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HomeMy WebLinkAbout10030 Adams Ave - CofOCertificate. of Occupancy No. 0200 APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH — -DEPT. OF BUILDING & SAFETY (3"d Floor — Must Apply In -Person) Business License # .A-4�q1 Business Address 100 O NO/\A,�s /VC-- Business Owners Name .Jo i-�-1 (-t /Ae-�,- w i r H Business Name _ :5'(— e_ Fi-\c:)JM I N S v?-ltN CE _ Business Type 1' iry k N, Lk^,L SEv.y icES Date l 2 -1 9 -UG IW— Zip Code ri Z by G Telephone No. 7 14- Z 0 G- c1So2- Bus. Phone Property Owner Information_ (regyk*red i L IA0-r"Venant/Emergency Contact (required) Name e, r__ tU -Name ju 1 tc-r Address 1 U U 2- b- Home Address 9,3 ti ( /�T-c NN City State/Zipg 24,L-1G City I k V-21 State/Zip Telephone No. Telephone No. . 71 `f 9 6 B --3 L 5S THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or Axisting Building CHECK ALL THAT APPLY: ❑ Change of Property Owner ❑ Change of Occupant ❑ Change of Use ❑ Additional Occupant ■ Indicate former type of business ■ Are you requesting that the electricity be turned on? Yes 0No❑ ■ Is the building sprinklered? Yes 0 No X ■ Will operations produce dust/wood shavings or similar material? YesONox ■ Will operations involve the repair or replacement of automobile parts Yes QNo K If yes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? Yes 11No,4 ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes �No;4 ■ The following best describes my operation: X Office Only ❑ Retail Sales ❑ Medical/Dental ❑ Restaurant/Take Out Food ❑ Warehouse /Manufacturing/Distribution (describe process and end product) ❑ Other (describe) For O,ff cial Use Only Occ Group: Occ Group: Occ Group: Total Sq Ft Occupied: Bldg. Permit # Area: Area: Area: No. of Stories: Entitlement #: Plnr Initials. Date: Plan Chkr Initials: Date: Conditions of Annroval or Other N Inspection Date: Occ Load: Occ Load: Occ Load: TIF Review: ( N Zoning: `—"'R Insp Initials: Date: (G:Building/Forms/document id goes here) r Ja � HUNTINGTON BEACH CERTIFICATE OF OCCUPANCY 020 - CITY OF HUNTINGTON BEACH — DEPT. OF PLANNING & BUILDING APPLICATION 714/536-5241 (3`d Floor — Must Apply In -Person) Business License # kIfJ(J Date t - %3 _ I L Business Address t o a A-,2z Zip Code S z I y I Business Owners Name j� 5^ s Telephone Nol-),y)-3 921/ 9 i, Y Business Name'SO��- s/i►,, u�L s 6-y FAt+, Bus. Phone 6,416IS- 3 214 Business Type i ,,S S<e-V.�9- s Property Owner Information (required) Tenant/Emergency Contact (required) Name �,o,,,,o w��.„t��,�, Name Address Home Address 16- �� �� • n bt City State/Zip City ^w, a,5 v, cS G State/Zip C& 9 Z 6 SL Telephone No. S `/ i-7z- 1 Z t o Telephone No. THIS USE WOULD BE DESCRIBED AS: ❑ Newly Constructed Building or [V Existing Building CHECK ALL THAT APPLY: ❑ Change of Property Owner DC ange of Occupant ❑Change of Use ❑Additional Occupant ■ Indicate former type of business S-r-y7s r,,,e,P , A 6&,__5"r ■ Are you requesting that the electricity be turned on? Yes [] No B-- ■ Is the building sprinklered? Yes❑ NoE- ■ Will operations produce dust/wood shavings or similar material? Yes ❑ Nofl' ■ Will operations involve the repair or replacement of automobile parts Yes[] NoF;-- Ifyes: Describe the components repaired or replaced. ■ Does the operation involve the use of welding or open flame? Yes[] Now ■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons? Yes []No lam' ■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes []No 9-- ■ The following best describes my operation: C?Office Only ❑ Retail Sales ❑ Medical/Dental ❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food (describe process and end product) Other (describe) For Official Use OnIY Occ Group: Area: Occ Group: Area: Occ Group: Area: Total Sq Ft Occupied: No. of Stories: Bldg. Permit # Entitlement #: Plnr Initia Date: Plan Chkr Initials: Conditions of Approval or Other Not es- 0 i se— �OP/1�— Occ Load: Occ Load: Occ Load: TIF Revi Y/ N Zoning: Date: Insp Initials: Date: Inspection Date: r South Coast Air Quality Management ement District 21865 Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-3529 • http:// «1«N,.agmd.goN, Air Quality Permit Checklist California State Law Code 65850.2 prohibits cities from issuing an occupancy permit to a business 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: -zZvb- S^�_,AbL 5 Property Address: l D b 3 a AvAk ,. s A it City: Vl� •-'6 - Zip Code: Z 1�6 Contact Person: 5A'^^ , ( Title: o,.� Type of Business: Szml� Telephone: -PY 62Y M7Y Fax Number: -)J,4 3 by dy °1 e-mail address: Applicant (print name):��— SAh-L,&Ls Signature: Date: % " 6 - I z Will the facility have any of the following equipment? Yes ❑ No 0^ Charbroiler Dry cleaning machine Spray booth Printing press (screen/lithographic/flexographic) Internal combustion engine greater than 50 HP (excluding motor vehicles) Boiler/combustion equipment (greater than 1 million BTU/hr. maximum input) Abrasive blasting cabinet/room Baghouse/cartridge-type dust filter/scrubber Motor fuel storage and dispensing equipment • Will any of the following operations be performed? Yes❑ No©' Application of paints or adhesives Etching, plating, casting, or melting of metals Molding, extruding, or curing of plastics Mixing and blending of liquids and/or powders Storage of acids, solvents, organic liquids, or fuels Production of fumes, dust, smoke, or strong odors If you answered "No" to both questions, this checklist is your clearance from AQMD. If you answered "Yes" to either question, you must contact AQMD 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. You can call AQMD at their Small Business Assistance Office at 1-800-CUT-SMOG (1-800-288-7664). -2- HUNTINGTON BEACH FIRE DEPARTMENT HAZARDOUS MATERIALS DISCLOSURE OFFICE 2000 MAIN STREET • HUNTINGTON BEACH, CA 92648 (714) 536-5676 • FAX (714) 374-1551 HAZARDOUS MATERIALS DISCLOSURE INFORMATION MANDATORY REPLY REQUIRED PRIOR TO ISSUANCE OF BUSINESS LICENSE Complete and return to the Business License Division PLEASE PRINT RD#: Business Name: Phone: IIc/ 62c( 5957V Business Address: I uo 30 Number Street Unit Zip Code Owner/Manager: Jots- SAS Date Business Will Start Operation: 3 - ► - % z Description of Business: STA-et-t; CA a- A0 ,>Cy California's emergency response network requires all businesses to notify their local emergency response agency if they store or use hazardous materials above certain threshold quantities. In the City of Huntington Beach, the emergency response agency is the Fire Department, and the method of notification is by filing a Hazardous Materials Disclosure Package with the Fire Department's Hazardous Materials Disclosure Program office. Types of hazardous materials that must be disclosed include: oils, solvents, paints and coating materials, gases (compressed or cryogenic), fuels, and hazardous wastes. You are required to submit a Hazardous Materials Disclosure Package if you store or use hazardous materials in quantities equal to or greater than the following amounts: ➢ 500 pounds of a hazardous solid ➢ 55 gallons of a hazardous liquid ➢ 200 cubic feet of a gas (or the compressed or liquefied equivalent) ➢ Extremely hazardous materials that exceed the threshold amounts listed in 40 CFR 355 Appendix A ➢ Radioactive materials that exceed the amounts listed in 10 CFR sections 30, 40 or 70 ➢ Hazardous wastes that exceed any of the thresholds amounts listed above ➢ Other materials determined to pose a significant hazard to human health and safety, or the environment Disclosure is NOT required for the following types of hazardous materials: ➢ When contained in a food, drug, cosmetic or tobacco product. ➢ When packaged for direct distribution to consumers (retail products). ➢ When the materials are stored, used, or handled at a facility for less than 30 days. ➢ Infectious waste generated by health care facilities. Please indicate which category most appropriately describes your business: 0 No hazardous materials are, or will be, used, handled or stored at the above location. ❑ Hazardous materials are present, but in quantities less that the amounts listed above. ❑ Hazardous materials are used, handled, and/or stored at or above the amounts listed above. A Fire Department representative will contact you at a later date to verify the above information and determine if you need to file a Hazardous Materials Disclosure Package. If you have any questions about the Hazardous Materials Disclosure Program, please call (714) 536-5469 or (714) 536-5676. You can also obtain additional information on the City's website at %vNvw.surfcity-hb.ore in the Fire Department page under the section Fire Prevention. I certify, under the penalt f perjury, that the above information is true and correct to the best of my knowledge. Signature: Home Phone: 71'/ d Z y p 9s Y Date: i"q- -3- 4 Department of Planning & Building 2000 Main Street Huntilhgtbn Beach, CA 92648 Phone (714)536-5241 Fax (714) 374-1647 10028 Adams Ave 10030 , APN 155-181 »03 N;, S S`L ASSN Occupancy Application ,4 P Application Binder Num Unit Bldg x Job Addres 10030 Adams Ave ` ' " eE APN 155-181-03� RD 3920 Zoning CG ��, Lot � Tract` 50006 Block 10 w e File Number CofO? Entered By Hipsher, Renchell Date Entered 01/16/2007 Default Inspector Benbow, Jeff Status I Pending Permit Type Certificate of Occupancy Issue Permit? Date' Origin Counter Issued By Building Use- City�� Planner Nguyen, Tess 3uitdingUse -County _ New Building? Plan Checker Y� Description OFFICE TO OFFICE h ,�n erna o es, CofO Number CO2007 000590 ,Choos6 Pnnt Aft CofO Type Permanent Fees and Payments - t issued By - �StaeetstotSwe � ` Inspections S�rigte Cl0 .„ CofO Status Pending 'e CofO Date Issued. t� Temp CofO !suede s Date Printed Utility Release Date ; Temp GOFO-Expiration � E I ��'Ctiek tacense Number A247406 . the e< button to copy the Business License e� °information into the Certificate of Occupancy, o Business Name MARKWIT}i J-STATE FARM AGENCY � Business Licenses Business Name business Type Exerptm� �, A013024 : ' A257424 " DAVID WILHELM DDS j � ` ,y r Business Phone(714} 968-3655 ' _ p e A177208 BUSINESS PROPERTIES PTNR #1 REFINISHING DOCTOR , t� r A183426 PERFECT IMAGE VIDEO PRODUC Proposed lase r ,Approved Occupied Area (Sq Ft) 0 00 Former Use # of stones F Conditions Change of Owner? [] ,Etec Available? Dnnl ing 7 Dining > 50 Occupants? _f � �Changeof„Use?� � ti ��WantEiectncityOn?� ` Weldingl0penFlame? c `Changeof0CctipantZ0 Srinkiered?A-- Automobile Repairs? 4 � Additional Oocupah Dust f Wood? Auto Parts Desc Group'-`Descnotion` ' "Area �, �� `>� Construc#ronTypeOccupancyLoad, Group Deflnitic7-1