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HomeMy WebLinkAbout10178 Adams Ave - CofO (3)CERTIFICATE orOCCUPANCY DEPARTMENT ofcowwumn,DEVELOPMENT ^cidress 10178 Adams Ave. Te; I�U""e"^r'pe_--Raker,,�,_CaL�e(="a.°=_�c�L--- ���-)INCi OWNt P� BuS114FISS f 'WNERVANAGE 1� wume__' x'.".^ ^~~~~~ Roberts...... 1' Acy1—.,-t)rA 01y __________�s-____-_�o... `" "°-,ws9�z" DEPARTMENT opoowmuwnvDEVELOPMENT SnAu asposted ma:mnspicvovsm" "^n I,vpremises and wrvno! be removed ex- cept .y the Building Official by __- G',)MrA-*N1TY '-*' -' 11, i / GEVE1,PMENT SUR-DINGDivISION 'APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOP-ENT i-4nNGTON KAM )I: -"� I , 'A 4 6 2 7 2 o _NA - 2 i Ac-;� i a —(.jg 3' THIS USE WOULD BE LESCRIBED A& ElNt,VLY (,-)%`7,41- t:7tI C 00 --,T!N1-i ----------- �—NO—T-IC`E-: Occup;.nc.,'-3f Ar, hl'wcllq itlil:--j .jnd a wfli notbe is,,,;ued tirtii Ine t, w1ding has been 2 No efecli*cal zervwew.!� fw arv� tiVitl! ttle S('T'I;-,-, t'jC-!j Tv,"le-cied .,;ld cerlifled ',,ife All f)F :r- Px,tmq n0i! iInfl,,if'- seqwretj t,- .thedwe- an �--' --trical Jt Se i:p' Of C�11T t EJE'Vt :?*, Itme this "Ipplt'"-Ition is fired 3 Change of r,-.cupancy ot tise;nspection fee.'I„it-z rec�--rvj lo e4a building of P c)f Vie i;roul:' of (--,Ccdpaticv t in is he pald tf-, P"e. CA, Huntington Beach Fire Code Section 1; �('A t4r_ I r;ni-,'04r'n of fs,mr (M !"Ichec- In re'qh* with 1"'i- !'.O 11j ,'!d -f ""ItT,rj'--'Ii" f;�W tle These ntvi-,bets mu,.t be ;11,3_tk,d on I T j �T I fj 1 1, 1 T qj It; 1 0 1 It 1 t 5. Hur ipgton Beach Fire Code Section 11.� !eoili fi-�, I Allrj per tr.e First 3 4.1 FOR OFFICE USE ONLYi SUPPLEMENTAL INFORMATI!)N,--. r4; T SUPPLEMENTAL INFORMATION 1. BoSINEL'S ADDRESS i tl ! 8 ALivc i ' Ave. 2. Person to contact in case of emergency: j!j,,,,,;,s B.ubtrCs Telephone number: 714-997-3'+53 3, Does the building in question have electricity? . a. if No, are y^u requesting that the electricity be turned on? 4. T:1e building is sprinklered? 5. Operations will produce dust/wood shavings or similar material? 6. operatiuns will involve the repair or replacement or automobile parts? If ye'e: (a) Describe the components repairers or replaced. .n Yes O No OYes ONO OYes ONO Oyes g-No OYes CINO (b) Does the operation �.nvolve the use of an o!pva flame? OYes 7. The business is drinking, dining or assembly use that will resulu in an occupant lead of more than 50 persons. CYes 0 8. The following best de:4cribes my operation: Office Only Retail Sales Warehouse Manufacturing/Distritution (describe process and end product)___,* Medical/Dental Other (describe). (QD62D) (1218186) SUPPLEMZNTAL '.NFORM.".TION (Continued) Does the operation involve any of the following materials? Oyes ONo ff Yes, in ica equantitzea: Material Q u a n t il�+��____ 1. Flammable ligt°'�Is Class IAA Clasp I-B x Class I-•C 2. Combustible liquids Class II Class III -A 3. Combination flammable 1igUids 4. Flammable gases 5. Liquefied flammable gases 6, Flammable fib'rs loose r. 7. Flammable fibers - baled r `. �8. Flar sable solids a; ; 9. Unstable materials 10. Corrosive liquids 11. Oxidizi: material uses 12. Oxidizing material.- liquids 13. Oxidizing material - solids 14. Organic peroxides a` 15. Nitromethane (unstable materials) 16. Ammoniun nitrate 111. Ammonium nitrate compound mixtures containing more than 60% nitrate by w�-)ight 18. Highly toxic material and poisonous sas 19. Smokeless powder 0. Blaca si?orti,ng powder I hereby certify that t'e above informatior is tru_ and correct to the best tf my knowledge. Signature Date (0562D) (12/8 °86) CERTIFICAVE OF OCCUPANCY CITY OF HUNTINGTON BEACH Date Address 10 1 P L lv Distftt Business Name L k A L Tel. Business Type Occ. Group BUILDING OWNER BUSINESS OWNER/MANAGER Name Nama- Address Home A ddress City Tel. City C V 11, P oI ,- THelme k Construction No. of Stories Occupant Load Sprinklers CONDITIONS OF APPROVAL DEPARTMENT OF COMMUNITY DEVELOPMENT This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and shall not be removed except by the by Building Official. COMMUNITY DEVELOPMENT 17 'r m, _ 'I) sly APPLICATION FOR CERTIFICATE OF OCCUPANCY GIT`( OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT HUK5NGT0N BEACH - (PRINT OR TYPE ONLY) ll siness Name siness Type 7< !'.a --off w k-r)-JQ Addr^ss iv(eC %/7 SEj: J� DATE rislrict Tel G%�i5-��3 -f _ Ocr_., Group BUILDING -OWNER BUSINESS OWNER/MAN4GER /City Tel Name Home Address 2-5/93 R41149[A 2- City COLS Del- Home Tel. `/ 5 307 7- THIS USE WOULD BE DESCRIBED AS: ❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER CHANGE OF OCCUPANT Ydica EXISTING BUILDING ❑ CHANGE OF USE ADDITIONAL OCCUPANT te former use. if any Occupancy Gr. Div. SQUARE FT. OF BUILDING TO BE OCCUPIED —56 16 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 vvill be released for any existing building until the service has been inspected and certified .afr;. All applic;?nts for occupancy in an existing building are required to schedule an electrical 'fuse up' inspection in ine 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 deter-nine'f a change may ae made in the character of occupancy or use C `the juilding or premises which would I^lace he building in a different division of the same group of occupancy or in a d'.1`erent group of occupancy, a r. ­�nge of occupancy inspection fee of $ shali be paid to the city. 4. Hunt.: cfon Beach F:-e Code Section 10.208 requires that building numbers must be a minimum of fou, (4) inches ,n height with one half (1/2) inch stroke, and of a contrasting color from the background. These numbers must be i-losted on your building in a location that is visib,e from the street. 5. Huntington Beach Fire Cede Section 10.301 requires fire ertinquis,or selection and distribution pe. the National Fire Protection Association pamphlet 10 (see reverse side). SU')PLEMENTAI_ INFORMATION y)2, OCCUPANCY GROUP— �J OCCUPANT LOAD — -�—�— NORIES A OVED B' DATE G (FOR OFFICE USE ONLY) PLAN CHECK NO, PERMIT NO. — ADMIN. ACTION_ loll 7 0 N I N G - Z NO. PARKING SPACES,/ HEALTH DEPT. APPROVAL UTILITIES RELEASED CERTIFICATE OF OCCUPANCY FEE $' CHANGE OF USE OR OCCUPANCY FEE g TOTAL { 75.035 Rev. 6/66 COMMUNI'rY 'DEVELP. I _ 'I) sly APPLICATION FOR CERTIFICATE OF OCCUPANCY GIT`( OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT HUK5NGT0N BEACH - (PRINT OR TYPE ONLY) ll siness Name siness Type 7< !'.a --off w k-r)-JQ Addr^ss iv(eC %/7 SEj: J� DATE rislrict Tel G%�i5-��3 -f _ Ocr_., Group BUILDING -OWNER BUSINESS OWNER/MAN4GER /City Tel Name Home Address 2-5/93 R41149[A 2- City COLS Del- Home Tel. `/ 5 307 7- THIS USE WOULD BE DESCRIBED AS: ❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER CHANGE OF OCCUPANT Ydica EXISTING BUILDING ❑ CHANGE OF USE ADDITIONAL OCCUPANT te former use. if any Occupancy Gr. Div. SQUARE FT. OF BUILDING TO BE OCCUPIED —56 16 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 vvill be released for any existing building until the service has been inspected and certified .afr;. All applic;?nts for occupancy in an existing building are required to schedule an electrical 'fuse up' inspection in ine 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 deter-nine'f a change may ae made in the character of occupancy or use C `the juilding or premises which would I^lace he building in a different division of the same group of occupancy or in a d'.1`erent group of occupancy, a r. ­�nge of occupancy inspection fee of $ shali be paid to the city. 4. Hunt.: cfon Beach F:-e Code Section 10.208 requires that building numbers must be a minimum of fou, (4) inches ,n height with one half (1/2) inch stroke, and of a contrasting color from the background. These numbers must be i-losted on your building in a location that is visib,e from the street. 5. Huntington Beach Fire Cede Section 10.301 requires fire ertinquis,or selection and distribution pe. the National Fire Protection Association pamphlet 10 (see reverse side). SU')PLEMENTAI_ INFORMATION y)2, OCCUPANCY GROUP— �J OCCUPANT LOAD — -�—�— NORIES A OVED B' DATE G (FOR OFFICE USE ONLY) PLAN CHECK NO, PERMIT NO. — ADMIN. ACTION_ loll 7 0 N I N G - Z NO. PARKING SPACES,/ HEALTH DEPT. APPROVAL UTILITIES RELEASED CERTIFICATE OF OCCUPANCY FEE $' CHANGE OF USE OR OCCUPANCY FEE g TOTAL { 75.035 Rev. 6/66 COMMUNI'rY 'DEVELP. I i y SUPP E.MENTAL INFORMaR'_TON 1. BUSINESS ADDRESS ql �� I % - v..._.......:....�..m..-� 2. Person to contact in case of. emergency: �ZS, e `-3-6 enS -do- Telephone number:--- 3. Does the building in question h&✓e electricity? )z des 6 ®No a. If No, are you requesting that the electricity be Oyes turned on? ONO 4. The building is sprinklered? s V 5. Operations will produce dust/wood shavings or similar meted ial? 07es fir 6. Operations will involve the repair; or replacement of OY s automobile parts? If yes: (a) Describe the components repaired or replaced. (b) Does the operation involve the use of an apotn flame? ( Yes 7. The business is drinking, dining or assembly use that will result in an occupant laud of more than -50 persons. ©Y-e-s s S. The following best describes my operation: Office only Retail Sales Warehouse Manufactrring/Distribution (describe prose s and end product) atau as e u t Foo edical/Dental Other (describe) (o562D) (12/8/86) 0 SUPPLEMENTAL YN?ORMATION ( Cont :.nUf.d ) Does the operct•ion involve any of the following materials? OYea— �•�"No IF.: —es, in zca ee gi ant tees: Mater.'.al Quantity — 1. Flammable liquids Class I -A Class I-B Class I-C 2. Combustible liquids Class II Class III -A 3. Combination flammable liquids 4. Flammable gages 5. Liquefied flammable_ ag ses 6. Flammable fibers —loose 7. Flammable fibers - baled �8. Flammable solids 9. unstable materials 10. Corrosive liquids 11. oxidizing material - gases 12. Oxidizing material - liquids 13. Oxidizing material - soli 14. Organic peroxides 15. Nitromethane (unstable materials) 16. Ammonium nitrate 17. Ammonium nitrate c ,mpound mixtures containing ma,,•e than 60% nitrate icy weight 18. Highly toxic material and _ poi"nouus 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. e South Coast AIR QUALI Y .1VtANAG EMENT DISTKICT 9150 R. AIR DRIVE, EL MONTE, CA 91731 `18101 572=$200 DATE. March 8, 1990 TO: Anytown Building.Dep4r ment Fkom: Arthur Lawler, Air 'Quality Eiiy �r-eer SUBJ-ICT: BUILDING PERMITTING UNDER AB3205, WATERS BILL Regarding PLAN CHECK #: 9.0-12345 LOCATION: John Doe I-nc. 12345 Main St. 1Anytown S A M P' L E S A M P L E S_A M P L E S A M P 'L E.1 This site has met or is meating the requirements of Section 42303 of the Health and Safety Code azaa ;the -rQequlxements for a permit to construct and operz-.te for the South Coast Air i Quality Management District APPLICANT HAS ALL REQUIRED PERMITS FROM "PRE SOUTH! COAST AIR QUALITY MANAGEMENT DISTRICT FOR THIS SITE AND/OR PLAN CHECK ONLY. APPLICANT HAS .FILED FOR PERMITS TO CONSTRUCT EQUIPMENT WITH THE SOUTH COAST AIR 'QUALITY MANAGEMENT DISTRICT. APPLICANT IS EXEMPT FROM PERMIT REQUIREMENTS AT TIVI S SITE -AND/OR PLAN CHECK ONLY. REVISED 7/13/89 N SOUTH COAST AIR GSJ�IY'v '�",,A�.�>•1T DISTRICT (Nonreside�ztial Buildings Onlyj� Location of Subject ect Property: 7- l r) 17 Property Owner name: _ Phone # Name of the Person Preparing this form in print ana signature x, Name , 7-yt�(_,_ ,'J S-r4gv.;r! z Sigr.atur The person preparing this form must be the same person applying for building permits. Please answer the following questions regarding your proposed occupancy of the subject building, IF YOU DO NOT KNOW THE ANSWER TO.A QUESTION MARK IN THE "YES" COLUMN: SCAQMO PERMITTING CHECKLIST YES NO 1. Does your facility usany internal combustion engines �-- cer than 50-HP? 2. Does you.. Ixzicility involve mixing, blending, or processing any solvents, adhesives, paints or coatings? 3. Does your facility create any dusts or smoke? 5—f-el 4. Does your facility refine any liquids or solids? Reclaim any metals? 5. Does your fac=lity plate or coat anything? 6. Does your facility have any combustion equipment i.e_. boiler, furnaces, broiler, baking ovens, etc.) rated greater than 2,000,000 BTU/HR? � 7. Does your facility handle or store solvents or motor fuel? F:1 8. Do you use or store any acids" 9. Do you use any chemical process? 10. Do you use any solvents for clean-up? 11. Are you a dry cleaner, restaurant with a charbroiler, ' ® body shop, +Yasoline station, printer, or part coater? 12. Is the subject building located within one thousand ��- ( 1 , 000 ) feet of any school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12. it �,ou have marked "NO" in all columns, you do not need an Air Quality ""I111it at this time. If you have marked any questions in the "YES" Column ® �-ou must contact the South Coast Air Quality Management District located .�t 9150 FLAIR DRIVE, EL MONTE, CA 91731 ttlo.ise. call these offices: Plan Check (818) 572-6406 (818) 572-6111, (818) 572-6261 I): A1,00603 I Address Business Name Business Type BUILDING OWNER Name i 1 Address City Tel. _ Construction No. of Stories CONDITIONS OF APPROVAL CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH Tel. Date District _ Occ. Group BUSINESS OWNER+MAXAGER Name Hame Address Home City Tel. Occupant toad Sprinklers _ DEPARTMENT OF COMV41JfiNITY DEVELOPMENT This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and shall not be removed except by the by Building Official. I COMMUNITY DEVELOPMENT r� APPLICATION FOR CERTIFICATE. CF OCCUPANCY 0 Easy CITY OF HUNTINGTON BEACH DEPA:ITMENT OF COMMUNITY DEVELOPMENT �`�� C7 � --- Hl'NTiNC,T(Nv BFA(}1 '[ (1. 7_c) UCH /rIplll fill' — e.,, _ 1 �/. �i' � - � , i"�,�� • -.. ��y SLY-c,���4�� �,�.,..-; T _ .'I -- C' .2 liY l f�f�; 1 t G "�L THIS USE WOULD BE DESCRIBED AS i P. ^•TIGF_: 1. 0ccupancy of any building is prohibited and a business licere, will not be issued until the building has been inspected and a certificate of occupan.-y is tssued. 2 No electrical service will be released 'or any ex sting building until the service has been inspected and certified s ife. All applicants for occupanc , m an existing building are required to schedule an electrical 'fuse uo' mspecuon in the Department of Cornmumty Development at the time this application is filed. 1 3 Change -f occupancy or us inspection fee. Wrienevcr it is necessary to make inspection of a building or premises ,n order to determine `f a cha; ige may be riade to the character or occupancy or use of the building or premises which would place the , -i+lding in a different division of the same group of occupancy or in a different group of occupancy.. a change 2f occupancy inspection fee of $ 0 shall j be paid to the city { 4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a mil iimi. In o, four (4) inches in height with one half (11) inch stroke. and of a contrasting color from the bar:ko;ound. These num' ers i�iust be posted on your bu Iding in a location that is visible from the street. P Huntington Beach Fire Code Section 10 30 t requires fire extinguisher selection and distribution per the iNational Fire Protection Association parnphlet 10 (see reverse side) (FOR OFFICE USE ONLY) SUPPLEMENTAL INFORR9ATiON 71 ! �— fJ •°ri` - --- JC)., L gT�PItS i P.PPF VE [ aTc 75•039 Rev. u;so `ij SUPPLEMENTAL INFORMAT!ON 1. BUSINESS ADDRESS _ �� (7 � -rr'r r 2. Person to contact in case of emergency- 141.1'14i T claphone number:.%- 3. Does the building in question have electricity? 0---Y'es ❑ No (a) If No are you requesting that the electricity be ❑ Yes turned on? ❑ No 4. The building is sprinklered? rL-4-<s J No 5. Operations will produce dust/wood snavincis or similar material?❑ Y 2— N o 6. Operations will involve the repair or replacement of Cl Yes automobile parts? EK0 If Yes: (a) Describe the components repaired or replaced. (b) Does the operation involve the use of an open flame? E7 Ye 7 -the business is drinking, dining or assembly use that will U result in an occupant ioa,,i of more than 50 persons. ❑ Ye C -Wo 8. The follow;ng best describes my operation; Office Only Retail Sales Warehouse Man ufactur'ng / Distribution (describe process and end product) Restaurant/Take Out Food Medical / Dental Other describe` — SUPPLEMENTAL —1-14-FORMATION ((3ontinued'), DoO8 -he CJ the C3 Yes No Class 1 4. Flammable, gasos Flarnmabie i,ttiero loose� 8 Flamn-,aWcz s,-ikAc a. Unslkab'!(" xidi4 -;r"g qa6�x 2, Oxid:np' loalen�&t! }ic",�ds ---------- rc� r. (i ij rf, -iif rate A m nit o r x r _�Jrj(j coli;ta� nw. by 18. I-iqh!y toxic, m&ter'fii and polsonous gas 19. qmokeiess powder 20. Bllacv, sporting powder I hereby certify that the above intormation is true and correct to the best of myr knowledge. t f igna uro Date, SOUTH COAST AIR QUALITY MANPGEMENT DIrTRICT (Nonresidential Buildings Only) Location of Subject Property- 10178 ADAMS HUNTINGTON BEACH Property Owner namePUSINESS OWNER NA.I,E: Paul Neuvirth 'Dhone # 434 7R68 Name of the Person Preparing this form in print and signat e Name { ( f�t���)'�� Signature ;��/K�_��� The person preparing thus form must be the same person applying for building permits. Please answer the iullowing qaestions regarding your proposed occupancy of the subject building. IF YOU DO NOT KNOW THE ANSWER '10 A QUESTION MARK IN THE "YES" COLUMN: SCAQMD PERMITTING CHECKLIST YES NO 1. Does your facility use any internal combustion engines greater than 50-HP? 2. Does your facility involve mixing, blending, or processing any solvents, adhesives, paints or coatings? 3. Does you.- facility create any dusts or smoke? �-- 4. Does you.: iacil?.ty refire any liquids or solids? Reclaim any metals? 5. Does your facility plate or coat anything? 6. Does vour facility have any combustion equipment , i.e. boiler, furnaces, broiler, baking ovens, etc.) rated greater than 2,000,000 BTU/HR? 7. Does viur facility handle o•: store solvents or motor fuel? 8. Do you use or store any acids? i 9. Do you use any chemical process? 10. Do you use any solvents for clean-up? — 1.1. Are you a dry cleaner, restaurant with a charbroiler, body shop, gasoline station, printer, or part matey? 12. Is the subject 17-1ilding located withir one thousand C r--��- (1,000) feet of any school? PROPERTY NINE TO Pi2OPERTY LINE. GRADES K-12. If you have marked "NO" in ali columns, you do not need an ,fir Quality permit at this time. If you have marked any questions in the "YES" Column you must contact the South Coast Air Quality Managerent District located at: 9150 FLAIR DRIVE, EL MONTE, CA 91731 Pleas( call these offices: Plan Check (818) 572-6406 D:AL00603 (818) 572-6111, (818; 572-6261 CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH Date Address District Business Name _ Tel. _ Business Type Gcc, Group BUILDING OWNER BUSINESS OWNER/MANAGER Name Name r Home Address ; ' _ Address City Tel. Home City Tel. Construction No. of Stories Occupant Load Sprinklers CONDITIONS OF APPROVAL DEPARTMENT OF COMMUNITY DEVELOPMENT This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and shall not be removed except by the by Building Official. COMMUNITY DEVELOPMENT JJ HUNTINaON BrAoi APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT (PRINT OR TYPE ONLYI DATEDATE Buusine ame SI- Bfisiness Type ",(`;`f___ Occ. Group---,z2— BUUIIyL,DDIIINGG�OW.,/NEEJ�R� BUSINESS OWNERr�M`ANAGER lAdd�e 112, A --yS"1i),C- C✓in)c- � • 1�7�1_—Tei4]C°'J. y C= �In. �z�avn !i7_f Qf Home Tel. S27 SZ, . THIS USE WOULD BE DESCRIBED AS: Q ❑ NEWLY CONSTRUCTED BLDG LJ CHANGE OF OWNER �^" �<NGE OF OCC+ 'WANT D EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT Indicate former use. if anyC,�Qf 1 • Occupancy Gr Div S E. 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 buildi+Ia 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 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 oct upancy or in a different group of occupancy, a change of occupancy inspeciion fee of $ shall 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 (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 to, National Fire Protection Association pamphlet 10 (see averse side). 21 (FOR OFFICE USE ONLY) SUPPLEMENTAL INFORMATION i OCCUPANCY GROUP PLAN CHECK NO. OCCUPANT LOAD PERMIT NO NOMSFIES ADMIN ACTION CERTIFICATE OF OCCUPANCY APPROVF9 BY DATE CHANGE OF USE OR OCCUPA TOTAL / 75.039 Rev. 11/90 COMMUNITY DEVELOPMENT ZONIN! , NO PAR aSPACES HE H DEPT APPROVAL_ TILITIES RELEASED � f FEE $ SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS 10/7,,--- -Ad, 1- 1 2. Person to contact in case of emergency ?-OyAx cf Telephone number: S2�' _.5 ' 3. Does the building in question have electricity? (a) If No, are you requ::;ng that the electricity be turned on? 4. The building is sprinklered? 5. Operations will produce dust/wood shavings or similar material? 6. Operations Will involve the repair or replacement of automobile parts? If Yes: (a) Describe the components repaired or replaced. 9--Yes ❑ No ❑ Yes No 01-Yes ❑ No ❑ Yes ©140- L7 Yes a o (b) Does the operation involve the use of an open flame? ❑ Yyps MIN o 7. The business is drinking, dining or assembly use that will result in an occupant load of more than 50 persons. ❑Yes 13d ICJ p 8. The following best describes my operation; Office Only C e al a� apse Manufacturing / Distribution (describe process and end product) estaurant / Take Out FQo7 Medical / Dental Other (describe) SUPPUMENTAL WORMATION SUPPLEMENTAL INFORMATION (Continued) Does the operation involve any of the fofloviing 0 �Ie7 18. Highly toxic material and poisonous gas 19, Smokeless powder 20. Black sporting powder / —hereby certify, that the above information is true and oorn*u . ~..^ of . knowledge. t ` `—_ L 91 naluny / Oate ` City ®f flnntingt�)n Beach 2000 MAIN STREET CALITORNIA 92648 DEPARTMENT OF COMMUNITY DEVELOPMENT Building 536-5241 Planning 536-5271 Housing 536-5271 1, Government Code Section 65850.2(b) requires the City of Huntington Beach Building Division not to issue the final certificate of occupancy unless the applicant has met or is sheeting the requirements of the South Coast Air Quality Management District (AQMD). The Building Division must obtain a written release from AQMD to show the applicant has complied with this law. The check list on the reverse side is designed to help the applicant and the building division to meet these requirements. 1. The applicant (the same per3on who applies for permits from the Building Division) must complete the check list which can be obtained either at the Building Division or at AQMD. 2. If all boxes in the list are checked "no", the Building Division can accept the check list as the release. 3. If there are any "yes" answers in the list, the applicant must contact an AQMD engineer by calling (714) 396•-2000 to find out whether air permits are required for the proposed construction project. 4. If air permits are not required, the applicant will obtain a written release from AQMD. 5. If air permits are required, the applicant must submit the necessary permit applications before the release can be issu Because of it may take for AQMD to go through the above procedures, )lir;ant is advised to contact AQMD immediately after applyi. i Building permits. (1360D) am SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT (Nonresidential Buildings Only) Location of Subject Property: Zf,/ZE�'� Property Owner Name: A�O'Y7 E'er"_ ' Phone #4 Name of the Person Preparing this form in print and sAAignatu e Name:Signaturesl� The person preparing this form must be the same person app 'ng for building permits. Please answer the following questions regarding your proposed occupancy of the subject building. IF YOU DO NOT KNOW THE ANSWER TO A QUESTION MARK IN THE "YES" COLUMN: AQMD PERMITTING CHECKLIST YES NO 1. Does your facility use any internal combustion engines greater than 50-HP? ✓ 2. Does your facility involve mixing, blending, or processing any solvents, adhesives, paints j or coatings? ✓ 3. Does your facility create any dusts or smoke? 4. Does your facility refine any liquids or solids or reclaim any metals? ✓ 5. Does your facility plate or coat anything? 6. Does your facility have any combustion equipment i.e. boiler, furnaces, broiler, baking ovens, etc.) rated greater than 2,000,000 BTU/HR? ✓ 7. Does your facility handle or store solvents or / motor fuel? 8. Do you use o. store any acids? 9. D,, you .use any chemical process? / 10. Dv you us, any solvents for clean-up? 11. Are you a dry cleaner, restaurant with a charbroiler, body shop, gasoline station, / }` printer, or part coater? v 12. Is the subject building located within one thousand (1,000) feet of any school? PROPERTY LINE TO PROPERTY LINE. GRADES K-12. If you have marked "NO" in all columns, you do not need an Air Quality permit at this time. If you have marked any question;; in the "YES" Column you must contact the South Coast Air Quality Management District located a{:: 21865 E. Copley Drive Diamond Bar, CA 91765-4182 Please call: Plan Check (714) 396-2000 (L360D-2)