HomeMy WebLinkAbout15081 Edwards St - CofO/ J 09-709
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON PEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT 0 1
rwrrtNc7on urea: (PRINT OR TYPE ONLY) DATE
Address 2_I C-7 6In f? ncl - Distria' 1L7 Rene/,
Business Name _ Tel.�21LJ
Business Type - t�l aI i' S'"��a J-_ O1`.l Occ. Group_L
BUILDING OWNER BUSINra: f)WNER/MANAGER
Name,-+ 44C Z& UiS-%7 A,-/4A/ T Name 0 V/+L I
Home'
Address �Sr3"7`j l'�rc�,�j., ��11/ _ Address ��—�i� h(�+(�In
City ________Tel City INZ'�`tr�lllS'�ClZ �'ll-en HomeTe(71s1cff"'J.//�E(i
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. f�g CHANGE OF OWNER CHANGE OF OCCUPANT
EXISTING BUILDING El CHANCE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, it any 5a YYASL —Occupancy Gr
SQUARE FT. OF BUILDING TO BE OCCUPIED_I--
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 Depar,ment of Community Development at the time this application Is filed,
3. Change of occupancy or use inspection fea. Whenever it is necessary to make inspection of a building or
premises in order to determine it a change maybe made in the character of occupancy or use of the building
or premises which wo;r,'d 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 ml11imum of four (4)
Inches In height with one half (+/z) inch stroke, and of a contrasting color from the background, These
numbers must be pcsted 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),
TRAFFIC IMPACT �
DA w
A T ltEGF:IVED
NAME ,,. � _ �..> (FOR OFFICE USE ONLY)
zONINGr. 0—(-52
%r
OCCUPANCY GROUP �_�. PLAID CHECK N0 NO PARKING SPA..^"eS
OCCUPANT LOAD Z �' K PERMIT NO e<,.�. ��,_ta._ HFALTH DFPT APPROVAL-
"RO
S.� __� ADMIN ACTION b „.,�,.m. _ UTILITIES RELEASED
C i_ CERTIFICATE OF OCCUPANCY FF,E y
P GATE CHANGEOF USE OR OCCUPANCY FEE
TOTAL
rs•oae Rev, vey COMMUNITY DEVELOPMENT
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS
_iS-D-a
i-lun f i'n c;�
Pj 0r� fz d,1 f f'3- iZ Ems-/ 7
2. Person to contact
in case of
emergency' ,Gc cj '7)/'Z jCA..,.
Telephone number:
"� � � �`� n
o o cl
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 sprinkiered? Yes
❑ No
5. Operations will produce dust/wood shavings or similar
material? k,] Yes
❑ ivo
6. Operations will involve the repair or replacement of Yes
automobile parts r' No
If Yes:
(a) Describe the components repaired or replaced,
(b) Dues the operation involve the use of an open flame? ❑ Yes
❑ No
7, Irhe business Is drinking, dining or assembly use that �.
result in an occupant load of more than 50 persons, ❑ Yes.
1 No`
8, The following best describes my operation;
Office Only
Retail Sales '
Warehouse
Manufacturing / Distribution (describe process and end product)
Kg4jK_
Restaurant / Take Out Food
Medical / Dental
Other (describe) otit1, ( l
SUPPL5MENTAL INFORMATION
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials? Yes
No
If YE indicate quantities;
Material Quantity
1. Flammable liquids -�
Class I -A
Class I-B-
1-0
.�.,� Combustible liquids
Class 11
._„ Class I I IaA
3. Com'aination flammable liquids
4 FIB .,rnable gases
5 Liquefied flammable gases
6. Flammable fibers - loose
7 flammable fibers - baled
Flammable solids
9 Unstable mat$rlals
10. Corrosive liquids
11. Oxidizing material - gases
12u x.��..hOxidizing material - liquids—'
ly. (7xidizing material - solids
i b,ganic peroxides
15. Nitromethane (unstable maternl )
16. Ammonium nitrate
1i. Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight .
113. Highly toxic matcrlal and
poisonous gas
19. Smokeless powder
20. Bla4;% sporting powder
I hereby certify that the above information Is true and correct to
the best of my knowledge,
m
a r.
Signature..
Date
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
Location of Property: �% f' ! u .. (� I l(-.c I'. � S
City: 9r1n 026%I _ A rq tk) Zip Code: _ -,w 1717. G6 7
Contact Person: ,.-A/4-[') 1 j.X—� Title: --I\) IS r1 �� �
Telephone Number: `i /l..i C1 D 1 Rl ! h _ Fax Number:
Type of Industry/Business: Dj Lil 1
To apply for a nonresidential building permit, you must complete this che,-U,st. Alfyou have any
questions
about completing this checklist, please call (800) 3M2121.
1.
YES
Will the facility have a charbroiler? [ ]
N
[
2.
Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)?
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 refuting of any liquids or solids be done at the facility? [ ]
]
6.
Will any plating or coating of materials be done at the facility? [ ]
[ ly
7.
Will any combustion equipment rated greater than 2,000,000 BTU&- be
operated at the facility? [ ]
U]
8.
Will any acids, solvents, or motor fuel be used or stored at the facility? ]
GJ
9.
Will any organic liquids or gases be reacted or produced?
10,
Will any ovens be used to dcy or cure products at the facility? [ ]
IV
11.
Will any CFC (Freon) rec clip lachines operate at the facility?
Applicant: Signature:°
(Print name clearly)
If you have marked "NO" in nU the boxes, an air quality pens dt is = needed at this time,
and this checklist is your written release.
If you marked "'YES" in any of the boxes, you roust contact the South Coast Air Quality
MlanaV9meat District (AQMD). Please read the requirements on the back of the checklist.
(800) 388-2121
ADDITIONAL SUPPLEMENTAL INFOnMATION