HomeMy WebLinkAbout10188 Adams Ave - CofOr�
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APPLICATION 'FOR C:ERTIFIC'ATE OF OCCUPANCY 47
CITY OF HUNTINGTON BEACH
DEPARTMENT OF DEVELOPMENT SERVICES ) 3- f-R
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HUNnNOTON WRINT OR TYPE ONLY) f ft DATE
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111 y
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lAddress
10188 Adams Ave. l District
TLC Medical Group 9G'3_3266
Business Name Tel.
BusinessT},ie Medical office Occ.:.rOLlo e'
BUILDING OWNER BUSINESS OWNERIMANAGEk
Name Business Prorert es Name Francis Foo,M.D
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Address 37631 Fitch Address 9441 Gateshead Drive
_
Irvine,Ce.. -48900 Huntington Bch. 963-7841
Cat' Tel._____,_, Cit Hor,e Tel. i
y- City-- - -r—�-
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THIS USE WOULD BE DESCRIBED AS:
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NEWLY CO 6TRUCTED BLDG. ❑ CHANGE OF, OWNER ❑ CHANGE OF OCCUPANT
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❑ EXISTING BUILDING ❑ CHANGE OF USE ❑ nLJDITIONAL :CUPANT
Indicate former use, if any,, Occupancy ur Div._
SQUARE FT. OF BUILDING TO BE OCCUPIED 4,386 sq.. ft.
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NOTICE: 1, Occupancy of any building is prohibited and a business license will not be issiled until the building has
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been Inspected and a certificate of occupancy is issued.
2 No, electrical service viil be released for any existing bt "ding until the serviro has uaen inspected and
certified safe. All applicants for occupancy in an existing building are requires; to schedule an electrical
'fuse up' inspection in the Department of Devo=:ipment Services at the time th;5 applicationis filed.
3. Change of occupancy or use inspection tee. �rvhenever it is necessary to make :nspectlon of a building
or premises in order to'determins if a change may be made in the character of occunancyor use ?)f the
building or premises which would place the building- in a different division of the sw mt group of occupancy
1 j% or in a different group of occupancy, a change of occupancy inspection fee of $
f 3 i
/ shall be paid to the city.
111 4. Huntington Beach Fire Code Sectior. 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 background. These
numbers must be posted on your building in a location that is visible from the street.
5. Huntington Reach Fire Code Section 10,301 requires fire extinguil ne) selection and a Aribuffon oer
the National Fire Protection Association pamphlet 10 (see reverse :-de)
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(FOR OFFICE USE ONLY)
ZONING
SUPPLEMENTAL INFORMATION
OCCUPANCY GRG,JP -- Z__9�
PLAN CHECK, NO. "NO PARKING SPACES .
OCCUPANT LOAD __ PERMIT NO, HEALTH DEPT APPROVAL
NO OF S70 IES ADMIN. ACTK•N- . - - UTILITIES RELEASED
-%-? -. CERTIFICATE OF OCCUR.^N Y FEE
APPROVE BY DATE CHANGE OF USE OR OCCUPANCY FEE $
TOTAL $ a
75039REV DEVELOPMENT SERVICES
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SUPPLEMENTAL INFORMATION
lBUSINESS ADDRESS 10188 Adams Ave. Huntington Beach
2. Person to contact in case of emergency; Francis or Ruby Foo
Telephone number:gr-1-7Qal ati1._7-7gG
3. Does the building in question have electricity? ' oYes
t:1 No
a,. If No, are yari requesting that the electricity be OYes
tu.rned on? ONO
4. The building is sprinklered? OYes
ONO
5. operations will produce dust/wood shavings or similar
material? OYes
%No
6. Operations will involve the repair or replacement of OYes
automobile parts? MNo
If yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame?, OYes'
W Nfl
7. The business is drin;,.Lng, dining or assembly use that will
result in an occupant load of more than, 50 persons. OYes
i�NO
S. The following best describes my operation:`
Office only
Retail Sales
Warehous,
Manufacturing/Distribution (desr-.ibe process and end
product)
Restaurant Ta a Out FOR
Medical/Dental
Other (describe) `Lh ,
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(0562D)
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following
materials? Oyes
ONo
Yes; -in3 cate quant ies:
--
Material
Quantity
1. Flammable liquids
Class I -A
_
Class I-B
Class Z-C
2. Combustible liquids
Class II
Class III -A
3. Combination flammable liquids
4. Flammable gases
5. Liquefied flammable gases
6. Flammable fibers —loose
7. Flammable fibers - baled
8. Flammable solids
9. Unstable ;materials
10. Corrosive liquids
11. Oxidizing material - gases
12. Oxidizing material - ILuids
13. Oxidizing material - 'solids
1.4. Organic peroxides
15. Nitromethane (unstable materials)
16. Ammonium nitrate
17. Ammonitit,I nitrate compound mixtures
containing more than 60% nitrate
by weir ht
18. Highly toxic material nand
poisonous ;gas
19. Smokeless poyde-
M Black sporting powder
I hereby certify that the above Inforination is
true and correct to the
best of my knowledge.
o,
9' 1
Signature
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Date
(0562O)
(12/8/86)