HomeMy WebLinkAbout15102 Bolsa Chica St - CofO (21)CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
Date
Address 1 a, 1 n% 13 Ci L S /i h i; rt r B District
Business Name LAR11ARK, ?NC. Tel.
C F'ICL--tac, PLODUCT SALES Occ. Group B I Business Type �
3 BUILDING OWNER nJSINESS OWNER/MANAGER 1
BRIAN G. WILSGN Name LARRY ;GASPER
Name
#
Home
Address 3121 KATFLLA Address 402'-) ALi1Dl-)1'P Home
City STANTON Tel. 71�527�94EU City fiUfiTIIIC.TUFI E Tel. 1Ltfi —!i3iif I
Construction No. of Stories 1 Occupant Load 1 Sprinklers
CONDITIONS OF APPROVAL
I
a'
a � 4
i 1
I'
DEPARTMENT OF COMMUNITY DEVELOPMENT i
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
3t4
peor
W.-
APPLICA C�ION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH �) 3DEPARTMENT OF COMMUNITY DEVELOPMENT DATEE
(PRINT OR TYPE ONLY)
Ii
"Z
ess 1 &LL5 Gn 5� � 5JJw,rrl District
IAPA � 1 Tel.
mess Name nn
r
mess Type t Q G� ^ eA'� i; Occ. Group
BUILDING OWNER % ��/�� BUSINESS OWNER/MANAGER
tme J _ Names
fume
4ddres t /1 ZA 19V67 Address ' q—I1
O C ply
Te l City �� C `Home Tel: �
THIS USE WOULD BE DESCRIBED AS:
/
NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER 1'11 CHANGi OF OCCUPANT
EXISTING E UILDING L CHANGEEs0, USE ❑ ADDITIONAL OCCUPANT
Indicate former se, if any 1(" ' '""'�i Occupancy Gr. Div. _
S SOUARE FT. OF BUILDING TO BE OCCUPIED 3
i
NOTICE: 1. Occupancy of anw building is prohibited and abusiness license will notbe 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 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 Section 10.208 requires that building numbers must be a minimum of four (4)
inches in height with one half ('/) 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).
f
TRAFFIC IMPACT FEE rr p y
DATE PAID ✓}�'I3• F t
VW
f
AMOUNT RECEIVED
NAME
(FOR OFFICE USE ONLY)
I
ZONING
SUPPLEMENTAL INFORMATION
OCCUPANCY GROUP
PLAN CHECK NO.
NO PARKING SPACES
` OCCUPANT LOAD
PERMIT NO.
HEALTH DEPT. APPROVAL
NO. OF STORIES
ADMIN. ACTION
UTILITIES RELEASED
�i 7 CERTIFICATE OF OCCUPANCY FEE
$
_
iJ
PPROVED BY
ATE CHANGE OF USE OR OCCUPANCY FEE
g
TOTAL
$ y e
I� 75-039 Rev. 1/07
COMMUNITY DEVELOPMENT
SUPPLEMENTAL INFORMATION
BUSINESS ADDRESS
2.
Porson to contact in case of emergency
<iec:ione number: 71 S`g '-I 14
Yes
the building in question have electricity?
❑ No
;t If No, are you reguestiny that the electricity be
❑ Yes
turned on?
❑ No
I
0"'Yes !
4.
The building is sprinklered?
❑ No
5.
Operations will produce dust/wood shavings or similar
material?
❑ Yes
CrYNo i
6.
Operations will involve the repair or replacement of
❑ Yes i
2-'No
automobile parts?
4
If Yes:
(a) Describe the components repaired or replaced.
❑ Yes
(b) Does the operation involve the use of an open flame?
❑ No j
7.
The business is drinking, dining or assembly use that will
°
result in an occupant lead of more than 50 persons.
❑ Yes j
�o
8.
The following best describes my operation;
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant/Take Out Food
Medical / Dental
Other (describe) _—
"UPPLENIENTAL INFORMATION V �'� e- V
i'
d
_.._ _.._ .. ,__ _.. _ _
a
SUPPLEMENTAL INFORMATION (Continued)
P
Does
the operation involve any of the following materials?
Res
o
If Yes, indicate quantities:
Material Quantity
1. Flammable liquids
Class I -A
Class I-B
Class I-C
2.
Combustible liquids
Class II
Class 11I-P
3.
Combination flammable liquids
i
P
4.
Flammable gases
'
5.
Liquefied flammable gases
6.
Flammable fibers - loose
_
7.
Flammable fibers - baled
8.
Flammable solids
4
9.
Unstable materials
i
10.
Corrosive liquids
11.
Oxidizing material - gases _
12.
Oxidizing material - liquids
_
13.
Oxidizing material - solids
14.
Organic peroxides
15.
Nitromethane (unstable materials) _
16.
Ammonium nitrate _
17.
Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight
ik
18.
K:ghly toxic material and
poisonous gas
19.
Smokeless powder
20.
Black sporting powder
W
I hereby certify that the above information is true and correct
{
to
the best of my knowledge.
Si nature Date
1
i
South Coast
AIR QUALITY MANAGEMENT DISTRICT F
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000 K
AM QUALITY PERMIT CHECKLIST
for nonresidential buildings only
r Company Name: L 1 11-4 0 9 IS -
Location of. Property
p � --•
City: H,13Zip Code:
Contact Person: ���� Title:
Telephone Number: `� $ �' G Fax Number: ?1i"'
Type of Industry/Busizaess:
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing -this checklist, please call (800) 389-2121.
YES NO�/
1. Will the facility have a charbroiler?
2. Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)? [ ]
3. Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings? [ ] [ 41'
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 dating or coating of materials be done at the facility? [ ] [
7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be
ili ? [ ] [
operated at the facility?
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 machir s operate at the facility? [ ] [
Applicant: G -LMy lC i�52 Signature:
/G3+
(Prit name clearly)
If you have marked "NO" in all the boxes, an air quality permit is not needed at this time,
and this checklist is your- written release.
If you marked "YES" in any of the 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
ADD11IONAL SUPPLEhAENTAL IMFORMAMON ✓ O t%2—l^