HomeMy WebLinkAbout15202 Pipeline Ln - CofO (3)V
s APPLICATION FOR CERTIFICATE _OE-OL
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPM NT DATE l'
HUNTINGTON BEACH (PRINT OR TYPE ONLY)
/Address P ��L� E LN1 "I District
Business Name � / &Z Tel.
Business Type. "Vs,r'e A-1 S' Occ. Group
BUILDING WNER BUSINE WNERIMANAGER d
---Name i—Name )
�,idress
City
Tel. City %d v Nome
)
THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG, IJ CHANGE OF OWNER CHANGE OF OCCUPANT
'EXISTING BUILDING -tf CHANGE OF USE
y ❑ ADDITIONAL OCCUPANT
Indicate former use, if any_Occupancy Gr. Div.
'SO UARE FT. OF BUILDING TO BE OCCUPIED—
NOTICE: 1. Occupancy of any building is prohibited and a business license will not 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
I� certified safe. All applicants for occupancy in an existing building are required to schedule an electrical
t fuse up' inspection in the Department of Community Development at the time this application is filed.
I 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 made in the character of occupancy oruse of the building
or premises which would place the building in a different division of the same group oficccupancy or in a
Q Ul/ different group of occupancy, a change of occupancy inspection fee of $ shall
1 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 contrasting color from the background. These
r numbers must be posted on your building in a location that is visible from the street.
Huntington Beach fire Code Section 10,301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
TRAFFIC IMPACT FEE ---L, — No /hd�*-s1wvj& dll
DATE PAID --
AMOUNT RECEIVED
NAME (FOR OFFICE USE ONLY) ZONING I -
SUPPLEMENTAL INFORMATION �
OCCUPANCY GROUP--- ^�/--- PLAN CHECK NO. NO PAR'<ING SPACES
OCCUPANT LOAD PERMIT NO. _ HEALTH DEPT. APPROVAL
NO. OF STORIES —. ADMIN. ACTION_ UTILITIES RELEASED
i
�- CERTIFICATE OF OCCUPANCY FEE y G
nO ED BY DATE CHANGE OF USES OR OCCUPANCY FEE g
(/ TOTA/w� I� $
75.039 Rev. 11190 COMMUNITY DEVELOPMENT
SUPPLY:M ENTAL INFORMATION
1.
BUSINESS ADDRESS /2-4/* J� ZA!%�
�
2.
Person to contact in case of emergency-
Telephone number: Tim S 7- 1!0 s
I ,
3.
Does the -building in question have electricity?
Yes
❑ No
I
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
4.
The building is sprinklered?
' El Yes
�y/
`� N O
5.
Operations will produce dust/wood shavings or `similar
material?
13 es
No
6.
Operations will involve the repair or replacement of
❑ �Ges
automobile , parts?
No
If Yes:
(a) Describe the components repaired or replaced.-
(b) Does the operation involve tCle use of an open
flame'?
❑ es
NO
7.
The business is drinking, dining or assembly use that
will
result; in an occupant load- of more than 50 persons.
El Yes
45'No
8.
The following best describes my operation,
Office ` Only
Retail Sales
Warehouse
}
.Manufacturing / Distribution ,describe.. process and end
product)
AIA /) a fA e Zi 2i'�1g /,� i✓� ssc. i v' v
�a
Restaurant / Take Out Foos
Medical / Dental
Other' (describe) _
1;
�I
i�
4
SWPLEMENTAL INFORMATION
SUPPLEMENTAL INFORMATION (Continued)
- Does
the operation involve any of the following materials? ❑ Yes
{
❑ No
If
Yes, indicate quantities:
1
Material Quantity
1.
Flammable Iiquicrs
Class I-A�
Class I-B Nd
Class I-C X U
.
2.
Combustible liquids
Class 11
Class 111-A
3.
Combination flammable liquids �(/D
4.
Flammab!e gases,U
I
5
Liquefied flammable gases
6.
Flammable fibers - loosed
- 7.
Flammable fibers - baled
S.
Flammable solids
9.
Unstable materials
10.
Corrosive liquids //p
11.
Oxidizing material - gases Al
12.
Oxidizing material - liquids
13.
Oxidizing material - solids o
14.
Organic peroxides NO
15.
Nitromehiar,? (unstable materials) VO
16.
Ammonium nitrate P
17.
Ammonium nitrate compound mixtures `
'containing more than 60% nitrate
by weight
18.
Highly toxic material and
poisonous gas
'19.
Smokeless powder 110
20.
Black sporting powder Al,:::?
,
i
I hereby certify that the above information is true and correct to
z
the st of my knowledge.
Date ignatur
?
i
�t
SOUTH COAST AIR QUAL?TY MANAGEMENT ENT DISTRICT
(Nonresidential Buildings Only)