH
fj DEPARTMENT OF COMMUNITY DEVELOPMEW't
�uxr, rob ,
(PRINT OR TYPE ONLY)
Address C2
Business Name 1t�tl,
Business Type
DATE
District
Tel
Occ ;Troup
BUILDING OWNER
BUSINESS OWNER MANAGER
Name •_ ja t311-a°
Name L e.fle
Gt • S J� yr
4` _'�
Home
City
_ Tel
___ _ 1;ity j-r��
,c G &elel Home Tel. ?'j�^cry
_ _�__ —
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLCG
CHANGE OF OWNER
aCHANGE OF OCCUPANT
Ij'EXISTING
El
'�:]
BUILDING
CHANGE OF USE
ADDITIONAL OCCUPANT
lnr.'-.,te wormei use. if any, _ _ Occupancy Gr Div
4 - KE FT. OF BUILDING TO BE OCCUPIED
NOTICE: I, Oc -�u )ancy of any building is prohibited and business license will not be issued until the building has been
inspected and a certificate of occupancy is issued.
2. No electrical service wiil be released for any exisiing building until the service has been inspected and
certified safe. All applicants fol occupancy in an existing building are required to schedule an electrical
'fuse up' inspection in the Department of Community Developmentat the time this arplication is filed.
3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a ;wilding or
premises in order to determine f a change may be made -n 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 orange of occupancy inspection fee of $ __ _ shalf
be paid to the city, j
4. r1+ xtington Beach Eire Code Section 10.208 requires that building numbers must be a minimum of four (4)
°hes in height with one half ('24 inch stroke, and of a contras`ing ccicr from the background. These
nt.:ibers must be posted on your building in a location that is visible from the street.
5. Huntington teach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the !l
National Fire Protection Association pamphlet 10 (see reverse side). j
TRAFFIC RtI PACT nL
DATE PAID_ -_-
AMOUNT RECEIVED
(FOR OFFICE USE ONLY) ZONING -
OCCUPANCY GROUP ._._-__,._,_..._._.....,._. r'LAN CHECi< N0 __ NO PARKING SPACES
OCCUPANT LOAD-- _ PERMIT NO � HEALTH DEPT APPROVAL-- .
NO, Of STa S _ t.. _. _i At3rttJN AC;"a n _ _ _ _...___ UTIiJ 'IFS RE EASED
.'. O CRTIFI'ATE OF OCCUPANOy FEF $
1 ROB Y T DATE CHANG. Q." USti; OR OCI UPANC.Y FEE $ � I
TOTAL $
75 oseRev ;tA97 COMMUNITY OEVEL.O,PMENT
SUPPLEMENTAL INFORMATION
1. Bi1•$INi!SS ADDR',,-:SS
• 2. Person to contact in case of emergency
Telephone number:
3. lees the building in question have electricity?
(a) If No, are you requesting that the electricity be
turned on?
4. The building rs sprinklered?
5. Operations will produce dust/wood shavings or similar
material?
&. Operations will involve the repair or replacement of
automobile parts?
If Yes:
(a) Dmscribe zee components repaired or replaced.
es
D No
0 Yes
0 No
n Yes
El No
El Yes
91-90
❑ Yes
0 No
(b) noes the operation involve the -.ase of an open flame? Q Yes
1, The business is d1 inking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Yes
1-Ala
8. The following best describes my operation;
Office Only,
et -ail -� --
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant / Take OuV Food
Medical / Dental
Other (describa)
sUPPLEMENiAL INFORMATION
SUPPLEMENTAL WORINIATION, (Continued)
Does 1"he opraratlon involve of he +>ll winki rnaterlals,,"
El Yes
r �f Yk:3s, ipdicate nuantities.
Material _.�_.��_ ._.._. __ . _. ___.._. _ � anIn
T.1"lr�r�rD'8a�i1 ltgCti�s
Class l-A
Class 1-3
class I-C
2. Combustible liquids
class 11
Mass Ill -A
I
3 • Combination flammable liquids
51 liquefied flammable gases
6. F lammabie fibers - loose
7.=larpnablrr fibers a baled
8. Flammable solids
9. Unstable materials. ..�.. .�,..�_.._. .. __. _,. ..._...,.. _�...___....v_..e�.��.....,�,..,w,..,_.�..�...,..��,-�.,,_..�w_..
10. Corrosive liquids
Ti. Oxidizing material gases,
12. Oxidizing material - liquids
137Oxidizing mareriai solidzs
14. Organic peroxides
16. Ammonium nitrate n
!�. ,,A-, "{1rnonivAm liftratc- F 4.vrop un u sa7l ;t 4Li
containing more than
b;, weight
18, i � Thly toxic mater,Al aw
poia € nGus gas
20. BlacK sporting powder
l Beret
th e:
certify that 'N"ie above i1furmatiun
of my ktaowIpdge,
Signature
is true and correct W
Date �
South Coast
AIR (QUALITY MANAGEMENT DISTRICT
2186E E. Copley Driver Diamond Bar, CA 91765.4182 11909) 396.2000
'AM QUALITY PE, RM_11T CHECKLIST
_ for nonresidential buildings only
CampanyNaine:'��><� v,.r/ua�' �-
Location of Property: 10/ �� 6 - �3 461, 11f
City:loe<, e. 4 e R Zip Code:
Contact Person: �Jp U ' . tt.�� G Title:
Telephone Number: �/ `f ,_ tr i�`I - r�z � Fax Number:
Type of industry/Business; - Kv r .� 6 -5 /• c ,' z
To apply for .nonresidential building permit, you must compete this checklist. If you have any
questions about completing this checklist, please call (800) 388-2.121.
MS NO
1. Will the facility have a charbroiler?
j I2---'"
2, Will any internall combustion engine v ith greater than 50 .horsepower
operate at the facility (excluding motor vehicles)?
3, Will operations at the facility involve mixing, blendiag or processing of
solvents, adhesives, paints or coatings?
4. Will dust or smoke be generated at the facility?
r
5. Will refining of any liquids or solids be dome at the facility?.---
5. Will any plating or coating of materials be done at the facility?
[ ] r
7. Will any combustion equipment rated greater than 2,000.,000 BTU br be
operated at the facility?
[ ] [
S. Will any acids, sol,aer:ts, or motor fuel be used or stored at the facility?
q, Will any organic liquids or gases be reacted or produced?
10. Will any ovens be used to dry or cure products at the facility?
[ [ ]
11. Will any CFC (Freon) recy 6ing machines operate at the f ` ' ?'
Applicant: Signature:
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is nQt- needed at This time,
and this checklist is your written release.
If you marked "YES" it any of the boxes, yo-i must contact the South Coast Air Quality
ManagementI'listrirt I"AQMD). Please read the requirements on the back of the checklist
ty
(800) 388_21E21
5
MANDATORY REPLY REQUIRED PRiOR TO ISSUANCE OF BLIsSINESS .ICENSE
Complete -nd return to the Business License Division
HAZARDOUS MATE€ ALS DISCLOSURE INFORMATI (O i
'Hunt! ton Beach F:;e Department
PLEASE PRINT RD
Business Address:1191-1� r�la0.11 �2G/-/1
m er Street � Unit Zip Code
Business name:/ tiU/j is fG.� ��✓ �t', F'hone:_%/1� - 3 b a �5 i
Owner/Manager: -'P the 4 Titie: ,13 &441eI`
Description of Business Operation: tire. r
California Health and Safety Code re:;quires the File nepartment tc regulate businesses that handle
hazar<)us materials. Motor oil, hydraulic fluids, gaso.oe, dry cleaning fluid, eto., are considered
hazardous materials and must be disclosed, if you use, handle or store hazardous materials or waste
miaterials equal to or in excess of the following basic quantities, you are required to disclose:
55 gat,ons of f. tuid
•- 500 pounds of solid
• 200 cubic feet of compressed gas
Any amount of radioactive materials
• Any amount of Class A explosive
Any amount of chemicals known to cause cancer
• Any .amount of commercial pesticides
0 Reportable quantity or any chemical on EPA Extremely hazardous Materials Substance List
Disclosure is not required for the fclic,ving:
;. Hazardous substances contained in food, drug, cosmetic or tobacco products.
2. Upon approval of the Fire Chief, hazardous matedais contained solely in consumer products
packaged for us by and distributed to the general public. Howev� :Stfcldes, herbicides,
and ammonium nitrate fertilizers over the required disclosure amoks are not exempt from
disclos"'e.
3. The transportation of hazardous rnaterials'accompanied by shipping papers prepared in
accordance with 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 Administrative Code.
Check ore of the following:
_ter` No chemicals are used, haod'.ed or stored at this business.
Chemicals are used, handled or stored at this business, but do not meet the requirements for
disclesr,re.
Chemi Gals are used, handled or stored at this business. Disclosure forms will he sent "o you.
Amounts wili be verified by the Fire Department during annual inspections. It is unlawful for any person to
knowingly, violate any provision of this ordinance.
I certify, under the penalty of perjury, that the above information Is true and correct to the best of my
knowledge.
Aff
Signature {r�15" Home Phone
—a Z6 s'Y° Date y
Please�,all 714-536-5676 with questions regarding the Hazardous Materials Program.
1
s,*A1estHHFD fonns/FDO04 (712W95)