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` APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH t
' DEPARTMENT OF DEVELOPMEN'. SERVICES , F
NuNitd6ttM c�wt7t DATE
Addivs,s
Busine, Nartm, 7ef CS 1 W`
Busmess 'Ype .,,.tl<_=. ! ,.r:..,.TS.'.f�_ °.;. ----- -,.. �.. _,,._:._..u.__._..:..,._..._�._...__ _�_�..:�._� Ow. Group
A. titl€LUNGowtJLr," HYANEWt,7YdNERMANAGEr3
Name S '
° �1� �
A.
City_._ _L�: _ i^ TtF.i c,.I ts.��At� 1`n+b2 CAS Home Tr;il�
THIS USE WOULD BE DESCRIBECi AS:
PJEWIY CONSTRUCTED E..PG jL DIAN(47 ;-,�F O�VNER �t-YJ4NaE OF OC UPAW'
!"_1 CXISTING f3f J"si_IANG ( C;HAN(!E iDF O-S' t�{ is .i ADDITIONAL AL OCCUPANT
ino;cath former io,.e, if any , !S-1'v
5d3UP.1? Pi -ri - fitli OiNU Tf E L i li.::
NOTICE: OCCy pan, y of any Md y is puQuKod = z + , zwsvivss a _its ; Wit not b,,issued _ n,!it the betiding has
Leen msrecicd and P tit° 3`c of
a No electrical service t! t �,;r >ir,f�a .x ; -�-Iv oxaNy byway unts' iP'r "diC„F his t7£dtr? in.;pected Arid
+,,or ifietlj s ♦fo Aft apr °G1-,ro- fti.. CYC.I�: p, ,,7C`n in an r.'" ling is#„d4 lig are rer.°7.1.:F d it).sE.tiemoe`. an 0ectrical -
`fl) b' up' iF! ,S;r.+.11rin :n ziT Depa true., c.f t1F, t;a'r;pirnt r't at tH{t-" tir'uf" th`ti applicationis filed,
I Change of occupancy or use inspection fee, %whammy r it to nc. _ on oaq 0 ?na SE, P l pection Of r build` g
3. or p em ter n order t") K"Mme A a daqe ,t q Lr1` mAp m the cha der r occupancy or use of the
/e oui ding fjr vxi,ld No, Me N ;nf < 1 m a r tf 'f d Li lir)n 7l grfiup of o(� C(;pancy
or in a different grmipt of L)ccupan—y. a _h,ini,F , t oucfjpLLnil
tt strati be paid to the city.
1! . p 4 Huntington Beach Fire Code Section 1 f• Mqwu a lot t} i `y n,j Ri 7;t7x r.1 iS �E' � r 13r71i7 L rtl Df tQUr
0 inche. in he yfli VJ 0 one h aH 1 VA inch suoke, and A 3 cion r :trot cdor tau Me Cpi3%.ymurmi. These
?'%•, nsrribers muc t be ostel to your f) Uddiri'j 1 a + '• t n i 'c f . e street.
F - .. C y t ) .� r a c...r',i,,.. t.a. ,.� io;,rErir� .risr�t its. ,itre.t.
5. Huntington Beach Fire Code Section t .:°.; 01 Ye U rr. e.Ongusher S6,94n and dcstriht bn per
Uw NWAmi Fore PTOlAE1 on AssoCobon rmrnphiei ir) (see rever e 50).
OWN Aj
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION ZONINCT rj
000}PANQY c, ROUP, _ F'I AN (;HF4 F* NO _ NO, PARKING; SPACES
OG(:tiPANT LOAD __ e _ _�__ _ tF0,111 NO ., HEALTH DEPTi APPi'OVAL_
NO, OF STOMES At'MIN Ai ,r tv:: _ �__ UTRIT4ES F`REASED
CERTIFICATE JE C) f JPA:t,Jt S FE:L:
APPFi Ei? FAY GATE CHANGE OF LEE: OR i7C`CUISANCY FEE
i t)T AL
is cm AFC. aa.„„E ^^�� r..
5�:.. di';,C.tl���1+:..j.° SERVICES
SUPPLEMENTAL INFORMATION
l,,"a..
1. BUSINESS ADDRESSf
t
2. Person to contact in case of timergency :k?�
Telephone number
3. goes the building in question have electricity? [des
a C3 No
A. If No, are you requesting that the electricity be OYes
turned on? ON'o
4. The ouild,iny is sprirklered DY� s
5. Operations will produce dust/wood shavings or similar
material?
0Yas
6. Operations will involve the repair or replacement cf QYes
automobile parts?
If yes -
{a) Describe the components repaired or replaced,
(b} Does the operation involve the use of an open flame? OYe�
0
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
0
8 The following beat describes my operation:
Off_ce Only_
c'Retail Sales._r
Ware )ouse
Manufacfuring/Distribution {desrribe process and end
product}
Restaurant Take Out Food
Medical/Dental
Other (describe)
(0562D) (I2/8/86)
i
r
E
r
i,
Siir 4:tv`'AL !NFORMATION (Continued)
1
Does the operation incai.^re an
� Y of the following materials? CiY,�%s
o
t Ia des, in irate gizanties:
Material Quantityi
Flammable liquids
class I-,
i
Class I—B
class I--O
2. Combustible liquids i
Class it
Class 111-A
h
3. Combination flammable li uj6s
4. F.Iammab];e as¢s i
5. Liquefied flammable gases i
5 Flammable Fibers - loose ..M.
7. FJ ammable fibers - baled
,. 8. Flammable solids
9. Jnstable materials"
10. Corrosive 1iQuids _
11. Oxidizin material - gasps -
12'. Oxidizing matezial 1iuids
13. Oxidizing materiQ - solids
14. Organic roxides
15. Nitromethane (unstable materials)
16r Ammonium nitrate
17. Ammonium nitrate compound mixtures
containing more than 60% nitrate
I _ by weight
I 18. Highly toxic material and
�ci.�onaus 5as
19. Smc.;eless Powder
f 20= Black sporting powder
I hereby certify that the above information is true and correct to the
best at my knowl 4g ;
f.. .........,..W__
13
�CC�C }}dry}} , Date
' 0562Dl
(1218186 )
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