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CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
Data
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Address _ ..
District
Business Name r T'j— r T. t i EP P I! c, Tel. 71 r+ c o d
Business Type PET I CAT 17
Occ. Group �r
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BUILDING OWNER
BUSINESS OWNERIMANAGER
Liikr<"i ELRIGHT"
Name Ef:7L C. VARGN
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Name
Home
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Address t tr T T T r.
�. Address ^ n n r; Tl; c r'
~Home
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City l t.L,i�9 rT i. TeL k
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Construction No. of Stories
Occupant. Load =� .Sprinklers _
CONDITIONS OF APPROVAL
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DEPARTMENT OF COMMUNITY DEVELOPMENT
This Certificate of Occupancy
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SHALBE posted in a conspicuous place on the
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t b the
� e removed except and s hall not b P Y
premises a
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Building Official.
COMMUNITY DEVELOPMENT
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�� APPLICATION FOR CERTIFICATE OF OCCUPANCY
' CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
- HUNTiNDATEGTON 6SA61 PRINT OR TYPE ONLY) ,.
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Zess A1,.1 T-1 f-��>�Y—; = of,4 � 6 �� SS District i.
Addr—. _
%�iness Name SU i�^ P. (= < 'r�+� L R �' .S Tel __ r L 2 � 7
r v'Business Type 2 L l/� 7 / �.< �= G Occ. Group'
BUILDING OWNER BUSINESS OWNERWANAGER
X%ame �BR6
�/t; t /�� l{)j{+7 t�Nane
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r/ ress 4 jl df �/ ��, 'once
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City � r=v1?E72 Tel .._ i y U,_,e, Iq Home Tel.
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HIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG. �� CHANGE OF OWNER ® CHANGE OF OCCUPANT i
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
ndicote former use, if any Crtri �•'t�- _Occupancy Gr Div
1 SOUARE FT. OF BUILDING TO BE OCCUPIED
NOTICE:
1. Occupancyof 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 ,
applicants for occupancy in an existing building are required to schedule an electrical tt
P certified safe. All pp p y 9 9 �
'fuse up' inspection in the Deoartment 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 place the building in a different division of the same group of occupancy or in a f
different group of occupancy, a change of occupancy inspection fee of $ _ shall
be paid to the city. 'I
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 Evade Section 10.301 requires fire extinguisher selection and distribution per the
1 I t National Fire Protection Association pamphlet 10 (see reverse side).
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION ZONING h
OCCUPANCY GROUP PLAN (`iECK NO PARKING SPACES
OCCUPANT LOAD PERVIII NOZOCFANCY
H -ALTH DEPT APPROVAL
NO. OF STORIES _ ADMIN ,CTIONUTILITIES RELEASEDde
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/? $
Y 6 /J f,3 CE TIFICATE OF U
PROV BY DA E CHANGE OF US
TOTAL$
75-039 Rev. 11/90 cOMM
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SUPPLEMENTAL INFORMATION
1 16 /, Aq 97 A, 71-,� 711
1.
BUSINESS ADDRI<SS ��LI
2.
Person to contact in case of emergency
% '72_
Telephone numbor:
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3.
Does the building in question have electricity?
Yes
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
❑ No
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turned on?
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El Yes
4.
The building is sprinklered?
f� No
5.
Operations wile produce dust / wooer shavings or similar
El Yes
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material?No
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6.
Operations will involve the repair or replacement of
❑Yes
p No
automobile parts?
It Yes:
(a) Describe the compo Tents repaired or replaced.
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❑ Yes
❑ No
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(b) Does the operation involve the use of an open flame .
7.
The business is drinking, dining or assembly use that will
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result it) an occupant load of more than 50 persons.
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8.
The following best describes my operation;
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Office Only
Retail Sales �C
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Warehouse
Manufacturing/ Distribution (describe process and end product)
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Restaurant/ Take. Out Food.
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Medical / Dental
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Other (describe)
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SUPPLIMENTAL INFORMATION
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SUPPLEMENTAL INFORMATION (Continued)
Goes the operation involve any of the following materials?
El Yes
I8 No
If
Yes, indicate quantities:
Material Quantity
1.
Flammable liquids
Class 1-A
a
Class I-B
Class I-C
2.
Combustible liquids
Class Il
L
Class III -A
3.
';ombination flammable liquids
4.
Flammable gases
5.
UgUS ied flammable gases
6,
Flammable fibers - loose
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7.
Flammable fibers -baled
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Fluii. ^.able SOI'i(s
9.
Unst�it?le materials
10.
Corrosive liquids — —
11.
Oxidizing material - gases
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Oxidizing material - liquids
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Oxidizing material - solids
14.
Organic peroxides
15.
Nitromethane (unstable materials)
4 15.
Ammonium nitrate
17.
Ammonium nitrate compound mixtures
containing more _ than 60% nitrate
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by weight
18
Highly toxic material and
poisonous gas
19.
Smokeless powder
20.
Black sporting powder
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I hereby certify that the above information is true and correct to i
the 'est of my knowle ge.
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/57
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! Name. of ihie rersor, p ,pa!, :m 'hi.-', forry'', in pv1W any Flit! .. °,: .,--
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Name:- M/� V�1c7Ne4` ,ur t
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The person preparing this form rrwst be the same person applying for build;-iy permits. Please answer the
fc1lowing-vestions regarding your proposed occupancy of the subject t uilrL iY :F YOU DO NOT rNOW
THE ANSWER TO A QUESTION, MARK IN THE "YES" COLUMN:
AQWID PERMITTM,,IG CHECKLIST
YES No
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k 1. Does your ~'acility use any internal combustion engines preatc-a than 50HP?
2. DceE: your facility involve mixing, blending, or processing any solvents, 1X!
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adhesives, paints or coatings?
3. Does your facility create any dusts or smoke?
E 4. Does your facility refine arty liquids or solics or reclaim any metals?
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5. Does your facility plate or coat anything?
j6. Does your facility have any combustion equipment (i.e. boiler, furnaces,
broiler, baking ovens, etc.) rating greater than 2,000,000 STIJ HRI,?
7. Does your facility handle o • store solvents or motor fuel? --_
8. Dry ,you use or store :any acids?
9. Do you use any chemical process?
10. Do you use any solvents for clean-up?
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11. Are you a dry cleaner, restaurant with a charbroiler, hody Shop, gasoline
I. station, printer, or part coaier? -- - --- —
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12. is the subject building located within one thousand 1 000 feet of an;r
school? PROP17FI-Y LINE TO PROPERTY LINE. GLADES K-12.
I:;- you have; mari.ed `1,4 " ;rt all columns, you do not neet !in ,, , Ovaisty ncmk .3t .ni , arF �e. i ; tay. r arked
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j ,apy questiono in tite ` l S " ooli�mn you 3nust contact Snuth east A r Jluad l . ;J�E. � c �:�r,t �� , s t , atLd at:
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kf 21855 E. Colney Dd ve
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Diamond Bar, CA PI
Please .all' Plan 5�ht� kt , , J, u95 ,*0L 10i
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Government Cade 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
F Coast Air lQuality Management District (AQMD). The Department of Community Development must
obtain a writ{yen release from AQMD to show the applicant has complied with this law, The check s
list or, the revo se side is designed to help the applicant and the building division to meet these
requirements.
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1. The applicant (tire same person who applies for permits from 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.
t 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. y
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4. if air permits are not required, the applicant will obtain a written release from �
i AQMD.
a. if air pert tits are required, the applicant must submit the necessary permit
app►ications before the release can be issued. -
Because of the time it may take for AQMD t( go through the above procedures, the applicant is
advised to contact AQMD immediately after applying for building permits,
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ADDITIONAL SUPPLIMENTAL INFOSMATiON
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