HomeMy WebLinkAbout15185 Springdale St - CofO• g,I.
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HUNT".: tON SAOi
APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
(PRINT OR TYPE ONLY)
DATE
l SI 5 �= District
Address
eiGt�' o�'!7P �.La3
Business Name 1 .a —5 �' Ts
Business Type Occ. Group
BUILDING OWNERBUSINESS OWNERIMANAGER
I Namey Drl C�cSL.R 1/�Vs. lT.�G'�� Name�rSPi`oCZ� -\ivy
LZS'� Home sin Sa\�.3 tt Prl
Addres�^��`k� K� Addres f
i tJ` 5fi�s� \I.�S�/'. Tel 3'k�o, City'�y�rr�a1$�!P Home Tel
City � r� �
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THIS USE WOULD BE DESCRIBED AS:
❑ NEWLY CONSTRUCTED BLDG ❑ CHANGE OF OWNER / CHANGE OF OCCUPANT
3
EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT
Indicate former use if any
C—�� �� Occupancy Gr.—Div.
SQUARE FT. OF BUILDING TO BE OCCUPIED
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(FOR OFFICE USE ONLY)
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` SUPPLEMENTAL INFORMATION
�
ZONING a
OCCUPANCY GROUP
6
PLAN CHECK NO.
NO PARKING SPACES
!
OCCUPANT LOAD
PERMIT NO.
HEALTH DEPT.APPROVA:.
NO. OF STORIES
ADMIN. ACTION
UTILITIES RELEASED —.
s
/
TIFICATE OF OCCUPANCY PEE
$
AP VED
DAT
HANGE OF USE OR OCCUPANCY FEE
$ {
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TOTAL
$
Y �
COW 0U7lO D,
I ; 5.039 Rev. 11/91)
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS U5
2.
Person to contact in case of emergency5=
Telephone number:
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3.
Does the building in que,3tlon have electricity?
Yes
❑ No
(a) If No, are you requesting that the electricity be
❑ Yes
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turned on?
❑ No a
E
eyes
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4.
The building is sprinklered?
No
l
5.
Operations will produce dust/wood shavings or similar
material?
El Yes
RNo
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tr
6.
Operations will involve the repair or replacement of
❑ Yes
ff"No
automobile parts?
1
If Yes:
(a) Describe the components repaired or replaced.
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flame? ❑ Yes
(b) Does the operation involve the use of an open
7.
The business is drinking, dining or assembly use that
will r
result in an occupant Load of more than 50 persons.
❑ Yes
Eg�No
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8.
The f�[lowing best describes my operation;
✓Office Only
Retail Sales
Warehouse
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Manufacturing / Distribution (describe process and end product)'
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Restaurant/Take Out Food
Medical / Dental
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Other (describe) _
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SUPPLIMENTAL INFORMATION
11
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SUPPLEMENTAL INFORMATION (Continued)
Does the .>operat[on involve any of the following materials? Pes
o
If
Yes, indicate quantities:'
Material Quantity
1.
Flammable liquids
Class I -A
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Class I-B
Class l-C
2.
Combustible liquids
Class 11
Class III-A10
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3.
Combination flammable liquids
r 4.
Flammable gases
5.
Liquefied flammable gases
6.
Flammable fibers - loose
7.
_Flammable fibers - baled
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8.
Flammable solids
}
9,
Unstable materials
10.
�:orroslve liquids
11.
Oxidizing material - gases
12.
Oxidizing material - liquids
13.
Oxidizing material - solids -
1 14.
`Organic peroxides
'r 15.
- Nitromethane (unstable materials)
16.
Ammonium r,itrate
g
17.
Ammonium nitrate compound mixtures
containing more than 60% nitrate
by weight
18.
Highly toxic material and
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poisonous gas
f
19.
Smokeless powder
20.
Black sporting powder
I hereby certify that the above information is true and correct to
best of my knowledge`
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Signature Date
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Government Code Sgri ,., 65850.2(b) requires that the City of Huntington Beach not issue the -,final
certificate of occupancy unless the applicant has met or is meeting the requirements of the South
l Coast Air Quality Management District (AQMD). The Department of Community Development must
obtain a written release from AQMD to show the applicant has complied with this law. The check
list on the reverse side is designed to help the applicant and the building division to meet these
requirements.
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1. The applicant (the same person who applies for permits from the
Department of Community Development) must complete the check list
which can be obtained either from the Department of Community
Development or at AQMD.
2. If all boxes in the list are checked "no", the Building Division can accept the
check list as the release.
3. If there are any "yes" answers in the list, the applicant must contact an
AQMD engineer by calling (714) 396-2000 to find out whether air permits are
i required for the proposed construction project.
4. If air permits are not required, the applicant will obtain a written release from
AQMD.
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5. If air permits are required, the applicant must submit the necessary permit s
<. applications before the release can be issued.
Because of the time it may take for AQMD to go through the above procedures, the applicant is
advised to contact AQMD immediately after applying for building permits.
ADDITIONAL SUPPUMENTAL ENFORMATIOIV
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