HomeMy WebLinkAbout101 Main St - CofO (38)t
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CAPPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNIW6TON WACO (PRINT OR TYPE ONLY) DATE i
1;.
101 MATa Sr. So Irk $Z , V„arj,�L,roA 9 :..g CA 9a(PLIS
/Address � r-� AA-- t Distract L;
AA`�teA,> Urr,,,.s t iN:�r;C1y14 'AbViso"- tNG. Tel 53t� � 3io(o�
Business Name f
Business Type F;,y JC1&- Si-RuIGs'S Oce.Group
BUILDING OWNER BUSINESS OWNERIMANAGER I"
/dame /�31%�t �1yr t eyty�ZLpPM4,5i' CO. -NameHome
r \K£ /A �'�r��LIMU Yl cr
dresst
hln�,J S7 %Address 1%0(00 �AKOrA Jr-
/ CjtY �tuaTrJ3G�zZ R4Ac >1.: CA, Tel 3(�-ft56 , OUNT ILtL£Y �A Home Tel%3'399C
/city r>�a U t'
THIS USE WOULD BE DESCRIBED AS: j
i
NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
` V
` ❑ EXISTING BUILDING �\ Lam,❑ CHANGE OF USE ❑ ADDITIONAL OCCUF; VT �,`
Indicate former use, if any 'y ew CdLA f� _Occupancy Gr. Div i
SQUARE FT. OF BUILDING TO BE OCCUPIED 2Z19(a
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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 1
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
F premises in order to determine if a change may be made in the character of occupancy or use of the building
l or premises which would place the building in a different division of the same group of occupancy or in a
I +� different group of occupancy, a change of occupancy inspection fee of $ shall' 1
be paid to the city. I'
4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum of four (4) C;
f inches in height with one half (1/2) inch stroke, and of a contrasting co;or 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
g 9 3National Fire Protection Association pamphlet 10 (see reverse side).
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION ZONING �f� L �• '�
i
OCCUPANCY GROUP, PLAN CHECK NO. NO PARKING SPACES 4„ j
OCCUPANT LOAD y PERMIT NO. HEALTH DEPT APPROVAL_ l
NO. OF STORIES ADMIN. ACTION �P-j:f-q Uq �IIITILITIES RELEASED
r; lllf......,���"�tt,
M` Y - 3�'S CERTIFICATE OF OCCUPANCY FEE $
5Q+1
-�
APP D BY DATE CHANGE OF USE OR OCCUPANCY FEE S-
TOTAL $ '
75.039 Rev. 71/90 COMMUNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS 101 AM,) Z WanA'raJ 4ktui CA
42Gyj�
2.
Person to contact in ease of emergency* Mky-le-
Telephone number: Olt 53C- %j-3990
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3.
Does the building in question have electricity?
G-les
I
No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
9 Yes
G
10
❑ No
5.
Operations will produce dust/wood shavings or similar
material?
❑ Yes
C-'No
r b.
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
Ca' o
t
If Yes,
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flume?
❑ Yes
s
I
E No
7.
The business is drinking, dining or assembly use that will
1
result in an occupani load of more than 50 persons.
❑ Yes
C o
-
8.
The fo!low*!nQ best describes my operation;
'lice -
r
Retail Sales
Warehoui3e
Manufacturing / Distribution (describe process and end product)
f
C
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Restaurant/Take Out -Food
Medical / Dental
Other (describe)
T
SUPPLIMENTAL- I'NPORMATION
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{
SUPP.EMEFNTAL INFORMATION (Continued)
Does the operation involve any of the following � materials? 13 Yes
Ca �N o
1f
Yes,^ indicate —quantities:
1
Material,Quantity
1.
flammable liquids
Class I -A
C
Class I-B
I.
Class I-C
2.
Combustible liquids
Class 11
Class 111-A T
4
3.
Combination flammable- liquids
4.
Flammable gases
5.
Liqueit i flammable gases
6.
Flammable fibers - loose
7.
Fiammable fibers - baled
1
8.
Flamm-ble solids
9.
Unstable materials
10.
Corrosive liquids
11.
Oxidizing material - gases
°
12.
- Oxidizing material--- liquids
4
13.
Oxidizing material - solids
I
14.
Organic peroxides
15.
Nitromethane (unstable materials) -- �-
16.
Ammonium nitrate
17.
Ammonium nitrate compound mixtures _
containing more than 60% nitrate
by weight,
4'
18,
Highly toxic material and
poisonous gas
19.
Smokeless powder
20.
Black sporting powder
1 hereby ,ertify that the above information is true and t arrect to
the best of my knowledge:
✓� !- 23 - gam"
S;)nature Date
y
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1.
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P Government Code Section 65850.2(b) requires that the City of Huntington Beach not issue the final
certificate of occupancy unless the applicant has met or is meeting the requirements of the South
Coast Air Q,aality Management District (AQMD). The Department of Community 'welopment must
obtain a written release from AQMD to show the applicant has complied with this law. The check
list on the roverse side is designed to help the applicant and the building division to meet these
r requirements. r
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1. The applicant (the same person who applies for permits from the
Department of Community Development) must complete the check list
which can be obtained either from the Department of Community
j Development or at AQMD.
2. If all boxes in the list are checked "no", the Building Division can accept the i
check list as the release. l
3. If there are any "yes" answers in the list, the applicant must contact an
i. AQMD engineer by calling (714) 356-2000 to find out whether air permits are,
required for the proposed construction project. I 1
j 4. If air permits are not required, the applicant will obtain a written release frog;
AQMD.
5. If air permits are required, the applicant must submit the necessary permit S
applications before the release can be issued. }
Because of the ,me it may take for AQMD to go through the above procedures, the applicant is
I. )
advised to contact AQMD immediately after applying for building permits.
I
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(1360D).
ADDITIONAL SUPPLIMENTAL INFORMATION
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.,J ,,.,7 `. 9��L' b� � �.1. eJ �{' 4 ., i-.JL'r,� ,. .. .11.,...✓r."J c..
lJZ�,r7,+�I�r0 ._
H�\K� Rl�LN•rt.ii i
of piervi.~n pn, pai,l ,ng this 1cim m p.,,ini and
� l•1P.rrtir.._ _!�U!�"` _�..._��.4J�iC �>gnatu,;.
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The. pers-in pr�y'p&a it:z1 this rorkn m--st by the same person applying for building permits. Please answer the
,� .�,�. tr4>'it'� ! r�kkx+� 5iuu �,n' � „.„i�ti �,. ;.ke� .. r� � lkl ek .; a7iWt.o ��irtalt�,�.y', if Y4./L.i P.dV NOT KNOW
.
i ANSWER 70 A QUESTION, MARK IN THE "YES" CQ'.LINWN:
AWD PERMITTING CHECKLIST
YES N0
1. U _._-,S ycur facility use any internal combustion engines greater than 50HP?--
2. Dcew yoour facAit;{ iri= li ve nixing, blending, or processing any solvents,
j achesiveg, paints or coatings?
r 3. Does ,{our facility create any dusts or smoke?
4. Occo J'ou :fac;ii,} of ne any liquids or solids or reclaim any meials"
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5. Does your facility plate or coat anything?
6. Does your facility ha,'e, any combustion aqulpment (i.e. boiler, furnaces;
i
broiler- baring ovens, ate.) rating greater than 2,000.000 f5TUIHR?
i
?, faces your facility handle or store solvents or motor fuc l?
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8. Do you use or store any acids? X
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9. Do you use any chemical, process'?
10. Do you ues arty solvents for clean-up'
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11. Are ys)u a o ciec'ier, restaurant with a charbroiler, body shop, gasoline
station, prints. , or par« coater?
12. Is the subleC t bt0lding, locatod within one thousand (1,000) fe+ct of any
school' PROPERTY gY LINE TO PROPERTY LIME. GRADES K-12. - — --- A
If you h ive rnr t 1 e NO" in all columns, you do not nc; .d an :"'Air Gera ity ppr pit et this brrie. it%;you have marked
' t°5ttt�na kp ta:'"x �-`}" CG.a,;rrsr: jfC3' must contact the South fi' a fir a ty i ;�aC rCB rd'i Oistract IC3C8teCi at:
k
2,1865 E. Copley Drive
Diamond Bar, CA 91765.4182
1= iease ce,H: Plan Chack (909) 396-2000
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- - AL _ . _ . . _ ..Oa _
MANDATORY REPLY REi1U1R£D PRIOR TO ISSUANCE OF BUSINESS LICENSE
Complete and return this form to the Business Licensing Division
HUNTINGTON BEACH FIRE DEPARTMENT
HAZARDOUS MATERIALS DISCLOSURE
INFORMATION SHEET
PLEASE PRINT
RD
Business Address: I W W A"i ' S7 S(n- R-L Htg. Bch. Q2 W8
Number Street Unit Zia Code
Business Name: />m utr-AA �YLPK4S5 r�� tiaG� k /AVmSa25 1AC, Phone: (71y) 536- 3(ab14
Owner/Manager: ,NORM Q-eAo�k Title: '3k,)tot:VIC-L Nts'h4Ji
Date of Occupations If rental, nu,.ober of units:
Description of business operation:5 S
A Hazardous Materials Disclosure Form must be completed and returned to the Fire
Department if any of the following are used, handled or stored in your business:
1. Any amount of chemical carcinogen.
2. Any amount of radioactive material.
3. Hazardous materials or hazardous waste in amounts equal to or greater than 55
GALLONS (if liquid) or 500 POUNDS (if sotid) PER YEAR or 200 CUBIC FEET of
gas ON SITE AT ANY ONE TIME. Hazardous materials are defined in Municipal
Code Chapter 17.58 and include materials for which the manufacturer or producer
is required to prepare a Material Safety Data Sheet (MSDS). Hazardous waste is
defined by Sections 25115 and 25117 of the California Health and Safety Code.
Disclosure is not required for the following:
1. Hazardous substances contained in food, drug, cosmetic or tobacco products.
2. Upon approvalof the Fire Chief, 'hazardous materials contained solely in
consumer products packaged for use by and distributed to the general public
However, Restickes, herbicides and ammonium nitrate fertilizers over the
required disc'_tisure amounts are not exempt from disclosure.
3. The transportation of hazardous materials accompanied by shipping papers
prepared in accordance with the provisions of 49 Code of Federal Regulations.
k. InfectIous waste generated by health care facilities that are regulated under Title
22 of the California Administrative Code.
CHECK ONE OF THE FOLLOWING:
No chemicals are used, hand; ed or stored at this business.
Chemicals are used, 'handled or stored at this business, but do not meet the,
-equirements for disclosure.
chemicals are used, handled or stored at this. business. (Disclosure required;
forms will be sent to you.)
Amounts will be verified during annual inspections. it is unlawful for any person to
knowingly violate any provision of this ordinance.
I certify, under t e penalty of perjury, that the above information is true and correct to
the best of my owledge.
Signaterei-F 4-- � Home Phone:Oq )QG2-Y3s"9 Date: /-;Z3 9�
l
Questi ns regarding the Hazardous Materials Program, please call 71.4-536-5676.
070317/14 (1/92)