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CERTIFICATE OF OCCUPkNCY
CITY OF HUNTINGTON BEACH
Date
Address i 1 atF9 t iI
i 1 f District
F
Mi TAXI
-7872
Business Name
Tel.
CLG`i'a ILL
Business Type
B-2
Occ. Group
BUILDING OWNE? t
BUSINESS OWNER/MANAGER
C:LFtiii LI�t%I'c"t
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Name
Name
11 2 I%
Home , f] F:TI .` x
Address
Address
C, Home 714-. 960— P72
City Tel.
City TeL
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Consil action No. of Stories
Occupant Load Sprinklers
CONDITIONS OF APPROVAL
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DEPAFTrMENT OF COMMUNITY DEVELOPMENT'
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This Certificate of Occupancy
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SHALL BE posted in a conspicuous place on the
by the
premises and shall not be removed except
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Building Official.
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COMMUNITY DEVELOPMENT
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APPLICATION FOR CERTIFICATE OF OCCUPANCY
1 CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT ?5 DDAI
Hu NGTON BrAOT (PRINT OR TYFE ONLYI -
Address District �t-��7- /
t /�l, t Tel ''3 �1Vv �g�2.
Business Name I r
�Occ. Group
Business Type
r I a4M.✓l�
BUILDING OWNER BUSINESS OWNEWMANAGER
Taco
Name (�C�r �� W Name l�Ylr {- j
l Home � �l '� � I I
AddrE,3s_ wit ` Address ,f
� I Tel __ City ' r `� ' ' Nome Tel--- - r
City G[ fo0 --7 2 f
THIS USE 'S."•,OW_D BE DESCRIBED AS: t
❑ NEWLY CONSTRUCTED BLDG:
CHANGE OF OWNER CHANGE OF OCCUPANT
EXITING BUILDING El CHANGE OF USE ❑ ADDIT'.ONAL OCCUPANT a
Occupancy Gr Div
Indicate to .,)er use, if any �
SQUARC FT OF BUILDING TO BE OCCUPIED
NOTICE: 1 Occupancy of any building is prohibited and abusiness 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
I certified safe. All applicants for occupancy in an existing building are required to schedule an electrical
'fuse up' inspection in the Department of Community Development at the time this application is filed.
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3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a building g
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
` q different group of occupancy, a change of occupancy inspection fee of $ shall
be paid to the city. t
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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 ('/x) 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. 1
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).
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(FOR OFFICE USE ONLY) ZONING
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SUPPLEMENTAL INFORMATION r . j;
1 PLAN CHECK NONO. PARKING SPACES i
OCCUPANCY GROUP HEALTH DEPT APPROVAL -
OCCUPANT LOAD PERMIT NO.
ADMIN. ACTION
z7�-7 UTILITIES RELEASED
NO A
OF SSTIZII i
C�
CERTIFICATE OF OCCUPANCY FEE $
APPROVED DATE CHANGE OF USE OR OCCUPANCY FEE $
/ TOTAL $
75•o39Rev. 1T/9b COMMUNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS
2.
Person to contact in case of emergency''
Telephone number:
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
4.
The building is sprinxlered?
Yes
c❑
'vo
5.
Operations will produce dust/wood shavings or similar
material?
Yes
(❑
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6.
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
o
If -Yes:
(a) Describe the components repaired or replaced.
t
flame? ❑ Yes
(b) Does the operation involve the use or an open
:
❑ No f s
7.
The business is drinking, dining or assembly use that
will
result in an occupant load of more than 50 persons.
❑ Yes
O
8.
The following best describes my operation;
Office Only
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Warehouse
Manufacturing / Distribution (describe process and end product)
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Restaurant / Take Out Food
Medical/ Dental
;
Other (describe)
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SUPPLIMENTAL INFORMATION
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SUPPLEMENTAL INFORMATION
(Continued)
Does
the operation involve any of the follow,4119
if Yes, indicate quantities:
Quantityterial
1. Flammable liquids
Cla,-,s [-A
Class
Class { C
2.
Combustible - liquids_,..
Class
Class III - A
3.
Combination f{ammable liquids
&.
FEamnai�le gases
5.
Liquefied flammable gases
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6_
Fiar��mal�le fibers -loose
Fiammab{e fibers baled
8,
Flammable solids
9.
Unstable materials
10,
C'crrosive liquids
11.
Oxidizing material - gases
12.
Oxidizing materia{.- liquids
13.
Oxidizing material solids
14,
Organic peroxides
15.
Nitromethane (unstable materials)
16.
Ammonium nitrate
1i.
Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight _
18.
Highly toxic: material and
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poisonous gas- -----
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19.
Smokeless powder
----- -- i
20.
Black sporting powder
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1 hereb, --certify that u e--�above i rmation is
true and correct to
the p St of mY ledge.
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Signature
Date
Y
.'` . City of Huntington Beach
2000 MAIN STREET~ CALIFORNIA92648
DEPARTMENT OF COMMUNITY DEVELOPMENT
Building Division 536-5241
Planning Division 536.5271'
• Government Code Section 65850.2(b) requires the City of Huntington
Beach Building Division not to issue the final certificate of
occupancy unless the applicant has met or is meeting the
requirements of the South CoastAirQuality Management District
(AQMD). The Building Division must obtain a written release from
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AQMD to show the applicant has complied with this law. The check
list on the reverse side is designed to help the applicant and the
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building division to meet these requirements.
1. The applicant (the same person who applies for permits from
the Building Division) must complete the check list which
can be obtained either at the Building Division or at AQMD.
2. If all boxes in the list are checked "no", the Building
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Division can accept the check list as the release.
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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.
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9. If air permits are not required, the applicant will obtain
a written release from AQMD:,
5. if air permits are required, the applicant must submit the
necessary permit applications before the release can be
issued
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Because of the time it may take for AQMD to go through the above
procedures, the; applicant is advised to contact, AQMD immediately
after applying for Building permits.
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(1360D)
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SOUTH COAST AIR QUALITY MANPGEMENT DISTRICT
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(Nonresidential Buildings only)
Location, of Subject Property; (�'i t(Z
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Property O,- ner Name:• � -ci E (3 C4 Phone it
Marne of theI Person, Preparing form in print and sigria -ure
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Name:_ 11t� f1✓�� HnrrOGG� Sig n1'ture
_he person preparing this form must be the same person applying
for.
- -wilding permits. Please answer the following questions regarding
--ur croposed occupancy of the subject building. IF YOU DO NOT
KNOW
-;; SWE}2 TO A QUESTION MARK IN THE "YES" COLUMN
AOMD PERMITTING CHECKLIST
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YES
NO ,
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1. Does your facility ;use any internal combustion.
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engr.;es greater than 50-11P?
2. Does your facility involve mixing, blending, or
Processing any solvents, adhesives, paints
3r ccaf :.ngs?
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3. Does your facility create any dusts or smoke?
4. :Jaes •your facility refine any liquids or solids
or.re- -'aim any metals?
S. Does your facility plate or coat anything?
6. Does .our facility have any combustion equipment
?,e. ooiler., furnaces, broiler, baking ovens,
etc.) rated greater than 2,000,000-BTU/11R?
7. Jots your facility handle or store solvents or
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motor _uel?
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B. Do ycuse or store: any acids?
9. Do yc use any chemical process? -
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s . yc _, us(� any solvents for clean-up?
cleaner, restauLant with a
l char :oiler, body shop, gasoline station,
F p, z,,t_'er,nr parr crater? y
,
:? I5 tt.e subject building located within one
-:ne is and (1,000) feet of any school?
ROPERTi'LINE TO PROPERTY LINE. GRADES K-12,
-= ychave marked "'NO" in all columns; you do not need an Air
s
~.-ali-y permit at this time. If you have marked any questions in
0 "':ES" Column you must contact the South Coast Air Quality'
..4ar= ^errt District located at:
21665 E. Copley Drive
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)iamond Ear, CA 91765-4182
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- eas4 call:" elan Check (714) 396-2000-
(1360d-2)
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