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CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTi,)N BEAC4'�"`'
Date
Address
Gr ; r, tr .p c
r, i
District _
Business Name 4, ,
p
i i t .s., t t,r- ti Tel.
_ ss
Business Type It :: t r t, _
t i IN i s `
Occ. Group .,.
BUILDING OWNER BUSINESS OWNERIMANAGER
Name ',+ t i I, -
kA. f r ".% 1::!
Name ! "
Home
Addresso t `; �Y
? �y::
s Address
Ctt r! T ".:
y
Home
Tef. City Tel,
Construction
No. of Stories
Occupant Load }' Sprinklers
CONDITIONS OF APPROVAL
This Certificate of Occupancy
SHALL BE posted in a conspicuous place on the
premises and shall not be removed except by tp a
Building Official.
DEPARTMENT OF COMMUNITY DEVELOPMENT
by
i
COP°MUNITY DEVELOPMENT
u
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUN"INGTbN BEACH f C�
DEPARTMENT OF COMMUNITY DEVELOPMENT a
HUNnNGTON BUtCH (PRINT OR TYPE ONLY) DATE
Address ( ', �'" �t 6H `�� + District
Business Name j ��-1 /` f I"� t'vt Tel.
Business Type 0 I ` Occ. Group
BUILDING OWNER BUSINESS OWNERIMANAGER
Name�"� iL �r"''{��/.1 i Name
Address ��I ` E � % J D address
City t" I� City Home Tel.
THIS USE WOULD BE DESCRIBED AS:
NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
❑ EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any Occupancy Gr. Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED
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 in the Department of Community Development at the time this application is filed.
f3. 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 roade 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
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)
t inches in height with one half (1/2) inch stroke, and of a contrasting color from the background. These
t 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
National Fire Protection Association pamphlet 10 (see reverse side).
finRN0AQ1
-
SUPPLEMENTAL INFORMATION ez, (FOR OFFICE USE. ONLY) 7.ONING
OCCUPANCY GROUP �PLAN CHECK NO. NO PARKING SPACES
OCCUPANT LOAD - PERMIT NO. -9 HEALTH DEPT. APPROVAL —
NO. OF STORIES ADMIN. ACTION Id U`ILITIES RELEASED
al, C /� C CERTIFICATE OF OCCUPANCY FEE $
VED D TE CHANGE OF USE OR OCCUPANCY FEE $ _
TOTAL $ r ..
0
75.039 Rey. 6/88 COMMUNITY. DEVELP.
SUPPToEMENTAL INFORMATION
1. BUSINESS ADDRESS ! '--> i �
2. Person to contact in case of emergency:-
-Telephone number.- �2J,7,l -, r f (-
3. Does the building in question have electricity? ; Yes
ONo
a. If No, are you requesting that the electricity use Oyes
turned on? O No
4. The building is sprinklered? es
O No
5. operations will produce dust/wood shavings or similar
material? O Yes
,io
6. Operations will involve the repair or replacement of Oyes
automobile parts? ONo
If yes:
(a) Describe the components repaired or replaced.
YS
(b) Does the operation involve the use of an n f1w"? OYes N 0
i. The business is drinking, dining or assembly use that will
result in an occupant load of more than -50 persons. ®des
c�
S. The following best describes my operation:
Office Only
Retail Sales
warehouse
Manufacturing/Distribution (describe process and end
product)
)
® A e do E 7Y—&R—e--6-uToo
Medical./Dental
Other (describe) Izz-
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of. the following materials?
C-Y e s
ONo
if es, in ica a quantities:
Material Quantity
1. Flammable liquids
r 1 A S G i- A�.-----
Class I-S '
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 _-
7.
Flammable
fibers -
baled----
B.
Flammable
solids
� -
9.
Unstable
materials
10.
Corrosive
liquids
11.
oxidizing
material
-_gases
12.
oxsdi,,r.2
material
- liquids
ii_
nxidizino
material
- solids
14.
15.
16.
17.
I
I �
16.
organic peroxides
Nitromethane (unstable
Ammonium nitrate
terial
Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight
Highly toxic material and
poisonous gas
19. Smokeless powder T -A, , --
20. Black sportin powder
I hereby certify that the above information is true and correct to the
best of my knowledge.
ignature Date
(0562D)
C
1
Q
SOUTH COAST AIR'QUAL-ITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
Location of Subject Property:_ ( 5 I (o P,4(-� F ' C- C-C3 r`� S i
Property Owner name: Phone #
Name of the Person Preparing this for; in print and signature
Name KILL--� --� fi-J� _ Signature °-
The person preparing this form must 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:
SCAQMD PERMITTING CHECKLIST
YES NO
1. Does your facility use any internal combustion
engines greater than 50-HP?
2. Does your facility involve mixing, blending, or
processing any solvents, adhesives, paints !4>4j
or coatings?
3. Does your facility create any dusts or smoke?
4. Does your facility refine any liquids or solids --
Reclaim any metals?
5. Does your facility plate or coat anything? C�
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. Doesyour faclity handle or store solvents or motor
fuel.?tom! L&Q
8. Do you use or store any acids?
9. Do you use any chemical process?
10. Do you use any solvents for clean -,up?.
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
(1,000) feet of any school? EPD
PROPERTY LIRE 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 "YES01 Column
you must contact the South Coast Air Quality Management District located
at:
9150 FLAIR DRIVE, FL MONTE, CA 91731
Please call these offices: Plan Check (818) 572-6406
D:AL00603 (81.8) 572-6111, (818) 572-6261
SUPPLEMENTAL INFORMATION
],. BUSINESS ADDRESS 4,��:• �.`�
2. Person to contact in case of emergency:
Telephone number. _
3. Does the building in question have electricity? OYes
s Gito—.
a. If Not are you requesting that the electricity be 21fe—s
turned on? C %- ,
4. The building is sprinklered? Cf1es
ONo
5. Operations will produce dust/wood shavings or similar
material? OYes
Q-Wo
6. Operations will involve the repair or replacement of OYes
automobile parts? ONO -
If yes:
(a) describe the components repaired or replaced.
(b) Does the operation involve the use of an Men flame? UYes
ONO
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than •50 persons. OYes
S. The following best describes my operation:
Office Only
Retail Sales
Warehouse
Manufacturing/Distribution (describe process and end
product)
f a s,� t r� u r a n 7a e u E—Pood
Medical/Dental
Other (describe)
N.
V
SUPPLEMENTAL INFORMATION (Continued)
c
Does the operation involve any of the following materials? ❑`fie
0
es, in ica a quant ties:
Material 4uantity -
1. Flammable liquids
Class I -A
Class I-B
Class I-C
2. Combustible liquids
Class II
Class III -A
3. Combination flammable liSjuids
4. Flammable gases
Liquefied flammable gases VI
6. Flammable fibers —loose
7. Flammable fibers - baled
B. Flammable solids
9. Unstable materials
10. Corrosive liquids ----
11. Oxidizing material -gases _
12. Oxidizing material - liquids
13 Oxidizing material - solids ---
14 Organic 2eroxides _
15. Nitromethane (unstable materials)
16. Ammonium nitrate -
17. Ammonium nitrate compound mixtures
containing more than 60% nitrate
bweight
18. Highly toxic material and
poisonous gas
19. Smokeless 2owder _--
20. Black sporting powder
I hereby certify that the above information is true and correct to the
best of my knowledge.
rh:
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF,HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNTINGTON KAGi
(PRINT OR TYPE ONLY)
I
4
% "�'O--%0
DATE
R40 K
Address f C%%i c (ftVCe ST ��rictt �►
Business Name // /S 711t
Business Type ed S 7-1,�' �-'y �Q �-L Ccc. Group
BUILDING OWNER BUSINESS OWNERIMANAGER
Name�IrfeL frame < Sf�n�`-
3-- SQc�L 1�e /_9XV ��2� Home
Address Address .--�—
City Z 3EezG��Te3��0 City Home Tel. —
THIS USE WOULD BE DESCRIBED AS:
NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any Occupancy Gr. Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED
NOTICE: 1, Occupancy of any building is prohibited and a business license wiii 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 ar 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 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
different group of occupancy, a change of occupancy inspection fee of $ shall
be paid to thr city.
l r 4. Huntington Beech Fire Code Section 10.208 requires that building numbers must be a minimum of four (4)
(, inches in height with one half (1h) inch stroke, and of a contrasting color from the background. These
�/ numbers .mot be oosteJ on your building in a location that is visible from the street.
fy5. Huntington DeaLn t.re Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
J
(FOR OFFICE USE ONLY) `.11-41�
SUPPLEMENTAL INFORMATION) ZONING° L-r
OCCUPANCY GROUP ! �� PLAN CHECK NO. NO. PARKING SPACES _
OCCUPANT LOAD Jf PERMIT NO. HEALTH DEPT. APPROV.5L
NO OF STORIES ADMIN. ACTION LI,A UTILITIES RELEASED
// LS 7clCERTIFICATE OF OCCUPANCY FEE $_ �
A PROVE Y DAT CHANGE OF USE OR OCCUPANCY FEE $
TOTAL $
75.039 Rev-s199 COMMUNITY DEVELP.