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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY CF flufl I INCTt?N BEACH
DEPARTMENT OF COMMUNITY
iDEVELCiPPA�IVT 7/6 ��I� _
MNTW+clov 8EAr3t DATE
(PRINT OR TYPE ONLY)
i
Address ' 1" i \ 1.._..,._%2L1 �� District
12
Business Name 1�SyG ! G 5 . 4e > _ _. _ Tel ! i 3i �-
Buslness;Typeuc&/-�c���r c, c>r C �� v c� /Z e__ c; cis Occ Group
Ct".L llte i L S AS c'+-1 t �� C'c{r > CIcA� llrr-rs ,
A SUILMNQ QWMER BUSINESS OWNEIPUMANAGER
» C"
Name.,
ii �ih S? =` " Address _ 2___ �"1!1Li___ %..T �!1lef� lls
Address ^>
miry rJ �Z. __.� Tet7 Y tf� S City L�r 1..2-..-___-----Home Tel 3 7/ - rt
THIS USE WOULD BE DESCRIBED AS: ��-
El NEWLY CONSTRUCTED BLDG. El CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
EXISTING BUILDING CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any t__ _Div
SQUARE FT. OF BUILDING TO BE OCCUPIED_:.2:a emu. F7 Mc� pF�cMae e",cGihs�
NOTICE: 1. Occupancy of any building is prohibited and a business ficease will not be issued until the building has been
inspected and a certificate of occupancy is issued.
2. No electrical s?rvice will be released for any existing building unlit 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 in a
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)
inches in height with one half (!,,2) inch stroke, and of a contrasting .color from the backgrcund. These
numbers must be posted an your building in a location that is visible trom 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).
C'jf�fy:s.�.•i�.'.�,
a
, fir:,
_LIrr'r
(FOR OFFICE USE ONLY)
OCCUPANCY GROUP-
_ _- ...
P, No _- _._
ERMIT NO
Pd ? PARKr37f;`5PACES �—
tax AI xH DEPTkPPRO'aAL.
f3
OCCUPANT LOA�.-
_ _� _..
__ _
-
NO Or' STORIES
rt'ATE. CF OCCUPANCI F-EF
x -. �.•? �
j OVED BY � DATE
CHA OF O ��� iJ*AIUt,t FIE
tt�
$��-'—
TOTAL
Ia s,r
76,039 Rev.1/97
;.t ''i N1 Y` �'' t'
SUPPLEMENTAL INFORMATION
t 1.
BUSINESS ADDRESS L l 6' Z 11 S
(,j i'
%r
2.
Persian to contact in case of emergency,
Telephone number:
3.
Does the building in question have electricity?
eyes
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
E es
171 No
5.
Operations will produce dust/wood shavings or similar
material?
❑� �Y s
No
6.
_
Operations will involve the repair or replacement of
❑ Yes
automobile parts''
"o
If Yes:
(a) Describe the comp�jnents repaired or replaced.
(b) Does the oper;ltio n 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.
8,
The following best describes my operation;
0
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
{
Restaurant/Take Out Food
Dental
fOther
ncalf
describe) rr4rs�ys tG ct. �"Sre
t�-�7-�zt�
Doe, Vie operatioa }i v `=.Y an-y of -,T e foliov inq yelo-
No
!Material Cuan t s
.»....�..,.,.,..«,....,,. �.......,...-,... _. _.a«.....-.. ...,tea.,„.... _ s.. ...... « ., ..- .,.: _, .... . ,....«... ,«.,.,..,.... _. .. .
i. Flarnmable liquids
Class 1.
Class 191
Mass
2, Combustible liquids
Class I
. Combination fiari"ima le liquids
�. Flammable ga e=s
............ 5. Liquefied flammable asc-:s
T. l`lammai i filers tl I t
7. Flammable fibers - baled
`l0. rr•€�si�e� li�r.iid�
,
i�riaten l ., gases
12, Oxidizing material
��. Oxidizing material - solids ._......_. �...,_,._... _ .,_ .r_. .... ,..�.,�...._._ .,._ ....._ n . �.. ,. Y ..
..__
14. Organic peroxides
T5. ' Nifrometharie (unst'ab3E MV0Fi,-,!Sj
16. Ammoriurn nitrate
l a°it3iili€dii!itrst:? civkr miyWres
containing more than 60r-,,,,b mt�WL:-,
by weight
18. Highly toxic materizi and
Poisonous alas
19. Smokeless powder
20, Stacy sorting pg.wdea
l 6 i r erti that err ve info F~ation €s E� e and cori cct. to
the lest of my knowledge.
�a
t Signature Date
x
•
.SIR QUALIP( MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PERMIT CRECIMST
for nonresidential buildings only
Company Name12
:
Location of Property: / 2 �l;IG1✓� �'T C%G, r Or`i
P _,,
Ciy; l Zip Code:
Contact Person: Sou-e:. Title: b -41 c
Telephone Number: 7- Fax Number:
Type of Industry/Business:
To apply for a nonresidential building permit, you must complete this checklist. If you have
P
questions about completing this checklist, please call (800) 388-2I21.
YES NO
I . Will the facility have a charbroiler? E
) I L
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? (�
44. Will dust or smoke be generated at the facility?
�'�J
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? [l�'
7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be
operated at the facility?
, r. _•,...,
8. Will any acids, solvents, or motor fuel be used or stored at the lac Uit� c L
s L 1
9. Will any, organic liquids or gases be reacted or produced? [
a 1 4
1.0. Will any ovens be used to dry or cure products at the facility? [
2
11. Will any CFC (Freon) recycling machines operate at the faci
1
Applicant: t S le-' ut. n � Signature. _
.>
(Print name cleuly)
If you have marked "NO"` in all the boxes, an air quality permit is n(t needed at this time,
and this checklist is your written release.
If you marked "YES" in any of the boxes, you muss contact the South Coast Air Quality
Management District .4,Q ). please read the requirement'S on the back of the checklist.
(800) 3 8-212
., x .. €it3.se �:tl7�f�5i_. Lj���"i C-��'�. C:4Y �`Y� I;N?`�riAk*d'F� tea r•f,1
G011,ERMNIENT CODE SECTION 65850.2.(AB3205)
Cllifomia stat,a Cede 655101 a-,c
issuing a tinal foea-', airqniiiy agency ;zc
met. 1111 appicalit's are M&A M CAMM W
dedgned to aid fka-)7
Vic pasUons is "YER" the ThAng, 19panown! nov; Mah; z, xwon ralcom hown tic local air
ap"',
1 All
2, 1fhe am�v,--,,Y to qU q=akv 'I'la KANS; Wponvan Coll am,14 Aw 0:051
as thc lvfitten reiea,;Q,
3. If arty cWowow art munvad "MY k jv"xw 7w: eon= row AQ%O) b; moog
r-ly lie az the sm. if A,! AQ1111 omernvm,,�-." nla,ais qva'-dty
tr-t,;:,d Or a-, i two bun nwo a re'iC44t� vvii, b,,z
-iw -��en 4It au qu-Aity are %, h 110-t 1 4Ubv-uditxkl, tile applica-az
must Submit the mad approprime 1%; writt-m-,
release WH lie KUM
comivniae3 to A Walance Wer T�,qaesz.;;, Hiowcvt:r, i'4 pa -'ay tzd.v szevosue;
-Azeks to veri',,r ize)inpli=;� l,�ail Thowi1m 3vu mc M3 r.°,2 to coatu,,? AQ,',!D
irmim,i-ediately after applyiv-_g iOr t�wldnng perri-o1s.