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Home My WebLink About101 Main St - CofO (12)J,W APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH DEPARTME14T OF COMMUNITY DEVELOPMENT HUNTINGTON BEACH (PRINT OR TYPE ONLY) ATE t /Address D >< m i n 5"f 54c.� �f f L7 Distract ✓B/u�iness Name �dg T �-- TeL /Business Type �'CeSfi tab �^ ` �' Occ. Group _B}�UILDING OWNER // BUSINESS OWNERIMANAGER mei ✓Nae -A 1-��Ly OiWrw 4CrlySC��T 7�d�ress Z-1 tF �� r S i c i�Orr c) Address / TO City�2ds�1s"I �� Home Tel.2j?—g1y HIS USE WOULD BE DESCRIBED AS: NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT Indicate former use, if any Occupancy Gr Div SQUARE FT. OF BUILDING TO BE OCCUPIED 2.B -3 Q 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 p emises in order to determine if a change may be made in the characterof occupancy or use of the building G 2 or premises which would place the building in a different division of the same group of occupancy or in a I(�,7✓ different group of occupancy, a change of occupancy inspection fee of $ r shall d 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. �f 5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the t� National Fire Protection Association pamphl t 10 (see reverse side). j�j G� ! V— ' 6%/� 1-1 - t, i (FOR OFFICE USE ONLY) SUPPLEMENTAL INFORMATION ZONING`S OCCUPANCY GROUP PLAN CHECK NIQ. iG NO PARKING SPACES � OCCUPANT LOAD PERMIT NO HEALTH DEPT APPROVAL NO OF ST RIES ADMIN ACTION( UTILITIES RELEASED CERTIFICATE OF OCCUPANCY FEE $ $ �� AP VED DATE CHANGE OF USE OR OCCUPANCY FEE EE� TOTAL 7 SUPPLEMENTAL INFORMATION 1. BUSINESS ADDRESS 2. Person to contact in case of emergencyy��+�� Sir Telephone number: 7/p0- 1274 i7- r'r 3. Does the building in question have electricity? Yes l� No (a) If No, are you requesting that the electricity be Yes ❑ turned on? No 4. The building is sprinklered? I YNo Yes ❑ 5. Operations will produce dust/wood shavings or similar Yes material? material? No o. Operations will involve the repair or replacement of ❑Yes No automobile parts? ,® If Yes: (a) Describe the components repaired or replaced. (b) Does the operation involve the use of an open flame? ❑ Nos 7. The business is drinking, dining or assembly use that will Yes result in an occupant load of more than 50 persons. ❑ No 8. The following best describes my operation; Office Only etail Warehouse Manufacturing / Distribution (describe process and end product) <Aestaurant�/ Ta nut Medical / Dental Other (describe) r SUPPLEMENTAL II'4r'ORMATION (Continued) Does the operation involve any of the foilcv:ing 13 Yes G! N o If Yes, nciicate quantities: _ Material Quantity 1. Flammable liquids Class I -A Class I-B P Class I-C E 2. Combustible liquids i Class 11 Class III -A ' 3. Combination flammable liquids 4, Flammable gases 5. Liquefied flammable gases 6. Flammable fibers -loose 7.— Flammable fibers - baled 8. Flammable solids 9. Unstable materials 10. Corrosive liquids 11. Oxidizing-rna+erial - gases i. 12. Oxidizing material - liquids 13, Oxidizing material - solids �. 14. Organic peroxides I 15. Nitromethane (unstable materials) 16. Ammonium nitrate 17. Ammonium nitrate compound mixtures containing more than 60% nitrate o i by weight 18. Highly toxic material and z� I: poisonous gas 19. Smokeless powder 20. Black sporting powder I _ 1 hereby certify that the above information is true and correct to the best of my knowledge. f' Signature Date j I 1 j 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 Ccast Air Quality Management District (AQMD). The Department of Community Development must i obtain a written release from AQMD to show the applicant has ;;omplied with this law. The check lis; on the reverse side is designed to help the applicant and the building division to meet these requirements. r 1. The applicant (the same person who applies for permits trom the Department of Community Development) must complete the check list which can be obtained either from the Department of Community Development or at AQMD'. 2. If all boxes in the list are checked "no", the Building Division can accept the check list as the release. 3. If there are any "yes" answers in the list, the applicant must contact an AQMD engineer by calling (714) 396-2000 to find out whether air permits are required for the proposed construction project. t ► 4. If air permits are not required, the applicant will obtain a written release from AQMD. I` 5. If air permits are required, the applicant must submit the necessary permit applications beforo the release can be issued. Because of the time it may take for AQMD to go through the above procedures, the applicant is advised to contact AQMD immediately after ap lying for building permits. i i (13ND) ADDITIONAL SUPPLIMENTAL INFORMATION r su, I'r%,�4vey � a.':'"?r i�`y:-.7ite �../`C�GI..��1 ,ifs(.G.[..1�_�.G.�..�.4'%'%y�'uf .;� !. ti,1't11.:",-i 1,1110 form in p ript ar16 'k{;, . n I4 iri "` _ _l _� P✓L_ i��✓ �- 'riCc ia,uif 1: i. �jeizolf ..f.`., r,,,; tells torinn rliust b:: the sP1i1e lis p�?J�i Cl c.}pi� '11�.� !,,j; bai;uii (j pl-a ls. I'igase &;-S wer the ,,r I. s re,;;;ardii,,3 y:aur proposed occup,..� y .r _.i-- <- ui ,I".-. g; € ; i_i ; !°: IS"A ER a e n � I'ESTION. MARK IN THE "YES" COU- i" rk'd MAD PERMIffTiNG YES } . Dieu t sur facility use any internal combustion engines greater then 50H.P? -------.--- �� -_-- 2, Does your facility involve. rnking. blending, or pr ,f;e sing r ;~olvcnts, adhosives, paints or coatings? 3. Does your fac' t l nreate any dusts or smoke? ✓ _ ._ __.. 4. Does your• fi'icility refine any liquids or solids or reciairn any m,;,,tals? � 5. Dotes your facility plate or coat anything? _- -_ _ _ ✓ ___ 6. noes your facility h^ ve any combustion equipment (i.e. boiler, furnaces, broiler, baking ovens, otc.) rating greater than 2,000,000 37 :., I iR?�-_.-- D,.ges your facility han le or store so vents or motor fuel?-------� _ __.✓. ____.._- 8. Do you use or" store any acids? _-___-______---. __✓ ____.. 9. Cho you use: any chemical process? 16. Do you use n y s° h!e its fo. clean-up?i/_-_-- f 1. Ave you a d!, cleano_. restaurant wifl9rhr�n3er, i;Cy shop. gasoline st ,t 3 a, .. rti-ctu-, of pari con-ter?- 12- �s the sa<<.lef,t bu i!d!ng Icoated within one thousa{iul (I t 130t-,i fect c.a an yr sc,,:so P : �i` rE t x'rs LIME TO PROPERTY LINE' GRAD4 �` i - 2. i Ivf�.^ 4 4'v+' �,r:: }" i .,'� vu'; 'Qta do not -,,�,n "Clel, _ s ._1fed s a. 21865 E. C:)piev I +4 vv Di-Arnond Bar, Cyi PV-ase call: Plan 4. he t° t, ), 4 SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT Permit No. 21865 East Copley Drive, Diamond Bar, CA 91765 D78385 AIN 286633 PERMIT TO CONSTRUCT/OPERATE Pagel This initial permit must be renewed ANNUALLY unless the equipment is moved, or changes ownership. If the billing for annual renewal fee (Rule 301.0 is not received by the expiration date, contact the District. Legal Owner ID 099322 or Operator. ELLERBROEK ASSOCIATES, BURGER KING DBA 101 MAIN ST, STE #410 HUNTINGTON BEACH, CA 92648 Equipment Location: 101 MAIN ST, STE #410, HUNTINGTON BEACH; CA 92648 Equipment Description: CHARBROILER, NIECO, MODEL NO. 962, 2'-113/8" W. X 3'- 2 3/8" L. X 6-5 3/4" H., 96,000 BTU PER HOUR, WITH SIX NATURAL GAS BURNERS. Conditions: 1. OPERATION OF THIS EQUIPMENT SHALL BE CONDUCTED IN ACCORDANCE WITH ALL DATA AND SPECIFICATIONS SUBMITTED WITH THE APPLICATION UNDER WHICH THIS PERMIT IS ISSUED UNLESS OTHERWISE NOTED BELOW. 2. THIS EQUIPMENT SHALL BE PROPERLY MAINTAINED AND KEPT IN GOOD OPERATING CONDITION AT ALL TIMES. 3. THIS EQUIPMENT SHALL BE FIRED ON NATURAL GAS ONLY. 4. THE TOTAL AMOUNT OF MEAT PRODUCTS PROCESSED IN THIS EQUIPMENT SHALL NOT EXCEED A MAXIMUM OF 125 POUNDS IN ANY ONE DAY. , 5. AN OPERATING RECORD OF THIS EQUIPMENT SHALL BE MAINTAINED IN A WRITTEN FORM. THE RECORDS SHALL INCLUDE, AT A MINIMUM, THE HOURS AND DAYS OF OPERATION, THE AMOUNT OF MEAT PROCESSED THAT DAY OR A CASHIER'S RECEIPT WHICH SHOWS THE QUANTITY OF CHARBROILED PRODUCT SOLD THAT DAY, AND THE DAILY AVERAGE AT THE END OF EACH CALENDAR MONTH. THE OPERATING RECORD SHALL BE KEPT FOR A MINIMUM OF TWO YEARS AND MADE AVAILABLE UPON REOUEST OF DISTRICT PERSONNEL. 66 - — A .d. 1. a — _„ Wl _ .. .._ SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT Permit No. 21865 East Copley Drive, Diamond Bar, CA 91765 D78385 A/N 286633 PERMIT TO CONSTRUCT/OPERATE Page 2 CONTINUATION OF ,PERMIT TO CONSTRUCT/OPERATE NOTICE IN ACCORDANCE WITf. RULE 206, THIS PERMIT TO OPERATE OR COPY SHALL BE POSTED ON OR WITHIN 8 METERS OF THE EQUIPMENT. THIS PERMIT DOES NOT AUTHORIZE THE EMISSION OF AIR CONTAMINANTS IN EXCESS OF THOSE ALLOWED 13Y DIVISION 26 OF THE HEALTH AND SAFETY CODE OF THE STATE OF CALIFORNIA OR THE RULES OF THE AIR QUALITY MANAGEMENT DISTRICT. THIS PERMIT CANNOT BE CONSIDERED AS PERMISSION TO VIOLATE EXISTING LAWS, ORDINANCES, REGULATIONS OR STATUTES OF OTHER GOVERNMENT AGENCIES. EXECUTIVE OFFICER By Dorris M. Bailey/ hd �f 11/15/1993