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A' APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
e DEPARTMENT OF COMMUNITY DEVELOPMENT �w�t
HUKTIWAON BEACH (PRINT OR TYPE ONLY1 DATE
Address . —� la L ��-� ll� P�Q1 Q _ - ��iFj �G4 @ District-
Busin- s Name d l I� y C'�vk� Tel _ _
Business Type— (J1t �r�i�t, C� ( �� a �� �_� �� e.� J
BUILDINGOWNER
/t 'p BUSINFSS fOWNERIMANAGER
Nam
e �. O^�( J�4S $ _-mV
- Na e- ,d PV
Address Home
.35� z--—_�'-�h.�.�- G- L� ArjdreSc _ _ - ------
p soil ��c u� t C - 4J J {� ?w, li c�3 -�� 1� r .� �, rn r c, 1 Cf dzc�o,Home Tel u
City_ __--_.____-- y �i S �.- 3�40-1cc
THIS USE WOULD BE DESCRIBED AS: /
❑ 1EWLY CONSTRUCTED Bt DG ❑ CHANGE i.)F OWNER LJNCHANGE OF OCCUPANT
17) EXISTING BUILDING II_1—'j
CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, It any _ _ _Occupancy Gr Div
�G-
SQUARE FT OF BUILDING TO BE OCCUKL _
NOTICE: 1. Occupancy of any building is prohibited and a business license will not be issued until the building has been
-nspected and a certificate of occupancy is issued
2. No electrical service will ue released for any existing building until the service has been inspected and
certified safe. All applicants for occupancy in a,n 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 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
n \ different group of occupancy, a change of occupancy inspection fee of $ _ shall
�IVJ4Jj") 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 (112) inch stroke, and of a ;ontrasting color from the background. These
/ 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
l: National Fire Protection Association, pamphlet 10 (see reverse side).
TRAFFI^v i' P=.rC", C : . � . 2Er YarT R ii.rr P-4r a V'
Uratf. PAIDrir y7tx�j� �6s � �tr��s.�� Fyn. ivy
ArJIC IJP'T RE F'Va-n
NAME _.—- (FOR OFFICE USE ONLY) ZONING
OCCUPANCY GROUP- Si 'z PLAN CHECK NO __ NO PARKING SPACES
OCCUPANT LOAD PERMIT NO _ _ __ HEALTH DEPT APPROVAL
NO T STORIES ADMIN ACTION UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE $
APPROVED BY DATE CHANGE OF USE OR OCCUPANCY FEE $
TOTAL $
75-039 Rev. I/97
1 --
.. - lw� .. Fi , . lid..
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS f �if'f 1,W
2.
Person to contact in case of emergency -
Telephone number:
3.
Does the building in question have electricity?
1 Yes
(a) If are you requesting that the electricity be
No
❑ Yes
turnened on?
❑ No
4.
The building is sprinklered?
❑ Yes
5.
Operations will produce dust/wood shavings or similar
dNo
material?
Yes
No i
6.
Operations will involve the repair or replacement of
❑ V-.
automobile parts?
Nos
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operarion involve the use of an open flame?
El es
7.
The business is drinking, dining or assembly use that will
1-�- N o
result in an occupant load of more than 50 persons.
fees
8.
The following best describes my operation,
N
o
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant/Take Out Food
Me Jical / Dental
Other (describe)
d
ra
11
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials?
{es
[Qy No
If
Yes, indicate quantities.
Material Quantity
_
1.
Flammable liquids
Class i-A
Class I-B
Class I-C
2.
_
Combustible liquids
t
Class 11
Class III -A
3.
-
Combination flammable liquids
f
4.
Flammable gases
5.
Liquefied flammable gases
6.
Flammable fibers - loose
7
Flammable fibers - baled
8.
Flammable solids
�
4.
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
containing more than 60% nitrate
by weight
18.
Highly toxic material and
poisonous gas
19.
Smokeless powder _
20.
Black sporting powder
hereby certify that the above in-ormation s true and correct to
the best of my knowledge.
Signature Date
South Coast
AIR. QUALITY MANAGEMENT" DISTRICT
21865 E. ropley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PERMIT CHECKLIST
for nonresidential buildings only
Company Name: � �� C" Q�IA
Location of Property: 2- V, .p W
City: U 6 Zip Code: G �,9
Contact Person: OJ e Ul re" 2 e_ Title: W G
Telephone Number: `7 P-' Y"' ° - 7- Fax Number: (`j)�—
Type of Industry/Business: P� t F % l - 0"F b0,-e
To apply for a nonresidential building permit, you must compl!te this checklist. If you have any
questions about completing this checklist, please call (800) 388-2121.
YES NO
1. Will the facility have a charbroiler? ( ] [ ]
2. Will any internal combustion engine ;with greater than 50 horsepower
operate at the facility (excluding motor vehicles)? ( ] [ ]
3. Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings? [ ] [ ]
4. Will dust or smoke be generated at the facility? [ ] ( ]
5. Will refining of any Iiquids or solids be done at the facility? ( ] [ ]
6. 14"ill any plating or coating of materidIs be done at the facility? [ ] [ ]
7. Will any combustion equipment rated greater than 2,000,000 BTIJIhr be
operated at the facility? [ ] [
8. Will any acids, solvents, or rnotor fuel be used or stored at the facility? [ ] [ ]
9. Will any organic liquids 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: Ojec ( U Signature: _(-)-'_-c ,"
(Print name clearly)
If you have marked "NO" in all the boxes. an air qualir, pe.,nit is not needed at this time,
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 (AQ- ). Please read the requi"ezrtents on the back of the checklist.
(800) 388-2I21
Lip
NO FICL OFRI.QUIREMENTS
GMTRNNITTAT CODE SECTION 65850.2 (AB3205)
the Build;�I.�- Deparldnen*S from
of is !oval air quality apenev aro
a r r" 7nit St- J'h e cl :K-j
ist is
desic'ned to ai.1 th.-� oril'.. If tlie. answer to ariv af
'rorp the local air
xrLpliance
1-- in r
1 !,,,to t1l.-s chec'!"J",-t-
T
as the uTi., ten r" i C iS
r.
a P Ct Q' ID bv callini-7
x,r
OJ- fit, permits are required 1br any t'quipm-cnt
11) d, rimls are
Opo-,0c,' a! the �;te I I' th,- AQ' etemiine�; that air quality'
I pe
not e- a;11 re hate Qe-, rnet, a vx-tteri release will be issued
4, p- not been submitted, the applicant
ma;,! ri
71,11 aPNC—Imi(,i and apprcpriate fees before a ,v tt,
c(1',-,-ir-.-1.�t!ed to exp-,ditip.g all clearance letter IeC1llZS2S. However, it inay take several
wekz! to . o-,jf-. .ou are. 3dvised to contac, AQN1D
immediately applyirkg for buflamg permits.
(800) 388-2121
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