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CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
Date
Address L' ; I i t I" � 1, District —
Business Name 1, &A E, i Tel, i — ' ", J! —" '!J
Business Type Occ. Group,
BUILDING OWNER BUSINESS OWNERWANAGER
Name Name
Home
Address j Address
ome
City Tel. H
Cky Tel,
Construction No. of Stories I Occupant Load — % .10 Sprinklers .,
CONDITIONS OF APPROVAL
Thia Certificate of Occupancy
SHALL BE posted In a conspicuous place on the
premises and shali not be removed except by the
Building Official.
DEPARTMENT OF COMMUNITY DEVELOPMENT
by
0
COMMUNITY DEVELOPMENT
�J,or.
HLIN71NGTON BFA01
Address V_
Business Name
Business Type
APPLICATION FOR CERTIFICATE OCOi►PANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
(PRINT OR TYPE ONLY)
P /
6118190
DATE
District --
Tel 213-774-0761
Occ. Group_
BUILDING OWNER BUSINESS UWNERtMANAGER
Name GARY B. EVANS T� Name _� GARY 8. EVANS
28 DANA PLACE Nome 28 DANA PLACE
Address -- - -( lbw- - Address G� _.1. �1 /
City.,, BELMONT SHORE • CA Tel 438-5973 City, �9_L� N1 SHORE, _ C,A _ Nome Tei,174-0761
THIS USE WOULD BE DESCRIBED AS:
L^._I NEWLY CONSTRUCTED BLDG, Q CHANGE OF OWNEF3 LJ CHANCE OF OCCUPANT
EXISTING BUILDING ❑ C NGF Or USE ❑ AODITIONAL 0C3UPANT
Indicate former use, if any NONE
SQUARE FT. OF BUILDING TO BE OCCUPIED..__L 1Z 14 /8
FNC)TICE: 1, Occupancy of an building is prohibited and a business license will not be issued until the bul'din has been
p Y Y 9 g
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 tc schpdule 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 c: der to determine it 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 $ ,.. ,. w .... F. shall
be paid to the city,
l � 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).
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION
OCCUPANCY GROUP--- "2` PLAN GFIE:CK No NO P-VIXING SPACES
OCCUPANT LOAD PERMrT NO HE At H DFPT APPROVAL
NO OF STORIES ADMIN. ACTION. _r w,.,, „,.... — U1ILITlf S REI-EASE D
b0
E RTIF ICATE OF OCCUPANCY PEE g;
APPRVED B — )ATEft�CHANGE
TOTAL OF US[. OR OCCUPANCY FEE: $
7u•aa9AnGrOo COMMUNITY D VEL,F.
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e
1 .
0
SUP? MENTAL INFORMATION
BUSINESS ADDRESS 15221 CONNECTOR LANE, HUNTINGTON BEACH, CA 92E48
2. Person to contact in case of emergency: GARY B. EVANS
Telephone number: 2, y-438-5973
3. Does the building in question have electricity? ' jvyes
. C� Plo
a. If no, are you requesting that the electricity be Oyes
tuxned on? C3No
4. The building is sprinklered? myes
O No
5. Operations will produce dust/wood shavings or rsixilar
material? 0Yes
M No
6. Operations will involve the repair or replacement of OYes
automobile parts? ®No
If yes:
(a) Describe the components repaired or replaced.
N/A
(b) Does the operation involve the use of an ova flame? OYes
13No
7. The `easiness is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ClYes
G)No
® 8. The �tollowing best describes my operation:
Office Only
Retail Sales
warehouse
(Manufacturing/Distribution (describe process and end
product)
® SHEET METAL FABRICATION
e— r Train a e ut PoVd�-----
Medical/Dental
other (deacribe) N/A
Y � b
SUPPLEMENTAL INFORMATION (Continued)
AI.
Does the operation involve any of the following materials? ®Yes
C3No
IF eso indicate quan les: �
Material Quantity
1. Flammable liquids
Class I -A COMPLIANT ACETONE SOLVENT
Class I-B
Class I-C
2. Combustible liquids
Class II
Class II: -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
0. 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 r
containing more than 60% nitrate
by weight
18. Highly toxic 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 nowledge.
Signature Date �.
(05620)
0
(12/8/86)