HomeMy WebLinkAbout2533 ORANGE AVE - Building Permits(714) 754-5273 • Fax (714) 754-4856 • v+ww.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
.lab nddress: 2533 ORANGE AV
Suile: C
Vicinity: ROOF
Parcel Number: 43941115
,4pplicant: DANILO ROQUE PARUNGAO
Address: 13241 BARLIN AV
DOWNEY, CA
Owner: MEKAMBE DEVELOP.
Address
IRVINE
Contractor: O W N E R-B U I L D E R
Address:
Zip:
ArCh :
Address:
Phone:
Zip: License:
TEAR OFF EXISTING ROOF. INSTALL 1
C
Plan Check: $0.00
Permil: $125�
SMIP Res: $0.60
SMIP Com: $0.00
Other: 50.00
Inspection: $0.00
Total:
SETBACKS '�-,,,
MAIN STRUCTURE Frpn 0- 0� Rear 0- 0
ACCESSORY Front Rear 0- 0
PARKING Exi_stinq: 0 Required: 0
Zoning:
Phone: 562-6:
Zip: 90242
(
Phone: 949-41
Zip:
Status: ISSUED
�pplied: 03/08/2005
�
Issued:- 03/08/2005
Phone:
License:
AND 30 YEAR COMPOSITION SHINGLES. 2,300 S.F. FOR UNIT
PLANNING & ZONING
Left 0- 0
Left 0- 0
Pr000sed: 0
Calc Valuation:
Claim Valuation:
Right 0-0
Right 0-0
56,000.00
ss,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21•g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 1B0 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under Ihis permit to be considered legal, such work must comply with all applicable codes, and all
required Inapeetione and final epprovel must be obtainetl. Failure to obtain inspections and final approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626 .
!666a6 (B�W)
WORKERS' COMPENSATION DECLARA710N:
I hareby etlirm under penalry o� perjury one of Ihe following declarations:
❑ I heve end will malntain a certificate of consent to self-Insure for workers' compensation, es providetl for by section 3700 of the Lebor Code, for the pertormence of the
work for which this permit Is Issued.
❑ I have antl vrill maintain workers' compensation insurence, as required by sectlon 3700 of Na Labor Cotle, for the pertortnance of the work for which this pertnit is issued
My workers' compensation Insurance cerrler end policy number ara:
Carrier. Pplicy Number.
(This section need not be comp/eted i/ the permif is valued et one hunOred dollers (5700) or IessJ
��--I�c9Mi1y that in ihe pertormance of the work for which t�is permit is issued, I shell not employ any person in eny manner so as to Cecome suD�ect to the workers'
:1:�..>'dompensatio ws of Calilornia, antl egree that i� I shoultl become subjecl Io t�e workers' compensatlon provision�f $�1�0�37� f Ihe Labor Cotle, I shall forthwith
complywit�t �s�°q� s. �1,�/I� / I
�'�n.wa-�T' G1 I Yf�/"'— 1�� �,D.a.�te:.— ��
VIA NING. FAIL TO SEC FKERS' COMP 15ATION COVERAGE IS UNL4WFUL AND SHFLL SU&IECT AN EM'yl=QYFAITpCRIb L F�NALTIES AND CIVI� FINES UP TOONE HUNDRED
THOUSANDDOLLA 100,000),IN DOITIONTOTHE�OSTOfCAMPENSATION,OAMAGESA$PROVIDEDWRINSECTION39060PTHElABORCA�E,INTEREST,ANDATTORNEY'SFEES.
LICENSEU CONTRACTORS DECLARA710N:
I hareby aHirm thai I am licensetl untler proNsions of Chapter 9(commencing with Section 7000) of Division 3 of �he Business and Protessions Code, end my license Is in full
force end eflect Lia a Class a
ContreCrors SlgnaNre: Dale:
CONSTRUC710N LENDING AGENCY:
❑ I hereby ettirm thet Ihere is e consiruction lending agency for ihe pedormanca of ihe work for wNch i�is permit is issued. (Sec. 3097, Civil Code).
Lender's Neme: Lender's Atltlress:
Signeture: Date:
OWNER-BUILOER DECLARATIONS:
I hereby eHirtn thet under penelry of Oerjury ihat I am EXEMPT FROM TME CON7RAC70RS LICENSE LAW for ihe tollowing reason (Sec. 7031.5, Business and Professions
Cotle: Any ciry or counry which requires e permit to construct, alter, improve, tlemolish, or repair any strucWre, pnor to its issuanca, also requires t�e applicant for such permit
to tile e signetl statement that he or s�e Is Iicensetl pursuant to the proWslons ol the Contrectars License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 ot Ihe
Business end Professions Code) or that ha or she Is exempt therefrom antl t�e besis for the alleged exemption. Any violatian oF Sectlon 7037.5 by any applicent tor e pertnit
sublects Ihe epplicant to a civil penelry of not more than five hunOred dollars ($500).):
❑ I, es owner oi Ihe property, or my employees with wages as ihelr sole compensation, WILL DO THE W08K, and ihe sWcture Is not intendetl or oHered for sale (Sec.
7044, Business and Professions Code: The Contrectors License Lew dces not apply to en owner of property who builds or improvas thereon, and who tloes such work
himself or hersetl or through his or �er own employeas, provitled ihat such improvaments ere not Intended or otteretl for sale. If, however, �he builtling or improvemam is
sold within one year ot completion, the owner-builder will have ihe burtlen of proving ihat 6e or she ditl not build or improve for purpose of sale.). �
❑ I, es owner of the property. em E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to constmcl the prolect (Sec. 7044, Busine59 antl Professions
Coae: The comractors License Law tloes not apply to an awner ol property who builds or Improves I�ereon, and who contracts for such pro�ect with e coniractor(s)
license pursuant to the Contrattor5 LlcenSe LewS.).
❑ I em e:empi under sec. Business end Prolessions Code for this reason:
Signature: Date:
Owner ID veritied by dnvers license. ❑ Yes ❑ No Drivers License No. E:pires:
Verilicatian at Ownership by (rype ol dxumem, i.e. - property tex bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I here6y certify thet no excavation five (5) or more feet in depth into which a person is requiretl to tlescend, wlll be made in connectlon with work euthonzetl by Ihis
pertnil, and that no 6uilding structure, scaHolding, lalsework, or demolition or tlismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 3.2, Grp 2, Ar12, Sec.
341, Tltle B, Califomla AdmlNstretiva Code).
❑ As owner-buildar, I will not employ enyone to tlo work which would require e permit from the Dlvision ol Indusirial Sefery, as noted ebove, unless such pereon has e
pertnit to do such work irom t�e division.
Signeture: Date:
Division of Induslnal Safety Permit Number.
CERTIFICATE OF COMPLIANCE AND AIffHORIZATON OF ENTRY: I cenify under penalty oi perjury ihat I have read this epplication end state that the informellon given Is
correct. I agrea to comply with ell state laws end city ordinances relating to building consiruction, and euthonze represantatives of iha Ciry af Coste Mesa to enter upon �he
above-descnbed property for inspection purposes. I egrea not to occupy or allow occupanry of eny building authorized by ihis permit until tinel inspection.
�QOE �.
i616
12fi6
200
201
202
203
Fixed System Final Fire Preventlon
Pool Spa Final
Final Re-Roof
Final BIocWRetaining Well
Final Factory Fire Place
Final Sign
204 Final Demolition
DpTE UIIQ1BL�i
CO�E I INSVECTION ttPE
206 Final Mec�enical
208 Final PlumDing
210 Finel Electrical
212 Finel Fire Prevenilon
220 Final Planning Approval
222 Final Site
250 Final Building�Occupancy
Q�¢ INiR1�LS
�
C� � L'� ��eda �uit'du:y Du�iv.i�s
OWNER-BUILDER
VERIFICATION
A city or county, which is reyuired �o give notice pursuant lo Section 19830, shall attach ro such notice, and,
as a condition precedent to issuing a building permit, reyuire the completion and require lhe rewrn of, an
owncr-builder vcri�ication.
Altention Propeny Ownee
An 'owner-buildgr' building permit has becn applicd fur in yuur name and bcanng your signaturc.
Pleuse rnmplete anJ return this informaiion in Ihe cnvelupe pruvided al your earliest opportunity iu �rvoid
unnecessary delay in processing and issuing yuur huilding permi�. No builcling pertnit will he issued until Ihis
vcrification is ree�i��cd.
.-� 1 persanally plan �u pruvide thc majar labor and materials for cunsWction of the proposcd
pro�erty improvemenf. �Yes ❑ No
�2 �' I(have/have not) signed an applicalion for a building permit fi�r
V thc proposcd work. .
�"°" ' rve contracteJ wilh the following persun (tirm) �o provide Ihe proposed conslruction:
� /Name
Address
City
Phqnc ( ) Contracior's Lic. No.
4. I pl;m �u provide purtiuns ol ihe work, hul I huvc hired the following person ln coordinale,
supervisc and pruvidc ihc m.�jor wurk:
Nainc
Address
Phone (
City _
Contractor's Lic. Nu.
S. I will provide some of ihe work bw I iiave contracted (hirecq the following persons to
pruvide the work indicated:
Name Address Phone Type of Wnrk
iM9�<5 �FEV D/9P�
DECLARATION OF AUTHORITY
FOR AGENTS OF PROPERTY OWNER
TO APPLY FOR PERMITS
Street AdBres�
Bidg. Permit #
This Permit #
S�� APNumber.
1. ' F(We), � tik..�� v� Y�I z , declare that I am the Owner of Title of the above
referenced real property, and that 1(we) hereby authorize:
Name: �� LlJ ��1� � W�' "� Telephone Number. �z 17�� ��i-1-
Street Address:
City: 6 l� W lw / Slate: � Zip: �� ^?/
to obtain pertnits in my behalf, as owner/builder, for
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I(we) shall immediately provide Workers
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Cosla
Mesa, as required by State of California laws.
3. As owner/builder in fact, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. 1 agree lo indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty oi perjury that the foregoing is true and correct.
Executed this day of
W]9d6 (rev.N/0p)
20_,at
(bate: ? � � a , 0 }�—
�
Note: This authorization does not grant authorization to perfortn the work as owner,
it solely provides for limited power of attomey to secure this permit in any behaH.
California.
(714) 754-5273 • Fau (714) 754-4856
� CITY OF COSTA MESA
BUILD/NG D/V/S/ON
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
Job Address: 2533 ORANGE AV
Suite: C
Vicinity:
Parcel Nunmber: 43941115
npplicant: AMERICAN WRECKING INC
BUILDING PERMIT
�
Zoning:
NUMBER
I �99-01260
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Address: 2459 LEE AV . - .
+ � Phone: 626350-8303 � , . -
� , .
SOUTH EL MONTE -'��-� � - , Zip: 91733 .
� � .
owner. MEKAMBE DEVE�OP: � � � � �
Address � ' � �
" ,i.i�'��� - - ,
�-IRVINE � � � Phone: 949�176-3133. - .
,,�j � ��, ' _
� � �� � - , ' Zip: _ ,
v, � , � _ �`--
Contractor. � AMERICAN;WRECKING INC �
Addreas: 2459,LEEAV- �� �
'"' = > �- %� Phone: 626-350.8303 '
. � ' ' SOUTH EL MONTE �
� ' �Zipi ; 91733%� License: 685192
� Arch : , . � � � ' Eng: .
Address: , , � - � � Address:
. ,' . Phone: � - �
� ; I - . -- �..
. , Zip: / -- . License: �
.
.� �� . �
/ ' � SCOPE�OF PERMIT
� i DEMOLISH SFD. � � � � ' � -
Plan Check: � $0.00
� Permit: �, $97.25
SMIP Res: $0.00
SMIP Com: $0.00
� Other: $0.00
Inspection: , $0.00
; Total: $97.25
�, r ,
�-�
_� .__. _���
SETBACKS �� :' � �
MAINSTRUCTUREFront 0-0 Rear �0-0
ACCESSORY � FronF. 0- 0 Rear 0- 0
PARKING Existinq: 0 Re uired: 0
NOTES:
FEESUMMARY -
, . • �!
_ ;,
a .
Left 0- 0
Left 0- 0
Proposed: 0
Status: ISSUED
Applied: 08/10/1999
Issued: OB/10/1999
Calc Valuation:
Clsim Valuation:
Right 0- 0
Right 0- 0
�� �l
DA'i'E � �
Phone:
License:
�
sa,000.00
sa,000.00
NOTICE: The work authorized by ihis permit shall comply with all applicabla handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRATION: This permit shall automatieally expire and become void i( work is not commenced within 780 days, or if work is suspended or abandoned
for a period o� 180 days. _
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetione end final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMVENSAnON DEG�RAnON:
I hereby atlirm un�er penalry of perjWY one ol the following tlaclarations: �
❑ I have entl wlll malntain a certiiicate of conseni to self-Insure for workers' compensation, as pmvitletl for by section 3700 ot the Labor Code, Por the partormence ot the
work for which this pertnit Is is5ued.
❑ I have and wlll maintein workels' compensation insurence, es required by section 3700 ot the labor Cotle, for Ihe peAortnance of tha wak for which Ihis permit Is issued.
My workers' co—mp�ensation Insurence carner antl Ilcy nu r are: /1 / /�
Carrler.�%C—��_��_ POIIcyNum6er: !��-�! �v
(This secHon neetl not be comp/efed il the Oermlfls veluetl et one handred dWlars ($700) ar Iess.J
� I CBRIh/ IhBI In ihB pertormanCe oi lhe work for w�ich this �nit is issued, I shall not employ eny person in eny manner so as to become subject to the workers'
compensatlon laws oF CaliF i�d egree Ihet it I sho eEome sub'ect to the warkers' campensetion provisions of Section 3700 of the Labor Code, I shall (orihwith
comply with these provisi /y /� (�
Applican� Signatur/a: � �� -•-• � - �/>/i .!� Deta: ii/`—� � ^ %��
WARNMG FAILUR2T0 ES OURE WOFK&RS' COMPENSATION CAVE NLAWFUL AND SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVII FINES UP TOONE HUNDRED
iHOUSAND DOLLARE ($100,000), IN ADDITION TO THE COST OF CAMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3]O60F THE IABOR fAOE, IMEREST, AND ATfORNEV'S FEES.
LICENSED CONTRACTORS OECLMATION:
I hereDy aHirm �het I am licensed under provisions oi
force end eflect. Lic. a ��
Coniractors SignaWre:
with Section 7000) of Divlslon 3 of ihe Business and Pmfessions Code, and my Ilcensa is in full
Class s � — Z
� � Dete: —
CONS7RUCTION LENDING AGENCY:
❑ I hereby aflirtn thet there is a construction lending egency tor the pedortnance oi Ihe work for whic� this permit is iuuetl. (Sec. 3097, Civil Cotle).
Lenders Name: Lenders Address:
Signature: Date:
�WNER-BUIL�ER DECI.ARATIONS:
I hereby attlrm that untler penalry of perlury ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (SecJ031.5, Business and Professions
Code: Any ciry or county which requires a permit to construct, alter, improve, demolish, or repair any struc�ure, prior to its issuance, elso requires �he applicant for such pertnit
to file e signetl statement Ihet he or 5he is licensed pursuent to tha p�ovisions of �he Conirectore License Law (Chapter 9(commenCing with Section 7000) of Division 3 of the
Business entl Pmtessions Cotle) or Ihat he or she Is exempt therefrom end the basis tor the alle8ed exemptlon. Any violation oi Section 7031.5 by any epPlicent tor a permit
subJects the epplicant to e civil penalry oi not more then tive hundred dollars ($500).):
❑ I, es owner of iha pmperty, or Riy employees with wages as their sole compensation, WILL DO THE WORK, end the structure is not intentlea or ottered for sale (Sec.
7044, Business end Professions Cotle: The Conirectors License Lew does not apply to en awner of properry who builds or improves thereon, and who tloes such work
himself or �eBelf or thmugh hi4 or her own employees, provideC ihet such improvements are not intentlad or offerad for sale. If, however, Ihe builtling or improvement is
sold wilhin ane year af completion, the owner-builder will have the burtlen ot pmving that he or she did not builtl or improve For purpase ai sele.).
❑ I, es owner oi the property, ar� EXCLUSIVELY CONTRACTING WfTH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business end Professions
Cotle: The contrectors License �w does not eppy to en owner of pmperry who 6uilds or improves t�ereon, end who comracts for such project wilh a contractoqs)
license pursuant to the Contrac�ors License LewSJ.
❑ I am exempt under sec. Business and Professions Cotle for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑ Ves ❑ No � Ddvers License No. Ezpires:
Venfication of Ownership by (rype oi document, i.e. - pmpetly taz bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATON:
❑ I hereby certity that no excava�ion fiva (5) or more feet in tlep�h Into which a person is requiretl to descen4 will be made in connection with work authorizad by Mis
permiL end Ihat no building stN�ure, scaHolding, lalsework, or demolition or tlismantling thereol, will De more Ihen ihirty-six (36) feet high. (Chap. 32, Grp 2, An 2, Sec.
341, Title e, Celitomia Atlministrative Code).
❑ A5 owner-buildar, I will not employ anyone to tlo work which would requira a parmit irom the Division ot Intlustnal Safety, as noted above, unless such person has a
permit ta do such work from the division.
Signatura: Date:
Division of Indusirial Safery Pertnit NVmber:
COOE I. INSPECTION TYPE
1616
1266
200
201
202
203
Fixed System Final Fire Prevention
Pool Spe Finel
Final Re-Fioof
Final Blak/Retaining Wall
Final Factory Fire Place
Final Sign
204 Final Demolition
L\I�L'1111L\4.
COOE♦ INSVECTIONTYPE
206 Final Mechanical
20B Flnel Plumbing
210 Finel Electncal
212 Final Fire Prevention
220 Final Plenning Approvfll
222 Finel SI�B
250 Final Building/Occupancy
BAIE INTITIALS
SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT
NOT�FICATION OF DEMOLITION OR ASBESTOS REMOVAL
21865 E. Copley Drive, Diamond Ber, CA 9 7 765-4 7 05 (909)396-2000
MPJL FORM AND FEE TO SCAQM�, ASBES70S NOTIFIGAT10N5, FILE # 55647, lOS ANGElES, CA 900745641
AQMD USE ONLY SCREEN BY RECEIVED POSTMARK ENTERED BY NOTIFICATION #
COMPLETED BY Duarte M. COMPANY American Wredcing, Inc. PHONE (626) 350-8303
DATE 07l30/99 CHECK# � fEE$ PROJECT# A99704D
NOTIFICA710N7YPE IGI REVISIONDATES REVISIONOTHEFi�hig�fqh�) CANCELLATION
PRpJECT TYPE OEMOLRION ORDERED DEMOLfT10N RENOVATION(removai) EMERGENCY REMOVAL PLANNED RENO�atmual)
SITE INFORMATION SITE NAME COMMERCIAL
SITE ADDRESS 2533 C OR4NGE AVENUE CROSS STREET MONTE VISTA
CITY COSTA MESA STATE CA ZIP COUNTY ORANGE
DESCRIBE WORK LOCP,TION Demolition of SUuctures and Site Clearing
BUILDING SIZE(S� F'I� 2800 NUMBER OF FLOORS 1 BUILDING AGE (YEARS) 2535 NUMBER OF DWELLING UNITS
BLdG PRIOR%PRESENT USE ��/�dERC10.t. HOSRtAL INWSTRIAL OTHER OFFlCE PUBIK &1Xi. RESIDENCE SCHOOL SNtP UNN�COLI.EGE
SITE OWNER MEKAMBE DEVELPMENT GROUP LLC ADDRESS 77775 MAIN STREET SUITE 6
CITY IRVINE STATE CA ZIP CONTACT BRETT ISAACMAN PHONE 949-4763133
R��UIRED BUILDING ASBESTpS YES NO AS8EST05 YES NO ASBESTOS YES NO BUILDING TO BE YES NO
INFORMATION PRESENT? VES SURVEV? YES REMOVED? YES DEMOLISNED? YES
PROJECT DATES START OB/13/99 END 08125/99 WORK SHIFT(aMpm) AM
ASBESTOS AMOUNT TO BE FRIABLE CLASS I CLASS II TOTAL REMOVED (add row)
R�MOVED (in squa�e feet)
ASBESTOS REMOVEDFROM SURFACES PIPES COMPONENTS
DESCRIBE TYPE 8 AMOUNT ACOUSTIC GEILING LINOLEUM INSULATION FIRE PROOFING DUCTING STUCCO MASTIC
OFASBESTOS
F�OOR TILES (VAT} ORY WALL PLASTER TRANSITE ROOFING OTHER
(describe)
CONTRACTOR INFORMATION CSBL LICENSE 8 685192 OSHA REG 1t AQMD IDp 97316
NAME American Wrecking, Inc. ADDRESS 2459 Lee Avenue
CITY South EI Monte STATE CA ZIP 91733 SITE SUPVR DON COBLER PHONE (626) 350-8303
WASTE TftANSPORTEft 1Ft LANOFIIL ORANGE COUNTY fN7ERGRATED LP,NDFILL
AbDRESS ADDRESS P.O. BOX DR.4WER 1955
CITY STATE ZIP CITY SANTAANA STATE CA ZIP 92702
Rifa 1603 mq NESMqP ASOrsim NW6m0on Fam REV 9]062[11 W3 Ffi9) Page t o12
Fqrtu. >�vp�cEoria. aM pre fiuk td03 �n Ee oMmn via FA%-BACK Ey Jia6rq han e larylmre (9091396Z150 a Wwpfi AOMD v.eG s4e htplMv.weqrM goWqMamxk.MM
� icm
..
TRANSPORTER7Y1
SCAQMD NOi7FICATION OF DEMOLITIOM OR ASBE5T05 REYOVAL
MAIL ORIGIANL TO SCApMD, ASBESTOS NOTIFICATION, FIIF # 5566t LOS ANGELES, CA. 900745W 7
STAiE
ZIP
STORAGE SITE
TROLS: DESCRIBE WORK PRAC7ICES AND CONTROlS T0 BE USED AT TNE DEMOL(T70N AND RENOVATION SIIF, FOR ASBESWS REMOVAL
:K, INUICATE RULE 1403 PROCEDURE # t, 2, 3, 4 OR 5 OR CON61NAT70N5 OF PROCEDURES USED. FOR PROCE�URES 4 AND 5 SUBMR PLAMS
A�MD PRIOR APPROVAL. PROCEDURE #:
STOS DEfECT10N PROCEDURE: DESCRIBE THE MEfHODS AND PROCEDURES USEO TO DETERMINE WHETNER ASBESTOS IS PRESENT qT THE
INCLUDING THE AW�.YTICAL METNODS (xevey, bWK samplirg, inspedion, asvmiM ACWM, e1cJ.
DEMq�iTONS GNE THE COMPANY NAIdE AND DATES OF TIE ASBESTQS REFIOVAL:
CAL
ORDERED DEMOLITION SEND A COPY OF THE ORDER AN GIVE THE AGENCY NAME:
10RI7JIlG PERSON;
= OF ORDER:
EMERGENGV A50E5T05 REMOVAL GIVE 7HE NAME AND PHONE NUMBER OF THE PEFtSON
HOUR OF EMERGENCY AND DESCRIBE THE SUD�EN, UN@XPECTED EVEM:
nn e:
DAiE ORDERED TO BEGIN:
7HEEMERGENCV,DATE
HOW THE EVENT WOULD CAUSE UNSAFE CONOR70NS, EQUIPMENT DAMAGE OR UNRFASONABLE FINANCIAL BURDEN:
NGpNCY PLAN: DESCRBE ACiIONS AND PROCEDURES TO 9E FOLLOVJED IF UNEXPECTED ASBESTOS IS FOLIND DURING DEMOLI710N OR NONFRIA6LE
{TOS MA7ERIAl, BECOME CRUMBLED, PULVERIZED, OR REDUCED TO POWDER.
DE6�OLITION WORK AN� N017FY AQMD.
IG CERTIFICATION: I oeltily that an ifMividuel trained in ihe ponsians d repulalion A�MD RWe 7403 aM NESHAP will 6e on sde duinp ihe
aM eriEenre itial ttie mquireE training I�as been accanpishM �y thrs pmsuri will De availde for impecdm tlimng nori�l Eusirress tn�rts_
CERTIFICATION: I ceNly �hai Ihe ahove'udormaiio is corted and 1 have errlosetl any required
INC.
Maria
OWNERIOPERATOR
PR0.IEGT COORDINATOR
nnt accepte0 willian tlre iequiretl asbestos lee (AQMD RUIe 301). Renrovals W less tl� 100 squere fee� aie pxempt hwn notl�sation h�e5.
.rk payable to'SCA�MD'. Fees are per noliffceAion, not refudable, arN vary accwtlinp to the as�estos amavtl to be removed. Fees are as fdlv«s_
�� �� TO 1,000 SOUARE FEE! t26.20 REVISION OF NOTFIUTIOM
FRqI1,W1TO5,0005CUpREFEEf t8p.10 C/JlCELLNTONOFMOiiFlCAl10N
FROY 5,00� Tp �0,000 SOUIIRE fEET itB) t0 PROCEDURE � Oq 6 PLp1I5
MORETXANIO,OOOSOUMEFEEf S2Y.00 RETURNF➢CXECKCIURGE
OEMOLRION OF LE53 TN�1N 100 Sp Ff f1620 $PECULL l41N011NG FEE
A7"fENT�ON: Kcep a mpy m yaur rotlfimEor�. stale iaw requres mat you prMoe a mpy otme aemofom rroofr�on m Buiainp ene Satery oet«e tssuence d a aemoWm penM
tANL FOWJI ANO iEE TO: SCAOMO, ASBESTOS NOTFIGATIONS, FILE Y 556t1, LOS ANGELES CA 9007�3641
iELEPMq1E :(909) 196-2336 FA%: (9U9) 3%33t2 Aseestos DemolttiorvRmovatim No�cation Form REV 990fi01
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(714) 754-5273 • Fa�c (714) 754-4856
1
CITY OF COSTA MESA
BUILD/NG DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
PLUMBING PERMIT
,lob Address: 2533 ORANGE AV
Suite No C
Vicinity:
Parcel Nunmber: 43941715
PER NUMBER
P99-00460
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 08/11/7999
Issued: 08/11/1999
ISSUED BY: �
Applicant: BELL, GLENN - � " ` " " ' ' -
� , � :
Address: 2459 LEE AV . � ,- � � '. � � '
. - i %�- � � Phone: 628350-8303 , � � _
SOUTH EL MONTE �, � Zip: 91733 ," �� -
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� '� % / .� �,. � ,- � �- " _ _ i �, � ' ,A
owngr � ;MEKAMBE DEVELOP" ". � �_ � � � _ � �
Address��� �� �, � � �' ��� �, �
� ; '� IRVINE,�i ��"� � Phone: 949-4763133 �� � � � � � � �` "�
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Contractor: : AMERICAN WRECKING INC
Addressi 2459 LEE AV �: � " :, �
� � '' %� ' - ' , - _- Phone: 626-950-8303
,SOUTH EL MONTE ; � � _ � � Zlp: 91733 .
- , � ' '' i r License: 685192" �
_ � . �,., , - _
ArchlEng:�`. �%� ������
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jAddress:� � � ' ,
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. .�-�� 7 SWERE CAP. REF B99-01260
�� � AMT
ISSUE FEE �. $23.50
Backflow irrigation , 50.00
Backflow Preventer $0.00
Bathtub �` � �' . $0.00
Clanfier System � � $0.00`
Conned (Ice,Soda,etc) $0.00
DentalUnits �. .'$0.00
Dishwasher � � �$0.00
Drain, Floor � , $0.00
Drain, Rainwater � _ � $0.00
Drain, Roof �� `�$0.00
Drinking Fountain $0.00
Expansion Tank $0.00
Gas Earthquake Valve $0.00
Gas (1-4 outlels) $0.00
Gas (Over 4 ouUets) $0.00
Gas Repipe $0.00
Gas Service $0.00
Interceptors (Grease, Oil) $0.00
Interceptors (Sand Auto ) $0.00
�
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0
0
0
0
0
0
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0
0
0
0
0
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0
0
0
0
0
. Phone: - � -. - -
Zip:
License: _.
SCOPE OF PERMIT -',
_ ;' , , �
FEE SUMMARY - _
' AMT QTY
Laundry Tub I Washer $0.00 0
Landscape Irrigation � $0.00 0
P-Trap , " � $0.00 0
Pressure Regulator ' � $0.00 0
Process Piping (per 10 ft) $0.00 0-
Receptore . 50.00 0
Septic Tank �: $0.00 � 0 ,
Sewer Cap for Demo "$9.80 1
Sewer Connect � $0.00 0
Sewer Private Line - � $0.00 0
Shower $0.00 0
Sink, bar $0.00 0
Sink, commercial $0.00 0
Sink, Floor $0.00 0
Sink, kitchen , . . $0.00 0
Sink, service/mop $0.00 �0 .-
Spa (private) . $0.00 � 0
Spa (public) $0.00 0
COMMENTS / SPECIAL CONDITIONS
, �
�
AMT
Sump Pump $0.00
Swimming Pool $0.00
Trap Primer. �$0.00
��Urinal � � � �$0.00
Vacuum Brkr Bkflow(1-4) $0.00
Vacuum BAcr Bkflow(5+) , $0.00
Wash Basin " % $0.00
Wash Basin Set � - � $0.00
Waste and Vent System $0.00
Water Closet (Toilet) $0.00
Water Heater / vent $0.00
Water Piping (Inst or Rep.) $0.00
Water,Re-pipe $0.00
Water Service $0.00
Water Soflener $0.00
OTHER $0.00
VIOLATION $0.00
PLAN CHECK $0.00
REINSPECTION $0.00
TOTAL CALCULATED FEES: $33.30
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0
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NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-g2)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 1 BO days. ,
INSPECTIONS: In order foi ihe work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inapectlons and final epprovel must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS' COMPENSATION DECLARATION:
I hereby ettirm untler penelty of par�ury o�e ol the following declaretions:
❑ I have and wiil maintaln e certifice�e of consent to self-Insure for workers' compensetion, as provldetl for by sectlon 3700 of Ihe Labor Gode, tor the pertormence ot the
work tor which ihis permlt Is issued.
❑ I have and will mainteln workers' compensatlon insurance, as requiratl by section 3700 of the Lebor Cotle, for ihe pedormence of the work tor which this permit is issuetl.
My workers' compensetlon Insuras�nce c�arder and policy number are:
Carrier: ��� i� f t-�� .�� S, Policy Number: � ij�S�o ��
(This sec(ion neetl nof be comp/efed i! tne permit is veluetl et one huntlred dollers ($100J ar less.) '
❑ I certity Ihet In �he peAarmance o� the work for which t is pertnit is issuetl, I shell not employ eny person in eny menner so as to become subject to the workere'
wmpensallon laws of }}California antl egree that it I s����JJ) bewr subject lo Ihe workers' compensetion provisions af Section 3700 oi the Labor Code, I shell torthwith
comptywith these prov' jns ^` ��� � c Dete: r{ �� �^_;? (
Applicant Signawre� �� � -e_
WARNING: FAILURE�ECURE WORKERS' �061FENSATION COVEfiA E IS UNLAWFUL AND SHALL SUBIECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE (5100,000), IN AW{SION TOTHE COST OF COMPENSATION, DAMAGES AS PROVI�ED FOR tN SECTIOtJ 31060F THE 1ABOR CODE, IMEREST, PND ATiORNEY'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby attirtn Iha� I em Iicense0 under p�a�i�ions of Chapter 9(commenci g with Section 7000) oi Dlvlsion 3 of fhe Business and Professims CoOe, and my license is in full
brce end eHecL Lic. a Z—� Class x
ContracroYs Signature: �j �,� a Date: r--L �._L .l�..
CONSTRUCTION LENDING AGENCY:
❑ I hereby aflirm thet thera Is a consvuction lending agency tor the pertormance of the work for which this permit Is issued. (Sec. 3097, Civil Code).
Lender's Name:
Signature: _
OWNER-BUILDER DECLARATIONS:
Lender's Adtlress:
Date:
I hereby aflirm thet under penelry of perjury ihat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any ciry or counry which requires a permit to construct, alter, improve, demolish, or repeir eny structure, prior to its issuance. also requires the applicant for such permit
to tile a signetl stetement thet he or she is licensed pursuant to the provisions of the Contrectors License Lew (Chapter 9(commencing with Section 7000) of Divislon 3 oi the
Business end Professions Code) or Ihat he or she is ezempt therefrom and the basis tor the allegetl ezemption. Any violation oi Section 7031.5 by any applicant tor a permit
sub�ects the epplicent to a civll penelry ot �ot more ihan five huntlred tlollars ($500).):
❑ I, as owner ol Iha property, or my dmployees with wages as Iheir sola compensation, WILL DO THE WORK, antl ihe structure is not intended or otteretl for sale (Sac.
7044, eusiness end Professions Code: The Contractors License Law tloes not apply to an owner of properry who builtls or improves thereon, and who does such work
himself or hersalt or through his or her own employees, provided ihat such improvements ere not Intended or oNered for sale. If, however, Ihe builtling or improvement is
sold within one year ot completion, �ha owner-builder will have the 6urtlen of proving Ihet he or she did not 6uiltl or improve for purpose oF sale.).
❑ I, es owner of the property, am E%CLUSIVELV CONTTiAC71NG WITH UCENSED CONTRACTORS to construct Ihe pmject (Sec. 7044, Business antl Professlons
Code: Tha conirectors License Lew tloes not epply to an owner of property who builds or improves ihereon, end who contrects tor such pmject with a wntractor(s)
license pursuent to the Coniractors �cense Laws.).
❑ I am axempt under sec. Business and Prolessions Code for Ihis reeson:
Signeture: Date:
Owner ID venfietl by tlrivefs license. ❑ Yes ❑ No Drivefs License No.
Venfication ot Ownership by (rype of document, i.e. - properry ta�c bill or deed):
DIVISION OF INDUS7RIAL SAFETV PERMIT CERTIFICATION:
Expires:
❑ I hereby ceniy that no excevation five (5) or more feet in tlepth into which a person is requiretl to tlescend, will ba matle in connection wi�h work authonzetl by this
permit, antl Ihet no builtling siructufe, scaHolding, talsework, or tlemolition or tlismantling thereof, will be more Ihan thirty-six (36) feet high. (C�ap. 32, Grp 2, An 2, Sec.
341, Tltla B, Celllornia AdminisVative Cotle).
❑ As owner-bullder, I will not employ anyone to tlo work which would require a permit from �he Division of Industrial Satery, es noted above, unless such person hes a
permit to do such work irom Ihe tlivislon.
SigneWre: Date:
Division af IndusMel Safety Permit Number:
CERTFICATE OF COMPLIANCE AND AUTMORIZA710N OF ENTRY: I certify untler penelty ot per�ury ihat I have read this epplication antl state ihat the information given is
correcL I egree to comply wl�h all state laws and city ordinances relating to builtling construction, entl euthorize representetives of the City of Costa Mesa to eMer upon the
ebove-tlescnbed propeny for inspection purpases. I agree not to occupy or allow occuPancy of any building authonzetl by t�is permit until final inspection.
COOE I, INSPELTIONTYVE
1616 Fixed System Finel Fire Prevention
72fi6 Pool Spa Finel
200 Finel Re-Root
201 Final BIocWRetaining Wall
202 Finel Fectory Fire Placa
203 Final Sign
204 Final Demolition
26a668
PB_E I[�dli
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CODE� MSPECTIONTYPE Qd7f. ��
206 Final Mechanical
20B Finel Plumbing ,'� � 1�- C�l �
210 Finel Electricel
212 Finel Fire Prevention
220 Final Planning Approvel
222 Final Site
250 FinalBuildinglOaupancy