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APPLICATION FOR CERTIFICATE O; OCCUPANCY CITY OF HUNTINGTON BEACH
Hl`NTI'd6TfNv BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT / •. — L/ry/
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THII1S UP = WOULD BE DESCRIBED AS:
l_! NIA.1 r i rr Ti . h,
a pl(,i 1 .,)PAN,
I�rlir.ab. dry; , .i'-, ��G-`�ii2"r C✓f�'e''iL,.:S'Y✓'i r�7/,'!�.,
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NOTICE:
1 Occupancy of any h ,ilding is prontbtted and;a business ficense will not be issued until the building has been
inspected and sa Ce rtt ,:cats Of occupancy e, issued_
2 No electrical service will be release d for ,any existing budding until the service has been inspected and
Certified safe All appf,c:ariis for occupancy +r> an existing building are required to schedule an electrical
'fuse up' inspection in the Department of Commun+ty Oeveicipmetrt rat tht tittle this application is filed. i
3- Change of occupancy or use inspection fee. Wher+ev()1 y to Qlake insftr>i,tiran of a building or
prer,u ses in order to determme if a change may be madJc in the character of rccupancy or use of the budding
or premises whitAh would place the buotling rri a different division Of the same gtouf7 of occupancy or in a
different group of occup,,j"(;y, a 01:1117e Of cccupzancy mspPctic,n fee. of $ _ shall
be paid to the city
f 4 Huntington Beach Fire Code Section 10 208 requires that budding numbers must be a minimum of tour (4a
inches in height with one half (',,i inch slrroke. and of a contrasting e;ofor from the background. These
numbers must be. po; Acid on yuur building in a location thzat s visible from the street.
5. Huntington Beach Fire Code Section 10.301 requires 1`110 C?xtitlguishOr selection and distribution per the
National Fire Protection Association paattphiet 10 (see reverse side)
SUPPLEMENTAL (FOR OFFICE USE ONLY) ✓^ SS..�� SUPPLEMENTAL INFORMATION , �
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SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS A411re
2. Person to contact in case of emergency -
Telephone number:
.3 .S,�,L.
3. Does the building in question
have electricity?
Yes
❑
No
(a) If No, are you requesting
that the electricity be
❑
Yes
turned on?
❑
No
4. The building is sprinklered? ❑ Yes
Z No
5. Operations will produce dust/wood shavings or similar
material? ❑ Yes
9 No
6. Operations will involve the repair or replacement of ❑ Yes
automobile parts? No
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
❑ Ne
8. The following best describes my operation;
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant/Take Out Food
Medical / Dental
Other (describe)
.Wl"W' . FAL INFORMA I ICON
SUPPLEMENTAL INFORMATION �Continuecl'
r
ri, No
Cass
C
a t !ld(Tlniai.o,0j; 4.,
a rT rna c4 it S
f a i
IG
x 1 1 z n
4
perk -x (les
N i Tf tit, .a1s'at: j muter ial'.
A M ITI I I!) f
A rn i t ri j r i d rr i i x! r
cl on t a f I f 1 o t e tfuj,"
by weight
18,
Highly toxfcr male'rial ar�d
PoiSOTIOUS gas
19.
Smokeless powder
20,
Wack sporting powder
I hereby certify that the abov(--, information is true and correct to
the best of my knowledge.
Sighature Date
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subject Property:
r - cperty Owner name: J?irf+h'r C �.r ,.�Y6n c �/? Phone
Name of the Person Preparing this form in print and signature
Signature G%'.f----w-
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:
SCAQMD F.RMITTING CHECKLIST
YES NO
I. Does your facility use any internal combustion
engines greater than 50-HP?
2. Does your facility involve mixing, blending, or
processing any solvents, adhesives, paintsL�1
or coatings?
3. Does your facility create any dusts or smoke?
4. Does your facility refine any liquids or solids?
Reclaim any metals?
5. Does your facility plate or coat anything? r�
6. Does your facility have any combustion equipment
i.e. boiler, furnaces, broiler, baking ovens, etc.)
rated greater than 2,000,000 BTU/HR?
?. Does your facility handle or store solvents or motor
fuel?
S. Do you use or store any acids?
9. Do you use any chemical process? FIA
10. Dc you use any solvents for clean-up?
11. Are you a dry cleaner, restaurant with a charbroiler,
body shop, gasoline station, printer, or part coater.?
12. Is the subject building located within one thousand
(1,000) feet of any school?
PROPERTY LI14E TO PROPERTY LINE. GRADES K-12.
If you have marked "NO" in all columns, you do not nerd an Air Quality
permit at this time. Tf you have marked any questions in the "YES" Column
You must contact the South Coast Air Quality Management District located
at:
9150 FLAIR DRIVE, EL MONTE, CA 91731
Please call these offices: Plan Check (818) 572-6406
D:AL00603 (818) 572-6111, (818) 572-6261
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