HomeMy WebLinkAbout10176 Adams Ave - CofO (4)s3
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINr:`fON BEACH
^ DEPARTtdENT OF COMMUNITY DEVELOP ENT r3 — (2f C2 1,
HUNTINGTON � (PRINT OR TYPE ONLY) DATE (`
Address
Business Namej, In Tel. i
Business Type? �l L1 ,�.1 T ' ` ' Occ Group
(Z S (�BJJ02L4,S OW . j-� C� BUSINESS OWNER/MANAGER
Name game_ -4 Z,c �I l
Home Address ,�`� �f� Y �� Address a ,.
City Telq (•Q City!.14 AZfJE 4 a 14- C 4 - Home Tel.S:
3f
THIS USE WOULD BE DESCRIBED AS: (;�C:HA�NGE
\
❑ NEWLY CONSTRUCTED BLDG. OWNER , ❑ CHANGE OF OCCUPANT
XISTING BUILDING HANGE OF USE / ❑ ADDITIONAL OCCUPANT
Indicate former use, if any'}ram Occupancy Gr.—Div.
SQUARE FT. OF BUILDING TO bE OCCUPIED
NOTICE: 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.
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 inspecti<<n of a building or
premises in order to determine if a change maybe made in 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 change of occupancy inspection fee of $ — shall
a
be paid to the city.
4.
Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum of four (4)
inches in height with one half ('/2) inch stroke, and of a contrasting color from the ba," 4round. 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 ;quires fire extinguisher selection am jution per the
+,
National Fire Protection Association pamphlet 10 (see reverse side).
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{ TRAFFi
CT FEE
DATE PAID
AMOUNT RECEIVED
� OFFICE ONLY)
? NAME
(FOR USE
ZONING
OCCUPANCY GROUP—
PLAN CHECK NO, NO PARKING SPACES
OCCUPANT LOAD
PERMIT NO. HEALTH DEPT. APPROVAL
NO. OF STORIES
ADMIN. ACTION UTILITIEb RELEASED
12 �w 00 CERTIFICATE OF OCCUPANCY FEE g
l APPROVED BY
DrATE CHANGE OF USE OR OCCUPANCY FEE g-
TOTAL g__ ^(L-
75-039 Rev. 1/97
l�/
COMMUNITY IOEVELOPMENT
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SUPPLEMENTAL INFORMATIO:M!
1.
BUSINESS ADDRESS ?&- 4-�tz_dal A S=�} � � �U�'' �v �f2�
P,��Cr�t.i;
ra
2.
Persc n to contact in case of emergency-77t�ff(=f C
Telephone number:
3. -
,Does the building in question have electricity?
® Yes
❑ No
I
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
Yes {
i
No
I 5.
Operations will
p produce dust/ wood shavings lor similar -
material?
❑ Yes
No
6.
Operations will involve the repair or replacement of
❑ Yes R
automobile parts?
No
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame?
❑ Yes
BY No
7.
The business 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;
r
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant / Take Out Food C/—
Medica 7-10 tat---- —�
Other "(describe)
SUPPLEMENTAL INFORMATICiN
i
I
y
r
SUPPLEMENTAL . INFORMATION (Continued)
Does_ the. operation involve any of , the. --fallowing materials: ai:t yes
Q I~!o
If Yes, Indic -ate quanfitres:._ ;
Material - Quantity
1. Flammable liquids
Class 1-Atd%?5
Class I-B
Class I-C -
2. Combustible liquids
Class 11
,-Class ll.!-A
nr0
3. Combination flammable liquids
4.
,,-Flammable gaseF, ,
5.
Ll4uefied flammable -asps
6.
flammable fibers •- loose
7.
Flammable fibers - baled
8.
Flammable solids _
9.
Unstable ma., als r.
-10.
Con-osive liquids
11.
_ Oxidizing . material - gasec.'
12.
. -_-Oxidizing- materiai - liquids -
a
13.
, Oxidizing material,- aoiids
{
14.
1!i
"Organic peroxides
15.
Niitromethane '(unstable materials)
;
`
16.
r ;4mmonium nitrate
17.
Ammonium nitrate compound- mixtures
containing more than 60% nitrate
r
by weight
18.
highly toxic material and
poisonous gas
i
19.
Smokeless. powder_
20.
Black sporting powder
I hereby _ m-tify that the above information is true and.,correct to
the best of my knowledge.
'1
Signatu a Date '
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10,
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OCT 01 '99 11:51RM PUBLIC AFFAIRS
' South, Cast
Air Quality Management District
.".21685 E. Copley Drive, Diamond Bar, CA 91765-4182
' :{909) 396-3529 • http:%/vn>♦v.agmd.gov
'Air' Quality Permit Checklist
P.1
California State Law Code 65850.2 prohibits cities from issuing an occupancy peiamt to a
business without clearance from the local air quality agency. • This 0, clslist will determine if you
need to obtain clearance from the South Coast Air Quality Management District (AQMD).
Company Name: r9 / ,i r r C wL(9 -SCra 4)ZZ_—(-e
Property Address: t-n -- _ 4 CLf �y�
City: AY 4L7 ,R FaCq, Zap Code: C _ T
Contact Person: fA s rA 4 dz �rllG 'Title: C e r) '�v.-C-V, .
Type of•Business: 177 0 '�.Y� s I JA A J�:r=` Telephone:
Applicarit.(print name) 1 rf�`� Signature. P
• Will the facility have any of the following equipment? Yes f ] No �4
Charbroiler
Dry c.eaning machine
Spray booth
Printing prec-t (scre*ithographic/flexographie)
internal comLustion engine'(greater than 50 HP (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 millior: BTU/hr, maximum input)
Abrasive blasting cabinettrooni
Baghouse/cartddgeMpe dust filter/scrubber
Motor fi;ol storage and dispensing equipment
Will any of the following operations be,performed?
Application of paints or adhesives
Etching, plating, casting, or melting of meals
Molding, extruding, or curing of plastics
Mixing and blending of liquids and/or powders
Storage of acids, solvents, orgairic liquids, or fuOIS
Production of furnei, dust, smoke, or strong odors
Yes[ ] No [k]"
K If you answered "No" to bnth questions, this checklist is your clearance from: AQMD. N you
answered "Yes" to either question, you must contact AQMD to determine if air quality petmiis
are required. If permits are needed, AQMD wi11 assist you in submitting permit application(s) and
then provide you with a clearance letter. You can call AQMD at their Small Business Assistance
Office at (808) 338-2121.
3tovue4FMtvuy 1999
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