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APPLICATION FOA r;ERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNr1NGfON awl
(PRINT OR TYPE ONLY) DATE
Address -Z �-1 Z%— !��—«�d�64Z_ District
Business Name Al" -1 k-L4 �' .t?tl�/Nx /��1� 'i �O 4 Te 7�y �— /-7 O
Business Type Occ. Grou
P
BUILDING OWNER BUSINESS OWNERIMANAGEr3_
Name Name d=,PJ j;7
Address 2��� ��J,g �}sZn L/L) Home -�
CityLl�f3 %"
/ Home Tel.
THIS USE WOULD BE DESCRIBED A5:
(7( G�t'y=-112a
❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER CHANGE OF OCCUPANT
EXISTING BUILDING ❑ C{hANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, it any AVM- �� 4 , 'eZ- t- f-j- P
_ Occupancy Gr.-Div,
SQUARE FT. OF BUILDING TO BE OC3QR �� U` 0G
r--
NOTICE:
1. Occupancy of 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
certified safe. Ali 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 if a change may be made in the characterof 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
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 minimurn of four (4)
inches in height with one half (1/2) inco stroke, and of a contrasting color from the background. These
numbers must be posted on your huildiag in a location that is visible from the street.
5. Huntington Beach Fire Code Section 1C.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
�t -:1-V Ai jj h
TRAFFIC IMPACT FEE _.______-- _ --
DATE PAID _
AitROUPdT RECEIl+ED
(FOR OFFICE USE ONLY)
NAMET ) l G
ZONIN-
OCCUPANCY GROUP 1 _ PL/,s! CHECK N - Q� � INO PARKING SPACES
OCCUPANT LOAD PERMIT NO HEALTH DEPT APPROVAL-
NO. OF STORIES - ADMIN ACTION UTILITIES RELEASED
APPROVED BY
75-039 Rev.1/97
CERTIFICATE OF OCCUPANCY FEE $
DATE CHANGE OF USE OR OCCUPANCY FEE $
TOTAL $
to �P.fil, 1 i *. iii G C� ::1;'.'.�c•..:T
APPLICATION FOR CERTIFICATE OF OCCUPANCY
FIRE EXTINGUISHER REQUIREMENTS
A. APARTMENT BUILDINGS (5 OR MORE UNITS): One (1) 2A rated extinguisher, to b,. 'ocated on
each floor level so as not to exceed 100 feet of travel. Two or less apartment units on an upper level
may be serviced by the extinguisher on the next lower level
B. INDUSTRIAL AND COMMERCIAL BUILDINGS:
(i) LIGHT HAZARD - fMay include offices, schoolrooms, churches, assembly halls, tele-
phone exchanges, etcl - One (1) 2A rated extinguisher is required for each 6,000 square
feet of floor area, or a portion thao3of.
(2) ORDINARY HAZARD - (May include mercantile storage and display, auto showrooms,
parking garages, light manufacturing, warehouses not classified as extra hazard, school
shop areas, etc.) - One (1) 2A rated extinguisher is required for each 3,000 square feet of
floor area or a portion thereof.
(3) EXTRA HAZARD - (May include woodworking, auto repair, aircraft servicing, warehouses
with high -piled ;over 15 feet in solid piles, over 12 feet in piles that contain horizontal chan-
nels) combustibles, and processes such as flammable liquid handling, painting, dipping,
etc.) - One (1) 3A rated extinguisher is required for each 3,000 square feet of floor area, Cr a
portion thereof. Certain extra hazardous uses and/or processes may require additional fire
protection systems. An on site inspection will be required to ma. e the determination.
C. SERVICE STATIONS: Are required to maintain one (1) 10BC rated extinguisher within 75 feet of travel
of the dispenser cabinets, and one (1) 2A rated extinguisher on the premises.
D. Fire extinguishers for commercial and industrial buildings are to be located so as to maintair, a maximum
distance of travel of 75 feet.
IMPORTANT: PLEASE READ THE FOLLOWING CAREFULLY
You may purchase this extinguisher at any hardware store and a number of department of discount stores, or
you may purchase your extinguisher from an extinguisher service company, which may be found under "Fire
Extinguishers" in the yellow pages of your phone book. The extinguisher is required to be serviced when new
and annually thereafter. The Hardware, department and discount stores usually are NOT licensed to service
extinguishers. Therefor:, you should expect an additional expense to have your new extinguisher certified by
an extinguisher service company if you purchase it from one of these stores.
If you have any questions regarding 'ihe inspection or fire extinguishers requirements, please feel free to con-
tact the Huntington Beach Fire Department Fire Prij�.entjon Bureau at (714) 536-5411.
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS — AG��72 �-z �y ��SPt� -1f
2.
Person to contact in case of emergency
Telephone number: —T2 D
3.
Does the building in question have electricity?
JA Yes
❑ 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?
❑ Yes
No
6.
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
0,No
If Yes:
(a) Describe the components repaired or replaced.
Yes
(b) Does the operation involve the use of an open flame?
0
7.
The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
.❑9 RY,es
8.
The following best describes my operation;
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Medical / Dental
Other (describe)
SUPPLEMENTAL NFORMATiON
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the follovIng materials? ❑ Yes
No
If Yes, indicate quantities:
Material Quantity
1. Flammable liquids
Class I -A
Class I-B
Class I-C
2. Combustible liquids
Class II
Class III -A
3. Combination flammable liquids
4. Flammable gases
5. Liquefied flammable gases
6. Flammable fibers - loose
6
7. Flammable fibers - baled
8.
Flammable solids
9.
Unstable materials
10.
Corrosive liquids
11.
Oxidizing material - gases
12. Oxidizing material - liquids
13. Oxidizing material - solids
14. Organic peroxides
15. Nitromethane (unstable materials)
16. `Ammonium nitrate
17. Ammonium nitrate compound mixtures
con .-aining more than 60% nitrate f
by weight
` 18. Highly toxic material and
poisonous gas
19. Smokeless powder
20. Black sporting powder
I hereby certify that the above information is true and correct to
the best of my knowledge.
i
�Slgn�ature Date
South Coast
Air Quality Management District
y,„ O 21865 E. Copley Drive, Diamond Bar, CA 91765-4182
(909) 396-3529 • http:/h"iiv.agmd.gov
Air Qualify Permit Checklist
California State Law Code 65850.2 prohibits cities from issuing an occupancy permit without
clearance from the local air quality agency. This checklist will determine if you need to obtain
clearance from the South Coast Air Quality Management District (AQMD).
Company Name: %j? l-1 /7 17411tll—< TD D 4
Property Address: /,17Z 7 2 /S Z,1�Z /i%as S
City: - Zip Code: Z Y-7 —
Contact Person: ?5 /L."D Title: �j2ES
Type of Business: /9 Telephone: ( )_
Applicant (print name) Signature:
• Will the facility have any of the following equipment? YES[ j NOf
Charbroiler
Dry Cleaning Machine
Spray Booth
Printing Press (screen/lithographic/flexographic)
Internal Combustion Engine (greater than 50 BP (excluding motor vehicles)
Boiler/Combustion Equipment (greater than 2MM BTU/hr. maximum input)
Abrasive Blasting Cabinets,Rooms
Baghouse/Cartridge-Type Dust Filter/Scrubber
Motor Fuel Storage & Dispensing Equipment
• Will any of the following operations be performed? YES[ ] NO
Application of Paints and Adhesives
Etching, Plating, Casting or Melting of Metals
Plastic Molding, Extruding or Curing
Mixing and Blending of Liquids and/or Powders
Storage of Acids, Solvents, Organic Liquids or Fuels
Production of Fumes, Dust, Smoke or Strong Odors
If you answered "NO" to both questions, this checklist is your clearance from AQMD. If you
answered "YES" to either question, you must contact the AQMD to determine if air quality
permits are required. If permits are needed, AQMD will assist you in submitting f ermit
application(s) and then provide you with a clearance letter. If you have any questions, please call
AQMD's Small Business Assistance office at (800)-CUT-SMOG, and press 41.
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