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' APPLICATION FOR CERTIFICATE OF OCCUPANCY
�. CITY OF HUNTINGTON BEACH
h
DEPARTMENT OF COMMUNITY DEVELOPMENT
HUNT#CTON E/401
(PRINT OR TYPE.JNLY) DATE
,4
Address
District
Business Name T.e,-L -Q1C �.�%/ 93-7k33�1
Tel
Business Type L CE�T.CicL Cc�r/T�,4CT01 Occ. Grou
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BUILDING OWNER BUSINESS OW R[MANAGER
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Name &h Name—D %3.+�KC.a/i er'c
nPHomeQAYI
Address �7�5�1 �i� TO 5//// le Aress 5'b �O
City ✓%!`SS�oN Vr'4T_/�iDCityiii`ir�fo2� u9c�trc `,� (f� Home Tel.
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N477- JAev% s
THIS USE WOULD BE DESCRIBED AS:
❑- NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER �I CHANGE OF OCCUPANT
EYiSTiNG BUILDING ❑ CHANGE OF USE ❑ ADDITIOt,AL OCCUPANT
Indicate former use, if any ecupancy Gr.—Di,,,
SQUARE FT. OF BUILDING TO BE OC UPIED-O %r �yy ��:�%Z = 2—
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NOTICE: 1. Occupancy of any building is prohibited and a business license will not be issued until the building has been
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inspected and a certificate of occupancy is issued.
it.
2. No electrical service will be released for any existing building until the service °-as 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 a building or
premises in order to determine if a change maybe made in the character of 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
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different, group of occupa:,icy, a change of oa:upancy inspection fee of $ shall
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be paid to the city.
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4. Huntington Beach Fire Code Section 10.208 1 equires 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'
numbersmust be posted on your building in a location that is visible from the street.
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5. Huntington Beach Fire Code Section 10.301 requir,s fire extinguisher selection and distribution per the
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National Fire Protection Association pamphlet 10 (see reverse ide).
Ifr TRAFFIC f CS �C �o✓ ir%rr ��--- /C�/v d
" U ° .� /
'.
DATE PAID eU.r✓.
i AMO
ECEIVED
E (FOR OFFICE USE ONLY)
- ZONING
OCCUPANCY GROUP
PLAN CHECK NO. NO PARKING SPACES
f OCCUPANT LOAD PCRMIT NO. - HEALTH DEPT APPROVAL
'
NO. OF STORIES ADMIN. ACTION UTILITIES RELEASED
`
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�a M1
CERTIFICATE OF OCCUPANCY FEE $
APPROVED BY DATE CHANGE OF USE OR OCCUPANCY, FEE g
TOT a; l
75-039 Rev. v97 COMMUNITY DEVELOPMENT C
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SUPPLEMENTAL 'INFORMATION
1
�� i� T.P Ns�s7v� L✓�A%C
1
BUISINESS ADDRESS;-
2.
Person to contact in case of emergency,7/ _ O
Telephone number:
3.
Does the building in question have Electricity?
,� Yes
❑ N
'7
r
(a) - If No, are you requesting that the electricity be
❑ Yes
❑ No
turned on?
K
Yes
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4.
The building is sprinklered?
❑ No
5.
Operations will produce dust/wood shavings or simlar
❑Yes
�
material?
No
6.
Operations will involve the repair or replacement of
❑ Yes
No
automobile parts?
If .Yes:
(a) Describe_ the components repaired or replaced.*
(b) Does the operation involve the use of an open flame?,
Yes
No
a
7.
The business: is drinking, dining or assembly use: that will
Yes
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result in an occupant load of more than 50 persons.
G No
?`
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8.
The following best ` describes my operation;
Office Only
}
f.Y
�
•I :Sales
I
lNarehouse
Manufacturing ("Distribution (fescribe process and end product)
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1,
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Restaurant / Take Out Food
1,
Medical'/ Dental
},
Other (describe)
SUPPLEMENVTAL INM MATON
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i
SUPPLEMENTAL 'INFORMATION (Continued)
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Does
the operation involve any of the following -` materials? ❑ Yes
,;5No
4
If Yes, indicate - quantities:
Material Quantity
,
1,.- Flammable liquids
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a
.
Class I -A
3,
:.Class I-B
'.Class I-C
2.
Comoustible ,liquids
Class II
Class 111-A
3.
Combin,-".:;. flammable -liquids
4. ,::`:Flammable gases
5`. '"
Liquefied flammable gases
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.
Qxidizing material - solids,
14.
'Organic peroxides
15.
Nitromethane (unstable materials)
Ammonium nitrate
17.
Ammonium ' nitrate compound., mixtures
containing more than 60% nitrate
by Freight ;
18.
Highly toxic material and
poisonous gas
19.
Smokeless_. powder.
r 20.
Black sporting 'powder
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hereby .certify_ that the above information is true, and , correct to
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the best of my knowledge.
Signature Date
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South Coast
Alit QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PERART CHECIMIST ;
for nonresidential buildings only
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CompanyName: ELFC?ri>'i `i✓�'
Location of Property: J5-7-D 77jf,4n/-S s ie9.Q ZA—
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C .
,-s a-
. L Zip �o tY' Code:
P _
Contact Person: n/ue rEem-4 no Title: sU fl y
1e/A sn.e_
Tele hone Number: 7IV p ��_9,73 - D 9 3 _Fax Number: 'Vy 9Gj
Type of IndustryBusiness:
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions about completing this checklist, please call (800) 39,8-2121.
YES NO
1. Will the facility have a charbroiler? (�
2. Will any internal combustion engine with greater than 50 horsepower
operate at the facility (excluding motor vehicles)?
l
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/nr be C'
operated.at the facility?
8. Will any acids, solvents, or motor feel be used or stored at the facility?
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 (Freon) recyelhig machines operate at the facili
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Applicant: J0 6- 6�EXA-" O Signature: /
(Print name clearly) `
If you have marked "NO" in all the boxes, an air quality permit is ngt needed at this time,
and this checklist is your written release.
If you marked "YES" in any of the boxes, you roust contact the South Coast Air Quality
Management District (AQA11D). Please read the requirements on the back of the checklist
(800) 388-2121
ADDITIONAL SUPPLEMENTAL INFORMATION
1
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1
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APPLICATION FOR CER,rIFICYATE OF OCCUPANCY
CITY OF HUNTING'ON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT 1�e�110167
HUON IiAOi DATE
(PRINT OR TYPE. ONLY)
r
i
:
Address l/5�/v�/s%o�� Gi9if% District t
Business Name JTFI-I:e �GT��'G, ,�,1/C Tel (`%/ �93-79`3f/
G LG--cT.E�i �.� L Ccsv'Te.4GTQ i2
Business Type. Occ. Grou
BUILDING OWNER BUSINESS OW RJMANAGER
Namel�O/I be,1,4`o- A16- VY �r^ � Name P4Yi'D f3ia°k�.i/vyJeie
Address 7Y5'�vaT0 S , �/d Home Address SDId S r
5Sr`oN r �I o) �/r II J i/rl!`/fti /J�-eic
City / V 'G f D C/�) % !a e(?�U3 y f dR% 0" `i, (lF� Home Tel.
JJj4TT jA,eW5 '57J-6fg-
THIS USE WOULD BE DESCRIBED AS: !
❑ NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER 19 CHANGE OF OCCUPANT
EXISTING BUILDING ❑ CHANGE OF USE ElADDITIONAL OCCUPANT
Indicate former use, if any + - e//4Ybecupancy Gr.—Div.
SQUARE FT. OF BUILDING TO BE OC UPIED �C y�y �� 2-
NOTICE: 1. Occupancyof 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, requiredto 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 maybe 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 orina
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 (1/2.) 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.
r Huntington Beach Fire Code Section 10.301 requires fire extinguisher selection and distribution per the
National Fire Protection Association pamphlet 10 (see reverse ide).
. .
�Cc�o✓ mar „--
TRAFFIC I
DATE PAI7ECEIVED
ti
AMO rQ
r \ (FOR OFFICE USE ONLY) ZONING i
I
OCCUPANCY GROUP J� PLAN CHECK NO. NO BARKING SPACES
I OCCUPANT LOAD PERMIT NO. HEALTH DEPT, APPROVAL
NO. OF STORIES / ADMIN. ACTION— UTILITIES RELEASED
CERTIFICATE OF OCCUPANCY FEE $
APPROVED DATE CHANGE OF USE OR OCCUPANCY FEE
TOTAL g
is-039Rev. vs7 COMMUNITY DEVELOPMENT �� 3 %53��—