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APPLICATION FOR CERTIFICATE OF OCCUPANCY
CITY OF HUNTINGTON BEACH i
DEPARTMENT OF COMMUNITY DEVELOPMENT
HmrtxNGTON arwai DATE
(PRINT OR TYPE ONLY)
� I�t At)I J+OY � �' District
Address
Business Name_ N Tel4_L4
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Business Typ��;�i V1 l o- ✓1+y-CL0 ;r �4' ✓� �. ✓1 °� G e � Occ. Group
UIL 1NG OWNER -y— BUSINESS OWNERIMANAGER' j
NameaL -tom ENWC. X \ Name
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LCA
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Addre s \\ Vt r Yl e ! Addre �7
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lnT '� CA 97-4�i � �gg Te
City L Tel. City L Home .
THIS USE WOULD BE DESCRIBED AS:
NEWLY CONSTRUCTED BLDG. ❑ CHANGE_ OF OWNER CHANGE OF OCCUPANT
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EXISTING BUILDING ❑ CHANGE OF USE ❑ ADDITIONAL OCCUPANT r y.
Indicate former use, if any Gi, Occupancy Gr. Div,
SQUARE FT. OF BUILDING TOBE OCCUPIED Ile Q
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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
inspected and' a certificate of occupancy is issued.
2. No electrical service will be released forany 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.
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3. Change of occupancy or use inspection fee. Whenever it is necessary to make inspection of a building or
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premises in order to determine if'a change may be made in the character of occupancy or use the bui►din, Q,
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 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)
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inchesin 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.
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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TRAFFIC IMPACT FEE
DiiiTE .PAID
;
M1101UNT .EIVED
y (FOR OFFICE USE ONLY) ZONING t--'
OCCUPANCY GROUP 5- ( PLAN CHECK NO. NO PARKING SPACES t
OCCUPANT LOAD `, -Z- 4B c rFq Z PERMIT NO. HEALTH DEPT. APPROVAL
NOfbF VORi S lr ADMIN. ACTION UTILITIES RELEASED
a pZ S' i CERTIFICATE' OF OCCUPANCY FEE $ p
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AP PR VED� ' DATE CHANGE OF USE OR OCCUPANCY FEE
TOTAL $_
75-039 Rev. 1/e7 COMMUNITY DEVELOPMENT - t
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SUPPLEMENTAL INFORMATION"
1'.
BUSINESS ADDRESS �.�1�%JZt 1117 rcx,y!_Q.
2.
Person to contact in case of emergencyy
Telephone number: `714 ;!�b9 `u - Vr
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3.
Does the building in question have electricity?
0--fes
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13 No
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(a) If No, are you requesting that the electricity'be
❑ Yes
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turned on?
El No
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The building -` is sprinklered?
❑Yes
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5.
Operations will produce dust/wood shavings, or similar
material"?
Yes
C�'No
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Operations will invc the repair or replacement ' of
❑ `(as
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automobile •parts?
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If Yes:
Describe; the components repaired or replaced:. '
(b) Does the operation involve the use -of an open flame?": Yes'
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'The -business- is- drinking, dining or assembly use that `will
result ,in an ;occupant load of more than 56 persons.
Yes"
C�o
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8.
The following best' describes my'. operation;
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ffice Only /000sa
e a'J q_sales
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arphous /a'jcG 910
Manufacturing / Distribution (describe process and end
product) ",
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Restaurant / Take Out Food
Medical % Dental
"= Other ,(describe)
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SUPPLEMENTAL INFORMATION
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South Coast`
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AIR QUALITY MANAGEMENT DISTRICT
21865 E. Copley Drive, Diamond Bar, CA 91765-4182 (909) 396-2000
AIR QUALITY PERMIT CHECKLIS
for non-residential buildings only
Company Name:
f Property: ?_CO i' Mai 0� ! S_-L �4 il
Locatic4i
City: aJ1110&C 0 ZipCode:
Contact Person:
��V{ T\-Title:' 0`J
Telephone Number:-1 I t-%qq D 4(oCC) Fax Number. 7-7L ;JSZ s11�/W
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Type of Indust y/Business: 0-bn -4,C,4 ✓ 0 is fj Mano-!u ✓
To apply for a nonresidential building permit, you must complete this checklist. If you have any
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questions about completing this checklist, please call, (800)_388-2121. "
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YES
NO
1. Will the facility have a charbroiler,?, [ ]
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".. 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,dustor smoke be generated at the facility? [ ]
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5. Will refning of any liquids or solids be done at the facility? [ ]
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6. Will any plating or coating of materials be done at the facility?
7. Will *ban 2,000,000 BTU/hr
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any combustion equipment rated greater be
operated at.the facility?
8. Will any acids, solvents, or motor fuel, be used or stored at the fatality?
9. Will any organic liquids or gases be reacted or produced? [ ]
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10. Will any ovens be used to dry or cure products at the facility? [ ]
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11. Wil y CFC (Fr n r ycling machines operate at the
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Applicant F L�,IL, Signature:
(Print name clearly)
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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
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Management D+isti iet (AQMD). Please read the, requirements on the back of the checklist.
(800) 388-2121
ADDITIONAL SUPPLEMENTAL INFORMATION
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