HomeMy WebLinkAbout15122 Bolsa Chica St - CofO (3)JIM APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT (o AVL 00
1iUNrRNK.7ON BEACH DATE
(PRINT OR TYPE ONLY)
Address � '^d�t�A C:M-LC.LZ �-Mkr �LJ0 —4-l.yq District c'
Business Name. mc- �l�i�u 2 tZ� I N L Tel �r mh. [Lqf
Business TypeNIG�EIi.:CTtZICAL_ g QUIT V—'_r Occ. Group_
BUILDING OWNER BUSINESS OWNERIMANAGER
Name � 1Ti1 �' co NameT)y_tif.CPrWEC JtkIP� Cam£ �tjr. /KEyio
Address q N� N Address 5n � WEST Z�
City5 • 65A � — 1el �15Ir� City— �'"� —Home -
{Uj,TftlJG�bkf CA- Home Tel.
THIS USE WOULD BE DESCRIBED AS: ��^^
❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER CHANGE OF OCCUPANT
❑ EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any Occupancy Gr Div
SQUARE FT. OF BUILDING TO BE OCCUPIED 21470 -
N( /'�ce S,i-acK
NOTICE: 1. Occupancy of any building is prohibited and a business license will not be issues: 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 ar. 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 halt (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
nn National Fire Protection Association pamphlet 10 (see reverse side).
79A, Ftr i;,iR f,'T :EL
p,ATE t `%'D _ _.
AiMl;UNT RECEIVE10
(FOR OFFICE USE ONLY)
I ZONING
OCCUPANCY GROUP L / 51 -- PLAN CHECK NO NO PARKING SPACES - OCCUPANT LOAD 2 PERMIT NO _ _ HEALTH DEPT APPROVAL
NO. OF STORIES -- ADMIN ACTION______---- UTILITIES RELEASED
ycCYRTIFICATL• OF OCCUPANCY FEE $��f
APP ED BY _ DATE CHANGE OF USE OR OCCUPANCY FEE $ _
TOTAL $
/'
75-038 Rev.1/97 i, P,:ii 11 I";;i ; J 4L; .I'" ''. 1 l
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS 1512-2—b�-5
2. Person to contact in 'ease of ernergency lyltU VO�c�Ey--
Telephone number:
3. Does the building in question have electricity? 19�Yes
❑ No
(a) If No, are you requesting that the electricity be ❑ Yes
turned on? ❑ No
4. The building is sprinklered? E Yes
❑ No
5. Operations will produce dust/wood shavings or similar
material? ❑ Yes
No
6. Operations will involve the repair or replacement of ❑ Yes
automobile parts? ' kNo
If Yes:
(a) Describe the components repaired or replaced.
(b)
Does the operation involve
the use of an open flame?
❑ Yes
❑ No
7. The
business is drinking, dining
or assembly use that will
result
in an occupant load of more than 50 persons.
❑ Yes
No
8. The
following best describes my
operation;
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Gi'i2Op.11'_
Cg01 P I-NrT
.lc
Restaurant/Take Out Food
Medical / Denta!
Other (describe) —
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials? C) Yes
52 No
If Yes, indicate quantities:
_ Maferiai Quantity
1. Flainma�ile liqu
Class I -A
Class I-B
Class I-C
2. Combustible liquids
Class 11
Class 111-A
3. Combination flammable liquids
4. Flammable gases-
5. Liquefied flammable uses
6. Flammable fibers - loose
7. Flammable fibers - baled --
8. Flammable solids —____—_
9. Unstable mater als
10. Corrosive liquids
11. Oxidizing material - gases^�
12. Oxidizing material - liquids —
13. Oxiaizing material - solids
14. Organic peroxides �~
15. Nitromethan.e 11�nstable materials'
16. Ammonium nitrate �!
17. Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight�-
18. Highly toxin, material and
poisonous gas
19. Smokeless powder
20. Slack sporting powder
I hereby certify that the above information is true and correct to
the best of my Knowle
dge.
signature Gate