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J APPLICATION FOR CERTIFICATE OF OC PUPANC'
-ITY OF HUNTINGTON UEACH
` DEPARTMENT OF DEVELOPMENT SERVICES �_.._ .
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Andress Distrir
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THIS USE WOULD BE DESCRIBED AS:
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NEWLY ",ONSTRUi TPA E?Er?Es CHAN::3(:_ OF Y'0;NEt t:41 PI aE OF OCCUPANT
EXISTING Ett}ikC�tnd a E.-� AtSC:f_ .., ?,;,E t ADDITIONAI OCCUPANT
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SOUARE FT OF BUII PIN TC' Fri. C;i.:ti
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[NOTICE, of any t ata '
th l bulidtng hviti at Lrb,,kr£d urfi,t
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3. Change of acCUpancy yr use inspection Fee. f
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y ,'�. Huntington Beach Fire Code Section t E '"1 "r, it' 't.at , ,r..i? �: i'.afli t r s!3Y�t ; mist C? al Ci[liFTi of fi1?l l
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S. Huntington Beach Fire Code Section 1 VJ1 !Nr < t r Frttifj t iiitzt ,7E� .Ction in ftt5lribUid.7rr Per
art- 1`'.'-'tle,
i (FOR OFFICE USE C}NI«Y)t
SUPPLEMENTAL INFORMATIO
C� C iPAp1t;Y t�F t 'l!I7._ _, ?"i , ` f;k?El .,, . . ; SPACES L
ry ^4 FI !ViT N, (,EFT. APPR� L'At _ "
t.:C>vUPAnTtti�A7 .__.�,:___....__. _._ _.� �_... ..�..._
NO OF STORIES
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SUPPLEMENTAL INFORMATION
1.
BUSINESS ADDRESS 1 "C 31 T! Itbo I D t%un� intS e, �
/Such
2,
Pers n to conf act in case of emergency:trSC,,2; E l aue+^
Telephone number: _413 Y 4,+-�
3.
Does the building in question have electricity?
%Yes
No
a. If No, are you requesting that the electricity be
0Yes
turned on?
ONO
` 4.
The building is sprinklered?
KYes
ONO
5,
Operations will. produce dust/wood shavings or similar
material?
❑Yes
t
t
110
6.-_Operations
will involve the repair a-: replacement of
[3Yes
automobile parts?
PNo
if ves
t
(a)d Describe the components repaired or replaced.
Gbi Does the operation involve the use of an open flame?
Oyes
JO No
7.
Tne business is crinking, dining or asse :ly use that will
result in an occupant load of more than 50 persons.
ClYes
igNo
5,
The following best describes my operation;
Office Only
Retail Sales
areh
Manufacturinq/Distribution (describe pr6cess and end
product)
Restaurant Take Out Foo
Medical/Dental
Other (describe)
(12,d8/86j
(0562D)
5
■
SUPPLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following materials?
C,(as
I Xes,n �cate quantities; Quantity
Material
,a 1. Flammable liquids
Class I -A
f
Crass I-B �--
Class I-C
2. Combustible liquids
�. class II
Class III -A ---
3. Combination flammable liquids
F 44Flammable gases
5. Lir-'defied flammable gases
{
6. Flammable fibers louse
7. Flammable fibers -baled
w
B. Flammable solids ------------
9. Unstable materials
10. Corrosiveliquids
11. Oxdixing material asos
"F2. Oxidizing material - l uids
--------
13 Oxidizing material - solid.
14 Organic peroxides
15. Nitromethane (unstable materials)
16. Ammonium nitrate
---'-
' 17. Ammonium nitrate compound mixtures
containing more than 60%' nitrate
bar yrei ht
18. Highly toxic material and
poisonous gas
19, smokeless powder
20Blank Sporting powder
----"
I`hereby certify that the above information is true and
correct to the
best of my knowledge..
Signature bate
(12/8/86)
�t3562�11
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