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APPLICATION FOR CEI9TiFICATE. OF OCCUPA14CY
} CITY OF h.UINTiNGTON BEACH 7-
DEPARTMENT OF [DEVELOPMENT SERVICES
HUN;,rK,100 BEACH
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Add}os
Business Na.Tro._.._.—k. �}
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Business . kA
BUILD NO OWNFU atNESS tJVINFR+k1f,IJAGFn
l Name—
Ftorne, I -7a Lf t. 't"rP 'n! 7YLr 6-
�}r .
AIdIU,S
Address _
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I THIS USE WOULD BE DESCRIBED AS:
fl r }- r-HANGE OF QCGUPANT
0 NEWLY CONSTRUCTED Bt CG � CHANGE Of CtWNFR �
EXISTING BUItL)MGi
CHAP1!xE aiF li4 i_ f AI7L,tTIONAL s�C CUF'ANT
Indicate ibrnier tlse, it drsy... _.___ _._ _
.__.._ a
a Soup. ,RF FT
F iFl:l(d n MC}rrh andand. % a ire Itr. r ,r will not tie !ssjjefj until tie; bUirfdint leas
NOTICE. ' oc(;up�incy 4 } ;
_ Y}r.Cn Inspci�*s fii)dai {"k>EtlfirHl..tt t}:,Gt9%�t?i�'�1 Ir t .,�i._d.
No electrical StFIiDCB V'.kII �e r�+(: a .ir,� for anv r x $M9 �?liilk'�t'aQ-.41i"illi ttTt?_ SF iytf;�ai8ii .��5'';n Insp.G'ceci i'ai
fif;it SlCf� i ifE'• Ai4 aI�I C•�xFit`> i}r G�:;'i. :iii;y' In al, ` x,.>l'Et"tt; t?irit(Iing are
r (` isred 1p � whediaEe an E:t@ctrtwal
!ns to 'I100 it I i t' 1< r4 }}t+F I of I, i(,-vetojo;li'yr l [a rVi H i ttlf taliF£> t i:S applicalion1 :s filed.
tklws': UrD IJ C V) t
4 Change of occupancy or use insp�'Gtton Ie r L�Ifa� au tar r c , n < ,�dty� jr) , r N In p� cht�dt of a bs;idrlittg
or rrrrlrSe,; 1P order tt? a char''„}ti mayt..:.m di ,a tilt charac,�c�r of G'yCy�Gp#,7y{�3?'1.nCj� or iiS�i of Ilik.'
r j Yi t}4 S F 4 yFC}1Y(1 of LC31I% iriC ;t
bu;1ding or r� ni a» WIti,-,h tirr �ICf ttYt }1,�srfln ,rl t>e #�rr�s>t di i ;(}.lct
i1rc 1±� O11i r Fl". �Ctu r fl! C{ CJtr ir.,aj, a I rT. r,t occur ancy "16pintion fee C?
V
,hail be paid .fa the r,..t`r
eI. Huntington Beach Eire Code Section If. 20 It' z,1rF= t at Pal3ii ; Cry rs^ to � ` rrr��t tae m+rairnum gat IOur
t r<a) at %flC . i ! r .c3h tvilh 0''e halt { r.. 1 i1jot t>ir aka, land of a GinJF,a{:ltri49 C()!or from the background, These
F?URibE r SlU'_'3 L)o, pc tee on 1(ok.jr huitai" � t 3 Io xa Wj ti ut !S V#5It)1 t6O i tli > tr 8t
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5. Huntington Beach Fire Code Sec s➢on Ir � i ,= ire t r� ex inguish osuclbon anr� di tnbut;Or' per
the I,43tior'ai Fire Pro lection A,,,ioc; tion pafnp ntet 1(i , vr. rever9s. side)
(FOR OFFICr, U'iE ONLY)
SiIPPL' IVf1ENTAL INFORMATION _
k_�fl l I9rC tF LOADFj� 'Wi3 PARK NC PRC S
OCCt3pANCY GROUP'f' _ ,��F3C1T NO, I `=At Ta I OEP t'. A �P�C JAi , --� - —
(_. ...—
;C;(;UPAtli' ..._ _rrrS u
nl,r trit AC I I0N � UTII l EI E tfil: t
N(; OF 5TOPI1 S _ _ w �
(I�rrl l;AtF inI (�r #aAls v f E
_ f uiATL C HANGLz OF Lil, )R tIWx ,U ANG'y FF.;
�,PP110VED=TC)TAt w �/
`1
SUPPLF, MDNTAI. INFOt7,4ATIr
l r
BUSINESS ADDRESS �ti�� � 7 � I �3 Tki �r&m LAA4 44
IS— (�0'9244i
'ersotl to contact 4,n case of emergency:y
Telephone numbers
3
Does the building in question have electricity?
p yes
z
a. if No, are yourequestingthat the electricity be
turned on?
C7 N is
Oyes
ONO
4.
Thebuilding is sprinklered?
Yes
Operations will produce dust/wood av sbin s or similar
material?' g
ONO
ayes
0 vo
6.
'
Operations will involve the repair or replacement of
automobile parts?
Dyes
W o
If yes:
(a) Describe the components repaired or replaced.
(b) Does the operation involve the use of an o pert flame?
Oyes '
3
(3 4o
7.
The business is drinking, dining or assembly use that Will
result in
'
an occupant load of more than'S0 persons.
dyes
ONO
8.
The following best describes my operation:
Office Only
etal sales
Warehouse � ��� ��
Manufacturing/D-i -r��utior (describe process and end.
product)
Restaurant Ta`R 5u2 -oo
Medical/Dental
Other `(describe) �rw
,
(OD62D)
r
4
6
SU:. PLEMENTAL INFORMATION (Continued)
Does the operation involve any of the following
materials?
Mes ,
WNo
F' x Yes, zn icate chant t s
material
Quantity
1. Flammable liquids
Class I -A
Class I-B
Class I-C
2. Combustible liquids
Class II
f. Class III -A
3.`<Combination flammable liquids
4 4. Flammable 'gases
�lrctr
`" 5. Liquefied flammable gases
6.-_Flammable fibers -- loose
7. % Flammable fibers balm
8. ,Flammable solids
9.'Unstable materials
10. Corrosive liquids
11. oxidizing, material - gases
12. oxidizing material - liquids
13. Oxidizing material - solids
14 g4nic beroxides
15, Nitromethane unstable materials
. 16 Ammonium nitrate
' 17.'Ammonium `nitrate compound mixtures
containing more than 60% nitrate
by weight
18. ` Highly toxic material and
poisonous ;gas
19.`Smokeless powder
20. Black s2orting powder
I hereby certify :that the above information is
true and co,
ict .to tb,e
best of my know) ,dge.
t
Signature -�
Date
(0562D)
3
t12/8/86-)
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