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CCRTIFICATE"OF OCCUPANCY
CITY OF HUNTINGTON BEz1Cfi It),
_
DEPA4
Date
MENT OF DEVELOPMENT.ScRVICES
HUNT NCION SIAM
Address ...______.—IYU).1^'z ttan
Lino, tjr_j_}j. 1,()ii_�� District+.
r
Business Name
I.;tJi:� 'IcT.C: I
Business TypeT.'Ct'P3: C?cc. Croup is
EsUfLit#NG OWNER
BUSINESS OWNEWMANAGER
Name
Name }3on Cllarrokn
t
Address 3435 flnhixa giva.
Homo 1.r 2t7. h;inter C,atYe
Address __ --
Tel. ___ City Hunt:ingt:on gc?a-ri'__, _Home Ter IFS-' 73
ConstrUctidn No. 6f'Stoties
Occupant loan___ 5prinkl'
Notice:
This Certificate of accuparcy
DEPARTMENT U, I)EVELOPMENT SEfAVICES
SHALL BE pasted In a`^onspiiv. uus Palace on
the prOBuses and shaif no be'iYmoved excnat
by
the Building(ficial.
by�.__
:....
D tif.:f..OF)W fy r :�f=fzvlr.Fs
I
f
U TI L I T Y R F. L F,'A S
L-___ ]
LX ZTINE B'ffft61
NEW I�UIIi�ING
POWE' R- POLL;
TEMP. WORK WfTH MPR
1. Pl.umb`Ing Inspeztar Clear
DATE
ELetrical Ini�Pectar Clear
9 --
DATE
UTILITY RELEASE AUT116RIZED
BY LAND USE
DATE
GM i T � ELECTRIC
UTILITY 'COMPANY NOTIFIED
DATE
US E;
7
Iwo IWV-14K
#& A PPLICATI 'FO' ATE OF OCCUPANCY
6N`A 0tATj`0JC
citVof A'dk NG'TON BEACH
ItIATING7004 MACH DEPARTMENT OF DEYVIEWPMEN't SERVICES
(PhIN-r OR TYpr: ONLY)
DATE
Address
Dkerict
I I hitiniiti N6mo Tel.
Business Ty'pe
fAA)A2- Occ. Group
BUILDING OWN
ER OWNERWANA.GER
Name
Name
i4diess
Address A/
'v City 2s- -I z7 lip
City
Tel. j`
WOULD P.E t)ESdRq"I-B'ED AS:
NEWLY CONSTRUCTED 8LbG. dHANGF OF OWNER CHANGE OF OCCUPANT
EXISTING 800ING CHANGE OF USE AbbiTIONAL OCCUPANT
Indicate former use, if any
Occuparidy"bf Any bUildirig'is0r6hibited a 'rid a business license will'not beissuedIntil ihe'b1dIj8Imb
has been inspected'and acertiflcate,of occupancy is issued.
2. No electilcal service will be'released for any existing buildlnqurifil'the service has been, irlipecte'd
and'd6efthed safe. All applicants for occupancy Im On 6kisithiq
scheddle'ari
electrical 'fuse -up' inspection In the Departm"erit of D6velo'pt-herii Services aUthe thba this 'apou&�.
ti6h is filed.
3. Change, ' ijf'bdcupahcy,br'u$e'lnspoc'ti6n fee. Whenever it is necessary to'triake'lin-spertidin6f a build-
Ing or premises In Order to d0tdMine'lf a change may bb'rade in the character of occdpah6y,6r use
of the, building ,-Or'premises which wotild place the611ding In a different div-191
6b,"df the sarl4group
OUbCCup8ricy-or in a different grotip of occupancy c a change of o cbpancyl,lnsn fee o $3
ipeiftlo f
sha'IF I bel:iald-to'ft city. .6 0' 0
4. 1-101iti6itbli Beach Fire Codji Section 10. . 768 requirjs tht * biji t t Iding hJ i h6drs ` riibst be a rr WiAlm
of f6tir (4) inches in height with one half V/2),inch:sb;?6ke, and of a con tratt! ng"60' I 6'r fr6mJhe'*ba'c'k-
ground. These numbers m-u,.t be osted'driyour 6010�in a loca s e o-im"t . he `stre, t.
P 9 location fr'
5. P.d,ntilridt6n:BeMi Fire Coil& Secti6n '16.3011 "requit6s fire ext1kquisher s6lec"fl6n and disteibiiitl
on
0per the National Fire Protection Associatidn paimphlet"10 (see reverse "i
3e,3 0
(FOWOFFICE USE ONLY)
SUPPLEMENTAL IN'r-- 61 IRMATION
SQUAPE FT, OF BOILDING PLAN CHECK NO. NO, PARKING SPACES
oCeuPM.cy GROUP PERMIT NO, HEALTH DEPT APPROVAL
i
OCCUPANT LOAD ADMIN. ACTION TI s P r i.EASED
NO. OF STORIES UTILI r
CERTIFICATE OF OCCUPANCY FEE
APPROVED 13Y DATE CHANGE OF OCCUPANCY FEE
TOTAL S
76 -03 9 REV.
i
I
CER'tIFiGA'i'E'OF dddL PANCY
CITY OF HUN?'IIVGTON BEACH
DEPARTMENT OF bEVtt:bPMEiJ7' SEt': Date --
Nt1Ai I-ViTON BIAt'H
Address �` _ bistrict_
Business Name:__ �._�� \� ___ _ _ — _ _ _ Tel.
Business 'Type Occ. Group
BUILDING OWt E' 13 OWNENi14tANAGER
NAme _ _ _ _ -__-- Nome
Address
Address
Tel. __ City Tel., i
Construction _—No. of Stories _ _ OCei►pant Load.__ — _____SnrinWeed
tJollce:
this Certificate of Occ+ipancy DEPARtMENT`OF DEVELOPMENT StkiilCES
SHALL BE poster( in a con:tiicuous'place on
the 04-mtses and shall iot be removed except .
'by the Building'Offietil. try______:___:---__
s_,_____ __..._..
i✓4Y C�„.Sii��if�i: i`i�t• �Jf.`,1i'r�!t. ��? __.___.__.._�..._._ _ .�_. _.___. 1
f
APPLICATION FOR CERTIFICATE 01. OCCUPANCY �
City of I'uhtington'Beach _ DeparItment of "Develophient Services
FOR APPI.JC-ANT TO FILL IN (Pr`int'`or type birly) DATE _ +
j f
Application is hereby made for << Certificate of Occupancy for a;
!✓r?_,tc'S� _ i� 2 �' � L Occ�uallc.Y: Grp My.
Describe Biis'iriess Use
To be knouiit" as _4c., C i r'����J iuc4sl-
ame "ofess____
Located at i3 i I2�17em,' %cL,v
Business �Ss Y'l
-5 �i A : / `G.,-c`.'?r-- %/--j .5'• `li;',�'�,�1',¢i�/`+� i/' lel) •,,� �G'.`t7 Z
dame: BUS MESS O NE t ^'��' Resence Tess __ ____ __ ty z p
Phone No, - Busioess: Residbhce;
toss i Gy 5. �Tone`1o.
TWS USE WAD' BE DES&I" ED -AS:
'Newly Cony;ructed Buildiwq F-] Change of Owner
EAsting Building Change of (Ise
Indicate former use if ally
[] Change of Occupant
��� Addi bona 1 Occu�art
OCcu1hancy: Gr. Div. _
�uiiur: i. uccupancy of any building T§ pro" it6 an a us ncss I i -cer�s- e w 1.1 not be Isirsul �
until the bulldfhg'has been inspected and a Certificate of Occupancy is issued.
2. No eloctrical service will be released for ally existing`L�tTi'.`dirig "until the
service has been inspected and certified safe. All applicants for occupancy
in an existing building are 'rerluired to schedule an electr�Cal. "fuse up"
inspection in the 'Department of Building and Community `Devela'pmdnt at the time
this application is filed.
A9V
3. CNANGF OF OCCt1PA CY OR'USE IWECTION :FEE. Whenever it is necessar ' to make
inspection of a buildiWg or`pronises in order to detormifie if a Change may. ;
be made in the character of occupancy or, use of the bbi ldiho or.. premi ses which
viould place the'bUtlding in a different division of the same group'of occuip"ancy
or, in a different group of occbpancy, a change of `occupancy i°ns ect:i fee of
` $30.00 shall be paid to the City, �ol
(FOR OFFICE USE ONLY)
SUPPLEMENTAL INFORMATION
Sq. ft. of building_ ___._.__.:� ! � :__ �_.w__.._._ ___ flan Check No.
Occ��pancy Group_ _ _..___.___.___..__._..__. Permit N
Occuant load-_.._.___.__...____.__.__.._._-4_,__�______..____
p _ Admin. Action
No. of Stories --.,a.-: No. Parking Spaces
Health Dept . Approv l_
��fi1iT Utilities R� leased
CERTIFICATE or OCCUPANCY FEE $ 6.90_
CFiAP,GF oi= OCCUPANCY OR USE INSPECTION FEE _._._.
TOTAL;
(05-039)--
a1
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