HomeMy WebLinkAbout101 Main St - CofO (39)APPLICATION FOP, CERTIFICATE F OCCUPANCY
CITY OF HUNTINGTON BEACH - DEPART iYItENT OF BUILDING & SAFE T v
(3"` Floor -Must Apply In -Person)
Business License 91`Q1/¢ `^%-s'T Date 3o — o
Address f P/ :_
Business Name Telephone 3 zSS
Business Type
Prouer:y Owner Information Business Owner
Name Name 11L (-lleac-
Address L0 ,'�!�i�iv':` Home Address 9_
City F'i r �f C� � �� Tel.-53b-�5G7 City%rt� G Tel. 9,y,t-76G-(o,5-s;i
THIS USE WOULD BE DESCRIBED AS:
E)Newly Constructed Buildin; or &Existing Building
CHECK ALL THAT APPLE':
❑Change of Owner ❑Changge of Occupant QChange of Use ❑Additional Occupant
Indicate former use, if any �, l Z'2eia iA
Does the building have electricity? Yes �R No❑
If No, are you requesting that the electricity be turned on? Yes ® No
The building is sprinklered? Yes No
Operations will product dust/wood shavings or similar material? Yes ® No ,
Operations will involve the repair or replacement of automobile pans Yes No
If yes: Describe the components repaired or replaced.
Does the operation involve the use of welding or open_ flame? Yes ❑ No
The business is drinking, dining or assembly use that will result in an occupant load
of more than 50 persons. Yes ❑ No
The following best describes my operation:
❑Office Only ❑Retail Sales ❑Medical/Dental WRestatuan TaEeOu:tFo)c)❑Warehouse
❑Maitufacturing/Distribution (describe ,process and end product)
w
❑ Other (describe'—r
' Office Use Onl
Zoning: LL,?--Sq Ft Occupied; 0 _ Occ Group: Occ Load:
ii Stories: Parking Spaces: TIF Review: YIN tint Paid:
3� Paid BEFORE Final Inspection i5
r* Building Permit Fntitic rnent F
Comments
er
Planner initials: Bldg/Plan Cl Ini f0
f
South Coast
Air Quality Management District
21865 E. Copley Drive
Diamond Bar, CA. 91765-4182
(909) 396-3529 htpp://www.agmd,ov
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities from issuing a Certificate or "Occupancy 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 (AQMD).
Company Name:
Property Address: L7
City: 1q,Zip ode: � L .Z2
f Contact Person:Title: a, r
i
Type of Business: t Telephone: O 37-�5 S5
Applicant: (print name) rJL c c-o Signature: Y4,, Lz 4,,
• Will the facility have any of the following equipment? Yes ❑ Na
Charbroiler
f Dry cleaning machine
Spray Booth
Printing Press (screcz�/lithographic/flexcgraphic)
Internal. combustion engine (greater than 501P) (excluding motor vehicles)
Boiler/combustion equipment (greater than 2 million BTUAhr. maximum input)
Abrasive blasting cabinet/room
Baghouse/cartridge type dust fitter/scrubber
Motor fuel storage and dispensing equipment
• Will any of the following operations be performed? Yes G No
Application of paints or adhesives
Etching, plating, casting, or melting of metals
Molding and blending of liquids and/or powders
Storage of acids, solvents, organic liquids or fuels
Production.of acids, solvents, organic liquids, or fuels
Production of fumes, dust, smoke or strong odors
• If you answered "No" ±^!both questions, this checklist is your clearance from AQMD.
Z
• If you answered "Yes" to either question, you must contactAQMD to determine if air quality permits are
required. If permits are needed, A QMD will assist you in submitting permit application(s) and then provide you
with a clearance letter. You can call AQTMD at their Small Business Assistance Office at (800) 388-2121.
1
.
%a APPLICATION FOR CERTIFICATE OF OCCUPANCY B CITY OF HUNTINGTONEACH
�+ DEPARTMENT OF BUILDING & SAFETY
HUNTINGTON ELAOi 71 RANT OR TYPE ONLY DATE
o� � III A-6 CA
.Address District
Business, Name i<40Gk a ti ffs P( ZZ A Tel '760-- q3 !1-
Business Type — O V "F Q I Z_SA Occ Group
BUILDING OWNER BUSINESS OWNERWANAGER
-Name_ ¢/1 , �. (_ . - Name J RYNC--S P PfW_Y- O h^
�- Home Z t to LAAJ b' dK
Address. l o l {/`" �_/C �jAddress—�—/ -i
City . f) •CA 9 z-be-`b'JCity C�IR`�.-� 8A � C� . Home �
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG ❑ CHANGE OF OWNER Y CHANGE OF OCCUPANT
❑ EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
'indicate former use, if any_,1L .Occupancy Gr Div
SQUARE FT. OF BUILDING TO BE OCCUPIED !Q Z-- Ta�-e_ c36, . - crr.I�j IZ
3 t��
NOTICE: t. 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' inspectioo in the D'epartmerit 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
premises in order to determine if a change may be made in the character of occupancy or use of the building
or premises which would pace 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
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 (vz) inch stroke, and of a contrasting color from the background. These
numbers must be posted on your budding in a location that is visible from the street.
5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection , f oistribution per the
National Fire Protection Association pamphlet 30 (see reverse side).
(FOR OFFICE USE ONLY)
�i�NING
OCCUPANCY GROUP 2 't K� PLAN CHECK N _L., NO BARK INC, SPACES
OCCUPANTi LOAD ___ _ � PERMIT NO. HEALTH DEPT APPROVAL
NO. OF STORIES _ ' - ADMIN ACTION I ITSLITIES RELEASED
p ' CERTIFICATE Of OCCUPANCY FEE $
APPROVED BY DATE CHANGE OF USE. OR OCCUPANCY FEE S
TOTAL S,
FORM 5 4�'ti t.Ev : � RE : KP.ER S�N4 .zCLyR ra.g3:..yfi
J� APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
g
°
DEPARTMENT OF BUILDING & SAFETY
m
HUNTtNGTON Bbipt '
i
SPRINT OR TYPE ONLYS
- DATE
Address
District
Business Name
Tel ' _' ,;* 4; �•r` ,
Business Type.—, : ° 7
;"' i 4.
Occ Group
! BUILDING OWNER
BUSINESS OWNER/MANAGER
Name t.
Name�'rd.,"
E a t P-.''� C
' Address l b t Li6i jj k
Home
Address
7
{,
City ;g Tel d, Cdyt L,r
f3, Hom' el r
( THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG
❑
I
CHANGE OF OWNER
p❑
CHANGE OF OCCUPANT
' ❑ EXISTING BUILDING
❑ CHANGE OF USE
❑ ADDITIONAL OCCUPANT
' Indicate former use, if any f< °�"r �:' L.
� �
Occupancy Gr.
—Div
SQUARE FT OF BUILDING TO BE OCCUPIED
r
-}
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 Developme.^t at the time this application is filed,
3. Charge of occupancy or use inspection fee. Whenever it is necessary tomakeinspection of a building or
premises in order to determine if a change may be made in the characterof occupancy; cruse ofthe 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
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.
5 Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
,� diI fib"
{
(FOR OFFICE USE ONLY)
.
ZONING—'.
OCCUPANCY GROUP
PLAN CHECK NO t `` -' `c
NO PARKING SPACES
OCCUPANT LOAD
PERMIT NO L4t
HEALTH DEPT APPROVAL.
NO OF STORIES
ADMIN. ACTION
UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE
$
APPROVED BY
DATE
CHANGE OF USE OR OCCUPANCY FEE
$
TOTAL
$
FORM 7E,?39 REV :•02 REORDERSAND DOLLAR 14-942.5.'48
RciE
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS 0 j n',i(42 �-� (�j. Ck cf Z6g3
2.
Person to contact in case of emergency, �.J A mGS ���ty-�A)q
Telephone number: 20'7.. 4«f
3.
Doesthe building in question have electricity?
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
2-Yes
❑ No
5.
Operations will produce dust/wood shavings or similar
material?
❑ Yes
D- N o
6.
Operations will involve tie repair or replacement of
❑ Yes
automobile parts?
C No
- If Yes:
(a) - Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flarne?
0-1es
13 No
7.
The business - is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
❑ Yes
D-1Q o
8.
The following hest describes my operation,
Office Onl
e:ta,etail Sales
use
Manufacturing I Distribution (describe process and end product)
Restaurant / Take Out Foodi
Medical I Den a
Other (describe)
.a
�. rF a.7t w.SE. 4.y,
F�itII SiPia;.
sa
Fcaf id; iy 4..Iijpl.
2.
csrnbusflbiLi!gm6ds
Class
Combination nammable liquid!
Liquefied flammabie gases
G.
Ffar ` jDe fibers loose
7.
Flammable filers* bale
"1C3,
t�rrcasitre !i�?u+td
11,
Oxidizing materialgases
12,
Oxidizing material - liquids
u.. _.. ..�.
1
rdizing�ymaterial solids
4
(5 aWic peroxides
1 .
. _ Nitromethane (unstable
i6.ttttrtium�
nitrate
;Ff
Amrrtrniurr? .nitrate compound mixtures
containing more than 6M,G nitrate
by weight
'tly,
l-lighly.,, toxic material and._..,a
poisonous gas
_...,._n,_..
19,
.�-rsokelees _powder_._....._ ..-.... _..a....
r _
..,.
20,
Black sporting powder
i he.reby certify that the above informati r. is
true and correct 'lo
the be f ,of my knowledge,
r� I� 0
t
South {'oat
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909� 396-2090
AM QUALITY PET IT CHECKLIST
for nonresidential buildings only
Company Name: KJ 0 CY-50T PI Z
Location of Property: 1 d l [tii A l r-j S`r
City: 14 N-rw 6 TUB J>3G - Cps Zip Code: qZ.
Contact Person: CS M A V 4 �l Title: 0 w'o L
Telephone Number: V ZUi ' 9 `� Fax Number:
Type of Ind astry/Business:C O (j i ! ZZ A
To apply for a nonresidential buildirg ,-cr,.ti 1t, you must complete this :hecklist. If you have any
questions about completing this checklist, please call (800) 3)88-2121.
YES
NO
1. WilI the facility have a charbroiler? [ 1
2. Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)? [ ]
4Q
3. Will operations at the facility involve mining, blending, or processing of
solvents, adhesives, paints or coatings? [
4. Will dust or smoke be generated at the facility? [)
j
5. Will refining of any liquids or solids be done at the facility? [ J
[A
6. Will any plating or coating of materials be done at the facility? [ j
b1i
7. Will any combustion equipment rated greater than2000,000 BTU/hr be
operated at the facility? [ ]
8. Will any acids, solvents, or motor fuel be used or stored at the facility?
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? [ ]
11. Will any CFC (Freon) recycling machines operate at the fac' I?
Applicant: t�� C---S �hA 1LyR'`�_ Signature:
(Print name clearly)
If you have marked ""NO" in all the boxes, ;an air quality permit is not needed at this time,
and this checklist is your written release.
If you marked "YES" in any of the boxes, you must contact the South Coast Air Quality
Management District (AQivfD). Please read the requirements on the back of the checklist.
(800) 383-2121
AM 1"ME CPT: REQUIMMEM
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A�:ra.ti< ;«411 all eQqi. rzilt'I:T T!Et''f,9t`e. You arc advised i<w coY'.G1+?
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