HomeMy WebLinkAbout15102 Bolsa Chica St - CofO (37)�1
APPLICATION FOR CERTIFICATE OCCUPANCY
�. CITY OF HUNTINGTON BEACH
FQk n� rU�� DEPARTMENT OF COMMUNITY DEVELOPMENT
(PR)NTi�TYPE Nly) �I DATE
ddress 15I0z-F ka-, a P-,Cj _ District
G 1OW 1 �',i/I e_iij f #� _
Business Name C%l � r1/I�.1 LM
Rusiness Type !'(�1}'i CeO
G-PIcc. roup
BUILDING OWNER BUSINFSS OWNERIMANAGER
Name Name__
Address Nome
i
Address
City_ Tel. _ City Horne Tel.
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER ® CHANGE OF OCCUPANT
® EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate rormer use, if any // Occupancy Gr Div._____
SQUARE FT. OF BUILDING TO BE OCCUPIED
NOTICE: 1. Occupancy ofany building is prohibited and a business license vrill riot be issued until the building e?n
inspected and a certificate of occupancy i has bi
P panc.y s 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 g
'fuse up' inspection in the Department o' 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 i; � the character of occupancy or use of the building t
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 1
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 (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).
TRAFFIC IMPACT FEE_,
DATE RAID
AMOUNT RECEIVED !�• i' ��
NAME
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION ZONING
OCCUPANCY GROUP— ''� PLAN CHECK NO. NO PARKING SPACES
OCCUPANT LOAD f� PERMIT NO. HEALTH DEPT, APPROVAL_
NO, OF STORIES ADMIN. ACTION _ — UTILITIE
llz�4AWYI CERTIFICATE OF OCCUPANCY F g
PROVED BY DATE CHANGE OF USE OR OCCUPAN FE $
TOTAL
75.039 Rev. 11/90 COMMUNITY DEVELOPMENT
SUPPLEMENTAL. INFORMATION
1510Z`F
1.
BUSINESS ADDRESS
2.
Person to contact in case of emergency -
Telephone number: 1-3,o
3.
Does the building in question have electricity?
N,Yes
❑ No
(a) if No, are you requesting that the electricity be
is II Yes
turned on?
❑ No
4.
The building is sprinklered?
5Qes
❑ No
5.
Operations will produce dust/wood shavings or similar
material?
0 Yes
0
6.
Operations will involve the repair or replacement of
Cl Yes
automobile parts?�V
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame?
❑ Yes
010 1
7.
The business is drinking, dining or assembly use that will
I
result in an occupant load of more than 50 persons.
l Yes 4
ONO
8.
The following best describes my operation;
Office Only
Retail Sales
Warehouse
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials?
If Yes, indicate quantities:
Material
1. Flammable liquids
Class I -A
Class 1-•13
Class I-C _
2. Combustible liquids
Class 11
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 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
Quanti
Yes
�o-
M'
18. Highly toxic material and
poisonous gas
19. Smokeless powder
20. Black sporting po%wder
1
I hereby certify that the above information is true and correct to
the best of my knowledge.
Signature Date
E
t
,, I
j
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT 4
(Nonresidential Buildings Only)
� Location of Subject Property:_ &CSa �h[�., Po(,
Property Owner Name:B ayi �,{ i_ _ _ 05 cw1_..._..__ Phone #:
Name of the person preparing this form in print and signature;
Signature: - - -
n
The person preparing this form must be the same person applying for building permits. Please answer the
following questions regarding your proposed occupancy of the subject building. IF YOU, DO NOT KNOW
THE ANSWER TO A QUESTION, MARK IN THE "YES" COLUMN: I
AQMD PERMITTING CHECKLIST
�h
YES NO
1. !Goes your facility use any internal combustion engines greater than 50HP?
2. Dces your facility involve mixing, blending, or processing any solvents,
adhesives, paints or coatings?
q
3. Does your facility create ah} dusts or smoke?
4. Does your facility refine any liquids or solids or reclaim any metals? —
5. Does your facility plate or coat anything?
6. Does your facility have any combustion equipment (i.e. boiler, furnaces, 4
broiler, baking ovens, etc.) rating greater than 2,000,000 BTU/HR?
7. Does your facflity handle or store solvents or motor fuel?
8. Do you use or store any acids?
9. Do you use any chemical process?
M`
10. Do you use any solvents for clean-up? -
11. Are you a dry cleaner. restaurant with a charbroiler, body shop, gasoline i
station, printer, br part coater? _
12. Is the subject building located within one thou -and (1,000) feet of arty
schook? PROPERTY LINE TO PROPERTY ! :'XE. GRADES K-12. i
If you have marked "NO" in all columns, you do not need an Air Quality permit at this time. If you have marked
any questions in the, "YES" column you must contact the South Coast Air Quality Management District located at:
21865 E. Copley Drive
Diamond Bar, CA 91765-4182
Please call: Plan Check (909) 396.2000 E
i
t
r
F