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Home My WebLink About101 Main St - CofO (96)i a l Cf 84A V ((APPLICATION FOR CERTIFICATE OF OCCUPANC( Cl TY OF HUNTiN% TON BEACH DEPARTMENT O� COki MUNITY DEVELOPMENT �� o�j HUNTttdGTpN eFFAH (PRINT OR TYPE ONLY) `--DATE Address _r I 'i °!I District - Business_ Name FA A 0 r'E�J C f Cf �j T1 A 1 t��' Tel 9 1 � 5 36" 0 0 Business Type S PO Krs AGE r. � Occ. Group_ _ SUILOING OWNER pp _ "p�� 8US •(F.SS OWNEPJAAANAG€A Name � i � � � f Name_"f �`r RA) /fi 1 Home C'it'o- ress /Cry ��79id S"�ly F6,"/ Address �l 37 L ylf�e _LUi � � Tel l- i o7City _ i i j , �. _ -Home TeIY2! � / S /s THIS USE WOULD BE DESCRIBED AS: NEWLY CONSTRUCTED BLDG Ll CHANGE OF OWNER � CHANGE OF OCCUPANT EXISTING BUILDING Cl CHANGE Ol' USE ❑ ADDMONAL OCCUPANT indicate former use. if any L) Occupancy Gr. _ Div SQUARE FT. OF BUILDING TO BE OCCUPIED 361M Al ; NOTICE:1. Occupancy of any building is prohibited and a business license will not be issued until the build.ng has been i inspected and a certificate of occupancy is issued. 2. No electrical service will be released for any existing building until thy: 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 tiffs 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 maybe 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 i 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 halt (1`2) inch stroke, and of a contrasting color from the background. These i numbers must be posted on your building in a location that is visible from the street. 0. hfuntinatori Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the Nationat 'moire Protection, Association pamphlet 10 (see reverse side), ' -Y--- �L6C9$ �Av aL'�'4ie4p {Itia�a. ..,�.,..� •;...:,..... .„. ..-,..._., . _ �.. (FOR OFFICE U3E ONLk)4� I ZONING. PAS OCCUPANCY GROUP PLAN CHECK NO _ Nli PARKINc;a SPACES -OCCUPANT LOAD _ _ r FERMIT NO � ___HFALTH DEPT APPROVAL NO OF STORIES ` _ . m _ _. AN ACTION____ UTILITIES RELEASED �- CEl1r1PICATE OF OCCiJ1=ANC FEE $ At'F (slECi 'i° (?ATE CHANGE OF USE OR OCCUPANCY FEE $ TOTAL, $ 75.039 8ev.1197 COf>riMtlfvi'TY a>~vELaPMl~riT $UPPI.EMENTA,L INFORMATION 1. BUSINESS ADDRESS 2, person to contact in case of emergency,:._. Telephone number: _ . 21 1` 3. Does the building in question have electricity? Yes a No (a) If No, are you requesting that the electricity be 0 Yes turned on? ❑ No 4. The building is sprinklered? Yes CI No 5. Operations will produce dust/wood shavings or similar material? El Yes No 6. Operations will involve the repair or replacement of 0 Yes automobile pans? No If Yee; ' (a) Describe the components , repaired or replaced. (b) Does the operation involve the use of an open flame? Yes ✓�� riVO 7. TSe' business is drinking, dining or assembly use that will result in anoccupant load of more than 50 persons. 0 Yes l AEP No {' 8. The following hest describes my operations ti r " Office 0ni`r Retail Sales , Warehouse Manufacturing / Distribution (describe process and end product) Restaurant/Take Out 'Food Medical / Dental Other (describe) SUPPLEMENTAL INFORMATION t SUPPLEMENTAL INFORMATION (Continued) Does the oper Ttion involve any of x i;"� materials? yes Material 1. Flammable liquids Class l-1 Class i-B 2. Combustible liquids Glass Il Glass 111..p Combination flammable liquidF 4. Fiammable gases S. Liquefied flammable rlases Flammable fibers - louse 7,, _ Flammable fibers - baled 8. Flammable solids Unstable materials Corrosive liquids TT— €dt.arig material _ gases 12. Oxidizing €water=al -- liquids 4 i- 0xid1zing n-�ctt rial -;solidi 14. Organic peroxides ts.ttso€ii nitrate f containing more than 600,4 by weight a 8. l l graly toxic mate. jal and Poisonous gas Smokeless powder 0. Black sporting powder y a' hereby certify that the above information is true and correct to F the best of my knowledge. Signature Cate Q South Coast ,j Air Quality Management [district j 21865 E. Copley Drive, Diamond Bar. CA 91765-4182 (909) 396-3529 ® hap://wffw.agmd.gov ; Air Quality Permit Checklist California State Law Code 65850.2 prohibits cities from issuing an occupancy permit to a business without clearance from the local air quality agency. This checklist will determine if you need- to obtain clearance from the South Coast Air Quality Management District (AQ1NM). { Company Name: 1 � h C-, G / Cyfil . 1"J C _ Li ! ' t C-I Property Address: % 'l �41(� �J T%� " r L) i-7-e ,_-3 «�7 City: , C _ Zip Code: Contact Person: o} J� C 0t Title: C to 0771 N�' Type of Business: S Pa � G q�A; y Telephone: 7/� 5 3C:, Applicant (print name) JKQ LA)� Signature: u IVill the facility have any of the following equipment? Yes[ Charbroiler Ivry cleaning maclune Spray booth z Printing press (screen/litLographic/flexpgraphic) Internal combustion engine (greater than 50 IiP (excluding motor vehicles) Boiler/combustion equipment (greater than 2 million BTU/hr. maximum input) Abrasive blasting cabinet/room Baghouse/cartridge-type dust filter/scrubber Motor fuel storage and dispensing equipment Will any of the following operations be periormed? Yes[ ] No [ .Application cfpaints or adhesives EWhing, plating, casting, or melting of metals / Molding, extruding, or curing of plastics Mixing and blending of liquids and/or powders Storage of acids, solvents, organic liquids, or fuels F Production of fumes, dust, smoke, or strong odors If you answered "No" to both questions, this checklist is your clearance from AQT'VlD. If you answered "Yes" to either question, you must contact AQMD to determine if air quality permits are required- If permits are needed, AQMD will assist you in submitting permit application(s) and then provide you with a clearance letter. You can call AQMD at their Small Business Assistance Office at (800) 388-2121. f . E Ravised Februazy'1999 i t r F r t ton APPUCATION FOR CERTIFICATE OCCUPANCY CiTY OF HUNTINGTON BEACH DEPARTMENT OF BUILDING & SAFETY ;` iSUTIr�1G irs $ACtt. iPR!1'4 Ur2 tyi`r. ONLY! � DATE Address rVgt , �c� �i1. �� District Business Name (0LOG tit TAX 1 +�.v°i�S�O 2 � J � - Tel Business Type a'_XV% 1: kARP 1N Ccl`r t " . t,,,tA-' Occ Group ._.__r..__ BUILDING OWNER SUSMESS OWNER.�ttihANAGER - Name. Ir Gent A Name— Horne@xQ't iLott-3 Address- �1t�cri:fi S� , �,� Address c+=k Ala'" 0- %# City.. &0- Ac�k Tel Cily r��` ` t�J�- Home Tet. S ( � -k SOO THIS USE 1iMC4ULD 6E DESCRIBED AS;. �k Ito ��Q� ` �,� y-y � MEWL � . CONSTRUCTED BLDG. �-� CHANGE OF OWNER L._f CHANGE OF CCCUPANT EXISTING BUILDING M CHANGE OF USE Q ADDITIONAL OCCUPANT ind;cate former use., if any Occupancy 4 r —.—Div. SQUARE FT. OF BUILDING TO BE OCCU;�kED_�� FTICM 1, Occupancy of any building is prohibiteia and a business license will not l)e issued until the building has been ` inspected and a certificate of occupancy is issued. n 2. No electricat service Will be released for any existing budding until tl�e senric-a has been inspected and s certified safe. All applicants for occupancy in an existing building are required to schedule an electrical `fuse up" inspection in th, Department of Community Development at the time this application is filed, 3. Change of occupancy or use inspection fee. Whenever it is necessary to rnrike inspection of a building or premises in order to determine if achange may be made in the characterof 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 orange of occupancy inspection fee of $ _ _ - shalt S. be paid to the city. 4, Huntington Beach Fire Code Section 10.208 requires that building numbers must bc, a minimum of- four (4) inches in height witl, one half (trz) inch stroke, and of a contrasting color from the background. These numbers muse be posted on your building in a location that is visible from the street. a. Nuntington Peach Fire Coda Section 10,301 requires fire extinguisher selection and distributlop per he National -ire Protection Associatioo pamphlet 10 (see reverse side). ` RAl- r,,1"e,ra , P w`« ^c " 4111 °. •' �.� ��-r (FOR OFFICE USE aNV) t 3t;C!,PANCY GROUP -- PLAN CHECK NJs NO P.MKING SPACES 0('CUPANT LOAD PEWIT NO HEALTH DEPT AP;'ROVAI. NO, OF STORIES ADMIN. ACTION UTILITIES RELEASED CERTIFICATE Or OCCUPANCY FEE g APPSOVED BY DATE CHANGE OF USE 0.3 OCCUPANCY FEE $ �� s TOTAL g f ORM 791C;3 REST V02 RE -ORDER SA1,4DUbkWA-14-242-'.i48 .. e, � ~� • ,