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APPLICATION FOR CERTIFICATE OFOCCIJrANCY ;
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CITY OF HUNTINGTON BEACH
DEPARTMENT OF COMMUNITY DEVELOPMENT
av trtaot DATE
(PRINT OR TYPE ONLY)
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Address L T District—
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Business Name
AW71d aD/S7.e uT oc/
Business Type Occ. Grgup..�.��._ ,
BUILDING OWNER l �^ BUSINESS OWN .RlMANAGER
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Name Name
t, Home <307 /{lJ�•'f! sJ.e
Address Addressl_
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City jt1,V, ^E% C ea Y 5 Tel. City -ZOA/l - C& H He et.
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THIS USE WOULD BE DESCRIBED AS
❑' NEWLY CONSTRUCTED BLDG. ❑ CHANGE OF OWNER )C! CHANGE OF OCCUPANT
EXISTING BUILDING ❑CHANGE OF USE ❑ ADDITIONAL OCCUPANT
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Indicate former use, if any Occupancy Gr, � Div.
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SQUARE FT. OF BUILDING TO BE OCCUPIED/��� ����-Ts� b ��Qpr'j;` ®�✓�E
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NOTICE:, 1. Occupancy of any building is prohibited and a business license will not be issued until the building has been
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inspected and a certificate of occupancy is issued.
2. No electrical service will be released for any existing building until the service has been inspected and ,
rertified safe. ;All applicants for occupancy in an existing building are required to schedule an electrical
`fuse up' inspection in the Department of Community Development at the time this application is filed.
3. Ch�hge of occupancy or use, inspection fee. Whenever it is necessary to make inspection of a building or
hat premises in order to determine if a change maybe made in the character ofoccupancy or use of the building
t7/f or premises which would place the building in a different division of the same group of occupancy or in a
different group of occupancy, a change of occupancy inspection fee of $ _ shall
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J�(� be paid to the city.
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4. Huntington Beach Fire Code Section 10.208 requires that building numbers must be a minimum of four(4)
Inches in height with one half ('/z) inch stroke, and of a contrasting color from the background. These
numbers must be posted on your building in a location that is visible from the street.
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5. Huntington Beach Fire Code Section 10.301 requires fire extinguisher select;on and distribution per the
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National Fire Protection .Association pamphlet 10 (see reverse side , Ir
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TRAFFIC IMPACT FEE o• i%' � � J
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DATE PAiD 4m-
' AtiAOUNT F ECEIVED J<ey �4�GE3S TO pit f�M b� fo "V l p f-v
61-Car)CA- j P Ayl-C 1
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rrA►Me `TD MAIN
(FOR OFFICE USE ONLY)
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SUPPLEMENTAL INFORMATION ZONING
OCCUPANCY GROUP PLAN CHECK NO, NO, PARKING SPACES
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OCCUPANT LOAD -� PERMIT NO_ HEALTH DEPT. APPROVAL
NO,OF STORIES p ADMIN. ACTION UTILITIES RELEASED
✓ r'_RTIFICATE OF OCCUPANCY' FEE
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`� FEE,
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APPf3UVE BY DATE CHANGE OF USE OR OCCUPANGY ;$
TOTAL $
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75-039 t sar COMMUNITY DEVELOPMENT
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SUPPLEMENTAL ICE FORMATIO
(Continued)
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Does
the operation involve any of the following materials? Yes
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Yes indicate quantities:
If Quantity
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Material
1. Flammable- liquids
Class I -A-
Class I-B
Class I-C
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2,
Combustible liquids'
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Class_ II
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Class Ill -A
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3.
Combination flammable liquids
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4:
Flammable gases
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5:
Liquefied flammable gases
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6:
Flammable fibers - loose
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7.
Flammable fibers'- baled _
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8,
Flammable 'solids'
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9:
Unstable materials
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10.
CorFosive liquids
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T1.
Oxidizing material - gases
12.
Oxidizing material - liquids
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13.
Oxidizing material -.solids
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14.
Organic peroxides
15.
Nitromethane (unstable. materials)
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16.
Ammonium nitrate
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17.
Ammonium nitrat-2 compound mixture's.
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containing more " than 60% - nitrate
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by weight'
18.
Highly toxic material and
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poisonous gas
19.
Sm,9keless , powder
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20.
clack sporting powder
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I hereby certify that t above information is
true and correct to
the st of m k wl ge
Signature
Date