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CERTIFICATE OF OCCUPANCY
r �;p CITY OF HUNTtNGTON BEACH j'ictZC 3 1'3 $ g
DEPARTIViENT OF COMMUNITY DEVELOPMENT Date
HUNTINGTON KAOi
Address:,— 1416 Alabama nistr?ct
Business Name HMS VAN RERK ret.
Business Type5 UNIT APARTMENT BUILDING Occ. Group
R-1
.—
BUILDING OWNER BUSINESS OWNERIMANAGER
Name Hans Van Heck Name Margaret: VAn perk, Mgr.
16285 Mom. Dana Home i3Ytsewater Irn
Address Address
Fountain Valley 213-�592-3642
City Y Ta..839-3805city Huntington tin Beach Home TeI.
Construction No. or Staries Occupant Load n/a Sprinklered
This Certificate of Occupancy DtPARTMENT OF COMMUNITY DEVELOPMENT
SHALL BE posted in a conspicuous place on
the premises and shall not be remover' ex-
cept by the Building Official y
APPLICATION FOR CERTIFICATE OF OCCUPANCY
i
�e CITY OF HUNTINGTON BEACH ` r/
DEPARTMENT OF DEVELOPMENT SERVICES
HUNnNGTON BEACH SPRINT OR TYPE ONLY) DATE
Address6�0 District —
Business flame % V✓ Tel.
Business Type ;77;oF Oce. Group
BUILDING OWNER BUSINESS OWNE .MANAGE
Name
%sS2 ky-- .�?% �i rsi.� Home a3L�/�w•9Ten ,n✓cy�
Address ,,rAddrrss _._�
City Al 9%D � Tel. ��3 City— ✓-j
f'
THIS USE WOULD BE DESCRIBED AS:
V �ry
❑ NEWLY CONSTRUCTED BLDG. CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
El EXISTING BUILDING ❑ CHANGE OF USE ❑ A�•DITIONAL OCCUPANT
Indicate former use, if any /10 �- i f e /�/ic?�osz�� _Occupancy Gr. _Div.
SOUARE FT. OF BUILDING TO BE CCCUPIED
i
NOTICE: 1.
Occupancy of any building is prohibited and a business license will not be issued until the budding has
been inspected and a certificate of occupancy is issued.
No electrical service will be released for any existing building until the service has been inspected and
certified safe. Al! applicants for occupancy in an existing builcvig are required to schedule an electrical
'fuse up' inspection in the Department of Development Services 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 del>rmine if a change may be mane in the character of occupancy or use of the
building or premises which would place the building in a different dvision of the same group of occupancy
or in a different group of occupancy, a cnange of occupancy inspection fee of $
shall be paid to the city.
4.
Huntingtoo Beach Fire. Code Section 10.208 requires that building numbers must be a minimum of four
(4) inches in height wiln one half ('lz) 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 extinguishes selection and distribution per
the National Fire Protection Association pamphlet 10 (see reverse side:).
(FOR OFFICE USE ONLY)
(FOR
SUPPLEMENTAL INFORMATION
OCCUPANCY GROUP
PLAN CHECK NO. — NO. PARKING SPACES
OCCUPANT LOAD _.-
—_ PERMIT NO. HEALTH DEPT. APPROVAL _
NO. OF STORIES —
ADMIN. ACTION— UT1t=iTfES+RELE7ASEt9..�_,
CERTIFICATE OF OCCUPANCY F
APPROVED BY
DATE CHAN E OF USE OR OCCIJPA Y FEE $
TOTAL S t
---
75-039REV
DEVELOPMENT SERVICES
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS�� •1��
2.
Person to contact in case of emergency:.s/
Telephone number: g PG
3.
Does the building in question have electricity?
Xyes
C3 No
a. If No, are you requesting that the electricity be
Oyes
turned on?
O No
4.
The building is sprinklered?
Cites
ONo
5.
Operations will produce dust/wood shavings or similar
material?
Cayes
g No
6.
Operations will involve the repair or replacement of
i
Dyes
automobile parts?
Ao
If yes:
(a) Desccibe1 the components repaired or replaced..
(b) Does the operation involve the use of an open flange?
Oyes
a
7.
The business is drinking, dining or assembly use that will
result- in an occupant load of more than 50 persons.
Oyes
�o
8.
The following best describes my operation:
Office Only
Retail Sales
warehouse
Mar,ufacturing/Distribution (describe process and end
prc-duct )
Restaurant/Take Out Food
Medical/Dental
Other (describe)_ /C ✓%si.+ri� a �� ,z,�"""
z
(0562D) (12/8/86)
�i
j
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following
materials? Oyes
ff
Yes, in icate quantities:
Material
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 games
-
_5.
Liquefied flammable eases
_
6.
Flammable fibers .Loose
7.
Flammable fibers - baled
8.
Flammable solids
9.
Unstable materials
10,
Corrosive Liguids
11.
oxidizing material -_games
12.
Oxidizing material - iiquids
13.
Oxidizing material - solids
14.
Organic peroxides
15.
Nitromethane (unstable materials)
16.
Ammonium nitrate
' 17.
Ammonium nitrate compound mixtUrei,
containing more than 60% nitrate
by weight
18.
Highly toxic material and
poisonous gas
19.
Smokeless powder
20:
Black sporting powder
I hereby certi y that the above i formation is
true and correct to the
best
yof/mn
SSi� ems_.
DaOe
(0562D)
(12/8/86)