HomeMy WebLinkAbout15202 Graham St - CofOAMe APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACHkepkv ,
DEPARTMENT OF COMMUNITY DEVELOPMENT 7-�I
NUNTVCTON EFA01 DATE
t (PRINT OR TYPE ONLY)
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Address ' " 2 0 2. (TRANA M Sr. # 43. CA. 9Z d y)" District —
Business Name �� a% K S i L VqA 4 T_ 111611- 2 je s 8
Business Type .tom &Ofgte eof F/t uu/I r--t /I-v�� — Occ. Group
BUILDING OWNER �( ^� jz"'� BUSINESS OWNER/MANAGER
Name URE S - R F f6rls Oea? Name_) d ik !'. PIA
Address /*W*WP /'.�st1i bee* /�+✓� Address /f2 d 1 L�/tANi►M JT. .,.T
City X24166"t 4A T .dP,j%�� %"City #B Home Tel,_AN"
THIS USE WOULD BE DESCRIBED AS:
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❑l NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT !'
L!'J EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
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Indicate former use, if any • Occupancy Gr. Diva
SQUARE FT. OF BUILDING TO BE OCCUPIED fS 8S 64AAAF owy� �Zc3ov+�
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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 fired.
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 ofthe building
or premises which would place the building in a different division of the same group of occupancy or in a
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different group of occupancy, a change of occupancy inspection fee of $ shall
be paid to the city.
4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum of four (4)
r 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 extiryguisher sel _action and distribution per the s
National Fire Protection Association pamphlet 10 (see revers side).
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TRAFFIC IMPACT FEE
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DATE PAID _ t
AMOUNT RECEIVED nl OR OFFICE USE ONLY) / I
NAME n ,�, A ZONING �✓
OCCUPANCY GROUP PLAN CHECK N0. I NO PARKING SPACES
OCCUPANT LOAD PERMIT NO. HEALTH DEPT. APPROVAL
NO. OF STORIES _ ADMIN. ACTION UTILITIES RELEASED
1
OV CERTIFICATE OF OCCUPANCY FEE g
APROVEU BY DATE CHANGE OF USE OR OCCUPANCY FEE $ lo
TOTAL $�
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75-03eRev.1/97 COMMUNITY GEVELOPflENT
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS 1,52 O.Z 6-014"A J?1 #15- (",04 9-4110*�e9
2.
Person to contact in case of emergency dOCf�✓ cS � Gc" ' %K. D✓a6c%dR
Telephone number: 7ly 936 —3
3.
Does the building in question have electricity?
911y-es
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
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turned on?
❑ No
4.
The building is sprinklered?
Lames
No
5.
Operations will produce dust/wood shavings or similar
material?
O Yes
CYNo
6.
Operations will involve the repair or replacement of
❑ Yes
4
automobile parts?o
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If Yes:
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(a) Describe the components repaired or replaced.
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(b) Does the operation involve the use of an open- flame?
[R-les
No
7:
The business is drinking.. dining or assembly use that will
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result in an occupant load of more than 50 persons.❑
-,Yes
WIN-
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8.
The following best describes my operation; orlc '�"�'
Office OnlyM Y-
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaur Take Out Food
Medical / Dental
Other (describe)
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SUPPLEMENTAL INFORMATION
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SUPPLEMENTAL INFORMATION (Continued)
Does , the -operation ` involve any of the following materials? L7 Yes
CAN o
If Yes, indicate quantities:
Material
Quantity
1. Flammable liquids
Class I -A
Class I-B
Class I-C
2. Combustible liquids
Class II
Class 111-A
3. Combination flammable liquids .-
4. Flammable gases
5. 'Liquefied flammable gases
ti. Flammable fibers - loose
7. Flammable fibers - baled
8.
Flammable solids
9.
Unstable materials
10.
Corrosive Liquids
11.
Oxidizing material - gases
12.'
Oxidizing material -liquids
{
13.
"Oxidizing- material - solids
14.
Organic peroxides
15.
Nitromethane (unstable materials)
16.
" Ammoniurxt;,ni rate
i 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
hereby certify- that `the 'above information is true and correct to
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the best f y knowledge.
Cigna re Date
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: Q C1 i N yeR
Location of Property: A72 0 Z 6 2fi'H AM cS 7
City: Aav 69ofC4 zip Code: 9,Z S y9 --
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Contact Person: aw r CTt: PC Title: «i I;,
Telephone Number: 7 / y" .Z z B $ Fax Number: 7/Y 8 9 J`W-.Z 31 Y
Type of IndustryBusiness: �h2,2¢.0 /fit, l4a�L is ! LA YiZ
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing this checklist, please call (800) 388-2121.
YES
1. Will the facility have a charbroiler?
NO
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 nixing, blending, or processing of
solvents, adhesives, paints or coatings? [ ]
[ ✓)'
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? [ ]
101,
7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be
j operated at the facility? [ ]
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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 an.{y� CFC (Freon) recycling machines operate at the facili ? [ ]
[•�)�
t Applicant: e�UNN cS/�i IBC' Signature;
(Print name clearl _
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Gal?,R�?ci7,�;7'e ,C^V
If you have marked "NO" in all the boxes, an air quality permit is ngot needed at this time,
and this checklist is your written release.
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If you marked "YES" in any of the boxes, you must contact the South Coast Air Quality
Management District (AQNID). Please read the requirements on the back of the checklist.
(800) 388-2121
ADDITIONAL SUPPLEMENTAL INFURMATION