HomeMy WebLinkAbout15081 Edwards St - CofO (14)b
APPLICATION FOR CERTIFICATVOF CCUPANlY
CITY OF HUNTINGTON BEACH
it A7 DEPAR7MENT OF COMMUNITY DEVELOPMENT
HUNYWY0004 KAQ1 (PRINT Ok TYPE ONLY)
Add,ess - A15-0 e
Business Name--.=
Business Type.. Alei,'/
BUILDING OWNER
Name Z�a /
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Name
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City- - Tol
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iYATE
A D:itrict
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Occ, Group
BUSINESSOWNFFVMANA R
Name.
Home
Address
City 7��_ UMz� Home Tel,6�
THIS USE WOULD BE DESCRIBED AS:
NEWLY CONSTRUCTED BLDG.XCHANGE OF OWNER ,XCIHANGE OF OCCUPANT
_N
EXISTING BUILDING 0 CHANGE OF USE 13 ADDITIONAL OCCUPANT
T� 5aAA^ Indicate former use, it any A -,--------Occupancy Gr _Div
SQUARE FT .)F BUILDING TO BE OCCUPIED
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 ere required to schedule an electrical
'fuse un' Inspection In the Department of Community Development at the time tills 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$ -_ $hall
be paid to the city,
4, Huntington Beach Fire Code Suction 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.
6. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side),
TINAI Fgpk& rcr�� 0
DATF RAI
AMO 0 E
(FOR OFFICE USE eNLY) i�ONINO_
OCCUPANCY GROUT PLAN CHECK NO NO PARKING SPACCS
OCCIJP^NT LOAD PERMIT No HFAI TH 01- PT APPROVAL— -
NO or STORIES I DMIN ACTION UTILITIES RELkASLO
(;LrITII`,I0ATL- OF OCCUPANCY F+1,
APPHOVED BY DATE GIIANGL OF USE Oil OCCUPANCY FLL $
761030140y. Ito? 'N" I V 4 Vi I k it 4,4[ 1
SUPPLEMENTAL, INFORMATION
1.
BUSINESS ADDRESS � ' �2 ,� 1 711 L;
4�'/1
V47J/
2.
Person to contact in case of emergency•.
Telephone number:
3.
Does the building in question have electricity?
V Yes
❑ No
(a) if No, are you request;-,., that the electricity be
El 'Yes
turned on?
❑ No
4.
The building is sprinklered?
0/yes
❑ No
5.
Operations will produce dust/wood shavings or similar
material?
Gl/vas
D No
6.
Operations will Involve the repair or replacement of
11 es
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
reault In an occupant load of more than 50 persons. Yes
❑ No
8. The following best describes my operation;
Office Only
Retail Sales
Warehouse
Mart ufacturing / Distribution (describe process and end product)
Restaurant/Take Out Food
Medical / Dental
Other (describe)
GUI)MI;PAUV AL iP-!Wt jRM4110N
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials? ❑ Xes
iVU
If Yes, indicate quantities:
Material Quantity,
1. Flammable liquids
Class I -A
Class 1-13
Class I-C
2. Combustible liquids
Class II
Class III -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--
10. Corrosive liquids -'
11. Oxidizing material - gases
12. Oxidizing material - liquids
13 Oxidizing material - solids
'14. Organic peroxides
1.5. Nitromethane (unstable materials)
16. Ammonium nitrate
17, Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight
18. Highly toxic material and —
polsonous gas
19, Smokeless powder
20. Black sporting powder
1 h yeby certify that the above information is true and correct to
the best of y knowlod
/�i3 A cTzr-t7
Signature ate
(D South Coast
AIR QUALIT)f MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR Q1UALICE-Y PERAUT CHECKLIST
for nonresidential buildings only
i
Company Name:
Location of Property:
City: —/7-/ - - Zip Code:
Contact Person: Title:
Telepbane Number: _ Fax Number:
Type of IndustryBusiness:
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing taus checklist, please call (800) 388-2121.
YES
NOj
1. Will the facility have a charbroiler?
2. Will any internal zombustion engine with greater than 50 horsepower
overate at the facility (excluding motor vehicles)?
3. Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings? [ ]
11
4. Will dust or smoke be generated at the facility? [ j
[
5. Will refining of any liquids or solids be done at the facility?
✓,J/
6. Will any plating or c. ' ating of materials be done at the facility?
7. Will any combustion equipment rated greater than 2,000,000 ETU/hr be
operated at the facility? [ J
[�
S. Will any acids, solvents, or motor fuel be used or stored at the facility? [ ]
14
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?
facili
11. Will any CFC (Freon) recycling machines operate at the
Applicant: % V470 Signature: -
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is nQt needed at thin" 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) 88-212I
ADD IONAL SUPPLEMENTAL INFORMATION