HomeMy WebLinkAbout15075 GOLDEN WEST - CofO (3)_f1
APPLICATI N 1=0R CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH I
rroHrwrcron ems+ DEPARTMENT OF COMMUNITY DEVELOPMENT
(PRINT OR TYPE ONLYI DATE
)iddress -82 Cam( oil �tiS� �� g ,
Dis
trict--
rt
ct �/ t
--Zusiness Name -Le—_ Tel.
Xusiness Type
Occ, Group
BUILDING OWNER BUSINESS OWNERIMANAGER
Name K"' ..&..y �. _ •, ;i 1�7-? ame_::r0A)
j .address dome
-iAddress
City i _ Tel
ity��'rJ Home Tel,e2aVA40
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. ' O WNER
/t9-CHANGE OF OCCUPANT
1EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any _
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 orcupancy or use inspection fee. Whenever it is necessary to make inspection of a building or
premises in o der to determine if a change may be made in the character of occupancy or use of the building
or premises wolch would place the building in a different division of the same group of occupancy or in a
different gro ,p of occupancy, a change of occupancy inspection fee of $ shall
be paid to amity. r
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 (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.
5 5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
NationalFire Protection Association pamphlet 10 (see reverse side).
— I
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SUPPLEMENTAL INFORMATION
(FOR OFFICE USE ONLY) C �- I, ZS gG2O
� � m, ZONING --• o-v
OCCUPANCY GROUP PLAN CHECK NO. NO PARKIN
OCCUPANT LOAD - �a *i PERMIT NO. HEAL EPT. APPRO AL
NO. OF STORIES ADMIN. ACTION CITIES RELEASED
U
` �` , -f ` 1'ctERTIFICATE OF OCCUPANCY FE
` APPROVED BY�r T ` DATE CHANGE OF USE OR OCCUPANC FEE $
---, J
TOTAL
7e-039Re 6/e8 COMMUNITY DEVELP.
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS
2.
Person to contact in c4se of emergency: swo -�
Telephone number:
3.
Does the building in question have electricity? 6ie3
ONO
a. if No, are you requesting that the electricity ba Oyes
�>
turned on? ONO
4>.
The building is ,sprinklered? Oyes
ONO
5.
Operations will produce dust/wood shavings or similar
`
material? Dye(dos
6.
Operations will involve the repair or replacement of DYes
l
automobile parts?
;
if yes:
y }
(a) Describe the components repair3d or replaced.
(b) Does the operation involve the use of an open flame? DYes
MR6
7.
The business is drinking, dining or assembly use that Will
result in an occupant load of more than 50 persons. 4y
S.
The following best describes my operation:
,f
office Only
Retail Sales
warehouse
Manufacturing/Distribution (describe process and end
y
product)
sstauran a e out Food
Medical/Dental
Other idescrikwe)
(0562D)
SUPPLEMENTAL_ INFORMATION (Continued) 16
Does the operation involve a..y of the fol:lowi.r;g materials? OYeONos
fifes, in ica e_quant ties: Quantity1
Material
I. `Flammable liquids
J
Class I -A
Class I-B
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 -----;
.s. Oxidizing material - solids
14. organic peroxides
15. Nitromethane (unstable materials)
;
i 16. Ammonium nitrate
17. Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight
18.. Highly toxic material and
poisonous gas ,_..>..,
19. Smokeless powder
20. Black sporting powder
I hereby certify that the above information is true and correct to the
best of._my knowledge. F
p
Signature Date
(Q562D)
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