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APPLICATION FOR CERTIFICATE OF CCUPANCY
CITY OF HUNTINGTON BEACH
w JNW4croN sE" DEPARTMENT OF DEVELOPMENT SERVICES
pF
VNT01TYPLONLY3
DATE
Address
-•---,....�/..��.�--Ls-I.L._�:�.District
Business Larne. _ �/%(����[�
st Tel. s
Business Type .'C' I L ?? {�2!�." f _—�
Group
Ufi OING OWNER
BUSINESS OWNERVANAGER
Name.k=-G r3
Name � c_ �4 tE
Add ess - _ _ _ _ Home
Address.Ll2��! '✓'i��t. � y
Te€
G,tq� Home Tel. Plll;f0
j THIS USE WOULD BE DESCRIBED AS
NEWLY G()NSTRUCTEE? Si,GC;.
L CHANGE OF 0trVNEp CHANGE OF OCCUPANTKE I
EXISTING BUILDNG CHANGE OF USE
ADDITIONAL OCCUPANT
Indicate former use. it tiny ._....,,__ t4_A Jf-AC TV 4t-A
SQUARE FT. OF BUILDING TO SE OCCUPIED MQ— �
I
NOTICE: 1. OccuP@nCy of any buJding is prohibited and a business licon-e will not be issued until the building has
been inspected and e certificate of occupancy is issued
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2- No electrical service will be released for a:iy existing building until PleSer�vice has been inspected and
II Certified Safe. All appltCLi!1#S.:Tot occupancy in "` existing building are requiredr" Schedule,I
fuss up' f o upa in Ii�e aepartreaertt ref Developrnent Servicesga€ the fiime his applicatonris filed real
'. Change of occupancy or use fit
fee. Whenever it is necL Ssaiji to make inspection of a building
or pritilniSP., in order to determine it a change may be made. in t �,> character of occupancy or use of the
building car pram ises which would place the building in a differetil civiSion Of the same group of occupancy
or in a different group of occi.rpt>nc . a char.
d shall be paid to the city. y g' of occupancy inspection fee of -
p�`� 4. Huntington Beach Fire Cade Section 1 i g
Ut3 gr re th7t iulding numbers fT usI be a minimum of four
D / i4t inches an height with , .tie half t } '. i inr h str ay;e ar t rsf ti
numbers rriuS c contrasting GQipf rfCrT+ thehaGkg?cUnd: These
t b� poi ,Edon yo,i buildtn� in a location that is visible from the street.
Ifuntington`Beach Fire Code Section 1().30, req r n, fire-- extincuiSher selection and distribution -per
the Nfationa,' Fire Protection Aissaciation pampf,,Iet 10 (see reverse side).
r
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(FOA OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION
ZCILILG=
OCCUPANCY GROUP.
OCCUPANT LOAD PLAN CHECK No --�._._,._ NO PARKING SPACES
NO OF STORIES � PERMIT NO, �a. � � HEALTH DEPT, APPROVAt
---- ---ti ADMIN ACTION— UTILITIESREL.EAS"eE-
CERTIFICATE ATE OF ()C< ja
APPROVED BY - -�z_ L , ANC:Y FEE 5
DATE CHANCE OF USE OR OCCUPANCY FEE $ �^
TOTAL �
J
a PTIO
co
not dataieh- xetetrat air>:opj*a
APPLIC#<1'J{ils➢. &C?R A1CQH®!(1C EIki9EAGE i.1�:E#.iSlr(S tic Not Write Above This 411»...far Headgvortars office, Oniy
) 1. TYPE($) OF LICENSE(S) FiIE NO,
To. Department of Alcoholic Beverage Control
1901 Broadway RECEIPT NO.
r Sacramento, Calif. 95818
d I�pIS7R)GY?CYtNGi„CCAPI(1N)' t GE'VfIAPtitCAL ,
The undersigned hereby applies for f, ,; CODE
licenses descr,,$ed as follows: Date u
s t °«` * Issued fjtft
F i
2, NAME(S) OF APPLICANT(S) Temp. Permit
x f Applied i;der Sec. 24044 0
Effective Date: Effective Date+
3. TYPE(S) OF TRANSACTION($) FEE LIC.
TYPE
$ l
f
4. N^.me of Business
5. Location of Business --Number and Street ----- -
City and Zip Cade
County ^----�--�--�-------._
zai a 6. 1f Premises tic rAl
enses, - $
Is
es
Show TYp'= of License 7, Are Premises Insf'µ +?
a :. , . City Limits? s'
B. Mailing Address (If different from 5)—Number and Strt et
rtmpyrrarq,i
9. Have you ever been convicted a felony?
a
ilo- Have you ever violated any of the rIs
,ons of the Alcoholic
Beverage Control Act or regulatic, or the Department per- ;
laining to the Acts
11, fXplato a "YES" answer to items 9 or 10 on an attachment which shall be deemed port of this appficatfon.
12. Applicant. agrees (a) that any manager employed in on sale licensed premises will have off the qualifications of a liceftsee, and
(b) that he will not y gjate or Cause or permit to be violated anyA� i the provisions of the Alcoholic Beverage Control Act. 1
13. STATE OF CALIFORNIA County of 1
•` - -- •.__ :..._gate_:. _ �w ]
_ » __r
Under PenaltY of prriucy tech parson whose crgnaturt ..appears bola , rard,rrs and nays F He is she applicant, ar ant of she aPp7ttant »-» -M'
alficer of the alo"I't n). torporahan, named in the foregoing aPPticlllian, d„lr iruth7rtsrd to m]kc this pq l;kah
s ar an link ur; <
going aPP1aKalion and. knows the rantanls thrraaf pnd:lhar arch .and ai( a' the P as an .rsbahr,,if, 2` .'bat he has .rend 11ra rere.
or opplicanit. has any direct ar mdiratt ntas•.est rn the frntem<ntx to tarn made art eroa, t5a{ na rycrsan athrt. +ypn the tt e & no# nrs oe aPG ,roans buUre.t 1p be p:dueied under �ha 'icanxe:.s, fry a% ad.- t
•.41 tFal the transfer oppfi(atiors or propO.rdha sft{ .s. nOr mode •o sas,sfp ihe Poymrnr et p 1aar, Lr rp Fuifts whi:h ih,r apptizatian days Pteceding the day on whi0i :he rron.te, opjp m "% made: i
defraud or miare any trrddor of. tronsfetar. ;5.� that eh n it fled wdh eft Ur -an agretmant entered iaiG mor0 hen ninety -,,go l
e transfer a Parrmanr or tq goo, 0' :arahlish a Gratmcnte so. ar tar rn,. "ed,tpr of transferor or to m
the t)cParlat tit ppficphcn may he w.rndrpw by either the opp,i I ar ,ht. lrcensea with na rclu7line Flofstl;ly. to t
14. A;PPLiCANT
SIGN HERE
- _ _ -- - _
- -
APPLICATION BY TRANSFEROR
15. STATE OF CALIFORNIA County af,__
., _ Dare _
Finder penptty of perlucy. akh Prrwn whose si9nater0 6PPrarf below, r fG<. and coy. LL ! rye a rha i mnsee,.^a, an ea<to4ye affitar of rheMmr orar .
name. in the fOrogpeng trontfer appl,cahgn, dutp aurhar;rcd ea makt In<s 4"nfrr appl to<ion a 09 ._ od.
ott I wets in the ottatbad h<enar.'sl d.,C6b<d below and.-lo trantar sane ra the n A a Itcrnsre
brhpiF 7` that hr. htr<bP makrsappf«kation. tP surrandar
.farm, it sukl+ Franstrr is appro.rd by the a;rrcrar 3, rhor rha Ironsfar n Hfixar;prr npph<anr l n , tatah,o nro tdt 'p on tt+e uPPrr pcthon of th:i aPphrat;pn
an 00 Itin- t •mitred Into most than rs, et days g Propstrd pli,.,ar is nut mach ep sal,s[p the payment of a TO." aY to fulFtl ?
n Y x Girca,al c the day o rh:ris tFa rya +sf<r. apahcor,Prt is fled 'witlq the arapHmanr -or to gain fir: establish:q
PYCft{enCe r4 of faY any cltldltaf Sr lran.terat ar t0 daFraud ar ,nlUke any C rdlar rf trartfferoY- .{ rhar fha lean{fer h t h.nr;an t.* Fsa wtogai n ,
applicant or it-,* lirenrec woh no rtlwiti tl t oa,hty 1.y tf ecpartmanl
r Y ±,)her iFr.
16, Name(s) of Litensee(s) 17. Sipnoture(s) of License-e(s)1
t — � • license NumbPrfsi
� ,.,.•-.—.�_...., v., _ � . Via., ~3 fi
1
19, Lacatran Number and Street
City and Tip Code
Court
w_
Do Xot Write 131t7out This Line, ror Department ['sr Only
s
Attached: 1 Recorded orded notice,
1"'' Fiduciary papers, d
» _ COPIES MAILED
at W ._. _. C7ffice an. _ .1ieCeipt No.
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