HomeMy WebLinkAbout15121 Graham St - CofO (38)J APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
MUNIINGTON 9F:%} a TYPE ONLY) _.,_, D fTE
Address / �- k i71 / 9
Z fQ/l Q ��a f° �fi �P- �P.�Gk District-
8usiness frame 4a11_>gy:;i loch. / Tel
_.
Business Type 1i1t71G#k.G�h P. ' . Group
BUIt..VJNG OWNER ice' j (�BUSINESS OWNEFVMANAGER
Blame- —AI
,Aa & K/�a� 0 Name
o b/C �1'S . y Nome
Address ,fLe w -�� Address
City--� f'X�r--�1�'_ Tel L. �.ity G'�_i�i tome Tel,_
THIS USE WOULD BE MESCRIBED AS:
NEWLY CONSTRUCTED SLf-- ❑ CHANGE OF OWNER 6CHANGE OF OCCUPANT
r—�
EXISTING BUILDING ❑ CHANGE OF t15t= L„J ADDITIONAL OCCUPANT d
Indicate former use, of ¢ _ _ Occupancy Gr Div
SQUARE FT, OF BUILDP�,G TO BE OCCUPIED.(Gov
� 6 6)rt ,41-4 Pilej 11 `W otk 1g*+��`
F
NOTICE' 1. Occupancy of any building is prohibited and a business license will not be issued until the ouilding 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 tr, make inspection of a building or
premises in' order to determine if achange 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, achange of occupancy inspection fee of $ shall
be paid to the city.
d. Huntington Beach Fire Code Section 10.208 requires thatbuilding numbers must be a minimum of four (4)
inches In height with one half (Il'a) 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 Code Section 10,301 requires fire extinguisher selection and oistribution per the
National Fire Protection Association piamphlet 10 (see reverse side). �
...
ti`=r�ik tu.�1C fl'�.f�l�.� c I-..�
UATf. PAP) .. y
(FOR OFFICE USE,fJfNLY)1... ^. . NINCr,,.,
OCCUPANCY GIRO P-D— .:!5n ,. PLAN DilMCK NO NO PARKING SPACES
C}CCUPANi LOAD i7> KJIMIT NO Hf At TFi PT APPROuAL
NO Aflilow AC`TIO14 ,., .--�---„.-0TttITIES RELEASED w
C 3-1`17IFI+ ATF OP GC`.LOPANC:'Y f E F $...,.r,
APPROVED BY DAtf CHANGE 01 USE E UR OCCUPANCY „Y €'LE
TOTAL
s
SUPPLEMENTAL INFORMATION
t ' 1
BUSINESS ADDRESS IS 67 / 4r4awl J�;& /0 3r
2.
Person to contact in case of emergency
Telephone number:
3,
Does the building in question have electricity?
❑ Yes
No
(a) if No, are you requesting that the electricity be
❑ Yes
'
turned on?
❑ No ,
4.
The building is sprinklered?
j'� Yes
❑ No
5.
Operations will produce dust/wood shavings or similar
material?
0 Yes
No
6.
Operations will involve the repair or -replacement of
❑ Yes
automobile parts?
j No
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame?
❑ Yes
A No
7.
The business is drinking, dining or assembly use that
will
result in, an occupant load of more than ,50 persons.
❑Yes
No
8.
The followingbest describes my operation;
Office Only
Retail Sales
Warehouse
Manufaciuring / Distrib tion (describe process and end
product)
Ga�rr� j�au.,
Restaurant/ Take Out Food
Medical / Dental
Other (describe)
i-
L 1CtN
SUPPLEMENTAL INFORMA
SUPPLeMENTAL INFORMATION (Continued)
O'Ges the °operation involy any `of the' foil6w;Q `material's? V'es
. No
It Yes, indicate Pantities:
Materia; Quanti _
1. Flammable liquids -
Clasa 1,-A
.- Class 1-S
Mass
2d Gomllustible liquids �• �""°"
Mass 11
Class
3. Combination flammable liquids#�
4. F)ammable gases
S. Liquefied flammablegases
6. Flamrnabie fibers - lease
7. Flammable W_.ers �baled _ -
8 Flammable solids
9. Unstable materials
1o. Corrosive liquids
1, Oxidizing materials gases
12. Oxidizing material - liquids
13. Oxidizing material - solids
14. +'Organic peroxides
16, lditromethane (unstable materials)
16, Ammonium nitrate
17. Ammonium nitra',e cornpoun mixture, ,..
containing more than 011% nitrate
by weight
'18. Highly toxic matet71al and
poisonous gas
19, Smokeless pounder
l�i Black sporting powder
E
t hereby, certify that the above ir,lorrmat:orl is true and correct to
the best of ray knowledge. _
i
Signature bate
l
,--f- r I
South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765•4182 (909) 396 3000
for nonresidential buildings only
Company Name: za �dn 96,
Location of Property: /S/y1 45;�,4 �d^ /n
City:_ fI—efor R,,l it Zip Code: --Z;4 t>
Contact Person: Gte _ Title: re+'
Telephone Number: ��liL ��9s a �5 0 Fax Number'
Type ofIndustry/Business- ;X
To apply for a nonresidential building pervait, you must complete this checklist. Ir you have �y
questions about completing this checklist, please call (800) 388.2121.
YES VQ1. 'Will the facility a charbroiler?
2. Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)' [
3. Will operations at the facility involve mixing, blending, or processing of solvents, adhesives, paints or coatings? [A
4. Will dust or smoke be generated at the facility? C
5. Will refining of any liquids or solids be done at the facility? []
6. 'Will any plating or coating of materials be done at the facility? ) to
7. Will any combustiota equipment rated greater than 2,000,000 B IJ/hr be
" operated at the facility`? ] [
8. �{Vill any acids, solvents, or motor fuel be used or stored at tho facility? t I
9. Will any organic liquids or ,gases be reacted or produced? [
10. Will any ovens be user to dry or cure products at the facility?
[
11. Will any CFC (Freon) recycling machinesoperate at the facility? [
Applicant: $ignature; /44
(print na'm learlyr ~
If you have marked "NO" in C the boxes, an air quality perinit is needed at this time,
and this checklist is your written re esso.
' If you, marked "YES" in any of the boxes, you must contact the South Coast .Aar Quality
Management Distriot (.A.QNLD). Please read the requirements on the back ofthe checkdist.
(800) 388 2 2
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