HomeMy WebLinkAbout15102 Bolsa Chica St - CofO (8)-
V2�� 3
01 APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
KINTIv0ONBEACH DEPARTMENT OF COMMUNITY DEVELOPMENT
(PRINT OR TYPE ONLY) DATE 1.
Address i cQ J-HLalff1li t o Bch J District
Business Name Tel._
Business Type f+ I C6 (A S�
Occ. Group
BUILDING OWNER BUSINESS OWNEWMANAGER
Name— --. T IA) -% l�01'N Name—RMA LA-ne.S
Address L K(Ite IICk MVP Home
Address t ; jCIC�
City S N0� ,�it�i �%062,96 Tel-M City D i Home Tel.
444,-5
THIS USE WOULD BE DESCRIBED AS: Q(o0 Q-&q i
❑ NEWLY CONSTRUCTED BLDG, ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
}
l� EXISTING BUILDING ❑ CHANGE OF USE ADDITIONAL OCCUPANT '
I
Indicate former use, it any Occupancy Gr. Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED
• � -a 6 �. S d � L aGcu1��4� 1'0
NOTICE: 1. Occupancy of any building is prohibited and a business license will not be 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 I
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 (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 Pro'ection Association pamphlet 10 (see reverse side).
0AAM TVTW, aP-F4� sPpree 9+1.,%" KW GgeAN Ida t010 a:
- _o
TRAFFIC IMPACT FEE
DATE PAID
AMOUNT RECEIVED
NAME (FOR OFFICE USE ONLY)
ZONING
OCCUPANCY GROUP— PLAN CHECK NO, NO PARKING SPACES
OCC PANT LOAD PERMIT NO HEALTH DEPT APPROVAL
NO. F ST RIE% ADMIN ACTION UTILITIES RELEASED
�J CERTIFICATE OF OCCUPANCY FEE $
APV,,OVED DATE CHANGE Of USE OR OCCUPANCY FEE $
TOTAL $
75 039 Rev. 1/97
COMMU SIT• ❑cVPI OPMENT
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS HUfdl',AlMl , a/17-t,
2.
Person to contact in rase of emergency�re'q
Telephone number: —S4=6 — 4-44:E
5
EX Yes
3.
Does the building in question have electricity?
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
KYeS
4.
The building is sprinklered?
❑ No
5.
Operations will produce dust/wood shavings or similar
material?
❑ Yes
K No
6.
Operations will involve the repair or replacement of
11, Yes
automobile parts'?
lNo
If Yes:
(a) Describe the components repaired or replaced.
❑ Yes
(b) Does the operation involve the use of an open flame?
❑ No
i
7.
The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
❑ Yes
K No
8.
The following best describes nay operation;
ffice n .
I
e_ail • ales
Warehouse
Manufacturing / Distribution (describe process and end `product)
i
Restaurant/Take Out Food
Medical / Dental
Other (describe)
SUPPLEMENTAL INFORMATION
SUPPLEMENTAL INFORMATION (Continued)
Doe.a the operation involve any of the fallowing materials? E1.Yes
No
If Yes, indicate quantities:
Material Quantity
1. Flammable liquids
Class I -A
Class 1-6 _
Class I-C
2. Combustible liquids
Class li
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)
15. Ammonium nitrate
17. Ammonium nitrate compound mixtures
containing more than 80% nitrate
by weight
18, Highly tonic material and
poisonous gas
19. Smokeless powder
20, Black sporting powder
I hereby certify that the above information is true and correct to
the best of my knowledge.
Si ature Date
I
Soudh Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 3Z6-2000
AIR QU.kLITY PEwAn CHECKLIST
for nonresidential buildings only
Company Name: Z �'._ 0.0 -
Locatic , of
f''Property: 1 l L an � � a � ��
City: UM, r oGt-0.6— Zip Code: C—)4 Q
Contact Person: ne ' Title: Er St"j,""x-
Telsrphone Number:.T' Fax Number:
Type of Irdustry/Business: —j 0,, i(oof'i e con u Li La _
J \j 0
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.
k
YES NO
1. Will the facility have a chexbroiler? [ ] [ X]
2. Will any internal combustion engine with greater than 50lorsepov✓er
operate at the facility (excluding motor vehicles)? [
3. Will operations at the facility involve mixing, blending, or processing cif
solvents, adhesives, pavats or coatings?
4. Will dust or smoke be generated at the facility? [ ] [?U
5. Will refining of any liquids or solids be done at the facility? [ I [X]
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
operated at the facility?
8. Will any acids, solvents, or motor fuel be used or stored at the facility? [ ]j
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? { ] (xj
11. Will any CFC (Freon) recycling machines operate at the facility? [ ] [x]
Applicant: Al Dom. Signature:QC�_�,
(Print name clearly
If you have marked "NO" in All the boxes, an air quality permit is ng.1 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 Qualify
Management District (AQM D). Please read the requirements on the back of the checklist.
(800) 388-2121
ADDITIONAL SUPPLEMENTAL INFORMATION