HomeMy WebLinkAbout15181 Springdale St - CofO0
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®' APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
NUM1N(ZON BFAQt DEPARTMENT OF COMMUNITY DEVELOPMENT 3-3p 2ZOi
Vk (PRINT OR TYPE ONLY( DATE
Address /S/00/ .Ji�iE!/✓�1 %�'t-E�
�%/lj
District
Business Name CAL.iR);Z;dlta (7rS!Vr^tc. C�9L j�!�Di1; S LG C'
L'Gl �G`�^/✓- Tel i-/aJ--V?od
Business Type o/-
Occ. Group;&g
BUILDING OWNER
BUSINESS OWNER/MANAGER
Name Udn/ D+'a_ N"tf_ PA Zj_✓&9ZS Name
ZA-1!_'71A, n/Aa,4-Z
Address es 2% f S�l
LoS L t ,JS Home
Address
?4 fdtSftk�✓r �, e� le i>L�✓i
UI 6 /�F✓� %�-� CC' j Q•
City
Tel !d City tLm/A
/t Home Tel. !ti
THIS USE WOULD BE DESCRIBED AS:
y�1L
NEWLY CONSTRUCTED BLDG.
❑ CHANGE OF OWNER
❑ CHANGE OF OCCUPANT
�❑
l rJ EXISTING BUILDING
❑ CHANGE OF USE
ADDITIONAL OCCUPANT
Indicate former use, if any
Occupancy Gr Div,
SQUARE FT. OF BUILDING TO BE OCCUPIED
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 inspectedand
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 a building or
premises in order to determine if a change may be made in the characterof occupancy oruse 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 $ 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 ('/z) 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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w PA :"� ACT FFF
DATE PAID+
AMOUNT RLCEt 7r'D
NAME -� (FOR OFFICE USE ONLY) ZONING_
f
OCCUPANCY GROUP �� PLAN CHECK NO NO PARKING SPACES
OCCUPANT LOAD PERMIT NO HEALTH DEPT APPROVAL
NO. OF STORIES ADMIN ACTION UTILITIES RELEASED
40Q CERTIFICATE OF OCCUPANCY FEE
PPROVED BY D TE CHANGE OF USE OR OCCUPANCY FEE I
TOTAL $ r
75-039 Rev.1/97 Ci)(e !OUNd 7 y
SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS
2.
Person to contact in case of
Telephone
emergency -
number:
f%/�/
i
3.
Does the building in question
have electricity?
Yes
(a) If No, are you requesting
that the electricity be
❑ No
turned on?
Yes
❑ No
4.
The building is sprinklered?
[Us
5•
Operations will produce dust/wood
shavings or similar
❑ No
material?
❑Y
6.
Operations will involve the repair
or replacement of
automobile parts?
�❑ Y
6 No
If Yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an open flame? ❑ Y
ftg-
7. The business is drinking, dining or assembly use that will Ui'No
result in an occupant load of more than 50 persons. ❑
Yeg-
8. The following best describes my operation; 42"No
ffice Only-
Warehouse
anu c uring / Distribution (describe process and end product)
Restaurant / Take Out Food
Medical / Dental
Other (describe)
SUPPLEMENTAL INFORMAT1074
,g
a
f
SUPPLEMENTAL INFORMATION (Continued)
j
Does the operation involve any of the following materials? ❑ ye
-
If
do
Yes, indicate quantities:
.
_ material Quantity
1.
v
Flammable liquids
Class I -A
Class 1-S
Class I-C
2.
Combustible liquids
Class II
Class III -A
3.
Combination flammable liquids
4.
Flammable gases
5.
Liquefied flammable gases
6.
Flammable fibers - loose
7.
Flammable fibers - baled
8
Flammable solids
9.
Unstable materials _
10.
Co,rosive liquid
11.
Oxidizing material - gases
12.
Oxidizing material - liquids -
13.
Oxidizing material - solids
r
14.
Organic peroxides
4
15.
Nitromethane (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
20.
Black sporting powder
I hereby certify that the above information is true and correct to
the best of my knowledge.
_ 3-- ?� i
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— Date
aigna ure
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South Coast
Alit QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar„ CA 91765-4182 (909) 396-2000
AIR QUALITY PERMIT CHECKLIST
for nonresidential buildings only
Company Name: , C�1 L �Gr� 2 411 /1 �� ✓lug r �r �� ri��,�z i� 1 L F
Location of Property: /� %c�/-'iz�,✓� �Ls s'� �r
4
City:. it i,✓��.✓ ��� -- Zip Code: -shy
Contact Person: �,'AVL n A-. dgt rya Title: %�2.t-Ti,�,�
° Number: Telephone 7«`
p ( / ��� � Fax Number:
.�
Type of IndustryBusiness: �� 3 C'�. , !7r�
i
To apply for a nonresidential building permit, you must complete this checklist. If you have any j
t questions about completing this checklist, please call (800) 388-2121,
I. Will the facility have a charbroiler? YES
No
[
2. Will any internal combustion engine with greater than 50 horsepower
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?
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? [
[
l 10. Will any ovens be used to dry or cure products at the facility?
11. Will ruzy Cl C (Freon) recycling machines operate at the facility? —`
Applicant: __ AV/1-/^-i A Signature:
tPrint name clearly)
` If you have marked "NO" in all the boxes, an air quality permit is not needed at this time,
fj
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 (AQMD). Please read the requirements on the back of the checklist.
(800) 388-•2121
ItGCT�TI�Nr1t SUF'PLFFs".f't ii�L iNFORMATtON