HomeMy WebLinkAbout126 Main St - CofO (32)dj APPLICATION FOR CERTIFICATE OF OCCUPANCY'
f-HUNTINGTON BEACH ® DEPARTMENT CITYOF COMMUNITY DEVELOPMENT
MNTI GTON MACH (PRINT OR TYPE ONLY) DATE -
Address 12 6 Math 3 7-t U f r. f2 42 6 �R District
Business Name YSYGry�C /3614 U�- _ - -- - Tel. -/y-gt/6-r-169Z _
Business Type $ ���ihS� �CYJiCS �4y,4 /�S .Zvr s" ce Occ. Group `
tA phav,wgd BUILDING OWNER ZP_IxdSh / BUSINESS OWNER/MANAGER
Name _?iiaas—IrJc�e� Name �Y�t/ S��✓ey S
Address CZ�42n N1 4 5tt . I PS 2/P; 2 gjAddress
City- Tel.W City Sub Sf��eC Home Tel.7J�/'g��`
$Z6-v 8SS'
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THIS USE WOULD BE DESCRIBED AS:
i
NEWLY CONSTRUCTED BLDG. LVJ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
ED EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
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Indicate former use, if any Occupancy Gr.—Div.
SQUARE FT. OF BUILDING TO BE OCCUPIE
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 i
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
be paid to the city.
4. Huntington Beach Fire Coda Section 10.208 requires that building numbers must be a minimum offour (4)
I 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 I, -_afion 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).
V.
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TRA IMPACT FEE
DATE PAI
AMOUNT REC -- —
NAME (FOR OFFICE USE ONLY) 22
�y ZONIN(Grt - J-G�
OCCUPANCY GROUP PLAN CHECK NO NO PARKING SPACES
OCCUPANT LOAD PERMIT NO HEALTH DEPT APPROVAL
NO. OF TORTES- ADMIN. ACTION UTILITIES RELEASED
Aj/j g -6k/ZRTIFicATE OF OCCUPANCY FEE $ -A CAL
TPIR6VEq_.BY DATE CHANGE OF USE OR OCCUPANCY FEE
TOTAL g _�
Fb
75-039 Rev.1/97 COMMUNITY DEVELOPMENT-
-
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS U4 Ma11,) S T� /b3
2.
Person to contact in case of emergency' A��t� S�cdch S
Telephone. number: G3
a.
Does the building in question have electricity?
19 Yes
No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
11 No
f
4.
The building is sprinklered?
❑ Yes r
&/No
5.
Operations will produce dust / wood shavings or similar
material?
❑ Yes
C9"'No
6.
Operations will involve the repair or replacement of
❑ Yes r'
l
automobile parts?
"0 i
If Yes:
(a) Describe the components repaired or replaced.
z
1+
F
Yes
E"h
(b) Does the operation involve the use of an open flame?
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
o
r 8.
The following best describes my operation;
Ofp Only
etai�—Sa
lr�a
Manufacturing / Distribution (describe process and end product)
x
C
Restaurant/Take Out Food
Medical / Gental
Other (describe)
SUPPLEMENTAL INFORMATION
J
SUPPLEMENTAL . INFORMATION (Continued)
j floes the operation, involve any of the following materials'? ❑ Yes
No
If Yes, indicate quantities:
Material Quantity
1. Flammable liquids
Clas3 I• A
Class I-B
Class I_C
2.
Combustible liquids
Class II
Class FLI-A
3.
Combination flammable :liquids_
4.
Flammable gases
S.
Liquefied flammable gases
6.
Flammable fibers - loose
--
7.
Flammable fibers - baled
8.
Flammable solids
9.
Unstable materials
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10.
j
Corrosive liquids
11.
Oxidizing material - gases
J
12.
Oxidizing material - liquids
13..
Oxidizing _material - solids
14.
Organic peroxides
15.
Nitromethane (unstable materials)
16.
Ammonium nitrate
17.
Ammonium nitrate compound :mixtures
containing more than 60% nitrate
by weight
18.
Highly toxic material and
poisonous gas
19.
Smokeless powder
i
20.
Black sporting powder
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I hereby certify that � e above information
the be of y kno
is true and correct to
r
edge.
Sign tore
Date