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APPLICATION FOR CERTIFiCATE OF OCCUPANCY
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CIT.'OF HUNTINGTON SCAOfi
DEPARTMENT OF DEVELOPMENT SERVICES c `(,,
HU"W-roN MACH 'PRINT Op TW+ GNLY, D TE
i
Addrt+5s i� C pr-rr �r�`y=r t"
District. .
Business Name. Mx'+�'a Tom
Business Types M—,V lea >r , t"rx,,
r. Orc. Group_
6UIt.I7NG OWNER BUSINES'3OW EHIMANAGL-
N�.,sttw.._ �:t� �.tr.� .�.� tdan'r, ..�.,:..=;_:?T-ft:,"�•,.� � k�.t ,
Home
Address"� � Lr I c T _ Addre s
Qty. L����---...... - 4,-Tc,4,_.._.._._ City. _.....:Nome Toi,
THIS USE U,tOULD BE DESCRIBED AS:
Q NEWLY GUNSrRUCTED BLDG. E1 CHANOE OF: 0,, JNEP CHANGE OF OCCUPANT
0 EXISTING PU1t DING D CHANCE OF Ul-, t El ADDITIONAL OCCUPANT
Indicate former use if any__ _ ... c. pcupanr y yak. Div.
SOUAR FT. OF BUILDING TO 9E QCC,URED �s:L c_.._�_
NOTICE. 1 Occupancy of any buiidfng is pro.•;Lzted and a ;.,zs.ness hrn. ^se will not be issued until the building has
ueen inspected and a certificale of occupancy 1.^ issued:
g. No electrical service wiii bu € ,Ida.-ed for ar y r �siing building until the service has been inspected and t
+:errtified safr.. All applicant, for occupar, y iia an axis fi€-,g bui dinq are rugxred to schedule an electrical
JuSe up' inspection n the Dopartrnertt Of C;evelonment Services at the tinte this application is liied.
3 Change of occupancy or use Inspection fee. Whetlever it is necessary to make inspection of a building
or premise,: in order to determine it a chance may be made in the character of occupancy cruse of the
buiiling or premises which would place t ic; bui€ding in a different division of the same group of occupancy
I 1 , or in a different group of occupancy, a change of occupancy inspecf'on fee of $
1 4` shall be paid to the city.
Huntington Beech Fire Cade Section 10.203 requires that bulling numbers must be a minimum of four
"J (41 i!icoes in height with one half i l,') inch stroke, and of a contrasting color from the background. These
numbers crust be posted on your building in a location that i3 visible frorn the street.
5. luntington Beach Fire Cade Section 10,301 requires fire extinguisher selection and distribution per
t ,ti the Navoriai Fire Frotectinr Associat€on p;jmphzr~t 10 isee reverse side),
(FOR4FiE USE ONLY)
SUPPLEMENTAL INFORMATION NC;,�_.��.,._.._ '
OCCUPANCY Gr GUP--- �. w PLAN CHECK Ni) _ � r� NO. PARKING SPACES
OCCUPANT LOAD . ,__ _ _ PEPI IT N') __ _�_,_:.. T__ HEALTP DEFT. APPROVAL
NO, OF STOMES Ar;lt IN PAGVn,V. UTILITIES RELLASED
C.F OCCUPANCY FEE
APPROVED BY DATE OHANGF 0 USE OR OCCUPANCY FEE $ _
TOTAL $
r•,�aHe; ;r
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT — _ 3 Gj
,ATi_
HIJN'TIwoois Bim)i PP114T (iP T:PE O'
B��np,, Njm• _ S" a eve I.<�CL W ✓(w✓101 '-L�✓ t/1' ��'- _
usrnes, -vo, _�_�hi1E_ 1 >` • .n. f ✓✓G {�Lt �^Or,or,r,
Name `�---SL ry off- -- - - ,. - -i bl✓ F
,A'dd,e1 ?C4E '' 7G32
H 1 i � "
C,ty f G 'v T.. $Er't �Zf %!'� (� (�r_ Home To, �47'�41 S
THIS USE WOULD BE DESCRIBED AS: (uve�d
❑ NEWLY CONSTRUCTED BLDG OF UCCUPp,rdT
❑ EXISTING RUILD`N r r.A'. �F ':,i ❑ �.DI IT1(>fVAL ;JC.:;UPaNF
Indicate
SQUARE FT OF R!J . DIW, T HE ' iU-
NOTICE: 1 upancy 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 j
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 j
'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 u se 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 S -_ _-___-_____._ ._ shall
/ be paid to the city.
I 4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum of four (4)
°? a inches in height with one half (12) inch stroke. and of a contrasting color from the background. These
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
F P t f A s ciat n am hlet 10 (see reverse side)
Natlonal ire ro ec ion s
o io p p
WJus
�LlJ
/
(FOR OFFICE USE O`N.LY)
m
SUPPLEMENTAL INFORMATION
OCCUPANCY GROUP _
PLAr,i ; .r0 ri,
OCCUPANT '. SAD _ --
ff rzra,' rd, " _-_ _ _
, i Ai i J
NO OF ^TORIES
iGl r
1
APPR�EC DATE
T,,�T [
75-039 Rev. 11/90
CO '%1j.MTY
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS c L1-1 t j-.a 17; C :l � 1 C-4`1
2. Person to contact in case of emergency's e,�"`u'`"�
Telephone number:
3. Does the building in question have electricity? ® Yes
❑ No
(a) If No, are you requesting that the electricity be ❑ Yes
turned on? El' No
4. The building is sprinklered? ® Yes
❑ No
5. Operations will produce dust/wood shavings or similar
material? 14 Yes
❑ No
6. Operations will involve the repair or replacement of ❑ Yes
automobile parts? No
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame? ❑ Yes
IN No
7. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons. ❑ Yes
V No
8. The following best describes my operation;
Office Only
Retail Sales
Warehouse
Manufacturing? Distribution (describe process /and end product)
Restaurant / Take Out Food
Medical / Dental
Other (describe)
SUPPLIMENTAL INFORMATION
SUPPLEMENTAL INFORMATION (Continued)
No
t rai
iL
C
"!ass
a in, a,, k3
L! f
rn rt
9. 1 ci I Li r T a
C7 1
Cx z i rl vf a i � r a4 If
riza; ti-I ds
CIx,,Jilina m a C t
14, tr>`Caariit, aft IJ
ro m n. r oF,
16, Arpmcnilwn, ri;!rat�
1 T
Aryimonit.;m nitriate, )ri,ouund mixtures
containing more. th,,,ri 4iO`11, rittir,-Je
by weight
18. '�qhly toxic material ar!d
.,oncus gas
19. brnokele-,s powder
20. Black sporting powder
I hereby certify that the above information is true and correct to
the ,Pest of my knowledge.
Date Signature
South Coast
AIR QgAUTY MANAGEMENT DISTRICT
9150 FLAIR DRIVE, EL MONTE, CA 91731 (818) 572-6200
DATE: ::" - c . -41 1'�
TO: 1'�1` T- q uilding Department
FROM:Al , ., Air Quality Engineer
SUBJECT: BUILDING PERMITTING UNDER AB3205, WATERS BILL
Regarding PLAN CHECK #:
LOCATION: �C�61�G�t.tc7Y�l�vt-+P.t;
This site has met or is meeting the requirements of Section
42303 of the Health and Safety Code and the requirements for
a permit to construct and operate for the South Coast Air
Quality Management District .
APPLICANT HAS ALL REQUIRED PERMITS FROM THE SOUTH
COAST AIR QUALITY MANAGEMENT DISTRICT FOR THIS
SITE AND/OR PLAN CHECK ONLY.
APPLICANT HAS FILED FOR PERMITS TO CONSTRUCT
EQUIPMENT WITH THE SOUTH COAST AIR QUALITY
MANAGEMENT DISTRICT.
APPLICANT IS EXEMPT FROM PERMIT REQUIREMENTS AT
II {/ THIS SITE AND/OR PLAN CHECK ONLY.
IW--?D�) U-Z;r1 ind� Q.A P i�2 2uLe. 3t
REVISED 11/91
