HomeMy WebLinkAbout15301 Connector Ln - CofO (5)F1U%TVNGTC41 BL40H
APPLICATION FOR CERTIFIrATE OF OCCUPANCY
CITY OF FrUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
(PRINT OR TYPE ONLY)
✓Address _ 1.5301 Connector Lana_
✓ Business Name HOLOGENIX
✓Business Type J,yi 1t, --
a7
DATE
District
Tel 714-903-5999
Occ Group B , 's-1
BUILDING OWNER BUSINESS OWNERWANAGER
✓ Name Bill Gregory __ __ __✓ Name PIAi1 Blaustein
Home
✓ Address 4961 Los Patos Avenue _.- -✓ Address 16642 Melvin e562-
ircla
9- Huritimfton Beach Home Tel 92- r, (
✓City Hutitin�ton Beacl•> _.___..__Tel __-8790,/C�ly—__
S USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG ❑ CHANGE OF OWNER
CHANGE OF OCCUPANT
LLN EXISTING BUILDING ❑ GHANGE OF USE ❑ ADDITIONAL OCCUPANT
ndicate former use, if any Or�,tlancy Gr Div
— -- -- - --
3i UARE FT OF BUILDING TO BE OCCUPIE 9000_
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
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 (112) 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 6$sociatiorl pamphlet 10 (see reverse side).
�o • 9 —
TRArric 6� ACT FEy
DATE PAID
1,10 , `17
AMOUNT RECEI D ��
:4
NAME----
-
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION
7t)NIN ..___�c'-_. -R
OCCUPANCY GROUP $ •}-- �I
---
�- ----- --
PLAN CHECK NO "
NO PAF7KIN6 SPACFS — ----
OCCUPANT LOAD -- -
--
PERMIT NO
HE At TH OE PT At PROVAL
NO OF STORIES
�___
ADMIN ACTION_ _ _ __
IILI (TIES RFIFASED
2 (•.
CERTIFICATE OF OCCUPANCY F I
FF E
_
�y
A R ED BY
D TE
CHANGE OF US(. GR OCE UPANCY
$ —
TOTAL
$— --- ---
v
75.039 Rev. 1/97 C`Oi'." J4l+EdIT'd rWVrt.OPI "`-
SUPPLEMENTAL. INFORMATION
1. BUSINESS ADDRESS C WtJEC-7D F- LA-P�
2.
Person to
contact in case of ernergencyh��
Telephone
number:
c, 7 _ �C1
3.
Does the
building in question have
electricity?
m/Yes
❑ No
(a) If No,
are requesting
you re uestin that
the electricity be
y
❑ Yes
Ye
turned
on?
❑ No
4.
The building is sprinklered?
9/Yes
❑ No
5.
Operations
will produce dust/wood
shavings or similar
material?
O�Yes
C9 No
5.
Operations
wil, involve the repair or replacement of
❑ Yes
automo� de
parts?
❑ No
I f Y'<-
(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.
U Yes
C�No
8. The
following best describes my operation;
Office Only
Retail Sales
Warehouse
Mao; a u Ag /I istribution describe process and end product)
(t/1 .l-x,�t 11(i dlF11J „'T-l--
fYl'Y't(' I�f\Gr-.��C
\
l�n t r
Restaurant / Take Out Food
Medical / Dental
Other (describe)
W— W
WPOLEMENIT!�' liNFORMATION
ye,.
C
j-
16
PO T11 0! 1,,) (13S
19. Sm(4�ip.,is p(-,woer
20 Wack,
i fmroby cuntAv lhol 'i;t:' oo I,; vand correct to
()f ht, Illy
ate
6AV
South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765.4182 (909) 396.2000
AIR QUALITY PERMIT CHECKLIST
for nonresidential buildings only
Company Name: G
Location of Property: \3C1 C N tiC jZ;;;L ►� �:;
City: •Ah)(\j T-i N C =, i�- it A ( 4 " Zip Code: Z �i
Contact Person:* _h~ k � I' D Title: �l�( E, 16 e td-
Telephone Number: Iq ) CiC3 --�c1 c q Fax Number: _ -714)t3y--�- `5 9 j9
Type of Industry/Business: i STD-( ate 7 to I�
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing thus checklist, please call (800) 388-2121,
1, Will the facility have a charbroiler? YES
[ ]
NO
[
2. Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)? [ ]
[V1
3. Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings? [ ]
4. Will dust or smoke be generated at the facility?
[ ]
5. Will refining of any liquids or solids be done at the facility? [ ]
[
[
6. Will any plating or coating of materials be done at the facility? [ ]
[
7. Will any combustion equipment rated greater than 2,000,00013T ar be
operated at the facility? [ ]
[
8. Will any acids, solvents, or motor fuel be used or stored at the facility? [ ]
[
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? [ ]
[ ]
11. Will any CFC (Freon) recycling machines operate at the facility?[ ]
[ A
Applicant: Signature:
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is not needed a 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 Quality
Management District (AQMD). Please read the requirements on the back of the checklist.
(800) 388-2121
10 i ,I I'T"I '')I N I
7 1
t'T t,) 111N' i.�f
T 1101,11 tLe L7C-11 air
!!I,.: ClIvAli't
th-.' AQ%11) tl} calfinp
Nits l�ennit; are rewired for an% equipment
ticterinitie� that air quaiitv per -nits are
tll('t a 'k-riatm release will be issued.
4, .�:z ' 1 art li,ive not peen submitted, the applicant
nul", "'C ,L:, Tri n applicatiow s) and appropriate fees before a written
Ideas- %kfll
At %fD k ,ornmitted to expediting all clearance letter requests However. it may Udw several
weeks to %eni ' ', eornpli,ince with "!'A requircinerit,. 1-1wret-Ore. you are advised to contact AQ,%fD
irnmediatel- after applying t6r building prmits.
(800) 388-2121
roil rd 9, V_