HomeMy WebLinkAbout15071 GOLDEN WEST - CofO (3)APPLICATiON FOR CERTIFICATE QE OCCUPANCY
CITY OF HUNTINGTON BEACH ,,,y,
' DEPARTMENT OF BUILDING SAFETY A`
MKTWCTori KA04 fPRINT OR TYPL ONM DATE
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. Address /5-0 7 / District
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Business Name Te'
Business Type r64/Z i l L_ !2 %`5 sy tcfJl0 Occ. Group ,
BUILDING OWNER
BUSINESS OWNEMMANAGEFR
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Name
i h Nome
Address_,✓ 9 61'� �f rGt� Address
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city -La
/yl�,� f� �lv'{tl Tef._ city t riii�lt�,9�' Ftotn e1��5
THIS USE WOULD BE DESCRIBED AS: CV44`� 7f4'
NB+vLY GOC1STFiUC7ED BLDG. ❑ CHANGE OF OWNER CHANGE OF OCCUPANT
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EXtSTING BUILDING �1 �!j ❑ ,CHANGE OF USE ❑ ADDITIONAL OCCUPANT
indicate farmer use. if any 6,blC Occupancy Gr. Div.
SQUARE FT. OF 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 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 makeinspecticn of a building ar
premises in order to determine if a:change maybe made in, the character of occupancy or use of the building
k 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 $ shad
f.
be paid to the city.`
Huntington Beach fire Code Section 1020$ requires thatbuilding numbers.mustbe amihimum offour (d)
inches in height with one half (1h' 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 Cade Section 10,301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10;(see reverse side).
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TRAFFIC IMIPA T FE-,.,.�
DATE AID-,
(FOR OFFICE USE ONLY) ZONING -
OCCUPANCY GROUP_ PLAN CHECK NO NO PARKING SPADES
OCCUPANT LOAD: A PERMIT NO, HEALTH DEPT APPROVAL
3 t40. of smRiEs ADMIN. ACTION- UTiLiTIES RELEASEi?
I d . CERTIFICATE OF OCCUPANCY FEE $ ���°^ �
.APPROVED Bl' D E CHANGE OF USE OR OCCUPANCY FEE $
TOTAL $
MORN 7s9)39 REV 2MI RE -ORDER sAnro.aarL4a7r4-8a2.iYa9 BU)'r..P'°: � "u^ M? �
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS/C=' 1j�bF�ta.'r" �`crs-�'ic J��r �e ✓`
2.
Person to contact in case of emergency -
Telephone number: ?IV 5 90
'
3.
Does the building in question have electricity?
D'Yes
❑ No
(aj if No, are you requesting that the electricity be
❑ Yes '
turned on?
ErNo
The building is sprinklered?
❑'Yes
c
❑ No
S.
Operations will produce dust l wood shavings or similar
material?
C1 Yes
[J No
6.
Operations will involve the repair or replacement of
❑Yes
'f
automobile parts'?"r+o
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
result in an occupant load of more than 50 persons,
1 Yes
CAN O
6.
he following best describes - my operation,,
,.f
Office Only
Retail Sales
Warehouse
Manufacturing ! Distribution (describe process and end product)
Restaurant / Take Out Food
Medical 1 Dental
Other (describe'
now
SUPPLEMENTAL TAL . rORM TTON �Continuedj
Does
the operation involve , any of the following ma�eriala? 0 Yes
-
o
if
Yes, indicate quantities:
Material Quanti
`
1.
Flammable liquids
Class ,I -A
F
Mass 'l-13
Mass I-
2.
Combustible liquids
k
Mass 11
Class
; .
Combination flammable liquids
6
4'.
i l'iAFI:Fbi able games
5.
Liquefied fla n mable gases
Flammable fibers _ loose
7,
Flammable fibers .. baled
pp,
3.
':- Flammable solids... � -
i
9.
Unstable materials .
M
,corrosive liquids
I l a
' ''Oxidizing material - gases
z
I .
Oxidizing material -, Rquids
13.
C>xidizing material - solids
14.
Organic peroxides
` 5.,
Nitrumetnane ( stable, .materials)
le. Arnrnonlum nitrate
IT
' Ammonium nitrate compound mixtures
Containing more than ' 60% nitrate
lay weight
i
78.
` Highly toxic material and
f
poisonous gas
e
1.
Smokeless powder,
23.
Slack sporting powder
I hereby certify that the above information'is true and correct to
the best of my knowledge.
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