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s J• APPLICATION FOR CERTIFICATE OFeCCCLUPANCY
CITY OF HUNTINGTON BEACH
DEPARTMENT OF. COMMUNITY DEVELOPMENT
' NUMurYaON BFAQi (PRINT OR TYPE ONLY) DATE
Address IJ Lf fi'ZZ,n5i`)"'(��' Lao I—, District G
Business Name _1 rG S /'GNU in %1 LL 1 Tel. ��Li
Business Type En a� rN Ge V" n �Atl MR7 ti plt �p�lAYQt S v S "a � Occ. Group 772
BUILDING OWNER `BUSINESS OWNERIMANAGER
Name 't ( t�t'tr1Gt y�Q1>� Nameat�/�{
i �f15 /� ( �te ((� Home 8 Lo-S i
Address_ /" ! � Addre
C�-b � C �
.City �t S51 U-� V i C� n �✓ � Tel City C.�f� 1''\ t � t'1 ��i � .Roma Tel;_ ,
THIS USE WOULD BE DESCRIBED AS:
NEWLY CONSTRUCTED BLDG. CHANGE OF OWNER L CHANGE OF OCCUPANT
EXISTING BUILDING C� CHANGE OF USE ❑ADDITIONAL OCCUPANT
Indicate former use, it any Occupancy Gr. Div
SQUARE FT. OF BUILDING TO BE OCCUPIED
NOTICE: 1. Occupancyef any building is prohibited and a business license will not beissued until the building has been
inspectee and a certificate of occupancy is issued.
-2. No electrical service will be released for any existing building until the service has teen 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 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 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
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 (1l2) 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 extinguishe. selection anddistributionper tt,e
I
SUPPLEMENTAL INFORMATIOM
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1.
i
'J�SINESS ADDRESS L5 3LI :I(- iS h� L�xn�
2.
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�S
Person to contact in ease of emergency tne,'�'-.r'S
Telephone number: :71`~I— 3'10-- 5516,5
3.
Does the building in question haveelectricity?
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?
❑ Yes P
No
6. -
Operations will involve the repair or replacement of
❑ Yes
automobile parts?
[�$, No
If Yes:
(a) Describe the components repaired or replaced.
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(b) Does the operation involve the use of an open flame?
❑ Yes
No
7.
The business is drinking,- dining or assembly, use that will
result in an occupant load of more than 50 persons.
❑ Yes
No t
8.
The following best describes my operation;
.Office ?Jn
'
Retai a es
Warehous�a
Manufacturing / Distribution (describe process and end product)
Restaurant / TakeOut Food
Medical / Dental
Other; (describe)
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I SUPPLE: ENtAL
_ _
Does the operation involve: any of tt',P
W- FORMA r fON (Continued)
following ` materials! Yes
I� No
If
Yes, indicate quant=tres:
-Material
Quantity
1.
Flammable liquids
Class 1-A
Class t=B
Class 1-C
2.
Combustible liquids
Class l
Class 11 -A
8.
Combination flammablel 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
18,
Oxidizing material - solids
14.
Organic peroxides
15.
Nitromethane (unstable materials)
16.
Ammonium nitrate
17.
Ammonium nitrate compound mixtures
containing more than 60% nitrate 7
by weight r
18.
Highly toxic material and
poisonous gas
19.
20.
Smokeless powder
Black sporting powder
1 hereby . certify that the. above information is true and correct to
the best of my knowledge.
&_:�
Signature Date
South Coast
AIR QUALITY MANAGEMENTS DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 896-2000
AIR QUALILTY PE PART CHECKLIST
for nonresidential buildings only
Company Name: 5E IS (Sy-b f ,f1�0 C_
Location of Property: 15
City i �un`�i na� D✓� 1 Gc� Zip Code: �a c 9
Contact Person: C I1/ i `l i n T)g,f PAS Title:" irC �� G �r �c C,
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Telephone Number: -7 / '1 — g Cq - 13'79 Fax Number: l 7— 3 �t 9 126
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Type of IndustryBusiness: E r`t
To apply for a nonresidential building permit, you must complete this checklist. If you have any
questions 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 horsepower
operate at the facility (excluding motor vehicles)? [ ] ()C]
3. Will operations at the facility involve mixing, blending, or processing of
solvents, adhesives, paints or coatings? [ ] ['M
4. Will dust or smoke be generatzd at the facility? [ ]]
5. Will refining of any liquids or solids be done at the facility? ( ] 1XI
5. Will any plati:rg or coating of materials be done at the facility? [ ]
7. ; Will any combustion equipment rated greater than 2,000,000 BTU/br be
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operated at the facility? [ ] pcJ i
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?
Y
10. Will any ovens be used to dry or cure products at the facility?
3
11. Will any CFC (Freon) recycling m machines operate at the facility? Applicant:(j SkS r1 e_ ' C) 6 � C�+S Signature
(Print name clearly)
If you have marked "NO" ;in all the boxes, an air quality permit is nQt needed at this time,
and this checklist is your written release.
If you marked "YES" in any of the boxes, you trust contact the South Coast ,fir Quality
Management District (AQMD). Please read the requirements on the back of the checklist.
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(800) 388-2121
ADOI -ICNAL SUs� �tt� rvrAt cry r�rAr o r
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NOTICE OF REQUIREMENT .
{ GOWPl TTATE' T CODE SECTION 65850.2 ( 320:5)
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California State Law, (Government Code 65850.2) prohibits the Building Departments from
issuing a finial certificate of occupancy unless all requirements, of the local air quality agency are
met. All applicants are required to complete't.he air quality pertmit checklist. The checklist is'
designed to aid Vie applicant for a nonresidential building permit only. if the answer to any of
r the questions is "YES," the Building Depaxunent mtist obtain a written rclease from the local air
quality agency veritr'ving that the applicant is in compliance.
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I • All nonresidential building permit applicants must complete this checklist
2. If the answers to al l questions are "NO." the Building Department can a; cerst the checYlist r
f as the N' M'ttea release„
3. If any questions are answered "ITI4S." the applicant must contact the AQN11) by calling
(800) 388-M l to detemine whether air quality permits are required for any equipment
which may be operated at the site. If the AQii determines that air quality
q ty permits are
u.ot required or that all requirements have been met, a written ;release will be issued,
4. If air quality permits are required and applications have not been submitted, thce applicant' {
must submit the necessarypermit application(s) and appropriate fees before a written
release -Mll be issued;
AQN- O is committed to expediting all clearance letter requests, However, it may take several
weeks to verify cornpliar.,ce N6,th all requirements. Therefore, you are advised to cQvtact AQi\,M
immediately after an 'ding permits. fi
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(800) 38$-2121 �.
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