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J� APPLICATION'FOR CERTIFICATE OF OCCUPANCY
CITY OF HURtlfi 3TON BEACH
DEPARTMENT OF DEVELOPMENT SERVICES
T'uNT1.vGTaJ �f.{LTi (PRINT OR TYPE ONLY) DATE
17
Address 1(r.fr�--r r ` _�^`' District
Business Name
Tcl.
Business Type �, , n� „y / t-��: �� ti i. {, i, it� ! - 5 �C!Yw� J_ Occ. Group
BUILDING OWNER OWNERIMANAGER
Name \`trr Xs flt r—1,Lt '1����1�:- Name
Address _SeY' �!� /r iR'r' 'C . is ` -- Aduress
City �.{�./f�t.lc.�'�Y� r�i ii3_ Tel.
THIS USE WOULD BE DESCRIBED AS:
NEWLY CONSTRUCTED BLDG.
�
EXISTING BUILDING
Indicata former use, if any
CHANGE OF OWNER
CHANGE OF USE
Occupancy Gr
CHANGE OF OCCUPANT
ADDITIONAL OCCUPANT
Div.
NOTICE: 1. Occupancy of any building is prAibited 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 llvill be released for any existing building until tl-ie 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 Develcpment Services at the Lime this applica-
tion is f)ied.
3. Change of occupancy or use inspection fee. Wh^never it is necessary to make Inspection of a build-
ing.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 some group
of occupancy or in a different group of occupancy, a change of occupancy inspection fee of $30.00
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 (M inch stroke, and of a contrasting color from the h-ck-
ground. These "timbers must he posteu -)n your building in a location that is visible from the street.
5, Hdntingtun Beach Fire Code Section 10.301 requires fire extigjuisher selection and distribution
per the National Fire Protection Association pamphlet 10 (see reverse side).
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION
sr,UARE FT. OF BOILDING — _ PLAN CHECK NO. r . NO. PARKING SPACES OCCUPANCY GROUP PERMIT NO. HEALTH DEPT. APPROVAL _
OCCUPANT LOAD 4 _ ADMIN. ACTION UTILITIES RELEASED
NO. OF STORIES
CERTIFICATE OF OCCUPANCY FEE 5 410 • 6'y7J
l PPR.GVED BY DATE CHANGE OF OCCUPANCY FEE S —
TOTAL $ Q —
754)39REV. DEVELOPMENT SERVICES