HomeMy WebLinkAbout119 Main St - CofO (2)S
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I• >>� APPLICATION FOR CERTIFICATE OF OCCUPANCY
E IL CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT % DATE
HUNTNUION ff.AOi (PRINT OR TYPE ONLY)
/ a l�111J s-r- Address - District
_1.J--1-- '.
Tel.
Business Name.. i
!� G T� / G L oT"H 11✓� Occ. Group
Business Type
I BUILDING OWNER BUSINESS OWNERIMANAGER
�h4^�nk A� �dhtt'� Name—
HomeL1� �? pcvA
Name
3 O ,/ G� tr A t^ . Address
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Addres—
We �- (� i c Tel. %City-�"�' `t uC- n� Lrf �C Home Tel. Slot,, —Z
City ;
l THIS USE WOULD BE DESCRIBED AS:
❑. NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER CHANGE OF OCCUPANT
r �i.XISTING BUILDING E OF USE LU ADDITIONAL OCCUPANT
'�?/�i�% HANG
Indicate former use, if any -�— Occupancy Gr. Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED! a b >a a
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TRAFFIC IMPACT FEE
DATE PAID --------
AMOUNT RECEIVED , -----•
(FOR OFFICE USE ONLY
NNAME�r
21)
ZONING
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PLAN CHECK NO,
NO. PARKING SPACES
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OCCUPANCY GROUP
PERMIT NO. �• in��3l�---
HEALTH DEPT.,APPROvgL
;
OCCUPAN"f LOAD
ADMIN. ACTION
UTILITIES RELEASED
NO. OF STORIES
CERTIFICATE OF OCCUPANCY FEE
$ _
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D BY DATE ATE
(„
CHANGE OF USE OR OCCUPANCY FEE g —
APPROVE
TOTAL
$ vlk—
75-039 Rev, 1/97
COMMUNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
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BUSINESS ADDRESS
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2.
Person to contact in case of emergency- dab-< \%A-Iz ,A
Telephone number: c-I l y U 0 1 a
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3.
Does the building in question have electricity?
Yes
❑ No
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(a) If No, are you requesting that the electricity be
❑ Yes
turned on? ..
❑No :.
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4.
The building ,is sprinklered?
❑ Yes _
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No
5.
Operations will produce dust / wood shavings or similar
material?
❑ Yes
No
6.
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
No
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If Yes:
y
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use , . an, .open flame?
❑ Yes .
'gNo
7.
The business is , drinking, dining or• assembly use that will
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result in an occupant load of', more than 50 persons.
❑ Yes
No
8.
The following best describes my operation;
Off r Onl
Retail Sal a
Warehouse
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Manufacturing / Distribution (describe process and end product)
y
Restaurant/Take Out Food
Medical / Dental
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Other (describe)
SUPPLEMENTAL INFORMATION
40
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SUPPLEMENTALINFORMATION
(Continued) �
Does the operation involve any of the following'- materials? ❑ Yes
N o
If
Yes, indicate quantities:
— k+
Material Quantity
1.
Flammable liquids
C
Class I -A
Class I-E;
Class I-C
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2.
Combustible liquids
Class it
.-Class 111--A
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3.
Combination flammable liquids
4.
Flammable gases
5.
Liquefied flammable ; gases
6.
"Flammable fibers - loose
7.
Flammable fibers - baled
8.
Flammable solids
9.
Unstable materials
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10,
Corrosive liquids
11.
Oxidizing material - gases
12.
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Oxidizing material - ,Ii Uid,,
13.
Oxidizing '�material'- solids
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14.
Organic peroxides
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15.
Nitromethane (unstable materials)..
16.:
Ammonium- nitrate
17.
Ammonium nitrate compound mixtures
containing more than 600/a nitrate
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by weight
18.
Highly toxic material and
poisonous gas
19.
- Smokeless powder
20.
_
Black_ sporting powder _
hereby certify ; that the above information is true
and .correct to
the best of my knowledge.
Signature
Date.
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South Coast
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AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
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AM QUALITY PERMIT CHECKLIST
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for nonresidential buildings only
Company Name: --TAX i S
Location of Property: ` < < 9 An a-
City: Zip Code: q Cp'4 IR
Contact person: C o-b`S \J'A-P-O N a Title: (� uvAJ
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Telephone Number: L - �i U O - D 9 -2 Fax Number:
Type of Industry/Business:�` L
To apply for a nonresidential building permit, you must complete this checklist. If you have any
;
questions about completing this checklist, please call (800) 388-2121.
YES
NO
1. Will the facility have a charbroiler? t ]
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 processingof
solvents, adhesives, paints or coatings? [
4. Will dust or smoke be generated at the facility? [ ]
?
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5. Will refining of any liquii , yr solids be done at the facility? [ ]]
6. Will any plating or coating cfmaterials be done at the facility?
7. Will any combustion equipment rated greater than 2,000,000 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 facility? [ '?
Applicant: oU`( VA-20rvA 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 (AQMD). Please read the requirements on the back of the checklist.
(800) 388-2I21
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A9DlTIQNAI SUPP_
. , ...� LEC•�ENTAL INFORMf�TIaN,,
Recorded in the County of orange, California
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Gary(L Granville, Clerk/Recorder
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Recording requested by and return to; IIIIIII{IiyIIIIIIIIIIIIIIIIIIIIII"�
CITY OF HUNTINGTON BEACH 2O000100534 2 ,11 PM 02/25/00
Department of Building & Safety 004 00124407 108 73
2000 Main Street-3rd Floor 365 01 0 0.00 10.00 0.00 0.00 0.00 0.00
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Huntington Beach, CA 92648 0.00 0.00
Doc Types: 3654
SPACE ABOVE THIS LINE FOR RECORDER'S USE
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RELEASE OF COVENANT AND AGREEMENT
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The Director of Building and Safety does hereby terminate the covenant and agreement recorded on the Seventh
day of May, in the year 1997, as Document # 19970212958, Records of the County of Orange, affecting the
property, legally described -as follows:
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APN: 24-153-18
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ADDRESS: 119 Main Street, Huntington Beach
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OWNER(S): Frank Alfonso
This covenant and agreement can be terminated for the reason: The above referenced building had been
inspected subject to the Huntington Beach Municipal Code, Chapter 17.16 and has been removed from the
hazardous classification. The structure has been retrofitted and fmalled on 11/18/99 under permit B065 727.
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Prepared 11/19/99 by:
CITY OF HUNTINGTON BEACH
I CA-1 ,(
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Khanh Nguyen
Permit and Plan Check Manager-
. 1 a _.�. i ............ ... r.. a..... ♦. . .. ... ... ....
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.... ..— ....-_ . � Ys _.-' ...«r .�,.....as .,.u.. .. ..
(State of California, County of Orange)
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- - Public personally appeared Khanh Nguyen, -personally known to
Onj 9 q9 before me, Lisa Koch, Not , p y PP
me to be the person whose name is subscribed to the within instrument and acknowledged to me that he
executed the same iii his capacity, and that by his signature on the instalment the person, or the entity upon
behalf of which the person acted, executed the instrument. - -
- -'%gTNESS my haiid and official seal. USAE. KOCH
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Commission #t 1171130 Z
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Notary Public- CaliforniaOrange County
%--;MyCornm.ExphmJan26,2002
Signature
G:\buitdinglcovenantVelease\119main.doc 02/10100
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