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CERTIFICATE OF OCCUPANCY Date
CITY OF HUNT
INGTQN BEACH
District f
13Z5 k'3PL' Tel. _ S_g
Address•—s
Occ. Group ---- ----
DF; Gt.
Business Name
Js--"APIUFACTUhI1'IG NESS OWNERIMANAGER
BUSI
I
I
Busineu Type j1 t; LI„E
BUILDING OWNER Name
i
R , J . SE;+RA Home g 77Ga SAi GANDELC ST
Name Address Home �14-9( r_7UBZ4 City FGLibI`+ASt 'i1LY Tel.
Address - I
Tel. 15Sprinklers
City Occupant Load i
Construction No. of Stories
CONDITIONS OF APPROVAL
{
DEPARTMEN
sT OF COMMUNITY DEVELOPMENT
i
This Ceriiticate of Occupancy
SHALL BE posted in a conspicuous place oh the by _
premises and shall not be removed except b' the
' Building Official.
COMMUNITY DEVELOPMENT_
i
a
APPLICATION FOR CERTIFICATE OF OCCUPANCY
cc rY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
HL'NTINGTON KAOi
(PRINT OR TYPE ONLYI DATE
Address 4,) fjf C'z /�/
��— District
Business Name—
oc- �/Ci1i c � Co.Tel enf -' /q7D
I Business Type / /li%1 ZY&V
I Ccc. Group
BUILDING OWNER BUSINESS OWNERWANAGER
Name Z SG a �) Name Home
Address Address 1Z%it1 SAa% Gi�AJ ZI SI
D
City Tel City —L `L ��4; LCC
y�Home Tel g� ,
THIS USE WOULD BE DESCRIBED AS: E
❑ NEWLY CONSTRUCTED BLDG ❑ CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ADDITIONAL OCCUPANT
Ind-cate'former I.se, if any—. d _Occupancy Gr D,v
SGUARE FT. OF BUILDING TO BE OCCUPIED XOt7 / 2
NOTICE: k
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 servicewill 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.
Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a building or jl
i premises in order to determine if a change may be made in the character of occupancy or use of the building
r or premises which would place the building in a different division of the same group of Occupancy or in a
V V� different group of occupancy, a change of occupancy inspection fee of $ shall
be paid to the city. j
4. Huntington Beach Fire Code Section 10.208 requires that building numbersmustbe 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 r
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 E
National Fire Protection Association pamphlet10 (see reverse side).
Z_ Z_
1 (FOR OFFICE USE ONLY) I SUPPLEMENTAL INFORMATION 1 ZONING-_. `A
OCCUPANCY GROUP '1 PLAN CHECK NO. _ NO PARKING SPACES '
OCCUPANT LOAD PERMIT NO. HEALTH DEPT APPROVAL
NO. OF STORIES ADMIN. ACTION UTILITIES RELEASED
x
CERTIFICATE OF OCCUPANCY FEE
r PPROVE Y. DATE CHANGE OF USE OR OCCUPANCY. FEE $
TOTAL S
7CIS
75039 Rev, 11190 COMMUNITY DEVELOPMENT
�I
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS /S� I � �lJln h� I U N• ��
2.
Person to contact in case of emergency, T
i
Telephone number:3 'mod
t
3.
Does the building in question have electricity?
Yes
No
(a) If No, are you requesting that the electricity be
El Yes
❑
turned on?
No
4.
The building is sprinklered?
Yes
❑ Nov
5
Operations will produce dust/wood shavings or similar
El Yes
material?
❑ No
6.
Operations will involve the repair or replacement of
❑ Yes
l No
automobile parts?
If Yes:
(a) Describe the components repaired or replaced.
y
❑ Yes
No
(b) Does the operation involve the use of an open flame?
` 7.
The business is drinking, dining or assembly use that will
❑' Yes
p
result -in an occupant load of more than 50 persons.
�1 No
8.
The following best describes my operation;
Office Only,
Retail Sales
Warehouse
/Manufacturing / Distribution (describe 'process and end product)
24 04C: � e%�-, 'ZVIAI
Cu 7/JVC7 77 R R
J [J
;
Restaurant / Take Out Food
Medical / Dental
Other (describe)
i
SUPPLIMENTAL INFORMATION
r
f
I
tlP ��lvd)rC,i H1! {�JFOI��ia�'IION (continued)
^
operation involve any of the follLvsls�g ;;; «�c��•C�?
o
G the.
._...._
[f Yes ;ndicate ,quantities: Quantity_
Material
{. Flammable liquids
Class I -A
class ----"'"`
_--___---
`�-Cor,lbustible liquids
2.
class
�, Combination flammable liquids _ � __--____....
--_ _- - able uses
4 �lamrn g
flammable g
ueP�ed .. __..,.__
6. Liq .. gases
6. Flammable fibers - loose
fibers - baled
- Fiammable - - --
-
r - FCarnrnable solids --._-_- _
material's
g. Unstable mater
10, corrosive lictul s
-
materi ses
11, oxidizing at - ga
_
liquids
2. Oxidizing --
1$ oxidizing material - solids
7j74— Organic et -oxides
-NCtromethane (unstable materials) ___ _---- -- -----`-
15,
6. ,�mmoniurh nitrate --
nitrate compound rr►ixtures
''�7
Amrnonium
containing more than 60% nitrate
by weight
18. toxic material and
r poisonous gas
-
- powder _-____-_----
19. Smokeless p
-
20. Black sporting powder
\ i
.
y that the above information is true and
� s
correct to
certify
1 hereby c
the best of my knowledge
Date
3
ature
I
i
I
e w
itv of A untington Bead
I
I
1
2000 MAIN STREET CALIFORNIA92648
I
DEPARTMENT OF COMMUNITY DEVELOPMENT
Building Division 536-5241
i
€
I Planning Division 536-5271
Government Code Section 65850.2(b) requires the City cf Huntingtpn
F Beach Building Division not to issue the final certificate of
occupancy unless the applicant has met or is meeting the
South Coast Air Quality Management District
requirements of the
(AQMD). The Building Division must obtain a written s.elease from
:.
AQMD to show the applicant has complied with this law. The check
the applicant and the
list on the reverse side is designed to help
building division to meet these requirements.
1. The applicant (the same person who applies for permits from
the list which
the Building Division) must complete check
eitner at the Building Division or at AQMD,
g
can be obtained
I
2. If all boxes in the list are checked "no", the Building
Division can accept the check list as the release.
3. If there are any "yes" answers in the list, the 96- applicant
by (?,14) 36-2OCQ to
must contact an AQMD er;ineer calling
find out whether air permits are required for the proposed
'
construction project.
hs
? 4. if air permits are not required, the applicant will obtain
a written release from AQMD.
5. If air permits are required, the applicant must submit the
necessary permit applications before the release can be
issued,'
Because of the time it may take for AQMD to go through the above
AQMD immediately
!
procedures, the applicant is advised to contact
after applying for Building permits,
i
=
t!
r. `I
(1360D)
1
is
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
(Nonresidential Buildings Only)
.ocation of Subject Property:'
,,� Phone #
Property O'riner Name:•�_��-
!came of the Person, Preparing this form in print and signature
Name:—
A6- L� Signature:
— / l
The person preparing this form must be the same person applying for
:
king permits, Please answer the following questions regarding
•_ur proposed occupancy of the subject building. IF YOU DO NOT KNOW
-cc r.:;SWIER TO A QUESTION MARK IN THE "YES" COLUMN:
AQMD PERMITTING CHECKL.:ST
YrS NO
y
).. Does your facility use any internal combustion
engines greater than 50-HP?
lity involve mixing, blending, or
2. Does your faci
proc=ss::.ng any solvents, adhesives, pairits
or coatings?
3.. Does your facility create any Gusts or smoke? —
refine any liquids or solids
Does your facility
or reclaim any metals? J�
-�. ?
Does your facility plate or coat anythingf= —
5,` ^oes your facility have any combustion equipment
i.e.oiier, furnaces, broiler, baking ovens, -- �; -
etc.) ra'.-.ed greater than 2:000,000 BTU/HR?' --
7 Does ,our. facility handle or store solvents or
x
rotor fuel?
S. Do yc se or store any acids?
7. Da yc use any
chemical process?
_,. Do - ;use any solvents for clean-up?
�.i.e 1 ou a dry c.leanar, restaurant tati� n
char, -oiTer; body shop, gasoline station,
_�
printer, or part water? - _..-
-2. Is the subject building located within one
thousand (11000) 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
all=y permit at this time. If you have marked any questions in
--e '•'_ES" Column you must contact the South Coast Air Quality
,�^.ace:nent District located at:
21865 E. Copley Drive
Diamond Bar, Chi 91765-4182
ease call: plan Check (714) 356-2000
E
f
(1360d-2)