HomeMy WebLinkAbout15121 Graham St - CofO (15){
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUMTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVEi.OPMENT
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(PRINT OR TYPE ONLY) DATE
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ress _/ _�/,�U
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Business Name
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Business TypeY2 L'OS/dY7 V C 3(/1 C' Occ. Group,
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BUILDING OWNER BUSINESS OWNERIMANAGER
NamtJame
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Address 3 3 Addre
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City tj hl�7Home Tel 7�
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THiS USE WOULD HE DESCRIBED AS:
NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER L'_! CHANGE OF OCCUPANT
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U'EXISTING BUILDING ❑ CHANGE OF USE ADDITIONAL OCCUPANT
Indicate former use, it 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.
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3. Change of occupancy or use inspection: fee. Whenever it is necessary to make inspection of a building or
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premises in order to determine if a change may be made in th•.: characterof occupancy oruse 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
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be paid to the city.
(r 4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum offour(4)
inches in height with half (1/2) inch stroke,'and of contrasting from the background. These
one a color
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i 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 distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
TRAFFIC IMP
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Aln•i . T Ft `D (FOR OFFICE USE ONLY)
NA ZONING =LA—
OCCUPANCY GROUP. - PLAN CHECK NO. NO. PARKING SPACES _
OCCUPANT LOAD ` PERMIT NO. HEALTH DEPT. APPROVAL
NO. OF STORIES _►,' ADMIN. ACTION UTILITIES REi.EASED
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CERTIFICATE OF OCCUPANCY FEE $
1XPAOVED
.BY DATE CHANGE OF USE OR OCCUPANCY FEE g
TOTAL g
Ta-dsss�sv.usT COMMUNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
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1.
BUSINESS ADDRESS
2.
Person to contact in case- of emergency - age
Telephone number; '7,/ !` 3
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3.
Does the building in question have electricity?
Yes
Q No
(a) If No, are you requesting that the electricity be
El Yes
turned on?
❑ No
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4.
- The building is sprinklered?
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,,eYes
No
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5.
Operations will produce dust / wood shavings or similar
material?
Yes
;
Al o
6.
Operations will involve the repair or replacement of
❑ Yes
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automobile parts?
No
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If Yes:
(a) Describe the components repaired or replaced.
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(b) Does the operation involve the use of an open flame?'.
Yes
7.,
The business is drinking, dining or assembly use that will
result in an occupant load of . more than 50 persons.
T] Yes'
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;No
8.
The following best describes my -operation;
F—Office Only
Retail Sales
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L-Warehouse
Manufacturing`'/ Distribution (describe process and end product)
Restaurant ! Take Out Food
Medical / Dental
Other (describe)
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SUPPLEMENTALINFORMATION
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SUOPLEMENTAL INFORMATION (Continued)
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Does the operation involve anty of the following materials
.tO Yes
,
C7 No
If Yes, indicate quantities.
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Material Quantity
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1. Flammable liquids`
Class I -A N
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Class I-13
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Class l-C
2. Combustible liquids
Class 11 �} U
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Glass 111-A
3. Combination flammable liquids
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4. Flammable gases d
5. Liquefied flammable gases
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6. ,Flammable fibers - loose
7. Flammable fibers - hales
8. Flammable solids
9. Unstable materials
10. Corrosive liquids
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it Oxidizing material -gases
12. `Oxidizing material-- liquici"s-
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13: Qxidi,_in mates ial — solids AJ 0
14. Organic ,
..,peroxides
15., Nitromethane, (unstable materials)
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l 16..•e Ammonium nitrate
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1T Ammonium nitrate compound mixtures
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containing more than 60% nitrates /
by weight
18. Highly toxic material and
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poisonous, gas
19,.._ Smokeless powder
20. Black sportt_ng powder
1 hereby certify that- the -above - information, is #rue and 'correct
to
the best of my knowl ge.
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f Signature Date
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South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PERMIT CHECKLIST°
for nonresidential buildings only
Company Name:
U cation of propprty:
City: Zip, Coder (ro�
Contact Person: llbP�s4C _ Title:/
Fax Number 3 3
.Telephone Number:.. G�� �/ �Lh.�
Type of Industry/Business:
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Y To apply for a nonresidential building permit, you must complete this checklist. If you have any:
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questions about completing this checklist; please call (800) 388-2121.
YES NO
1. Will the facility have a charbroiler? [ ] (
2. Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)? [ ]t
3. Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings? [ ] P4 `
4. Will dust or smoke be generated at the facility?
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? (?
7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be
operated at the facility? J r`
8. Will any acids, solvents, or motor fuel be used or stored at the facility? [ j
'. 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? [ J
3 11. Will any CFC (Freon) reCYC4ling machines operate at the facility? [ ] [
Applicant: 2 Signature:
(Print name clearly) i
If you have marked "NO in p11 the boxes, an air quality permit is not needed at this time,
and this checklist is your written release.
If you marked "YES" in ar; y of the boxes, you must contact the South Coast Air Quality
Management District (A,QMD). Please read the requirements on the back of the checklist.
(800) 388-2121
ADDfT10N4L_SUPPLE7v1EN7At iNFORMFTiON
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