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Home My WebLink About101 Main St - CofO (46)APPLICATION FOR CERTIFICATE CP OCCUPANCY ` CITY OF HUNTINGTON BEACH DEPARTMENT OF COMMUNITY DEVELOPMENT aurJrnasron a .. ' . (PRINT OR TYPE ONLY) DATE Address t 2" District Busfoess Name Out C. Tel -3 6v Business Type r-,errlppr�,7r1'Y1 <5 ��Y Vl C�2. jj�, a Occ Group.I, _ BUILDiNG OWNER r— BUSINESS OWNEWMANAGER i Name_ � � !� Cs l 1'Vl tl � a �'. V e- 71' .NamHome � Address IO l /L? A r ul S L1 _Address Jcs r 711 Zo " City �1 i el. Ci— �v/a y Horne Tel. -Vt THIS (ISE WOULD BE DESCRIBED AS ❑ NEWLY CONSTRUCTED BLDG ❑ CHANGE OF OWNER KCHANGE OF OCCUPANT ❑ EXISTING BUILDING ' ❑ CHANGEOF USE ❑ ADDiTiONAL OCCUPANT to indicate formeruse, it an .5 'io'l $ivy ttit y y ,Z Occupancy Gr —Div SQUARE FT. OF BUILDING TO BE OCCUPIED ,G0 »�QU�' 1/�- �� I :7o 4,1 PP-----�- .. I N Ti Occupancy of u' ti p y anyb building dac.usinesslkcensewitlootbeissueduntil the buildinghasbeen .; spected and a certificate of occupancys issued. 2. N' iectrical service will be released for any existing building until the service has been inspected and c rtifled safe. All applicants for occupancy in an existing building are r'�quired to schedule an electrical fu e up' inspection in the Department of Community Development at the time this application is flied, 3. C snge of occupancy or use inspection fee, Whenever it is necessary to mane inspection of a building or �'. pflamises in order to determine if a change maybe made in the character of occupancy or use of the building orlpremises 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 S shall f tie paid to the city. i1Aol� 4. ituntington Beach Fire Glade Section 10,208 requires that building numbers must be a minimum of fo41r (4) inches in height with one half (':z) inch stroke. -anti of a contrasting color from the bc:iAground. These numbers must be,pc;+ed on your building in a location that is visible from the street. f /,X1 Huntington Beach Fire Code Section 10,301 requires fire extinguisher selection and distribution per the National Fire Protection Association pamphlet 10 (see reverse side). TRAFFIC 1141PAC 7' FEE_ DATE PAID AMOUNT RECEIVED BdAiViG (FOR OFFICE USE ONLY) 2CNING__. OCCUPANCY GROUP _ Pt AN CHECK NO No PARKINC: -aPACES OCCUPANT LOAD PERMIT NO _ HEALTH DEPT APPROVAL NO. OF STORIES � . � _ _ ADM►N ACTION--- UTILITIES RELEASED CERTIF' OF QCC(1'�r�NCY FEE i APPROVED BY DATE CHANGF _. USE OR OCCUPANCY FEE $ TOTAi, $ is, 'as Rev, ttsz 0 OMMUN17Y DE VE"IOPMENT :;- SUPPLEMENTAL INFORMATION- 1. BUSINESS ADDRESS � � � �r�� ---,� �, _� , �.�' 2, 2. Person to contact in case of emergency i2 - -' Telephone number; 3. Does the building in question have electricity? ff Yes ❑ No (a) If No, are you requesting that the electricity be ❑ Yes turned on? ❑ No i 4. The building is sprinklered? YID es ❑ No I: 5. Operations will ' produce dust / wood shavings or similar' material? ❑L7 Y�...- s 0 6. Operations will involve the repair or replacement of D Yes • autorinobiie parts? i=3 ,No ,if Yes: (a) Describe the components repaired .or replaced. (b) Does the operation involve the use: of an open "flame? ❑ Yes 7. The business is drinking, dining or assembly use that will l result in an occupant load of more than 50 persons. " ❑ Yes ° ICf' No 8. Th f�ving best describes ,my operation, Off iGe 70;n y 1 etarl a es Warehouse Manufacturing/ Distribution (describe ;process and end product) Restaurant/Take Out Foote Medical / Dental Other (describe) — I .1 SUPPLEMENTAL INFORMATION - 3 SUPP ENIFENTAL INFORMATION (Continued) Dodgy;. We operation involve . ny, of . the following '' materials? Yes s. If Yes, indioato tru4ntities Material!Quantity 1 Flammable t rxnic� .l 'Class 1-A Class I Class i-G is Z Combustible liquids Class It Class lll-A �.�. . Combination flammable liquids 4. Iammable galas 5, 11quefied flammable uses �sra� llamrrrafle fibers loose 4� �� ..-rn.xr..•...w�.u..wn-+Yt,.u�r _: —+.ten 7. v..s.++nn...wr,-.+rv. Flammable fibers - baled tom.-r.. 8. - v.�...+...«....n+.rF..« Flammable solids .. ...,.:.....rarv.u.ew..: 9. Unstable materials tg. Corrosive liquids M ++wars• 11. w+-•.-+,«n,»vm+-+...r:+rra+rv+w.u.rtrnr.:.eerr.�. Oxidizing material gases - .: 1Z xrwwwun..aevnr..a Oxidizing material - liquids x+w .x »+wa.s. rwu� .r.�r�s...sr.ra.+..s.�...w+srer....+..' !:. 13, .s Oxidizing material solids u-+ar.r+wn•R+n.•.r.+ae ! Orpanicperoxides, is' Nitromethane (unstable matarials) 1 -,Ammonium nitrate 17.Ammonium .wu nitrate cor_por_nd' mixtures containing more than. 60% rxrtrate by warght 18. Highly toxic material and poisonous gas i 9. Smokeless powder Tacit powder I hereby certify that the above information is true and correct: to the best of my knowledge. JW /111� J Signature Date i South Coast AIR QUALITY MANAGEMENT DISTRICT 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000 j tAM QUALITY PERNUT CHECKLIST CKLIST for nonresidential buildings only Company Name: Location of Property; F City. Zip C e:" c Contact Person:.. title: Telephone Number; r- Fax Number: Type of Industry/Business: To apply for a nonresidential building permit, you mustcomplete this checklist. If you have any k questions about completing this checklist, please call (800) 388-2121. i YES NO i 1.. Will the facility have a char -broiler? [ ] 2. Will any internal combustion engine with greater than 50 horsepower operate at the facility (excluding motor vehicles)? [ ]►%,''� 3. Will operations at the facility involve mixing, blending, or processing of solvents, adhesives, paints or coatings? [ ] 4. Will dust or smoke be generated at the facility? [ ] [ 5. Will refining of any liquids or solids be done at the facility? $ 6. Will any plating or coating of materials be done at the facility? 7.. Will any combustion equipment rated greater tvan 2,000,000 BTU/hr be .,perated at the facility? ] 8. 'Will any acids, solvents; or motor fuel be used or stored at the fa,.dlity? 9. Will any organic liquids or gases be reacted or produced? 10. Will any ovens be used to dry or cure products at the facility? [ ] [ i 11. Will any CI~ C (Freon) recycling machines operate at the facility? [ ] [ Applicant: Signature: i (Print name clearly) 1 Ifyou have marked "NO" in all the boxes, an pair quality permit is not needed at this time, and this checklist is your written release. If u marked "YES" in an of the boxes you must contact the South Coast Air Quality < y0 m Y p Y Q tY l Management District (AQIV D). Please read the requirements on the back of the checklist. j (800) 388-2121 South Coast AIR QUALITY MANAGEMENT DISTRICT 21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000 j tAM QUALITY PERNUT CHECKLIST CKLIST for nonresidential buildings only Company Name: Location of Property; F City. Zip C e:" c Contact Person:.. title: Telephone Number; r- Fax Number: Type of Industry/Business: To apply for a nonresidential building permit, you mustcomplete this checklist. If you have any k questions about completing this checklist, please call (800) 388-2121. i YES NO i 1.. Will the facility have a char -broiler? [ ] 2. Will any internal combustion engine with greater than 50 horsepower operate at the facility (excluding motor vehicles)? [ ]►%,''� 3. Will operations at the facility involve mixing, blending, or processing of solvents, adhesives, paints or coatings? [ ] 4. Will dust or smoke be generated at the facility? [ ] [ 5. Will refining of any liquids or solids be done at the facility? $ 6. Will any plating or coating of materials be done at the facility? 7.. Will any combustion equipment rated greater tvan 2,000,000 BTU/hr be .,perated at the facility? ] 8. 'Will any acids, solvents; or motor fuel be used or stored at the fa,.dlity? 9. Will any organic liquids or gases be reacted or produced? 10. Will any ovens be used to dry or cure products at the facility? [ ] [ i 11. Will any CI~ C (Freon) recycling machines operate at the facility? [ ] [ Applicant: Signature: i (Print name clearly) 1 Ifyou have marked "NO" in all the boxes, an pair quality permit is not needed at this time, and this checklist is your written release. If u marked "YES" in an of the boxes you must contact the South Coast Air Quality < y0 m Y p Y Q tY l Management District (AQIV D). Please read the requirements on the back of the checklist. j (800) 388-2121 r? t i 1 l } NOTICE OF REQUIREMENTS GOV.ERNTMENT CODE SECTION 65850.2 ( 3205j California State Law (Government Code 65850.2) prohibits the Building Departments from issuing a final certificate of occupancy unless all requirements of the local air quality agency are met. ;All applicants are required to complete'the air quality permit checklist. The checklist is designed to ;aid the applicant for a nonresidential building permit only. If the answer to any of the questions is "YES," the Building Department must obtain a written release from the local air quality agency verifying that the applicant is ;in compliance. r 1. All nonresidential building permit applicants must complete this checklist. 2. If the answers to all questions are "NO," the Building Department can accept the checklist written release. ' 3. If any questions are answered "YES," the applicant must contact the AQMD by callin (900) 388-2121 to determine whetherair quality permits are required for any equipment which may be operated at the site. If the AQMD determines that air quality permits are not required or that all requirements have been met, a written release will be issued. 4. If air quality permits are required and applications have not been Tibmitted, the applicant must submit the necessary permit application(s) and appropriate fees before a written t release will be issued. AQNID is committed to expediting all clearance letter requests. However, it may take -several weeks to verify compliance with all requirements. Therefore, you are advised to contact AQI�0 immediately after applying for building permits. (800) 388-2121 revmd WS w k` CITE' OF HUNTINGTON BEACH Department of Building & Safety • Telephone: 71.4/536-5241 CORI2ECTIQN NOTICE El INSPECTION REPORT 1 Stiucair L) Eleetn al G Plumbing C� Mechanical they Job Address�'%i / Lot -2 Pen-nit(s) No. l d> rf C j ' t G' — ur` i