HomeMy WebLinkAbout14916 Springdale St - CofO (3)it
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�� f APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
NUNI7NGTOy. oEA61 (PRINT OR TYPE ONLY) DAT
Address `L( f) 1 District
Business Name ��' C i i-, i t Z.Z/� Tel (-I I Lf) Ll - 5 )'L 1
Business Type t ZZ- Occ. Group_z
BUILDING OWNER BUSINESS OWNER/MANAGER
Name {1�1V�SihIC!`1{S t 1T1C_. NameHome
I=iZA�IC. (=F�LZ
Address 1 4?)EA C � Address
City �JlltJ-r0—Te: City t,l TC1Z —Home Tel. �OiL4 t 6;
THIS USE WOULD BE DESi,AIBED AS:
❑ f>EWLY CONSTRUCTED BLDG X CHANGE OF OWNER ❑ CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use, if any Occupancy Gr Div
SQUARE FT. OF BUILDING TO OCCUPIED —
NOTICE:
1. Occupancy of any building is prohibited and a business license will not be issued until the building has been
inspected qnd 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 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.
3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of building or
premises in order to determine if a change may be made in the characterof 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
U 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
numbers must be posted on your but:Jing in a location that is visible from the street.
1()6 5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 ( ee reverse side).
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TRAi=FIC tMIP .0 8 .^EE if
`(� . Z�,. Q
DATL PAID _ 1
Ae,ICUNT RECEtVrC
NAIM —
- - -- (FOR. OFFICE USE ONLY)
7.ONING
OCCUPANCY GROUP PLAN CHECK NO NO PARKING SPACES
OCCUPANT L AD PERMIT NO HEALTH DEPT APPROVAL
NO. OF ES ADMIN ACTION— UTILITIES RELEASED
d -CERTIFICATE OF OCCUPANCY FEE $
APPROy DATE CHANGE OF USE OR OCCUPANCY FEE $
TOTAL. $--- - --
75-039 Pev.t/97
f
SUPPLEMENTAL INFORMATION
1: BUSINESS ADDRESS 1 �(p) I i�PI�_l►J(�f( �, (}� 1
2. Person to contact in case of emergency -
Telephone number:
3. Does the building in question have electricity?
(a) If No, are you requesting that the electricity be
turned on?
4. The building is sprinklered?
5. Operations will produce dust /wood shavings or similar
material?
6. Operations will involve the repair or replacement of
automobile parts?
If Yes:
(a) Describe the components repaired or replaced
(b) Does the operation involve the use of an open flame? ❑ Yes
O No
7. The business is drinking, dining or estwmbly use that will
result in an occupant 'oad of more titan 50 persons. ❑ Yes
XNo
8. The following best describes my operation;
Office Only
Retail Sales
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant/Take Out Fo
Medical / Dental
Other (describe) _
SUPPLEMENTAL ;P FURMATION
'i
1
5
1
-SUPPLEMENTAL- INFORMATION (Continued) '
Does the operation involve a of the following materials? C7 Yes
Yi No
'ff Yes—, -
V quantities:
Material Quantity
1. Flammable liquids _
Class I -A
Class I-E
Class I-G
2. Combustible liquids
— Class II
' 3. Combination flammable liquids F
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 I
i
14. Organic peroxides
15. Nitromethane j (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 r
20. Black sporting powder
F
�fiereby . certif that the above inforr.iation is true and correct to
-the I best of y knowledge.
Signature Date
1
I
South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUA-LITY PERMIT CHECKLI
ST
for nonresidential buildings onI
Company Name:
Location of Property: I Lk _11 1 6 S P j2
I1
City: i� lti tV -rC-1 Aj C z 1
Zip Code:. a2 � t.� '�
Contact Person: P< A 1,J —.. Title: C3+J N �Z
Telephone Number: i t �l t t Fax Number:
Type of IndustryBusiness:
To apply for a nonresidential building permit, you must complete this checklist. If you have an
! questions about completing this checklist, please call (800) 388-2121.
f
I. Will the facility have a charbroiler? YES NO
i' 2. Will any internal combustion engine with l�
g greater than 50 horsepower
i 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? r
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 used or stored at the facility?
9. Will any organic liquids or gases be reacted or produced?
10. Will any ovens b- used to dry or cure products at the facility? [ ,
11. Will an CFC y (Freon) recycling machines operate at
Applicant: 2-.A !J'�� `OC-2-4 Signature:
(Print name clearly) nz��
If you have marked "NO" in all the boxes, an air quality permit is Litt needed at this time,
and this checklist is your, written release.
If you marked "YES" in any of th-.- boxes, you must contact the South Coast Air (Duality
Management District (AQM]D). Please read the requirements on the back of the checklist.
(800) 388-2121