HomeMy WebLinkAbout15121 Graham St - CofOa
.jTI&IAPPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
4 DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNW.TON BLUN (PRINT OR TYPE ONLY)
Address / 5 / t� !�? A I-1/417 St' I7—I S 10 - - / C 7
Business Name ✓ R C' C /Iq /
Business Type __ 1-7
BUILDING OWNER
Name `�y� N � Name_
Home
Address y?166 (.tom/ 4_ _S ,4Leg,:�:— r I/ Address
City L VL %� H/C F=) _Tel Crty—
THIS USE WOULD BE DESCRIBED AS:
5_5—`71_l
DATE
District
Tel
Occ Group�gs
BUSINESS OWNERIMANAGER
ome Tel
❑ NEWLY CONSTRUCTED BLDG ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
0 EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any tt`` Occupancy Gr Div
SQUARE FT. OF BUILDING TO BE OCCUPIED A 0
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 make inspection of a building or
premises 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 ir: a
different group of occupancy, a change of occupancy inspection fee of $ shall
be paid to the city.
4. Hurtington 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. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
ifi ^,Tt: PAIL
OCCUPANCY GROUP
OCCUPANT LOAD
NO. OF STORIES
D-vv1
APPROVED BY DATE
75-039 Rev. 1/97
(FOR OFFICE USE ONLY) ZONING
-j-
PLAN CHECK — NO PARKING SPACES —
PERMIT NO�y - HEALTH DEPT APPROVAL
ADMIN ACTIO UTILITIES RELEASED
ADMIN ACTIO31 —
CERTIFICATE OF OCCUPANCY FEE
CHANGE OF USE OR OCCUPANCY FEE
TOTAL
SUPPLEMENTAL INFORMATION
IS��U � t:rkH�F( 57-.
1. BUSINESS ADDRESS
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? ❑ Yes
19 No
5. Operations will produce dust/wood shavings or similar
material? ❑ Yes
® No
6. Operations will involve the repair or replacement of ❑ Yes
automobile parts? ,Q No
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame? ❑ Yes
El No
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 56 persons. ❑ Yes
IS No
8. The following best describes my operation;
Office Only
Retail Sales
Warehouse
fiManufacturing/ Distribution (describe process and end product)
Restaurant / T.;ke Out Food
Medical / Dental
Other (describe)
SUPPLEMENTAL INFORMATION
Doe ii6 cperation invoive an?.' Of th(f, fn"lowing mater;ads?
F- Yes
2<:No
if Yes mdicav, quaritifties:
Material' C)LjanUtty
I. Harrimable
Ciao !-A
Clas,Q,
-i—Com—bu-s-t-ib-le-
Class 11
Class W4k
3
4. Flamnabie
gases
C. Fl.arnmabw
7.
gases
f2 Oxidizing rnate,,-`%! liquids
13. Oxidiziog material soll,is
14. Organ"'C des
'5. Nitrome-'Olane. (Iunstabl.irtaterialsj
—6 AmmoiliLOVI ,,,.rate
17. Animoniuni nitrait-.: =9ornpound M.'XtUrps
containing more, -2-han 60% nitrate
by weight
18. Highiv
and
poisonous gas
19. Smokeless rlowoer
20. Black Spi-21t!d',g p.jwder
I hereby certify that the above information is true and correct tr.
the best o my �wledge,
Signature Date
South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PEi2MUT CHECE11ST
for nonresidential buildings only
Company Name: ✓ f-1 Esc c; ,� ;—�
Location of Property: /�5 /2.i
City:__r�rvc,a c i r Zip Code:
t" Contact Person: l_—/> Title-.
Telephone Number: ' CZ - -`y0 - D Fax Number:
Type of IndustryBusiness: �-IW c c., c �—
To apply for a nonresidential building permit, you must complete this che--'_-.Iist. If you have any
questions about completing this checklist, please call (800) 388-2121.
1. VIiii the facility have a charbroiler? YES NO
2. Will any internal combustion ecigine 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? [ [
4. WilI dust or smoke be generated at the facility? [
5. Will refining of any liquids or solids be done at the facility? ( 1
6. Will any plating or coating of materials be done at the facility? [ 1 [ )
7. Will any combustion equipment rated greater than 2,000,000 3TU/hr be
operated at the facility? [
8. Will any acids, solvents, or motor fuel be used or stored at the facility? [ [
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? ( [
11. Will any CFC (Freon)- recycling machines operate at the facility9 [
Applicant: Signature:
(Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is not needed at this time,
and this checklist is your written release.
If you marked "YES" in any of the boxes, you roust contact the South Coast Air Quality
Management District (AQM D). Please read the requirements on the back of the checklist.
(800) 388-2121
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