HomeMy WebLinkAbout15061 Springdale St - CofO (44)z
APPLICATIO!, 'V-, CERTIFICATE OF OCdUPANC Y
CITY OF HUNTINGTON BEACH ur-tnD"t'n=tTNtEM�; ter" COMMUNITY DEVELdPtNt i•!TV?4tNryGrcxv eXncrtfitirar Of! YP�;,rt,� E
Adurr s,�,
Bu..inec"r, Type _---.-,i
THIS USE WOULD BE DESCRIBED AS:
NEWLY C,r N13TRUK:Tl I_ r i 7+C, t i
Ex71;PNG R%P UM1 t
Indicate forrrior t, ,, i rr
SQUARE Fi t.t
Ii dTICE• __,_-•
1. Occupancy of any building is prohibited . Ind a business I+rcon5c; will not fie issued until the b0idina has been
nspected and a certificate of ?iccupanc;y iS :ssrand
2. No electrical service will be released for any exthrig building until the service has been inspected and =
certified safe. All applicants for occupancy in an existing huitdirig are required to .schedule an electrical ,
l 'fuse up' inspection in the Departrrient of Corr mimity Deyeiop!Tient at ttte tame-t'lia application is filed.
3. Change of occupancy or use inspection tee. Whenever it is necessary to make inspection of a building or i
premises in order to deter me if a rllar` )e r.,rxy by inade in the chiaracter of occupancy or use of the building
or premises which would place the ti,: Id.ng in a d!ffetont 004 4iori of the same group of occupancy or in
diftHrr nt group of occuparwv a ch43rtge of grcupanr:v irspe—tion fee of S shah t
d he paid to the city, #
{
i A/ 4. Huntington Seach'Fire Code Section 4 f 208 rC;,uve:j drat bvadine r?umbers m ust be a minimum of#cur (,
A, ir,4lres in height with one nt�gf o "tiel inch �+ I ;, and c;f t:c ntraotirag i t pr tr:>m the background. These
t numbers must be pasted on ,foor btu.dinq ,n '.f IO tt:acr that is visible from the street
` S. Huntington Beach Fire Code Section tO 301 requires fire extinguisher seleclion and d;stribution per the
Nailnn3l Eire Prof0ctior, AssOciji,on pamphlet 10 ispe reverse .side!
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFCRMATION 6,W1, c
l
(7# i �ll
C^ t+
i+ t t t
NO
4.
?AI.
:.. Ca'30t?tL5t1NIT'Y nFIVEI.P
APPLICATION FOR CERTIFICATi? OF OCCUPANCY
' CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
ra tirmx.rnh r!,uti . F .
' THIS USE WOULD BE OESCPIPED AZ:
NOTICE. i _
f:3"ccapancy otary b utlidrwt'Jlt� i 1 f., Y F �� l��ll..i�JF'will not !f.ais;-led4intil the Ui.i:r1}ghas been 1
)nspectpd ann 3 l e rttr.i,atr-
2-
No electrical service k+.itl7 # t : of he flas been inspected and
.r
certified safe All „p)�.�c.�nt r _„" p-_°tc;,r �r :tit t�;t"z t7 1 re ir) zile required to sch dote an electrncai i
f&*-, up !r spect;r✓r' i1- t! ? Dep itti t .r 3f �. t I� �"'t.``nfg l.7xad�. ftf}! }g111 c+' it,'e. itmF'. ihis'applivatioo is filed. j
1 I 3,
r- c ,' t in 5 r g
Change Of occupancy Or use Ir15{3e0ttOn fee- rvr+•;' + .r ,' IS " Yr,l°�._- � ,3 ; 3k,..n$pc'G,ir r3 +af 3 bUzldin or
I3reffltses cn ofogc r t , tictt->rnon of ont upa!tcy or use of the building
u! pre"u ;es which oiould b.r i-Ittnq a tr:ffiire tit dl t kin ,f the same gtoup of a j
different grjijp of occc, a ;;, a :J x, r ;r#s ecliv:' fee shall
be paid to lhf' city
4.
Huntington Beach Fire Code Section 10 ,108 Iha't build"!=r] rt r rlber.s , r,! Lea m�tmniur'ri of four(4)
I�f, of
,nu .es !n height . r , ,, artf of `dr3UC2r7Sikr3 ti}rar fro t`t ttiY'; bacf�Crrnrf Those
�`#' _. v�[ril? {3nt? lr -t 1 s r ';*tic �Y
ported s must be r dtt i r, it oa, th<t e srt,l Ir lni r!w street
num,
v
Huntington n, 3ort Beach Fire Section f ay r��
gf i w B . fir extt,19u1;3i7E r.,rt{t ,is�'.irlflatic�rt riai il1Ei
t t +, t
Na.IrJn3I Fire i�!(k€�'r^itUf' Aw,4 FaitGr}I},'�;rt]ftl:'.6:f 1f) (.,H%^ i(?YkY k `,=ijt"{. }..
l
(FOR OFFICE I1SE ONLY)���
- :•
SUPPLEMENTAL IN TION
NO CF STrr Flt S � _ • ", ��" is t .- ....__�
Uzi
r
.
♦`_ .:.:.: :. �..
: _.. .. .. -.. mow.-. —J
F
�I
i—
'e
I'
f
it
s
4�
o
{
� , .., ... ..
�•ay y,r:.:D "�7tP3...MRy:lrWtikiF
t"
t
�i
t � a..a� .x swti ts� .t,(+4�p+.��u+r^�".,[G�atF
p
t ��n��jrya/'r^rx�f/ct•,/ t n(n � � w ///
.
{���j. f%
l`SftSCFia: Cr'k:Sifs'R"
'
t
p
4
Y
�
I
i
3
s�
0. %e
r
I.tii: ? IiyC; .E1l.'RmI'E',/(:T it`_t'1-I.-.Et:1,`T'F? OP OCCUPANCY SUP)?LLl,!h ti5`'..
a
M
PE€ MIIT-rING, _J_CKl-JST
r,r•.<....
.. .. ..: s..,.�..c ":rv�v.;;w"rik:.*'.:+."'at...�.-.wa,.tx-•"-� v..._ .rl_c'16YL3.3 i11N Y
G3 ti..
J
T':'_f., ft ,N Y fit .7. 1'_..S'1.W:,.E: C(''7'{BUs.i .?.(-)N
HT
LL''N 1) T 1.1C` y olY
OR
..: IH TT METAL,
r.�'l' l'r OR COt,..P Al �X�Tl't'.i v?
ry
,v
= r F,,' C .T,.,.Ti At i .2 t'C3, F3tJS i t 2
Al
EQUIPMENT (I. ;,%, F:CILE'RS,, FUR11 CES, BROILERS,
`
BAXINC OVENS, FTC)
7. 7E Tir:' T`?1(- 7r' rj" Fi?J3 tT,F nTr t'^'ri'i? F r2.nT.t7}4rf C (%t7
fc%
MOTOR FUELS?
ss < DO YOU US1s OR STORE A14Y ACTlj'3?
9. DO YOU USE ANY CHEMICAL Pi�OCESQ�ES?
10. DO YOU USE ic: r Y SOLVENTS FOR C%F,:ZN UP?
k
I:I . 1'iRE "�Ji7 A �kx wr,F�'s. TER, REST-kUR . 4T, BODY SHOP,
GASOLINE STA.TTGN, PRZNTM--t, Uq P?4 T CO;A,TER?
IF YOU DO NOT KNOW THE ANSwI TO,A QUESTION, MARK IN THE "Y"
a
COLUMN x
TE YOU HAVE MA.RXED ANY QUESTIONS IN THE "Y" COLUMN YOU MUST
'
CONTACT THE SOUTH COAST AIR QUALITY MA NACE2dENfi DISTRICT LOCATE(
AT 9150 FLAIR DRIVE, EL MONTE CA, 91731, PLEASE CALF, PUBLIC'
e
INFORMATION AT (81.8) 572-5283 OR CUSTOMER SERVICE AT (818) 572
6347.
r
J013 ADDRESS: 1�, d <4'F�t�,�:,��+�
_`�
DATE: ° � � f � ✓ SIGNATURE:
r
®, IN APPLICATION FOR CERTIFICATE OF OCCUPANCY
via
CITY OF HUNTINGTON BEACHqDEPARTMENT OF COMMUNITY DEVELOP D TE
TON BFAQ1 1.
1 (PRINT OR TYPE ONLY)
'1
Address
Q 1 77 istrict
Business Name Tel
Business Type Occ. Group
Pi w nimr; owNFR BUSINESS OWNER/MANAGER
Name— tC— Name)/� SO�/ZGL.
Home
Address. /L' 1/Q Grha _In— Address q
City /% Q o2m % Tel s4+' ���City f%C/ 902 Home Tel.D` 9'f
THIS USE WOULD BE DESCRIBED AS:
❑( NEWLY CONSTRUCTED BLDG. ❑ CHA14GE OF OWNER `CHANGE OF OCCUPANT
4YSI EXISTING BUILDING g� ❑ CHANGE OF USE .14 ADDITIONAL OCCUPANT
Indicate former use. it any (Lj Occupancy Gr P —Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED S 'Rog Joao 2��D
NOTICE: 1. Occupancy o" 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 up' inspection in the Department of Community Development at the time this application is filed.
1 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 cruse 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 fe? of $ shall
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 building in a loration that is visible from the street.
5. Huntington Beach Fire Code Section 10." 11 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse side).
L
D;�Y; i•: ;iti
7 r/
C'rf;-c (FOR OFFICE USE ONLY) � —�
�J ZONING
OCCUPANCY GROUP PLAN CHECK NO NO PARKING SPACES
OCCUPANT LOAD PERMIT NO HEALTH DEPT APPROVAL
NO.OlSTORIES —a ADMIN ACTION_ UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE $
/ ATE CHANGE OF USE OR OCCUPANCY FEE g
FROV B
TOTAL
75-039 Rev.1/97 -
-u-
V\
SUPPLEMENTAL INFORMATION
1. BUSINESS ADDRESS
2 Person to contact in case of emergency
Telephone number:
3. Does the building in question have electricity? suz:aD/� ❑ Yes
.� No
(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
material? El Yes
Ga° N o
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?
t. The business is drinking, dining or assembly use that will
result in an occupant load of more than 50 persons.
8. Thed251
o'best describes my operation;
y
Res
Warehouse
Manufacturing / Distribution (describe process and end product)
Restaurant/Take Out Food
Medical / Dental
Other (describe)
suFTLEMENTAL INIFORMATIf7l
SUPPLEMENTAL INFORMATION (Continued)
Does the openu1mn involve any of ihe following materials? 0 Yes
wn
/f Yom. inU|cato quantities. '
Material Quantity
1. Flammable liquids
Class |-A
-Class I-B
Class (-C
2. Combup^'b|e U4u'du
Ocos ..
~—' ^' ^
uaxou m-*
u. Cornmnoumn flammable /iqU/gu ~
' . .
4. FkamnnaUia gases
5. Liquefied 0annnnub(a Cases
` S. Flon�n�ab�o fibers - loose
` !
'. ,/am"/uu/e xuv,s - vu/eu
fi Fbynnuob|o solids
/
' �
Q Unstable nnatahu|a
' .
` 10. Corrosive liquids
------- '
. Oxidizing material "^~~.
12. Oxidizing material - liquids
18. Oxidizing material - oohda �
_
14. [)r8ao)c peroxides
15. Nitrornmthane (unstable materials)
16. Ammonium nitrate
17. Ammonium nitrate compound rnhduroa
containing more than 6096 nitrate
by weight| ` `
18. Highly toxic material and
poisonous gas
,
Smokeless19.
20, Black
sporting
| hereby certify that the above information is true and correct to
the beat of my knowledge.
_
� Signatuny � u Date
'
'
'
'
South Coast
AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
r'AR QUALITY PERMIT CHECKLIST
for nonresidential buildings only
I
Company Name: �J
Location of Property: 15 De'a / S,O/it�K /� �n� • 0;2OZ, - —709
city: J �le>A- Zip Code; 9 ��
Contact Person:
�QUIGfS�Q / 2 �, Title:
/ ,,---
Telephone Number: (7/-41)8 93 -35/ / Fax Number: (-'-7/�42
Type of Industry/Business: ��+✓t �
` To apply for a nonresidential building permit, you must complete this checklist. If you have any
1 qu,-stions about completing this checklist, please call (800) 388-2121.
YES NO
1. Will the facility have a charbroiler? [ ] [
2. Will any internal combustion engine with greater than 50 horsel �.wer
operate at the facility (excluding motor vehicles)? [ ]'
3. Will operations at the facility imvolve 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 used or stored at the facility? t�l
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 (Frecycling machines op(Freon) erate at the facility? [ ] [v1
(
Applicant: �Q v /�-',s�DIrg-ZCc, S_,Tnature: _ 7/ -/,U1—
r (Print name clearly)
If you have marked "NO" in all the boxes, an air quality permit is not needed 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
Management District (AQMID). Please read the requirements on the back of the checklist.
(800) 388-2121 I
i A :iPiAL SUPPLEMENIk '" FOCIVAT1: 't
I
'j
J
Exhibit "A..
I
i
2
a
r
O
cn
o
\ m
0
1
ul
CD
C
N
CCD
0
rT
I
W
CL
N
s
_y.
N
i
O C
i
N
I
o
0M
N
Z