HomeMy WebLinkAbout15070 Edwards St - CofO (4)_r0&31::CL$ 1
Ji APPLICATION FOR CERTIFICATE OF OCCUPANCY
,� CITY OF HUNTINGTON BEACH
am DEPARTMENT OF COMMUNITY DEVELOPMENT
"UNnNGTON KACH (PRINT OR TYPE ONLY)
If
D)
0 1
DATE
Address Zdl,)a!"* 57 Hf%ftvT *oto 1 CJPGA-/z& istrict
Business Named 2 O P= C f,% ,a /� �-P TeL � d
Business Typed { [i- �/*'�µ� — Occ, Grouper
BUILDING OWNER BUSINESS OWNERIMANAGER
Name �l'�,i� R'i`C%S�A6 hZ:42&e�S� PName /�J4,rC ,���!�5'�,�G�
Home
Address 1844.?z ✓�n�� eft/ G' Address i:f406t-�-tA
City �,�b % nS!-o� tcA Tel. p ` /City—. Home Tel.
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THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER t!-`J CHANGE OF OCCUPANT
EXISTING BUILDING ❑.rCHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any 1 Occupancy Gr.— Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED -5 -OO 56LIlP
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.
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 (Yz) inch stroke, and of a contrasting color from the backgruund. 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),
10. In-- - /P.
A � 41 /2
TRAFFIC IMPACT FEE
DATE PAID _e�f
(FOR OFFICE USE ONLY) ZONING
OCCUPANCY GROUPA� PLAN CHECK N NO PARKING SPACES --
OCCUPANT LOAD �� PERMIT NO. N>7� HEALTH DEPT APPROVAL _
NO. OF STORIES ADMIN. ACTION — UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE $
APPROVED BY DATE CHANGE OF USE OR OCCUPANCY FEE $ I'
TOTAL $
LOPMENT
75-039 Rev. 1/07 COMMUNITY DEVE
0
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS
M`r��
Le
2.
Persor to contact in case of emergency, r
Telephone number:
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
�o
5.
Operations will produce dust / wood shavings or similar
C7 Yes
material?
1� No a
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
,T•No
7. The business is drinking, dining or assembly use that wiil j
result in an occupant load of more than 50 persons. 'Yes
'W Na
8. The following best describes my operation,
9
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product) {
i
Restaurant /
Take Out Fo
Other (describe) ----'—
1
SUPPLEMENTAL INFURMATION
SUPPLEMENTAL
Does the operation involve any of the
INFORMATION- (Continued)
following materials? Yes c
c IVO
If
Yes, indicate quantities;
Material
Quantity
1,
Flammable liquids
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 gases
6.
Flammable fibers - loose
7.
Fivmmabie fibers - baled
8.
Flammable solids
9.
Unstable materials
10,
Corrosive liquids
11.
Oxidizing material - gases _
12.
Oxidizing material - liquids
13.
Oxidizing material - solids
14.
Organic peroxides
15.
Nitromethane (unstable materials)
16,
, Ammonium nitrate
1,7.
_
Ammonium nitrate compound mixtures
coniaining more than 60% nitrate
by weight
18.
Highly toxic material and
poisonous gas
.�
19.
Smokeless powder
20.
Black sporting powder
I,
I here'oy certify that the above information is true and correct to
the best of my knowledge.
t�A -c
Signature I--- Date �— --
South Coast ofi,�
AIR QUALITY MANAGE1�1t E[`�1T QISTRY :,.T
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AM QUALITY PERMIT CHECE-UIST
for nonresidential buildings only
ComP any Name:
— �
Location of Property:
*I
-
Code:
—Zip
City: ANT
Q Title:Jh
LLl
Contact Person:
Telephone Number: t La � �-� ` 3 » Fax Nurnber:
Type of Industry/Business: s Dwv�r �
To apply for a nonresidential building permit, you must complete this checklist. if you have any
call (800) 388-2121.
questions about completing this checklist, please
YES
NO
EJ
1. Will the facility have a charbroiler?
2. Will any internal combustion engine with greater than 50 horsepower
,
[�
operate at the facility (excluding motor vehicles)? processing of
blending, or p
3. Will c Aerations at the facility involve ,ruxiiJg,
solvents, adhesives, paints or coatings! t )
at the facility?
4, Will dust or smoke be generated
5. Will refrning 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 %-Iy combustion equipment rated greater than 2,000,000 BTUft 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?
Will be used to dry or cure products at the facility?
10. any ovens
11. Wi:_ 1-4 CFC (Freon) recycling machines operate at the facility?
Applicant; `Q�`� j °"` "L Signature: --• - "
(Print name clearly)
If you have marked "NO" in & the boxes, an air quality permit is = needed at 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'Gistrict (AQMD). Please read the requirements on the back of the checklist,
(800) 388-2121
ADDITIONAL SUPPLEMENTAL ;it4roRMATION