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Home My WebLink About10136 Adams Ave - CofO4� A� APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH DEPARTMENT Or COMMUNITY DEVELOPMENT HUNnNG10N UA M (PRINT OR TYPE ONLY) Address — , 13�— " 5 �' z_ Business Name De".L)/o Business Type f 5 f ) DATE District Tel. _ Occ.Group�� BUILDING OWNER A!D ),r BUSINESS Or. '1ER/MANAGER Name 3 i/5%/L' 55 f�(zL� ,t�i� (3r? �)�2 � N me_ S Li�t� �L> Ve-1SS IqC%J Home Address t� �`{G' stet !>. __ Address City (f ,NP '��rr Tel City i�`�)C tz'A"1 (!14 i�liS' HomeTel.66/-Z$S 1rS' THIS USE WOULD BE DE: CRIBFD AS: ❑/NEWLY CONSTRUCTED BLDG. 9( EXISTING BUILDING L`J CHANGE OF OWNER •I ❑CHANGE OF OCCUPANT c El CHANGE OF USE J ❑ ADDITIONAL OCCUPANT Indicate forme use, if any V _Occupancy Gr _ Div _ 3 SQUARE FT. OF BUILDING TO BE OCCUPIED L NOTICE: Occupancy of any ding is prohibited and a business license will not be issued ur±il 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 placo the building in a different division of the same group Lf occupancy or in a different group of cupancy, a change of occupancy inspection fee of °i shall be paid to the c' , 4. Huntington Bec -ire Code Section ' 0.208 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 Protecti~n Association primphlet 10 (see reverse side). TR -FF:", 1.017ACi r. _ DAVE NgZ; Af�7::PAID ^.. ,aNT RECEIVED --N1/7 I1— NAME - __/--- _- OCCUPANCY GROUP 3 OCCUPANT LOAD NZT ES 2 -2hr' OQ APPROVED DATE (FOR OFFICE USE ONLY) PLAN CHECK NO PERMIT NO _._ ADMIN ACTION. - CERTIFICATE OF OCCUPANCY FEE CHANGE OF USE OR OCCUPANCY FEE TOTAL 75-Ld9 Rev.1/97 ZONING NO PARKING SPACES — HEALTH DEPT APPROVAL_ UTILIi IES RELEASED — - Qrt SUPPLEMENTAL IiN1FORMATION! 1. BUSINESS ADDRESS tGii� f �ti•.�� fH»- ��z,r?/n'1�L�.9(' .? 4; qK, 2. Person to contact in case of emergency* _ Telephone number: _ 3. Does the building in question have electricity? 19 Yes ❑ No (a) If No, are you requesting that the electricity be ❑ Yes turned on? ❑ No 4. Tite building is sprinklered? ErYes L7 No 5. Operations will produce dust/wood shavings or similar material? ❑ Yes Eg-No 6. Operations will involve the repair or replace,, -it of ❑ Yes automobile parts? r_ NO If Yes: (a) Describe the components repaired or replaced. �b) Does the operation involve the use of an open flame? ❑ Yes D-No 7. The business is drinking, dining or assembly use that will result in an occupant load of more than 50 persons. E` f Yes ❑ No S. The following best describes my operation; Office Only Retail Sales Warehouse: Manufacturing / Distribut' n (describe process and end product) Restaurant/Take Out Food Medical / Dental Other (describe) SLIf'M _MF" TAL 1 J+ MAI71r_11"1 SUPPLEMENTAL INFORMATION (Continued) Dons the operation involve any of the fo",owing materials? ❑ Yes 1�a No If Yes, indicate quantities: Material Quantity _ 1. Flammable liquids ':lass I -A Class I-`3 Y Class i-C 2. Combustible liquids Class II Class III -A 3. Combination flammable liquids 4. Flammable gases ~�Y G�, 5 Gt,2-4 LC 5. '_iquefied flammable gases 6. Flammable fibers - loose 7. Flammable fibers - baled 8. Flammable solids 3. Unstable materials 10. Corrosive liquids 11. Oxidizing material - gases 12. Oxidizing material - liquids 13. Oxidizing material - solids 14. Organic peroxides 15. Nitromethanc (unstable materials) 16. 17 Ammonium nitrate Ammonium r Je compound mixtures cor:taining mop 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 infc,rmation the best of my knowledge. Signature is true and correct to —_.._--- ---Date South Coast Air Quality Management District 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 v (909) 396-3529 e http://cvww.agmd.gov Air Quality Permit Checklist Califorr*a State Law Code 65850.:' prohibits cities from issuing an occupancy permit without clearance from the local air quality agency. This checklist will determine if you need to obtain clearance from the South Coast Air Quality Management District (AQMD). Company Name: Property Address: City: Contact Person: 1-3 pFjeuy� i�i.3�- a-P14- —5 (tiZ- (4t-:,-�1'jC1 Z'�� d3F4eg Zip Code: `J 2E-q Type of Business: gZ3 T //,I iZ-FF,17— Title: _ ff-� t P P, 0 Telephone: (661) 2 q- L Applicant (print name) -'21L D 5 A-1 Signature: • Will the facility have any of the following equipment? YES[ j Charbroiler Dry Cleaning Machine Spray Booth Printing Press (screen/lithographic/flexographic) Internal Combustion Engine (greater than 50 HP (excluding mote- Boiler/Combustion Equipment (greater than 2MM BTU/hr. may, Abrasive Blasting Cabinets/Rooms Baghouse/Cartridge-Type Dust Filter/Scrubber Motor Fuel Storage & Dispensing Equipment Will any of the following operations be performed? YES [ Application of Paints and Adhesives Etching, Plating, Casting or Melting of :Metals Plastic Nfolding, Extruding or Curing Mixing and Blending of Liquids and/or Powders Storage of Acids, Solvents, Organic Liquids or Fuels Production ofFunies, Dust, Smoke or Strang Odors NO [Xj ales) ,put) NO[,'] If you answered "NO" to both questions, this enecklist is your clearance from AQMD. If you answered "YES" to eit'i r question, you must contact tho AQIvID to determine if air quality permits are required. If. permits are needed, AQMD will assist you in submitting permit application(s) and then provide you with a clearance letter. If you have any questions, please call AQMD's Small Business Assistance office at (800)-CUT-SMOG, and press 41.