HomeMy WebLinkAbout15077 GOLDEN WEST - CofO (2)J, APPLICATION FOR CERTIFICATE OF OCCUPANCY
CiTY OF HUNTINGTON BEACH
• `� DEPARTMENT OF BUILDING $ SAFETY
rivrrTwcrcxr MACH aae+NT OR TYPE rNI yj ,.- RAT
'fi 1
ui— I� N
Ad��ireus � 6 �
Business Name W %Tod 0. Tel
Business T e __ ' C r p t5 , _ Oc Groups...
80tLDZG OWNER BUSINES-- r1 ,RtMANAGER
Name LDS h P r.5 _ i� ? ! Name-, s� H96 4.0cwi
Addre s �—, F'r Vic- Addle ='a
Cityl` i ' h`Q"✓ �__. TP z Q city ' `� r i 1 f--' .......Home Te�� r
.. t,, { ....� y ...,. � ,,..,...-- _...._,
'rHis USE WOULD BE DESCRIBED AS,. _
El CONSTRUCTED BLDG CHANt3E OF OWNER HAtNGE OF OCCUPANT
EXIST,N'G BUILDING I CHANGE OF USE �AGt71T1ONAl OCCUPANT
Indicate farmer use. if any_...._ _ _ .. .. ,__ :ax.. C)c,rt�parr4y Gc Div
SQUARE FT OF BUILDING TO BE OCCUPtED-1- v—
NOTICE , 1 Occupancy of any building is prohibited and a business arise will not be issued until the budding lies been
inspected and n certificate of occupancy is issued.
2. No electrical service will be released for any existing building unlit the service has been inspnted and
certified safe All applicz ss 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 le . Whenever it is necessary to make inspection of a building or
prrmtses 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 s
different group of occupancy, a change of occupancy inspection fee of $v. shall
be paid to the city, i
4, Huntingto-n Beach Fire Code Section 10,208 requires that building num 5ers must. be a minimum of four (4)
inches in height with one half (i/z). 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 reach fire Code Section 10,301 requires fire extinguisher selection and distribution per the
National Ftre Prote ion Assoctatinp pamphlet 10 (see reverse aide).
e�� pl:,t�..i"&i' Ir.l� d,w v+r i �. _ �► "� � t°�,
k�b„tw F75 FFICE USE ONLY) NI
ONG ,
OCCUPANCY GROUP— PLAN CHECK NO ��. NO PARKING SPACES
OCCUPANT LOAD PERMIT NO _ _ - HEALTH DEPT APPROVAL. —
NO OF STORIES _.-.. _ A w..-_.,.k_» ADMIN ACTION, UTILITIES RELEASLD
«'
�� a4✓ CERTIFICATE OF OCCUPANCY FEE
APPROVED ,BY DOIF � C`HANGE OF USE OR OCCUPANCY KE $
TOTAL S �r
F{7RFA:°T:I#9a{r+"aX.=i.ir*`:7iR',,A:.I�i,1�CtaeARa+a=�:9*4� ,gg 4
SUPPLEMENYAL INFORMATION
1..
BUSINESS ADDRESS
aor:2.
Persen to contact in case of em
�
1
Telephone- number: /�, '�Sf
---
3.
Does the building in quesi on have electricity?
Yes
4No
(a) If No, are you requesting that the electricity be
C7 Yes
turned on?
No
4.
The building is sprinklered?
G Yes
JR�'No
5.
Operations will produce dust/wood shavings or similar
material?
0 Yes
No
6.
Operations will involve the repair or replacement of
1:1 Yes
automobile par:. ?No
If Yes:
(a) Describe the components repaired or replaced.
(b): Does the operation involve the use of an operaflame?
YnC!
No
7.
The business is drinking, dining or assembly use that will
result in an occul-iant load oi" more trzan 50 persons.
Yes
No
8.
The following best describes my operation;
'
�RetaLil Sale
Warehouse
Manufacturing Distribution (describe process and end product)
rant/Take Out Food
Restau-
Medical I Dental
p
Other (describe)
,
s - ♦. r ."k ik i.ue. .i. -i r
SUPPLEMENTAL
INFORMATION 3Ct htinued)
Does
the operation involve any of the
fallow>{i. materials? 0 Yes
N
If
Yes, indicat, quantities.
Quantity
1.
".
t1 jyyy �ryyt/':''�{�i nater1ia)t� /�1
Flammable liquids
Class I -A
Mass 1-B
:•.wum.n,.i+ur.++•.-ova-w..-�•+rn.+..,,.n.w.•,w+.-�+.,ms..wi,w•...wa•w=
w..r+x..,.....n.....e+�-..wm.m
Glass i-C
mw.uw,:+.,ww�.+x+.�r,.=-.w-......m..re.....•«,w..;.sua�..�w.w,..nw...+w..-,u,E e...u.c
.._��.�..�.e.re+r.....
�+
..— _...s..�.�....�.�.�.....w...,*e-e.n..�..ww. nr:r.s.mrwx-.:w..a.�...�w.......n....,.+8.......
G�rnbuStikile siilt,"i(�S
..nw.n.k.r+a�n -wpm..,...
Class I1
....=u..+r.us..xr
..+.+.a '«�+�,.,,.•..,:,.-r.
«u..mu--r�.m.•
Class ill-
"v...roewr+M-ev.;rlur...w+,-a.•-.+.�.x-m+n••.'«..�u
I>.
Combination flammable �Iigi.iids_,...w.,.n„.�.�,.,�
Liquefied #tarilmalNle eases
6.
Flammable fibers - loose
'�.�
�Iamitiable �:S�ersM baled
Flamrncable solids
i t...
Oxidizing _ mator`.ai. w es
Gxidizing material liquids
13.
Oxidizing iraterWl solids
.M.��...,,»��...r.��....k�...�..,m.=.F..�..,...�...a.-,.-.W.-,...,....w...,..�,,,.....�...�..,....,>~..»__,.,,_..�,...w.,..,..�,n,,a—....-_,,,...,...:....�,.,,...»,..,......
+C„gani+c peroxides
w.,,..._�.vw.,......._....,.......,a.._......,,...�.k,.,.....
e
_
rWrri -nano 'ainst zbie materials)
mmonluiri nitrate_
f x
�# nrrioi ii m rtitr to i; ,rnfaound—rjxtures
containing more th.3n 60% riiWitiy
by we ght
H- ig-hly toxic material and
poisonous gas
19.
oXe ess powder
d ick forting powder
t epy certi th above information
is true and correct to
se ii sit of isnol, e e.
4ignature
K ;ate w
A
South Coast
AIR QUALITY MANAGEMENT DISTRICT
` 21865 E. Copley Drive, Diamond Bar, CA 91765.4182 (900�, 896.2000,
AIR QU kLITY PERMIT CHECKLIST
for nonresidential buildings only
Company Name:
I,acatioa f Pxope t ? �t W vs -'t
City: t lj YAC, e C r Zip Code: / 7`
Contact Person a -G'041 Title:, 1,0 Pi l f
' JJ �1 `'
Telephone. �vumber:..._j_„ f L> �' Fax Dumber: .._._,
f4 ^
Type of TntiusttytBuszness:
To apply for .t nonresidential building permit, you mist complete this cbecklist. Ifyou have any
questions about completing this checklist, please call (800) 388-2121.
YES �O
1 Will the facility have a charbroiler?
2. Wil.l any internal combustion. engine ;vith greater than, 50 horsepower
operate at the facility (excluding motor vehicles)?
3. Will operations at the facility involve mixing, blending, or processing of n ,
solvents, adhesives, paints or comings`'[ ]
4. Will dust or smoke be generated at the facility?
5. Will refadmg of any liquids or solids be done at the facility?
6, Will any plating or coating of materials be done at the facility
7. Will any combustion equipment rated greater than 2,000,000 1 rr be
operated at the facility? [ }
$. Will any acids, solvents, or mote! -.del be used or stored a the4 ty"t� ] j
Will any organic liquids or gas be reacted or prod
10. Will any ovens be used to dry cure pr elude a ytherac6i'lifty�;71
11. y CFC (Freon recycling, ;:esolierate,�t � ,� Ln-S
Applicarst! �, igna
(Print name clearl)�
If you have marked "NO" in �t1 the bn:ces, air quality permit is � nee _d' at this time,
and this checklist is your written release.
If you m?rked "YES" in any of the boxes, you, must coacactthe South Coast Air duality
Management District (AQMD). Please reach the requirements on the back of the'checklisL
(800) 388-2121.
r
Rr '%mTl
GOVEMNWIS
Califf n,Ja :eta is Lax (Gove"m'ttert t.oje O'i'K502) pl-ohibit,, d-w x � �g Dcp tea, f
. �«s i�l�.t, �. 3.k ��tlus .cw12
-ruin- a final E;esLi?:c e of 0 Cupanc1 -" u:' esi all requi-Lem,=as oi the lo, I fir i�C ity i%;ei3cyaW
met, ll'applicr,ztb are -equixed to cofnipletc Lke 2a quality pe=it Oieit kjiit, The c e6kjist a$
designed to 3tt' i G" aPliLaaat for a no xresid zntial build-ing pzrnit a—'4- if'tho Ea?1lwer to Ma N of
diw tr." Stion's i;i a yrs. ''t Building l)epu:iR,i ent must obtaiti a written release frorn the local air
quality agtnc4� � er$�;�'ir� ^ tly�« �� at ��i� ktr:t is in
1. All nonresidenrrral buildinty must eo.ltplete dus
2 � 44'' t", tSg �t 't �d:E 1 Ra u'ti r:x t ! .. ah-- Bgy utd 'cam; yy# p ' x' ' t ��`", tilt; w�i$',E:kl1 t
t��,.» ' L7 ui �.'° &,F6i rlk�`�t�A MY�2o �T"i X�. �E: 6 t 5jY'
,3t the '4N'r't'tt�.�ii r&:lci+ * E�'.
If :!v-Ei questtY,.t s Wf ' +�'..., `a`:4 Y:n L`ed �� �I;, e, ,.*$G�. Zpn4c ! ' x `' ng
� «. � � <�'r. "'f�y� uli 7�"$��;t :.5 i1u�Zt, tr1`,'', ������ �y' calling
f 0) 388 permit: are rquired for anN equipment
ipment
wl ieb rn4y be oporated 31 th,w site•, if tlty AQ.MD dc-lennines that fir qoality pets are
not. requind 07 all N11:1Mrkvnlz, have beeii met: ;a wrinen. l�!ase 1011 be i$$ue'
4, if aix quality pern it:,, are r.quixec l an4 applicAlions have str$t c.en subrrutted, 'the uppliwat
Muse subn-itl *,e necc-,s ry ver it application(s) and appropriate fees before a vaitten
will
be issued.
AQ.NfD i,.� committed to expediling, all clearance letter requests. However, it may 4.,0 several
weeps to veril 'y co pli=ce w0h all requireractats. I lterefore, you are adNised to toutaet A :MD
Immediately, aftcrapptying for building permits.
(8€ 0) 388-212
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