HomeMy WebLinkAbout15000 Bolsa Chica St - CofO (5)v SY
0
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
in DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNTINGTON BEACH
(PRiaT OR TYPE ONLY)
Address 1.5_�QQO AO-1,5.i�C�/z°� �C �11J�7`� �e/JCi5!._
Business Name -50/� / ;5%i-;/G
Business Type
4 A) 7"/ P5 11 N 5
DATE
District.-7
Tel : 1
Occ Group
BUILDING OWNER BUSINESS OWNERIMANAGER
Name UPS .8,q�uk' ,t�LZ �srE �= �.�, �U%L � Name zO, 101 S`.t> A�-Vk
VL T-el)5r Home G
Address ciJrS`i TAddress'
City • Tei City Home Tel:3,�
t 00/(, 6 %VJ9
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED ELDG. ❑ CHANGE OF OWNER
EXISTING BUILDING ❑ CHANGE OF USE
indicate former use, if any - Occupancy Gr
SQUARE FT. OF BUILDING TO BE OCCUPIED �� d 0 # 0en &E);
CHANGE OF OCCUPANT
ADDITIONAL OCCUPANT
NOTICE: 1. Occupa.icy of any building is prohibited and a business license will not be issued until the building has been
inspected and a c.:rtificate 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 inspection of a building or
premises in order to determine if a change may be 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
be paid to the city.
4. Huntington Beach Fire Code Suction 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 the
National Fire Protection Association pamphlet 10 (see reverse side).
Ast
TRAFFIC KIP,ACT FEE. ---
DATE PAID �.
AMOUNT RECEIVED -
NAME (FOR OFFICE USE -ONLY)
OCCUPANCY GROUP_ do =i— --
OCCUPANT LOAD NO. OF STORIES
ge j "W61 7 ; 'Z.
i APPROVED GATE
r
ZONING _1 L
PLAN CHECK NO
_
NO PARKING SPACES
PERMIT NO
HEALTH DEPT APPROVAL
ADMIN ACTION
UTILITIES RELEASED
LEAS6ED
r102,
•Jq�,
CERTIFICATE OF OCCUPANCY FEE
$ z` Jn
CHANGE OF USE OR OCCUPANCY FEE
$ C1`77��
TOTAL
$ �-
75-039 Rev.1/97 COMMUNITY DEVELOPMENT
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS /5-0120 601', jsr
2.
Person to contact in case of emergency -
Telephone number:
3.
Does the building in question have electricity?
IS'Yes
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
M-
4.
The building is sprinklered?
es
n No
5.
Operations will produce dust/wood shavings or similar
material'-'
❑ Yes
9 No�
6.
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
C9-
If Yes:
(a) Describe the components repaired or replaced,
(b) Does the operation involve the use of an open flame? ❑ Yes
El-m-
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 54 persons. ❑ Yes
B-N o -
8. The rI lloaaciag� ,best describes my operation;
Office Only
Retail ales
r� areho
Manufacturing / Distribution (describe process and end product)
Restaurant /Take Out Food
Medical / Dental
Other (describe) W-A'Q1,e:S L(f
SUPPLEMENTAL INFORMATION
I,,
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials? -171 YesrD i
0
If Yes, indicate quantities: —
Material Quantity
1. Flammable liquids
Class I -A
Class I-B
Class I-C
2. Combustible liquids
Class 11
Class 111-A
3. Co ination flammable liquids -�
4. Flammable gases
5. 1_iquefied flammable gases
6. Flammable fibers - loose
7. Flammable fibers - bated
8.._..� .t^�ammable solids
9..�4.,�.Unstable materials
10. Corrosive liquids
11. Oxidizing material - gases
-1 -'—Oxidizing material- liquidsOxidizing material material - solids
14.__ Organic peroxides
1 a. _ lilitromethnne (unstable materials)
16. Ammonium nitrate
17. Ammonium nitrate compound y mixtures
containing more than 60% nitrate
by weight
18. Highly _toxic material and
poisonous gas
10. Smokeless powder
20, Black sporting powder
I hereby _certify that the above information is true and correct to
the best of my kno ledge.
,: -:mac..-
Signature Date
South Coast
AIR QUALITY 10,ANAG-EMENT DISTRICT
21865 E. Copley Drive, Diamond I3ar, CA 91765-4182 (909) 396-2000
AM QUALITY PERiVHT CHECKLIST
for nonresidential buildings only
Company Name: ae r5 2` Tu--,c-- /"
Location of Property: 15 r0 DO .7-� C S 1.4 OA /C'.52 ,�� C's _
City: St,-,`/ t-'Lz Zip Code:
Contact Person: Sly` XW G X Title: d /-e'91-.)
Telephone Number: ,7 Fax Number: %/ y- Z32, - 6 Zy
Type of Indust'; /Business: S
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing this checklist, please call (800) 388-2121.
YES NO
1.
Will the facility have a charbroiler?
2.
Will any internal combustion engine with greater than 50 horsepower
facility
]
operate at the (excluding motor vehicles)?
[ [
3.
Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings?
4.
Will dust or smoke be generated at the facility?
5.
Will refining of any liquids or solids be done at the facility?
6.
Will any plating or coating of materials be done at the facility?
7..
Will any combustion equipment rated greater than 2,000,000 BTU/hr be
facility?
[ ] [
operated at the
8.
Will any acids, solvents, or motor fuel be used or stored at the facility?
9.
Will any organic liquids or gases be reacted or produced?
10.
Will any ovens be used to dry or cure products at the facility?
11.
Will any CFC (Freon) recycling machines operate at the facility?
Applicant: f�? i?lG y/J 5 U` h�U,eV Signature: _�
c
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is ng—t needed at this time,
and this checklist is your written release.
If you marked "YES" in any of [lie boxes, you must contact the South Coast Air Quality
Management District (AQMD). Please read the requirements on the back of the checklist.
(800) 388-2121
ADDITIONAL SUPPLEMENTAL INFORMATION