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APPLICATION FOR CERTIFICATEOFOCCY
CITY OF HUNTINGTON BEACH r ''j t
DEPARTMENT OF COMMUNITY DEVELOPMENT s
( 'T ■ACH (PRINT OR TYPE ONLY) DATE
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Address Jam' 1 Ti;>&-i-'4W— /I -A Di/st�riict /�
Business Name t`32�d/�n �' T \. f
Business Type -0cc. GrouP&•���1—
BUILDING OWNER BUSINESS OWNERIMANNAAGEERR
I W � t d�AACe j
(Address
ame ^� (Nameome
/ Addressty N'23 Tel, City Home Tel wit G/70 i
HIS USE WOULD BE DESCRIBED AS:
i
❑ NEWLY CONSTRUCTED BLDG, L_J CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
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❑ EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
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Indicate former use, if any r, �Oc ancy Gr. Div.
SQUARE FT, OF BUILDING TO BE OCCUPIED ��® /. P E • C� �� 1fl`C�
NOTICE:
1. Occupancy of any buildinc is prohibited and a business license will not be issued until the building has been
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4 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 fer 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 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 aminimum offour(4)
inches in ;height with one half (1/2) inch stroke, and of a contrasting color from the background. These
numbers must be posted on your building in a location that is vls'" z from the street. i
5. Huntington Beach Fire Code Section 10.301 requires fire extinguish,jr selection and distribution per the
National Filre Protection Association pamphlet 10 (see reverse side).
TRAFFIC IMPACT FEE.,
DATE PAID
AMOUNT RJECEIVED
Ail —
NAME (FOR OFFICE USE ONLY)` i
SUPPLEM INFORMATIONI ZONING {
OCCUPANCY -GROUP'-I PLAN CHECK NO. NO. PARKING SPACES i
OCCUPANT LOAD- PERMIT NO, HEALTH DEPT. APPROVAL — i
NO. OF STORIES ADMIN. ACTION UTILITIES RELEASED —
r '� 5 CERTIFICATE OF OCCUPANCY FEE g _ _ 6
L
PPROVED .B TE CHANGE OF USE OR OCCUPANCY FEE g
TOTAL $ f
75-039 Rev.1/97 COMMUNITI" DEVELOPMENT
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SUPPLEMENTAL INFORMATION
�
1.
BUSINESS ADDRESS _ 15-2111 r.it
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2.
Person to contact.. in case of emergency- XA4o. t 1 .
Y
III
Telephone number: 6a��S-4ai7o
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3,_
Does the building in question have electricity?
L� Yes
❑ No
(a) If No, are you -requesting that the electricity be
❑ Yes
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turned on?
❑ No
?'
4.
The building is sprinklered?
Yes
'
❑ No
5.
Operations wiil produce dust/wood shavings or similar
material?
_
❑ Yes
,.
ONO,
P
6.
Operations 14111 involve the repair or replacement of
❑ Yes
i
automobile parts?
El No
ri
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an openflame?
❑ Yes
ONO
7. -
The business is drinkAng, dining or assembly use that will
result in an occupant load of more than 50
p persons.
❑Yes
;
No�
8.
The following best describes my operation;
ffic Only
a
les
Ware Buse
i
ng / Distribution (describe process and end product)
i
Restaurant /Take Out Food
Medical / Dental
Other (describe)
SUPPLEMENTAL INFORMATION
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SUPPLEMENTAL
E
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litilF®RMATi®N (Continued)
,
Does the operation involve any of the
following materials? Yes
7�No
If
Yes, indicate quantities:
'
- Material
Quantity
1.
_
Flammable liquids
Class I -A
Class i-8
_Class I-C
2.
Combustible liquids
r
Class II
r,
Class 111-A
;
3.
Combination flammable-, liquids
4.
Flammable gases
5.
Liquefied flammable gases
F
6.
Flammable fibers - loose
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
l
17.
Ammonium nitrate compound mixtures
conta;;jing more than 60% nitrate
l
4
by weight
18.
Highly toxic material and
4
poisonous gas
'
19.
Smokeless powder
20.
Slack sporting powder
{
( here certif tat the above
information is true and correct to
i
the b of nowledge.
Signature
Date
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,
South Coast
C
AIR. QUALITY MANAGEMENT DISTRICT
4
21865 E.'Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
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AIR QUALITY PERATiT CHECKLIST
for nonresidential buildings only
k CompanyName: A CEO. c7S�L
Location of Property;
City: Zip Code
Contact Person: Title:
I'
r Telephone Number: Fax Number:
Type of Industry/Business:
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing this checklist, please call (800) 388-2121.
YES
NO
i . Will the facility have a charbroiler? j ]
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 liquids or solids be done at the facility? [ ]
[]
6. , Will any plating or coating of materials be done at the facility? [ ]
7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be
operated. at the' facility?
8. Will any acids, solvents, or motor fuel be use( r .,,. rztdi at the facility?
( 9. Will any organic liquids or gases be reacted or 1;. > - sd? [ ]
[ ]
1.0. Will any ovens be used to dry or cure productsat the facility?'
11. Will any CFC (Freon) recycling machines o era e faciii
Applicant: Si(—gnature:---)
S
- (Print name clearly)
If you have marked "NO" in g the boxes, an air quality permit is =1 *seeded 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
1vlanagement District (AQMD). Please read the requirements on the back cf the checklist.
°.
(800) 388-2121
_ ADDMONAL SUPPLEMENTAL INIFORMA71ON
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�a le APPLICATION FOR CERTIFICATE OF OCCUPANCY • �� t
APPLICA _
I 0 CITY OF HUNTINGTON BEACH Y G
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNnNGTON AFACH (PRINT OR TYPE ONLY) / d DATE
Address 7 rDc��- �-{' Z,��i District s
Busine s Name f _AtI •110111. >,- Tel. W3
Business Type—tds W on Occ. Group
OWNER/MANAGER
IN WNERl1A
` ESS O
F BUILDIN WNER
Nam-; 161 -Al dS — PG od C Name
rHome
Address 417 ,712 t✓ aril: M A n/- Address �� 1 G t d► �'.seL
p . 3
City v- � ®® .A, Tel City ' Home Tel
THIS USE WOULD BE UESCR!BED AS:
� !
R
NFWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT s
`XISTING BUILDING El CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any Occupancy Gr.--Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED
NOTICE: 1, Occupancy fanybuildingisprohibite A ab sinesslicens tlnotbeissueduntilthebuildinghasbeen
inspected an a certific e e ccupann I is ued.
2. No electrical ervice w! be r, I ased fob any existing ildi til the service h s been inspected and
ce ' ied safe: Il applicaUfo,cupancy in anexisti g uil Ing are requir 5 schedule an electrical
fuse ' inspe• ion in thment of Community eve p ntat the e th pplication is filed.
Change f occu ncy oection WlI never' ' necessar to ak ection of a building or
premises i order o determine if a change ay be made in the charac f o cu ancy or use of the building
(/ or premises I r would place the b 'Idin in a different division of t e my group of occupancy, a
x 1 different group ccupancy, hang of ccupancy ins 'ec 'on a of shall
be paid to the city.
4. Huntington Beach Fire Code cti n .208 rekai
at ildi g umbers must be a minimum of four(4) }
inches in height -with one half (�/z) inch strokef co tra ting color from the background. These
numbers must be posted on yo building in aha is visible from the street.
untington Beach Fire Code Section 10.301 rIre extinguisher selection and distribution perthe
ational Fire Protection Association pamphleta reverse side). i
p,1
•'OR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION — •+ ZONING
OCCUPANCY GROUP--rf-- PLAN CHECK NO. NO. PARKING SPACES
OCCUPANT LOAD _ PERMIT NO, HEALTH DEPT APPROVAL
NO. OF STORIES —T ADMIN. ACTION UTILITIES RELEASED --
p CERTIFICATE OF OCCUPANCY FEE $
APPFIOVED Bbr CHANGE OF USE OR OCCUPANCY FEE $
w TOTAL $
i
75 039 Rev, t tlao COMMUNITY DEVELOPMENT
r, ,
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS — 12t �- 6�J'Aze- Z12Z
.
2.
Person to contact in case- of emergency- 7% 73 ( 2
Telephone number:
i,
3.
Does the building in question have electricity?
Yes
I
❑ No
1
(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
j
material?
s
6.
Uperations will involve the repair or replacement of
❑ Yes
automobile parts?
--Q-NO
If Yes:
M
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open
flame? ❑ Yes
,L-No
7.
The business is drinking, dining or assembly use that
will
result in an occupant load of more than 50' persons.
r e P
❑` Yes
8.
The following best describes my operation;
Office Only
'
y
Retail Sales
Warehouse
n �uru��Disfribution (describe process and end product)
04
Restaurant/Take Out Food
Medical /'Dental
3
Other (describe)
SUPPLIMENTAL INFORMATION
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SUPPLEMENTAL. INFORMATION, Continued
Does the .pperation Involve any of the following --materials?
E Yes
i
If
Yes, indicate quantities:
Material.., Quantity
1:
Flammable liquids
Class 1-A
Class I-S
Class 1-C
2.
Combustible liquids
P
Class II
.
Class III -A
3.
Combination flammable liquids
I
4.
Flammable gases
5.
Liquefied flammable gases
r
6.
Flammable fibers - IUose
7,
Flammable fibers - baled
8.
Flammable solids
9.
Unstable materials
10.
-
Corrosive liquids
P
11.
Oxidizing material - gases
F
12.
Oxidizing material - liquids
if
I&
Oxidizing. material - solids
14.
Organic peroxides
15.
Nitromethane '(unstable materials)
`A
16.
Ammonium nitrate
`
17.
Ammonium nitrate compoundmixtures
containing more than 60% nitrate
r
by weight
18.
Highly toxic material and
poisonous gas
19_
smokeless powder'
-
20.
x
Black sporting powder
t
l_ hereby gertify that the. above information is . true and correct
to
the bXtf my knowledge.
`
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Signature Date
s
I
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1
x
a
y
South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
4
.AIR QUALIFY PERMIT CHECKLIST
for nonresidential buildings only
Company Name: G
:i
e
J
f ,
s � .
Location of Property: -/'
;. City:. Lip. Code; 2
Contact Person: ' 1�2,r�,d/Z A % WA Title:
�. Telephone Number: , 4 - z / Z Fax Number: . -?re ? z, 62
Type of Industry/Business: E ,
To apply for a nonresidential building permit, you must complete this checklist. If you have any
j
' completing this checklist please call 800 388-2121.
questions about corn 1 , _ ( )
. q p g
YES _
NO
4 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 liquids or solids be done at the facility?
6. Will any plating or coating of materials be done at the facility?
7. Will any combustion equipment rated greater than 2,000,000 BTU/hr be
operated at the facility?
r
8. Will any acids, solvents, or motor fuel be used or stored at the facility? [ ]
[r }
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 facility?
Applicant: /1 41-4 Signature:
(Print narne clearly)
1
If you have'markPd "NO" in all the boxes, an air quality permit is not needed at this time,
and this checklist is your written release.
If you marred "YES" in any of -the boxes, you must: contact the .South Coast Air Quality
Management District (AQMD). Please read the requirements on the back of the checklist.
(800) 388-2121
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Trancode : [PERMIT] C 0 M M U N I T Y D E V E L O P M E N T [40711
Function: [HST] P E R M I T I D E N T I F I C A T. 10 N PG. 1
[ ] [ ] Permit [E0249131 Address [15311.] [PIPELINE ] [
Next Page No. [2] [PLEASE CONTINUE ] [ BO) Appl.Date A080896]
Tract A ] Lot A ] Block A ] Multi -Address? [N] New Tract? [N]
Owner: [SPEED VENDING ] Phone: [ lL l St zip �
Addr A ] [SAME AS ABOVE l [ 7 city: [HB ] [CA] [926491
Contractor: [ACCORD ELECTRIC CO ] Phone: [964-9750 ] St Zip
�•,
Addr: [18437] [PIT LANGLEY ] [ K ] City: [FO'UNTAIN VALLEY- CA ] [92708]
City Lic: [A169690 ] State Lic: (607120 ] Classes [C10] [ ) [
If Licensei � renewed today, enter initials to indicate receipt of renewal:
_
r New Building? [N] Use [COM ] Code [ADD- ] [
k***************** Certification ******a**************** Fees/Statistics *****
Builder = Contractor? [Y]Builder = Owner? [N] * Is this a City Job? [
Builder Self -Insured? [N] Builder Non -Employer? [N] *Administrative Only?
Project [(1) 50 AMP 220 VOLT RECEPTACLE ]
]
Description: [
�
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Voided By;, [ l [ ] Cancelled By; [ ] [ ] Expired By: [ ] [ ]
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