HomeMy WebLinkAbout101 Main St - CofO (66)jMe APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENTOF COMMUNITY DEVELOPMENT 4310
HUNTPIGTON BEACH O
(PRIi7TOATYPE ONLY) ATE
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Address lot MST � 6^�" �j Q
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Business Name V C—STia Go} lotTn L 50— z-
' Tel ��
Business Type _J V�T M�� I
Occ. Group !
1 p�BUILDING OWNER / BUSINESS OWNER/MANAGER �
Name 0� �J I I Name_.a4e17u /R-AJ!� #
Address p1 i� S (� Address Home 6 i £/.1 VIA 4ier2$A a
City 61hJ12J67Gt115101 224-Yirel City MAIM M2BA2fl C-14 Home Tel _
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THIS USE WOULD BE DESCRIBED AS:
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{{❑��' NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER ❑ `CHANGE OF OCCUPANT
YEXISTING BUILDING % ❑ CHANGE OF USE ❑' ADDITIONAL OCCUPANT
Ind" ,ate former use, if any Occupancy Gr. Div.
SQUARE FT, OF BUILDING TO BE OCCUPIED
NOTICE: 1. Occupancy of anybuilding 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
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.
3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a building or
premises in order to determine ita change may be made in the character of occupancy or use of the building F
or premises which would place the building in a different division of the same group of occupancy orin 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 in height with one half (1/2) inch stroke, and of a contrastinq color from the background. These
numbers must be posted on your building in a location than is visible from the stree';.
5, Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the p
National Fire Protection Association pamphlet 10 (see reverse side). I
TRAFFIC IMPACT FEE
DATE, PAID
AMOUNT RECEIVED'
NAME (FOR OFFICE USE ONLY)
ZONING
OCCUPANCY GROUP_g PLAN CHECK N NO PARKING SPACES
OCCUPANT LOAD _ PERMIT NO. HEALTH DEPT. APPROVAL
NOST IE ADMIN. ACTION UTILITIES RELEASED
6 ®/CERTIFICATE OF OCCUPANCY FEE g
A R ED Y' DATE CHANGE OF USE OR OCCUPANCY FEE $ 1
TOTAL $
75-039 Rsv.1/97 COMMUNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS 1 BSI� Q
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Personto contact in case of emergency' 6"y Ayp-/j E
Telephone number:�6�,�
3.
Does the building in question have electricity?
FY` es
s-
No
(a) If No, are you requesting that the electricity be
❑ Yes€
turned on?
❑ 'No
I
4.
The building. is s,prinklered?
IF�s
-
❑ No
5.
Operations will produce dust/wood shavings ' or >similar
material?
❑ Yes
:{
U-No
E
6.
Operations will involve the repair' or replacement of
❑ Yes
�r
automobile parts?
�1
l
Ia
If Yes: _
(a) Describe the components repaired or replaced`.
(b) Does the operation h1volve the, use of an open flame?
❑ Yes
�o
t
7.
The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
Yes'
R 3.
The fo�lgng st describes my operation;
�ffice Only
les
a
Warehouse
Manufacturing / Distribution (describe ;process and end product)
Restaurant/Take Out Food
Medical / Dental
Other (describe)
1
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e
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SUPPLEMENTAL INFORMAT101IN
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SUPPLEMENTAL INFORMATION' (Continued)
Does the operation "involve any of the fohowing materials? D Yes
r
If
Yes, indicate quantities:'
Material Quantity t
1.
Flammable liquids
Class I -A
Class I-B
Class i-C
2.
Combustible liquids
Class 11
Class 111-A
3.
Combination flammable -,liquids l
4.
Flammable gases l
5.
-Liquefied flammable gases F
6,
Flammable fibers - loose
Flammable fibers - baled
8.
Flammablesolids
'
9.
Unstable materials
10.
Corrosive liquids -
11.
Oxidizing material - gases
;
12.
-Oxidizing material - liquids
13.
f?xidizingj, material - solids ._
1�4.
N'L=
Organic peroxides
15.
Nitromethane (unstable mate ais)
16.
_ l
Ammonium 'nitrate
17.
Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight M
18.
Highly toxic material , and
a'
poisonous gas
19,
-Smokeless .powder
20.
Black_ sporting powder
s
I hereby ceilify that the above information is true and correct to
the best o my �knovtledge. ;
-Z4
Signature at
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South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond. Bar, CA 91765-4182 (909) 396-2000
I ,
AIR QUALITY PERMIT CHECKLIST
for nonresidential buildings only
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Company Name: _
p Y
Location of Property;
City:-1A A. Zip Code:
�`, r �
Contact P erson:Q./- y Title: _i3Ouar.���- w
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Telephone Number: ��a�� 6 L Fax Number: � v�e54 7o zl
Type of Industry/Business: - I &I U(r* TC ,715
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 i2
I. Will the facility have a charbroiler?
2. Will any _ temal combustion engine with greater than 50 horsepower{
operate at the facility (excluding, motor vehicles)?
3. Will operations at the facility involve mixing, blending, or processirg of
solvents, adhesives, paints or coatings? [ ] [.-
4. Will dust or smoke be generat d P, the facility? [ ] [
5. Will refiningf any liquids ur sc ' 1� be done at the facility? [ ] [
6. Will any plating or coating of materials be done at the facility? [ ] [
7. Will any combustion.equipment: rated greater than 2,000,000 $TU/hr be
operated at the facility?
L 8. Will any acids, solvents, or motor fuel be used or stored at the facility?„
9. Will any organicliquids 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 facili
Applicant 6 d Signatures ^ _---•.,.
(Print name' clearly)
If you have marked "NO" in all the boxes, an air quality penrut is IIQt needed at this ti=e,
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) 388-2121
>� ADDITIONAL SUPPLEMEN iAL.INFORMATION
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