HomeMy WebLinkAbout15061 Springdale St - CofOC
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APPLI ATION FOR CERTIFICATE OF OCCUPANCY
c CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNWCTON BEACH DATE
(PRINT OR TYPE ONLY) :.
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Address l�— District
� IO� 01 932
Name d �PN _ `ice
1
Busi ness
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Business Type 1 t� Q- �.� ��l'�'����-F'-'`� TW �it Occ. Group
�%1rt�✓'vC
BUILDING OWNER' t/ �j BUSINESSQWNERIMANAGER
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Name_ P55: -4 �. cif'<���" i—>��� Name
Home �)QD.�r.��\->�
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Address Address � �
City Tet. City NIL,::- . U \ P Home Te`71�6—
' THIS USE WOULD BE DESCRIBED AS:
t!fCHA.NGE
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4
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ElNEWLY CONSTRUCTED BLDG, ❑ CHANGE OF OWNER OF OCCUPANT
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BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
J�ISTING
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Indicate former use, if Occupancy Gr.—Div,
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SQUARE FT, OF BUILDING TO BE OCCUPIED
I 00
NOTICE: 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 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 inspection in the Department of Community Development at the time this application is filed.
up'
3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a building or
premises in order to determine it a change may be made in the character of occupancy or use ofthe building
or premises which would place the building in a different division of the same 'Troup of occupancy or in a
different group of occupancy,_a chc nge o'r Occupancy inspection fee of $ __ shall
be paid to the city.
4. Huntington Beach Fire Code Section 10.208 requires that building numbers must b� a minimum of four(4)
inches in height with one half (r/2) 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
National Fire, Protection Association pamphlet 10 (see reverse side).
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TRAFFIC IMPACT FEES
DATE PAID
AMOUNT R CEIVED
NAME (FOR OFFICE USE ONLY)
SUwPLEI.iEN L INFORMA ION ZONING}
OCCUPANCY GROUP 'S r ' PLAN CHECK NO. NO. PARKING SPACES
'f
zL +�_ HEALTH DEPT. APPROVAL
OCCUPANT LOAD PERMIT NO. --
NO. OF STORIES — ADMIN. ACTION UTILITIES RELEASED
OF FEE
t! CERTIFICATE OCCUPANCY $
D BY DATE CHANGE OF USE OR OCCUPANCY FEE $��'
AF39Rev.
�— 7 7 TOTAL $ _ 1
711/90T
COMMUNITY DEVELOPMENT
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS ��c5 1 c � C3-�.SZ�
1 Ie�
Cb9.?6Y
s
2.
Person to contact in case of emergency "llpw�-
'
Telephone number:/
3.
Does the building in question have electricity?
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
turned on?
❑ No
!
4.
The building is sprinklered?
n'Yes
5.
Operations wi!I produce dust/wood shavings or similar
❑ No
material?
❑ Yes
E?--No
6.
Operations will involve the repair or replacement of
❑ /yes
automobile parts?
No
tt
If , Yes:
(a) Describe the components repaired or replaced.
:
(b) Does the operation' involve the use of an open flame?s
i.
The business is drinking, dining or assembly use that will
No
.I
result in - an occupant load of more than 50 persons.
Cl 4s
ZY"No
8.
The est describes my operation;
E
Office
R Sal s
i
Warphouse
Manu acturIn / Distribution (describe process and end
product)
'
1
Restaurant/Take Out Food
t
Medical / Dental
Other (describe)
u
d
-
SUPPLEMENTAL. INFORMATION
77
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Jul 15 03 10t1G* Cittj of Huntington Beach 714 374 1647 p.i
APPLICATION POP, CERTIFICATE OF OCCUPANCY
r
CITY OF ;HUNTWGFON BEACH - DEPARTMENT OF BL�J) G ,&& SAFETY
jq'4 Fioor --Must Apply In . Person j
Business License e, 2 71 Dat
Address r ' N.
5S 1 rtS Grim P �C!y
BusxnessNarne _Ijqc.Ttrcphpne/
Business Type
€ rn ation Business owner_
f
Flame L sD %%l c ,-� Name L. , 591 C'..( rVZ46f '
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Address _ '�3 ti�,'r� 'T HorAe Address v4 L-lgwe-
City_ff Te i.' if-24-5i City U, � Tel.�ryr Y
3
TMS USE WOULD BE DESCRIBED A Sc
Ul ew= Constructed Building or !, } xisting, Building
GfM.GK.ALL MAT ,A,.?P
CiChaange orowncr hArrga of Occupant Qr✓hange of`usG Q.ddltionatOccupant
Indicate fanner use= if any Q :ri Ct� ? -
Does the building have electricity? Yes t� itito�
turned 'des
TfNo,,arre you requesting that the cl cttnc rybo on? ,'
Tho building is sprinkl.ered? Y N.0
Gperutions will product dust1wood shavuigs or si nilar mater€al? Yes O N 0
Y
Operations 5vitl s'nvotyc therepair or repluc=ent of automobile harts Yes.�
If yes Describe.irecomponentsrepairedorreplaced.
Does the operation involvethe use of welding or open fume? Yes 0 No
i'he business is drinking, dining or asscm gtthat will result in as caccupant oa
of -more than 50 persons. Yes 0 No �
The follov4ng hest describes trey, operation
/*ff'ice Only DRetail Sales QMedical(Dental DRestaurant/Talte Ovt, Food UWarehouse
uManu acturingliiistsibution (describe process and end product)
Other (describe)
'ffice Use Cirtly:...�
�..— S�q R Gecupled: M Oce Group C?cc LaStories.
ParWing Spaces; 1U,Review: Y!N Amt Paid�zuildingPermit
[Phqnner
Entitlement
E
1141-0—cofo�
Initials- BldwePlan Checker 1n1h'
Jul 15 03 10: tGa ' City or ;fluntinctanBeach 714 374 IG47 p•3
HAZARDOUS iViXTER ALS DISCLOSURE INFORMATION
Huntington Beach Fire D artment
Wforni'a Health, and Safety Code requires the � ire Depm tment to regulate businesses that handle hazardous
materials. Motor oil, Hydraulic fluids, gasoline, dry cleaning iltaid, etc., are considered hazardous materials and
must be disclosed. If you use, handle or storehazardous zardous materials or waste materials equal to or in excess of
the following basic quantities, your are required to discloser
• 55 gallons of liquid
• 500 pounds of solid
• 200 cubic feet (:f comptesscd gas
• Any amount of rnd oactivo materials
• Any amount of Class A explosive
Any amount of cheruicals known to cause cancer
• Any amount of cummercial pesticides
• _ �Lepomble quantity of any chemical on EPA Extremely Hazardous Materials. Substance List
Disclosure is not--quired for the following;
1. Hazardous substances contz:ised in food, drug, cosmetic or tobacco products.
I Upon +.pproval of Fire Chief, hazwdous materials contained solely in consumer products packaged
for use by and distn-buted to the general public. However, pesticides, herbicides, and aamraoalum
ultrate fertilizers over the required disclosure amounts are not exempt f-Om discI0surt.
3. Tl e transportation; of hazardous materials accompanied by shipping papers prepared in accordance with,
the provisions of Code of Federal .Regulations.
C infectious waste generated. by healtlh ears facilities that are regulated under Title 22 of the California
Axisninistrative Code,
s
Check one of the follov�iegr
7K
No chemicals are used, handled or,stored at this business
Chemicals :are used, handl4 , or stored at this business, but do not meet the requirements for disclosure
Chemicals are used, lsanaled or stored at this business. Disclosure formes )Pitt be sent to you.
Amounts will be verified by the'Fire Department during annual inspections. It is unlawful for anyperson to
lmowingly violate any provisioa of this ordinance.
I certify, under the eualty ofpedury, that the abov- information is true and correct to the best ofmy
l now'16dge.
bate �//5'+ 3
Please, call 714-S36,5676 widt questions regarding I/re ffazardotrs Materials Program.
Jul IS 03 10:17a City OF Hwntinrtan Brach 714 '374 1047 p.O
i
South Coast
k Air Quality Management :District
21865 E. Copley Drive
Diamond Bar, MCA 91765-4182
(909)39&3529'htpp;t/w .agrnd�gov'
Air Quality Permit Checklist
California Government Code 65850.2 prohibits cities # om issuing a Certibeate of Occupancy to a businets
without clearance from the, local air gttality agency. This amkiist will dtitr line if yvu nced t4 Obtain
clearance :&om the South Coast Air Quality iitanagerrient D`[strict (AQIvm),
Company'Name., Li .dJ ►T41C 77 o
Propert)! Address: Z� 11`tl t.C:' S7xZ 7z~ .�
City. _ _i dip Code: 4
Contact Person b rlp,- T tle: 'EX: "�iLl
Typedf Husintss; t .����'`I}tlk,.rlt i`elenitase:(�.
Applicant. (prxut name),�}/�3� i _/} Sgxtattrrc t
dIll the facility have any of the following equipment? es 0 NO
Charbroiler "
Dry cleanfng machine
Spray Dooth
Printing, Press (screaerliithographiclflexp aic)
Intenual combustion engine (greater than, 50HP) (excluding motor vehicles)
Boiler/combustion equipment (greater than. 2 million HTU/ita maximum input)
Abrasive blasting cabfite*ooim
Daghouselcartridge type dust filtcriscrubbcr
Motor fuel storage and dispensing equipment
,Will axay of the folloW ng opmgons be per£ormtd4 Yes ❑ N()
Application ofpaints or,:adhesives
Etching, platin& casting, or melting of metals
Molding and blending of liquids -and/or powders
Storage Of acids, solvents, organic liquids or fucis
,Production of"acids, solvents, Organic liquids, or fetels
Production offuttles, dust, smoke or strong odors
• lPyou answered "No," to both questions, this checklist is your clearance from,AQMD.
•' If your ata5wezed "Yes" to either question, you Must contact AQ'vM to determine ifairquality permits are
required. If permits are needed, AQMD will assist you in, submitting permit applfcation(s) aazd then provide you
whit a clearance letter: YOU Cali cell A,QTMD at Hoerr` Small Business' Assistance OEilce at (800) 398: 21,2,1.
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APPt ATION FOR CERTIFICATE OF bCCUPANCY f , y
CITY of "UNTIIiOTON SEAGN
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