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COMMUNITY DEVELOPMENT'
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APPLICATION FOR CERTIFICATE OF OCCUPANCY 'v
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
HWIMNGTON BEACH AI
(PRINT OR TYPE ONLY) R
FEB 21 1991
Licensc- 0!,,pt,
Address Districc—
Business Name- Te7i-&- 37VO) 6-o
Business Type Occ. Group
BUILDING OWNER BUS jNESS OWNERIMANAGEP
Name Name —
Home
Address -2 Address
0 od 2
City
THIS USE WOULD BE DESCRIBED AS:
1:1 NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER CHANGE OF OCCUPANT
2/EXISTING BUILDING ❑CHANGE OF USE El ADDITIONAL OCCUPANT
Indicate former use, if any WML 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.
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 -iade 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 (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).
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION r ZONING
-2
OCCUPANCY GROUP ---- civ— PLAN CHECK NO, NO. PARKING SPACES
OCCUPANT LOAD FERMIT NO HEALTH DEPT APPROVAL
NO. OF STORIES ADMIN. ACTION UTILITIES RELEASED
4/Ql/CERTIFICATE OF OCCUPANCY FEE $
A F�OED DATE CHANGE OF USE OR OCCUPANCY FEE TOTAL
4X//
75-039 Rev. 11/90
COMMUNITY DEVELOPMENT C7
J
cu�
SUPPLEMENTAL INFORMATION
1, BUSINESS ADDRESS 31
2. " Person to contact in case of emergency.
Teephone number:
3. Does the building in question have electricity? 9/yes
No
(a) If No, are you requesting that the electricity be Yes
turned one 1, No
4. The building is sprinklered? �s
o
5. Operations will produce dust/wood shavings or similar
material? ❑ Yes
21N o
6. Operations will involve the repair or replacement of ❑ Yes
automobile parts'? 21 No
If Yes:
(a) Describe the components repaired or replaced. I
(b) Does the operation involve the use of an open flame? ❑ Yet.
a 11�0
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Yes
Q-No
8. The following best describes my operation;
Office Only
Retail Sales"V''--
WVarehouse
Manufacturing / Distribution (describe process and end product)
e
i Restaurant/Take Out Food
Medical / Dental
Other (describe)
( SUPPLIMENTAL IWORMAT"Iom _
'- a �
'I
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the foiiowina materials?
If Yes, indicate quantities
Material Quantity___
1,, Flammable liquids
Class I -A
p
Yes.
No
Class I-B
Class I-C
2.
Combustible liquids
Class 11
Class III -A
3.
Combination flammable liquids
4.
Flammable gases
5.
Liquefied flammable gases
6.
Flammable fibers - loose
7.
Flammable fibers - baled
3.
Flammable solids
g.
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.
Ammonium nitrate
17.
_ Ammonium nitrate compound mixtures
containing more than 60% nitrate
I
by weight
18.
Highly toxic material and
1
poisonous gas
19.
Smokeless powder
20.
Black sporting powder
h by certify that the above information
th b .st of knowledge
is true and correct to
t�
Signature
Date
7.7
Y
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subject Property:
Property Owner name: Phone
Name of the Person Preparing this form in prin nd si nature
Name �{ �v�✓ Signature
The person preparing this form must be thcs- s me person applying for
building permits. Please answer the following questions regarding your
proposed occupancy of the subject building. IF YOU DO NOT KNOW THE ANSWER
TO A QUESTION MARK IN THE "YES" COLUMN:
SCAQMD PERMITTING CHECKLIST
YES NO
1. Does your facility use any internal combustion
engines greater than 50-HP?
2. Does your facility involve mixing, blending, or C�
processing any solvents, adhesives, paints
or coatings?
3 Does your facility create any dusts or smoke?
4 Does your facility, refine any liquids or solids?
Reclaim any metals:
5. Does your facility plate or coat anything?
6. Does your facility have any combustion equipment �—
i.e. boiler, .furnaces, broiler, baking ovens, etc.)
rated greater than 2,000,000 BTU/HR?'
7 Does your facility handle or store solvents or motor
fuel?
8. Do you use or store any acids?
9. Do you use any chemical process?
10� Do you use any solvents for clean-up?
11. Are you a dry cleaner, restaurant with a charbroilQ'r,
bo y shop, gasoline station, printer, or part coater?
x 12 Is the subject building located within one thousand
(1,000) feet of any school.?
d PROPERTY LINE TO PROPERTY LINE. GRADES K-12;
If you have marked "NO" in all columns, you do not need an Air Quality
permit at this time. If you have marked any questions in the "YES" Column
you must contact the South Coast Air Quality Management District located
} at:
9150 FLAIR DRIVE, EL MONTE, CA 91731
+ Please call these offices: Plan Check (818) 572-6406
(818) 572-6111, (818) 572-6261
}
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