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1120 Pacific Coast Hwy - CofO (18)
13 /2 -APPLICATION FOR CERTIFICATE OF OCCUPANCY CITY OF HUNTINGTON BEACH DEPARTMENT OFCOMMUNITY DEVELOPMENT vi`l I q�2 HUNi1NUTON: aF4O1 (PRINT OR TYPE ONLY) t DATE F Address ( a(y Ptitct I e CnfSScr t It.-4 WA- 4 G3C , -kk1Xrrf1,T& C49 'khCa-District e�, BusinessName, _i I re �, S L° S r�rR3 r s Tel C'Itk4 2 �n Business Type Hflt t err )( z LA 1.3'mX. C0 - _ Occ. Group _ BUILDING OWNER BUSINESS OW . RiMANAGER Name It SoP-C eyZ py_kg \ Name n►kR5_Lktla-3 (j_4Q.0jNt Address _ Address 11 2[f NNO r FIc Ct^,tcSS OttK�4 i HomeCCA G _ I lls 14c I �� City �_. LLr;S "a 41-Vati9X T l ei_� ���L City f 1 'i 0 G-4—r-0 1�COct_ - Home Tel. 0 THIS USE WOULD BE DESCRIBED AS: i NEWLY CONSTRUCTED BLDG ❑CHANGE OF OWNER CHANGE OF OCCUPANT 9y ® EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT Indicate former use, it any I Cyr 1��- Occupancy Gr Div _ } SQUARE FT. OF BUILDING TO BE OCCUPIED I t &n ) 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. All applicants for occupancy in an existing building are required to schedule an electrical `fuse up' inspection i'r, the Department of Community Development at the time this application is filed. 3, Change of occupancy ,)r'ise inspection fee. Whenever it is necessary to make inspection of building or r premises in order to deterr..ine if a change may be made in the character of occupancy or use of the building or remises which would lace the building of p p g in a different division of the same group of occupancy or in a 2 different group of occupancy, a change of occupancy inspection fee of $ shall be paid to the city, a \ 4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum of four (4) I I cl- inches inheight with one half (Yz) inch stroke, and of a contrasting color from the background. These "\ q numbers must be posted on your building in a location that is visible from the street. \ 5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the k ' r National Fire Protection Association pamphlet 10 (see reverse side): t (FOR OFFICE USE ONLY) SUPPLEMENTAL INFORMATIONn ZONING E OCCUPANCY GROUP—. PLAN CHECK NO. _ NO PARKING SPACES OCCUPANT LOAD PERMIT NO HEALTH DEPT APPROVAL ;I NO. OF STOff ES ADMIN. ACTION UTILITIES RELEASED CERTIFICATE OF OCCUPANCY FEE Aff ROVED D E CHANGE OF USE OR OCCUPANCY FEE $ r` TOTAL $ f, 75.0.19 Rev, 11/90 COMMUNITY DEVELOPMENT r c s SUPPLEMENTAL INFORMATION 4 1. BUSINESS ADDRESS ( IIn ��e;�t� Ct�CC� k:!ILiu v,� 2. Person to contact in case of emergency. �Rt� Telephone number. 3. woes the building in question have electricity? ❑ No i (a) If No, are you requesting that the electricity be ❑ Yes ❑ No turned on? Yes ► 4. The building is sprinklered? ❑ No 5. Operations will produce dust/wood shavings or similar ❑ Yes material? ®No 6. Operations will involve the repair or replacement of ❑Yes 12 No automobile parts? If Yes: !a) Describe the components repaired or replaced. flame? ❑ Yes No �) Does the operation involve the use of an open r 7. The business is drinking, dining or assembly use that will ❑ Yes a result in an occupant load of more than 50 persons. No 8. The following best describes my operation; f �ffice Only ► REatai4 ,ales Warehouse Manufacturing / Distribution (describe process and end product) Restaurant / Take Out Food Medical / Dental f, Other (describe)' r SUPPLIMENTAL INFORMATION - - i E SUPPLEMENTAL INFORMATION (Continued) Does the operation involve any of the following materials? if Yes, indicate quantities: Quantity Material Flammable liquids Class I -A ------------- Class I-B Class I-C 2. Combustible liquids Class Class 111-A 3. Combination flammable liquids 4. Flammable gases 5. Liquefied flammable gases 6. Flammable fibers - loose 7. Fianimable fibers - baled -- T---T-J-ammable -solids 9. Unstable materials -0. :corrosive liquids 11. Oxidizing material - gases 12. Oxidizing material - liquids 13. Oxidizing material - solids 14c Organic peroxides 15. Nitromethane (unstable materials) 16. Ammonium nitrate 17. Ammonium nitrate compound mixtures containing more than 600[o nitrate 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. Signature Date A 1 ®� �'f '{{ 1 t � �f Huntington e CALIFORNIA92648 STREET 2000 MAIN # j DEPARTMENT OF COMMUNITY DEVELOPMENT { � ? P re Building. 536-5241 Planning 536-5271 I'loua Fig 536-5271 Section 65850.2(b) requires the City of Huntington { lr Government Code not to issue the final certificate of Beach Building Division unless the applicant has met or is meeting the,, Management District occupancy requirements of the South Coast Airmust Quality a tlawen echeck (AQp;D), The Building1Divisios compl�edaw th thisin relThe the AQMD t:o show the -app the applicant and side is designed to help list on the reverse building division to meet these requirements., F, a 1 The applicant {the same person who applies £or permits from check list which �. the_ Building Division) must complete the the Building Division or at AQMD. can be obtained either at in the list are checked "no", the Building 2. If all boxes the check list as the release. Division can accept 3. If there are any "yes" answers in the list, the applicant (714) 396-2000 to must contact an AQMD engineer by calling permits, are 'required for the proposed Ir �Y find out whether air construction project. 9, permits are not required, the a?�.':icant will obtain; If air a written release from AQMD. 5, IF air permits are required, the applicant must submit the the release can be necessary permit applications before issued. k, t Because of the time it may take for AQMD to go through the above AQMD immediately k procedures, the applicant is advised to contact h It after applying for Building permits,. I i (1360D) i Y lc I r SOUTH COAST AIR QUALITY 'MANAGEMENT DISTRICT J (Nonresidential Buildings Only) i Location of Subject Property: 113n PP{ it �c C'c+�aG^ ftrt.tr��� :4 k� Name:, 0A-W0LI Qr E0 N041491 `r Phone Property O,.;ner Lame of the Person Preparing this form in print and signature � � �•Qc�JC� Signature: i� �©C i �-r f3-�3 game:_ '7he person preparing this form must be the same person applying for the following questions regarding { =uilcing permits. Please answer the subject building. IF YOU DO NOT KNOW cur �ropo�ed occupancy of -=E !`SVJER TO A QUESTION MARK IN THE "YEn" COLUMN: } AQMD PERMITTING CHECKLIST' + YES NO _t 1. Does your facility use any internal combustion engines greater than 50-HP? -— t 2. Does your facility involve mixing, blending, or ar.ocessing any solvents, adhesives, paints or coatings? 3. Does your facility create any dusts or smoke? - f a 4. Does your facility refine a ny liquids or solids or reclaim any metals? 5. Does your facility plate or coat anything? 6. Does your facility have any combustion equipment I.e. ooiler, furnaces, broiler, baking ovens, f etc.) rated greater than 2,000,000 BTU/HR? 7. Does your facility handle or store solvents or / :rotor fuel? �— --- 3. Do yr-J use or store any acids? ---- 9. Do yc�' use any chemical process? ------ -0. Do yc-1 use any solvents for clean-up? -l. �.re you a dry cleaner, restaurant with a chartroiler, body shop, gast-%line station, ' orinter, or part coater? ---- — 12. Is tl.e subject building located within one j thousand (1,000) feet of any school? __ --- PROPERTY LINE TO PROPERTY LINE•GRADES K-12. yo--; have marked "NO" in all columns, you do not need an Air ,_:al _, permit at this time. If you have marked any questions in __-e iyS': Column you must contact the South Coast Air Quality l•r=nac_:nent District located at: i 21865 E. Copley Drive g Diamond Bar, CA 91765-4182 ease call: Plan Check (714) 396-2000_ 1 ++, (1360d-2) y { a