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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH t
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNTINGTON REACH DATE
(BRINY OR TYPE ONLY)
1
I 4 District
Address i
22
Business Name
Business Type _ Occ. Group
BUILDING OWNER BUSINESS OWNERIMANAGER
Name Name C*_
�Cof Home
Address _j Address
City __Tel City � C Home Tel
THIS USE WOULD BE DESCRIBED AS:
F ❑ F NEWLY CONSTRUCTED BLDG. ❑ CHANGE 0 OWNER CHANGE OF OCCUPANT
EXISTING BUILDING ElCHANGE OF USE ❑ ADDITIONAL OCCUPANT
{
Indicate former use, if any Occupancy Gr. Div.
SQUARE FT. OF BUILDING TO BE O' CUPIED -
NOTICE: 1. Occupancy of any building is prohibited and business license will not be issued until the building has been
inspected and a certificate of occupancy is issued.
I, 1 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 requil id to schedule an electrical
'fuse up' inspection in the Department 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 characterof occCupancy 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
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 III 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.
9 � oel�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).
� a1L "TU *�GTAi� CLtFOrz_ Llk+✓ (✓ G>� _ ct
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION ZONING
OCCUPANCY GROUP 46 PLAN CHECK NO, NO. PARKING SPACES
OCCUPANT LOAD PERMIT NO. HEALTH DEPT, APPROVAL
NO. OF ST E - ADMIN. ACTION UTILITIES RELEASED
7//q/f?CERTIFICATE OF OCCUPANCY FEE $
A ROVED U TE CHANGE OF 'Ust OR OCCUPANCY FEE $ j
`.
TOTAL $
I
MUNITY DEVELOPMENT
75-039 Rev.1'1790 COM
SUPPiLEMIFNTAL INFORMATION
1.
BUSINESS ADDRESS ZI L-�----"
2.
person to contact in case of emergency,
Telephone number:
—
r 3.
Goes the building in question have electricity?
Yes
0 No
-
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
❑ Yes
No
5.
operations will produce dust/wood shavings or similar
material?
El Yes
No '.
6.
Operations will involve the repair or ` replacement of
❑ Yes
automobile parts?
No
If Yes:
(a) Describe the components repaired or replaced.
❑ Yes
(b) Does the - operation involve the use of an open
flame?
1 No
7.
The business is drinking, dining or assembly use that
wlil
L7 `des
result in - an occupant load of more than 50 persons.
No
8.
The -following best describes my operation;
Offer nI
tail Sal
<___-Ware Ouse
Manufacturing I Distribution (describe process- and end product)
Restaurant /Take Out Food
Medical / Dental
Other (describe)`
SUPPLIMEWAL INFOFtMATtt1N
i
`I
1
r
Property Owner Name:fl- 4C482 Phone #
Name of the Person Preparing this form in_prin(t n signature
Named_ ���-��' Signature:
The person preparing thisformmust be the same person applying
for
building permits. Please answer the following -questions regarding
your proposed occupancy of the subject building. IF YOU DO NOT
'KNOW
THE ANSWER TO A QUESTION MARK IN THE "YES" COLUMN:
AQMD PERMITTING CHECKLIST
..
YES
NO
1. Does your facility use any internal, combustion
h'
engines greater than 50-HP?
/
2. Does your facility involve mixing, blending, or
processing any solvents, adhesives, paints
or coatings'!
3.. Does your facility create any dusts or smoke?
4. Does your facility refine any liquids or solids
,
or reclaim any metals?
X
5. Does ,your facility plate or coat anything?
6. Does your facility have any combustion equipment
i.e. boiler, furnaces, broiler,_ baking ovens,
,
etc.) rated greater than 2,000,000 BTU/HR?
_
7. Does your facility handle or store solvents or
motor fuel?
-8. Do you use or store any acids?
-
�
�I
9. Do you use any chemical process?_
l
10. Do you use an solvents for clean-up?
Y Y
11. Are you a dry cleaner, restaurant with a
charbroiler,'body 'shop, gasoline station,
printer, or part coater?
12. Is the subject building located within one
thousand (l, 0100) feet of any school? -
x
PROPERTY DINE TO PROPERTY LINE. GRADES K--12.
If you have marked "NO" in all columns, you do not need, an Air
Quality permit at this time. If you have marked any questions
in
the "YES" Column you must contact the South Coast Air Quality
Management District located at:
21865 E, Copley Drive
Diamond Bar, CA 91765-4182
Please call: Plan Check (714) 356-2000
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