HomeMy WebLinkAbout15011 GOLDEN WEST - CofO (8)APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNnwGTON WIQr1 (PRINT OR TYPE ONLY) V
{
Address I V n Y ` District
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Business Name ' Q (. TeC7%�i8 9' i, 7
1
Business Type b; vMAS s k np Occ. Group
BUILDING OWNER BUSINESS OWNERIMANAGER
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Name Name p Q
Waym.,e--r,3 Home . r�
Address `� ? 5 qRG, Ay emu e
Address .i
city � A <, . ^.r a- c A 5'02 4(/ % Tel �(-� y-i i�0 City — nlL"Is�6Js1 1Home Tel i
/
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. ZWHANGE OF OWNER HANGE OF OCCUPANT
i
EXISTING BUILDING ❑ CHANGE OF USE FIADD'ITIONALOCCUPANT
h
Indicate former use, if any �/"V�l Occupancy Gr. Div,
SQUARE FT. OF BUILDING TO BE OCCUPIED
NOTICE: I. Occupancy of any building is prohibited and a business license will not he issued until the building has been
j
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. WhenEwer It is necessary to make inspection Of a building or
premises in order to determine if a change maybe made in the charapter 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)
i
inches in height with one half (1/2) inch stroke, and of a contrasting color from the background. These
I
numbers must be posted on your building in alocation 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 FEE
t
ov`-
DATE PAID
AMOUNT RECEIVED
NAME (FOR OFFICE USE ONLY)
ZONING
OCCUPANCY GROUP PLAN CHECK NO. NO PARKING SPACES
OCCUPANT LOAD '` PERMIT NO. HEALTH DEPT: APPROVAL
NO. OF STORIES - ADMIN. ACTION UTILITIES RELEASED
g
CERTIFICATE OF OCCUPANCY FEE g ��
AP VE Y DATE CHANGE OF USE OR OCCUPANCY FEE $
TOTAL $_
i
T5-039Rev. 1/97 COMMUNITY DEVELOPMENT
i
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SUPPLEMENTAL INFORMATION
1.
BUSINESS 'ADDRESS
i
2.
Person to contact in case of emergency. -P) q Y `/ '"- �a
r`
Telephone number:
u
r
3.
Does the building in question have electricity?
[Yes
No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on? -
❑ No
i
4.
The building is sprinkfered?
Yes
No
5.
Operations will produce dust wood shavings or similar'
-
material?
❑ Yes
A No
-'6.
'►
Operations wiil involve_ the repair or replacement - of
❑ Yes
automobile _parts?
EWNo
If Yes:
(a) Describe the components repaired or replaced.
(b) Does 'the operation invo!ve the use of an open :flame?
❑ Yes
T� No
7.
� The business is -drinking, dining or assembly use that will
result, in an occupant Toad of more than 50 persons.
❑ Yes
7"i No
8.
The following best. describes my operation;
Office of r�
etaill Sales
arehouse
i
Manufacturing / Distribution (describe process and end product)
t
t
Restaurant Take Out Food
Medical/ Dental
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Other (describe)
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I
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i
_.
AL INFORMATION
...... SUPPLEMENTAL
.x ;,�.�,.-.�
...,,.
A
�
SUPPLEMItNTAL INFf9LRMATION (r-)ntinued)
E
Does the operation-- involve any of the following matt ,af87 !] Yes
If
Yes, indicate quantities:
_
Material Quantity
I
1.
Flammable liquids
Class l-A
Class I-8
!
Class I-C
2.
Combustible liquids
Class LI
Class III -A
3.
Combination fli mmable- liquids
4.
Frldmmable gases „
5.
Liquefied flammable gases
;
6.
Flammable fibers - loose
7.
Flammable fibers - baled
8.
Flammable solids
9.
Unstable materials-, ,•,..;
10.
Corrosive -liquids
-i fi:
-
Oxidizing -material - gases
12.
Oxidizing _ material - liquids
13
Oxidizing material-- 4olids°
14.-Organic
peroxides
15.
- Nitromethaf a (unstable materials)
16..
Ammonium nitrate
17.
Ammonium nitrate compound mixtures
j
containing more, than 60% nitrate
by weight
18.
Highly toxic material and
poisonous gasi
19-- Smokeless; .powder
20.
'Black sporting powder
11 hereby certify .-that ..the. above .,information _ _ is true 'and cot sect- to
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the best of my knowledge.
Signature —/DDate
r
J
r
OCT 01 '99 11:51AM PUBLIC AFFAIRS P.1
!
South. Coast
Air Quailty Management District
•21865 E. Copley Drive, Diamond Bar, CA 91765-41 82
• {909) 396-3529 • httpJ/www.agmd.gov
w
-Air'Quality Permit Checklist
California State Law Code 65850.2 prohibits cities from issuing an aecupancy permit toe
business without clearance from the local air quality agency., This checklist will determine if you
need to obtain clearance from the South Coast Air Quality Management District (AQMD).
Company Name: l 6P 5/`/ d=/`l uTl
Property Address: lSs
City: zip code: r Y
Contact Person: >
Type of•Business: (��r�l�rr� ��d� Telephone:
Applicent.(print name) ayl' Est o C flick Signewre:
Will the feeility have any ofthe following equipment? Yes[ ] No VA-'
Charbroiler
Dry cleaning machine
Spray booth
Printing press (screen/lithographic/flexograpNe)
Internal combustion engine'(gremer than 50 HP (excluding motor vch'tcles)
Boiler/combustion equipment (greater -than 2 million BTU/hr. maximum input)
Abrasive blasting cabinet/rooni
Baghouse/cartridge4pe dust filter/scrubber
Motor fuel storage and dispensing equipment
Will any of the following operations be,performed? Yes( No
Application of pants or adhesives
Etching, plating, Ong, or melting ofineWs
Molding, extruding, or curing of plastics
Mixing and blending of liquids and/or powders
i
Storage of acids, solvents, orgairic liquids, or foots
Production of fumes, dust, smoke, or strong odors
j
y if you answered "No" to both questions, this checklist is your clearance from- AQMD. If you
i
answered "Yes" to either question, you moat contact AQMD to determine if air quality permits
are required. If permits are needed, AQMD wiQ assist you in submitting permit appltcation(s) and
r then provide you with a clearance letter. You can call QUID at their Small Business Assistance
Office at (800) 3W2121.
AovbedFOCUNY 1999
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•
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01/OB/2001 14:23 5629893654 OUALITY BUILDEP.S - PAGE 03
TQ V}1 jci. UG1. S
0J, CITY OF' RUNTINGTON BEACH -�V• (� I'
19" DEPARTMENT OF BUILDING & SAFETY
INSPECTION RECORD
�wtnt rw awca
C
PL£AS£. POST ON -THE JOS SITE IN A CONSPICUOUS LOCATION. -
(PROTECT FROM GOS.9 OR. DAIHAOR)
F
F IH8r6CTION MUEST PROCEDURE
,! plc le cmll ( I nests received 4:30 PM. !
711 6363241 and follow th9 instructions given war the phone. Insputivn requests by
i i
.� will boper{otmed on the Wert nvkilable workday...
I
j Technic+!Q--dons?-.F2=e (7I41636-5241
Impactor Office Heura: 7:30 AM to 8:00 AM and 4:00. PM Io 4:30 PM Mondq th—gh F.WnY i
.t* Genml Bt1ildinBDivhru Office Howe: 8:00 AM. h, 5:OO PM Monday through.Fhday
1
Inep am p9_9.4iv ell applicable spaeee bef, work is ceree lod. Seethe inspection sequence on the backside of thin card or _.
v� JDIA11Yi�tt. `rn fi:Zis'r Goi�?lf�%1lniC,L`"�''�{t�-!'�.�� '.fscz'73;�o`uj:
Ito11)�2'
y t Y io
a � ,� -.. ; w r ': a " - k .=TIIBP.�t1'IOIF?i�±�!� r �.. -.r..: t . Ja .- .... .. bA'L'm r •. - !EL't'Ol
4� LINE � GRADE CALL PUBLIC W ORK6 AT 536-5431 YES D NO ❑
�'� �2DL' PLUMBING GROUNDWOAK-DRAIN.WASIEScVEIPI'(GAS '1F APFLIGBLEj
% -21n rLmmINGtiRooNDwoxK-wATER-Dtsrwetmox .
301 XLECTRICAL GROUNDWORK _ }}
-S02 •UFER GROUND (CONCRETE ENCASED ELECTRODE)
407 _ MECHANICAL GROUNDWORK f _...
101 .. 'FOUNDATION/SETBACKS
102 UNDERPINNING OR.FLOOR JOIST
103 S1,ABORDECK. -
•' ,t, L;; ;. ,,., aQ':RDTt:Q1tB)P;�ORIGDIITIG")1'li'i'3#At4H1N0i'BtliN96� , r . .it' :: :1.
203 PL•JIABING ROUGH
003 SHOWI7t PAN
`V03'••; MECHANICN. ROUGH -WALLS
-' 403 MECHANICAL ROUGK . CEILINO9 _
> � S ELECTRICAL ROUGH -WALLS . .
'909•' • ELECTRICAL ROUGH- CEILENO
Fy. •.- .'. iIOS . " ' ROOF SHEATifINO/PRE•ROOR' t
Ilya
GRID CEILING ! !
itl •' PRGGROUT MASONRY -
-t FIRE DEPARTMENT ROUGH INSPECTION (SPRINKLiRS/ALARM) 1536-54111
t Lkr_,•pI}.MdCCQlfli'40R1i9l1tY1e;41�11N0.. i31AA�CEMGM'
103 'INSULATION '
109 EXTERIOR LATH -
Y,
r,f 110 INTfR10A.-
�..a
.w� ._... 202 -WATER SERWCE
urAT( .204 SEWER PRC i
GAS TEST
F`e- r c , 'Fglf`.kQl'w`E[IT.�I,k.�P ,�RVHAL. ��:90.2it,h�Z?F>Y.14ARlk -. _
r, °•�a11i,L"iA36flRAfCi6ANUMIT .DI ®71Ot.. GOYPI:CZI� ORSiD_1'Hi «s=' •Ofr•UTIL1TfaS.
pRECJBE<tRADING .: A536-5431), YE.S13 - NOQ
.LANDSCAPING FINAL: (536-5480) . ,S _ zY ❑' NO ❑
WATER DIVISION FINAL s921) YES f] NO Q
PUBLIC WORKS. FINAL ( (5 -5431) - TES ❑ NO ❑
t' .. (536.5411) '. i .YES Q NO 0
:. • FIRED FINAL
t AsET'fIANEBARWER ,. Hs It) - r: •YESU No
TRAFFIC IMPACT PEE. ' +:(536 5431) .! E9 ❑. No[] SIGILtTUftE NtlT REQOFRLU.
412. " • MECHANICAL FINAL
!: 912 ELECTRICAL FINAL ' ;•r• 2•
4. ..
112• PLUMBING FINAL
_ i` .•1.12 BUILOINGFINAL } :..
(
i
i. APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPIIUitENT f f 2-
jH ; . f+ � J' (PRINT OR TYPE ONLY) DfTE
J�
1 s of
Address �4 G )` t , rr �.rr ,.r; c - r•1 District -
-- ---
Business Name _ _ � P4F 1-r ;DTIVLl�: 7-'' Tel
Business Type- ' r rTs Oca Group
BUILDING OWNER BUSINESS OWNERIMANAGER Cl()' e6'4 -52�"4�
.blame F I/k G%.5 d� AJ' a^'r / ...� Name -rr 4-c ^t'r �•#,�'tx:-�`
0-e;7r r tt Home C/'vX-4
Address.-= `= Address
City fir ' Tel 9 q"r- `f' Y City �i +"tyl-l-m X �'� Home Tel.6 I
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG E�RtHANGE OF OWNER ❑ CHANGE OF OCCUPANT
' EXISTING BUILDING ❑ CHANGE OF USE ADDITIONAL OCCUPANT
Indicate farmer use. if any -. s I7 c- _ ?ccupancy Cr Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED
NOTICE: 1 Occupancy of any building is prohibited and a business license{ ill not be issued until tile building has acen
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 building or
premises in order to determine if a change may be made in the characterof occupancy or use of the building
or premises which would place the building in a different div sion of the same group of occupancy grin a
different group of occupancy, a change of cccipancy`inspection fee of $ shall
be paid to the city.
4. Huntington Beach Fire Goole Section 10.208 requires that building numbers must be a minimum o• four (4)
inches In height with one half j1,2) inch stroke, and of a contrasting color from the background. These
numbers must be posted on your building in a io,ation that is visible from the street.
5. Huntington Beach Fire Code Section10.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
t T
TRAiF-FIC IMPACT FEe?
DATE PAID
AMOUNT RECEIVED
NAME � (FOR OFFICE USE ONLY)
- ZONING
OCCUPANCY CROUP PLAN CHECK. NO NO PARKING SPACES
OCCUPANT LOAD .. PERMIT NO HEALTH DEPT APPROVAL
NO, OF ST011,1ES _ .AL'MIN ?ACTION __._.. __ ---- UTILITIE/S� RELEASED
CERTIFICATE OF OCCUPANCY FEE $ l r ��� .S
APPo ED BY DATE _ CHANGE OF tj1G E OR CCC UFANCY FEE $
TOTAL
S Or'.
"r .7
75-039 ttaw. rrgr COMMUNITY DEVELOPMENT
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS p`� � f/ Z"_95iv
2.
Person to contact in case of emergency- 53 c'r'�'` /.z-;�- 6,
Telephone number: ) - .
3
Does the building in question have electricity?
8--Yes
No
(a) If No, are you requesting that the electricity be
❑Yes
turned on?
❑ No
4.
The building is sprinklered?
E Yes
❑ No
6.
Operations will produce dust/wood shavings ` or similar
material?
❑ Yes
3�'N o
' 6.
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
No
If Yes.
(a) Describe the components repaired or replaced.
❑ Yes
(b) Does the operation involve the use of an ; open flame?
No
7.
The business is drinking, dining or assembly use that will
I
result in an occupant load of more than 50 persons.
❑ Yes
fV
ij
o
S.
The. following beat describes my operation;
Office Only
Retail Sales
I'
Warehouse'
Manufacturing / Distribution (describe process and end product)
t
Restaurant! Take Out Food
Medical / Dental
Other (describe)
SUPPLEMENTAL INFOPMATION
SUPPLEMENTAL
INFORMATION (Continued)
Dees
the operation involve any of the
following materials? yes
o
If -
Yes.. indicate quantities.
Material
Quarititit
7.
iziammable liquids
Class t-
class I-S
Glass #-G
2.
Combustible liquids
Glass li
-
Glass lllmA
3_
Combination flammable liquids ..�
4.
Flammable gases
S.
Liquefied flammable gases
6,
Flammable fibers - loose
%.
Flammable fibers A bated
3.
Flammable solids
9.
Unstable Materials
1'l.
6 dsZjng material -gases
12_
Oxidizing material - liquids
13.
6YTc tzirtg material. - solids �.
_........ .
14..
O rgan;u peroxide
15.
Nitromethane (unstable Materials
16.
Ammonium nitrate
17.
um nitrate compound mixtures
containing more than 60% nitrate
by weight ;
—
13.
Highly toxic material and.
poisonous gas
f
19.
Smokeless powder
20.
Black sporting powder
3
t hereby certify that the above information is true and correct to
the best of my ` knowledge.
t
iorta
bete
South Coast
AIR QlJALI fY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
x AM QUALITY PEST sC CKLIrST
for nonresidential buildings only
Company Name;
Location ofProperty:
City_ rf -rlL� 1 zip code:
Contact Peraon: ;v 1 Ar Title:n-
Telephone Number: '-'/) ' tt Fax Number:
Type of IndustiylBusiness:
To apply for a nonresidential building permit, you must complete this checklist. Ifyou have any
questions about completing this checklist, please call (800) 388-2121,
YES NO
1. Will the facility have a charbroiler?
2. Will z,ny internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)?
3. Will operat; ons 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?
b.' Will any plating or coating of materials be done at the facility?
7. Will any combustion equipment rated greater than 2,000,000 BTLilhr 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 -mac es operate at the facility? £ ] { Applicant:,
Signature:
Signature:
(Print name clear
If you have marked "NO" in ill the boxes, an air quality permit is not 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 Qualify
Management district (AQN1D). Please read the requirements on the back of the checklist.
(800) 388-2121
ADDITIONAL SUPPLEMENTAL'INFORMATION