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HUNTINGTON BEACH
Business License #
Business Addr(
Business Owne
Business Name
Business Type
CERTIFICATE OF OCCUPANCY 020 & -
CITY OF HUNTINGTON BEACH —
DEPT. OF PLANNING & BUILDING APPLICATION
714/536-5241
(3'd Floor— Must Apply In -Person)
Date fs —14) — ) 3
Zip Code o/ 26
Telephone No.
Bus. Phone
Property Owner Information (required) Tenant/Emergency Contact (required)
Name 4Name
Address _1 — 1. Home Address (o Ulm AW
City FLA State/Zi la �9/_/1� City 1=_ State/Zi 6A GQ 270
Telephone No. QL1 rj L[ q Telephone No. _`] iLj 77 �— S77S-2
THIS USE WOULD BE DESCRIBED AS:
❑ Newly Constructed Building or )Existing Building
CHECK ALL THAT APPLY:
❑ Change of Property Owner ❑Change of Occupant ❑Change of Use ❑Additional Occupant
■ Indicate former type of business
■ Are you requesting that the electricity be turned on? YesQ No`�
■ Is the building sprinklered? Yes No❑
■ Will operations produce dust/wood shavings or similar material? Yes❑ No,�
■ Will operations involve the repair or replacement of automobile parts Yes NOP
If yes: Describe the
components repaired or replaced.
■ Does the operation involve the use of welding or open flame? Yes[] N4T
■ Will the business be a drinking, dining or assembly use with an occupant load of more than 50 persons?
Yes ONo �21
■ Will there be storage racks, gondolas, or shelving exceeding 5feet 9 inches in height? Yes QNo �b
■ The following best describes my operation: Office Only ❑ Retail Sales ❑ Medical/Dental
❑ Warehouse /Manufacturing/Distribution ❑ Restaurant/Take Out Food
(describe process and end product)
Other (describe)
For QfLicial Use Onl
Occ Group:
Occ Group:
Occ Group:
Total Sq Ft Occupied:
Bldg. Permit #
Area: 7-6c\
Area: ZA S O
T
Area:
No. of Stories:
Entitlement #:
Plnr Initials: Dater15 Plan Chkr Initials�t✓ Date: 1 t, �-1
Conditions of Approval or Other Notes:
Occ Load: 7j
Occ Load:—' S
Occ Load:
TIF Review: Y/ N
Zoning: I L,
Initials: Date: Z �O
Inspection Date: .
' r
• HUNTINGTON BEACH FIRE DEPARTMENT
HAZARDOUS MATERIALS DISCLOSURE OFFICE
2000 MAIN STREET • HUNTINGTON BEACH, CA 92648
(714) 536-5676 • FAX (714) 374-1551
HAZARDOUS MATERIALS DISCLOSURE INFORMATION
MANDATORY REPLY REQUIRED PRIOR TO ISSUANCE OF BUSINESS LICENSE
Complete and return to the Business License Division
PLEASE PRINT RD#:
Business Name: W&tea toanG Phone: 02-6 2-
Business Address: S c ZE
Number Street Unit Zip Code'
Owner/Manager: Date Business Will Start Operation: '3
� T
Description of Business: iSP4, Y64
California's emergency response network requires all businesses to notify their local emergency response agency if they store or use
hazardous materials above certain threshold quantities. In the City of Huntington Beach, the emergency response agency is the Fire
Department, and the method of notification is by filing a Hazardous Materials Disclosure Package with the Fire Department's Hazardous
Materials Disclosure Program office. Types of hazardous materials that must be disclosed include: oils, solvents, paints and coating
materials, gases (compressed or cryogenic), fuels, and hazardous wastes. You are required to submit a Hazardous Materials Disclosure
Package if you store or use hazardous materials in quantities equal to or greater than the following amounts:
➢ 500 pounds of a hazardous solid
➢ 55 gallons of a hazardous liquid
➢ 200 cubic feet of a gas (or the compressed or liquefied equivalent)
➢ Extremely hazardous materials that exceed the threshold amounts listed in 40 CFR 355 Appendix A
➢ Radioactive materials that exceed the amounts listed in 10 CFR sections 30, 40 or 70
➢ Hazardous wastes that exceed any of the thresholds amounts listed above
➢ Other materials determined to pose a significant hazard to human health and safety, or the environment
Disclosure is NOT required for the following types of hazardous materials:
➢ When contained in a food, drug, cosmetic or tobacco product.
➢ When packaged for direct distribution to consumers (retail products).
➢ When the materials are stored, used, or handled at a facility for less than 30 days.
➢ Infectious waste generated by health care facilities.
Please indicate which category most appropriately describes your business:
No hazardous materials are, or will be, used, handled or stored at the above location.
❑ Hazardous materials are present, but in quantities less that the amounts listed above.
❑ Hazardous materials are used, handled, and/or stored at or above the amounts listed above.
A Fire Department representative will contact you at a later date to verify the above information and determine if you need to file a
Hazardous Materials Disclosure Package. If you have any questions about the Hazardous Materials Disclosure Program, please call (714)
536-5469 or (714) 536-5676. You can also obtain additional information on the City's website at Nv%vw.surfcity-hb.org in the Fire
Department page under the section Fire Prevention.
I certify, under the enalty of perjury, that the above information is true and correct to the best of my knowledge.
Signature: Home Phone: 90T Date: 7 I ICI —) 7
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