HomeMy WebLinkAbout101 Main St - CofO (24)APPLICATION FOR CERTIFICATE OF OCCUPANCY
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WTY OF HUNTINGTON BEACH
4310
Jnnrrr.rzaN KAOH DEPARTMENT OF COMMUNITY DEVELOPMENT
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(PRINT OR TYPE ONLY)
15ATE
Address -lot M M SIT-
L�- 6 q7-6T O
Business Namey �STA C� It[ TO
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District C/
Tel jt7���Z
Business Type l A3 U ST MfrN�
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Occ. Group
BUILDING OWNER
BUSINESyS/OJW-N'ER//MANAGER
Name 4JTI
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Name
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Address 1 0 1 MAW S T"
Home
VIA
Address y ��IA je28�j
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City C�;�tV )CTCV 1G/,4- WIS
Tel. City ��i�i�
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THIS USE WOULD BE DESCRIBED AS:
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❑ NEWLY CONSTRUCTED BLCr
❑ CHANGE OF OWNER
❑CHANGE OF OCCUPANT
KEXISTING BUILDING
❑ OF USE
ADDITIONAL OCCUPANT
Indicate former use, if any:^i11I�"-
`CHANGE
Occupancy Gr.
Div.
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SQUARE FT. OF BUILDING TO BE OCCUPIED��
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SUPPLEMENTAL INFOAIIA'ATIONc
4.
BUSINESS ADDRESS 10 ( MAi,� :s-T— q, Z6gg
2.
Person to contact in `case of emergency -
Telephone nu,nber:
3.
Does thebuilding in
g question have electricity . Y �s
A
No
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(a) If No; are you requesting that the electricity be G Yes
turned one No
,
4.
The building is sprinklered? des
s
G.No
5.
Operations will r
p produce dust) wood sh,.vmgs, or, similar
material?
1
5.
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Operations will involve the repa^r or replacement of Q "Yes
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4_
automobile parts? GLtQo
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f Yes
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(a) D,
escriLe thecomponents repaired or replaced.
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(b) Does the operation involve the use of anopen ^flame? ❑Yes';
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7.
The business is drinking, dining or assembly use that . will
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result in ar, occupant load of. more than 50 persons. L7 Yes "
8.
'escribes my :operation;
The fo�aiess'
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R
1
Warehouses
Manufacturing / Distribution (describe process and end product)
M
Restaurant "fake Out Food ;
1
Medical / Dental
Other (describe) ,
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SUPPLEMENTAL INFORMATION
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SUPPLEMENTAL - !t o-Rl111ATION't (Continued)
Does `_h operation 'involve any -of . the. "kf'dllowing materials'?" [TY- esZkIKI
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I# Yes,. indicate` uantit�es " -'
. Material _ Quantity
1. Flammable liquids
t
.Class I -A ..
Class I-B' I
Class I-C
2. ' C6mbustible liquids
.� Class II
.-Class III -A
3. Combination flamt}lable liquids
4.. :Flammable gases
5. � L'lquefied flammable gases
,.
Flammable fibers loose
7. -Flammable fibers - baled
8. Flammable solids (.
9. Unstable 'materials., t
10. Corrosive liquids
U F
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1`f - Oxidizing material - gases -
1-2. ., ... Oxidizing material -- liquids .
13 , Oxtdizing�. ,material - solids
a
14. a -"'`"Organic peroxides C
a
15. Nitrometh he (unstable materials)
w :..
16 _ _,,,,Y,.Ammonium nitrate
17. Ammonium' nitrate compound . mixture,
containing„ more than 60% nitrate
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by weight
18. Highly toxic material and r
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poisonous gas.
1.9. Smokeless. powder
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20. Black sporting powder
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hereby _certify that , the above• , information is true anc correct to
the best my knowledge,
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Signature at
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