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c Sri iCAt C iw 6tcUPANCY
CITY'OF OUN�t#IVf tOkRtAcri
4-1 -79OEPARTAkl Nt--OF �b fl fJfNG & CO M MITY 'DEvtLO'I' ENT IfAfh
Titis' is kY ceefify`that tilt _ _______.� fi$ �QS�C$ Y . �t _ ._ . _. __ � _ __� ._._._ �►s ���►tl�t ti9r+d
tt c(et E3ti11tf t' iirtfit'No. JSxUfjn&_._._:..: ,1hd is%idemifiM as
s�l�lrott
t1wrled )y
ttsnte ..id�lrrt�s
comphe" kvitil 1fil* pfovisions of .111 pertirlent laws, emle", of(ftr),'tnca!" and imy iiltt)risrl
co dkiatls for 'tile use &Ist'tib,J ,ir}ti f"i,assifictf itr all u._w.._i' ��c.Jecuf)ancy.
'tVAXIMUMi'OCt:UPANT LOAD PE A Nit TTU D
"rills, cdetificitto of occupancy Jc�hil'i~, f3eiliens
+_ _.�....�, _.....,, t'?��+•�•itl+ Sri H..r.trt�:,L� i'ctt»!►�is�itty la�r�c'rit�..�,�.n.
SHALL E3E posted it) a =,or w . )us pzjco On
i
file pt0l)Ises mid Shall ro! 6
fly titit�� E:fit�ftisnt i��ffit`i,tf. s
,- r
ro OCCUPANCY
y o, H' t Beach I di coilul)(111i ty Develb,
f un bg on c n6partmen 'of BW
I FOR AWLICANT TO FILL IN :(Pri -or type Only) OAT[
Application is hereby made f6r a Certi f ate of OC6-up6hcy for a:L , T
'
Occo rcv: Gr. 01.V
DDescribeftt'ihoss Uso .
QAS
To be kftA',,��a s W
N611ie df _B0
'Eves to 6t
-B00hess- 7daP Lfts s
_z Res*i,dohce Ada sSs
Name:U 1M"SS 'OWNER
060— e ±No. -, -Rhs0e8s:
1NMe: Httbtft 'OWNER Addlftss .- Mfy p P fi -0'-F�eo
THIS USE WORLD 'DE RI tD AS:
[� Newly Constructed C3i`lding
` —Existi'hig Buildi
''Indicate fonior ute if a-h3l
Ch4nje -of OWhe'll
. E_ j Change of lise
Change of Occupant
P
-4 itional Occu'00-t
,Add
OccU0a"hCy. Gr. 01V.
c'c Afty-of an yTdifhfY - f-wi-te-d- 6ia sthbts I st U 6d
NOTICE: 10 Oi
ihso ete'd acid a Ceftif i cafe �6f 'Oc hifty s iss
anti 1 the bUi dfff�'�has bb6h -
2. .,No elecU1cal service 011 bereleasdd-for ,,ahy -- the
service Chas be6h, thtpeeted a`h"dcertified "safe. 'All a '0110nts, 6P ocCU Ah
are rbqUire'd to s6hoduie.aW-6lectrical. "fuse U
1*66ti6h in the `Ddp,�trltb61ft of Boilldifftg 6ftd—C'60wity Development at the'fike;
this application is filed.
3. :CHAN6E OF 'OCCUPANCY OR A St INS rVION - FEE.
-W64h0.dr i t is hecessaiAy to make
h9pett 01 of a bildi-hg or prenises in order to�ddrtlifht.i f a ange may
be made in the characte'T4 of, occupancy or use of the, lipildiho-or pi•enlises wlfileW
would-01acie the bUildth'g-th a difforent'div'isidfi,4f the same group of
occ dosk y
or th -a differ&ht qr(jup' of oceup0c'y , a ch6hqb -of occupancy iMpettib , 11 f e6l'ff
$30.00 shall be paid to the City.
SUPPLEMENTAL INFORMATION
Sq. ft. Ming
�Oq_cUpahcy Gro6p_
ricco0ant,16ad
'No. Of St6ri es
MIRVED
(FOR OFFICE 081 ONLY)
Plan Check No.
Permit�No.
Mimi n 4 t i on
No. Parkihg S*c,
Health Dept..;Approva
Uttlitios Released
DA ANCY FEE .4
CrR*r.IF1CATL'OF OC ' CO E
ChWt OF 'OU00AWY OR :'OSE I".80ECT'I"ON FE
TOT
CERTIFICATE OF OCCUPAN
CY
. 1
i CITY OF E HUNTINGTON BEACH
SERVICES Date
HUNTiNuTON BEACH E PARTM ENT OF DEVELOPMENT '
Address
Business Name_,__ District
i If— --__ _
! Business Type Tel.
OWNER i
i --- ---- _ Occ. Group
Name
OWNER/MANAGER
i,
Name
.Address
el.
Address
p
City TCity.
i
t;orstruction Tel.
No. of Stories_ Occupant Load
� Sprinklered
Notice:
I
This Certificate of Occupancy DEPARTMENT OF DEVELOPMENT SERVICES
SHALL BE posted in a Conspicuous place on
the premises and shall not be removed except
I,
by the Building Cfficial. by
I
I
F
U—Z-1—LITY R E L E A S E
USE g
ADDRESS
EXISTING BUILDING
NEW BUILDING
POWER POLE
TEMP WORK WITH POWER
L PlumbingInspector Clear
DATE
2. Elec 'cal Inspector Clear
�lLe4o,�-4p =f�
UTILITY RELEASE AUTHORIZED
BY LAND USE
DATE
GAS ELECTRIC
UTILITY COMPANY NOTIFIED
DATE
(#75 007 )