HomeMy WebLinkAboutDMO22-0094_Asbestos Disclosure for Demolition Projects - 11 Avalon Vista
300 N. Flower Street, Santa Ana, CA 92703 www.ocpublicworks.com
P.O. Box 4048, Santa Ana, CA 92702-4048
Revised 03/2017
P: 714.667.8888 | F: 714.667.7575
ocpCustomerCare@ocpw.ocgov.com
Asbestos Disclosure for
Demolition Projects
Date: __________________________
Applicant Name: _______________________________________________________________________________
Applicant Address: _____________________________________________________________________________
_____________________________________________________________________________
Applicant Telephone Number: ____________________________________________________________________
Project Address: ________________________________________________________
________________________________________________________
Unincorporated Area of Orange County Zip Code
Demolition Permit Application Number: _______________________________________
OWNER:
I declare that I am the owner-occupant of the single-unit dwelling and I will personally conduct
renovation/demolition activity at the dwelling. Written asbestos notification is not applicable to the
demolition project. (AQMD Rule 1403.j.9)
CONTRACTOR:
I declare that the demolition of the structure which job address is listed above may involve demolition or
removal of asbestos material, and attached is a copy of each written asbestos notification regarding the building
that has been required to be submitted to the South Coast Air Quality Management District
(http://www.AQMD.GOV).
(Health & Safety Code Section 19827.5)
OWNER/ CONTRACTOR:
I declare that the demolition of the structure which job address is listed above does not involve demolition or
removal of any asbestos material. Written asbestos notification is not applicable to this demolition project.
(Health & Safety Code Section 19827.5)
If the above demolition involves the taking out of load supporting beams and or load bearing wall, then a
SCAQMD notification is always required.
Signature of Authorized Agent or Owner or Contractor: ___________________________________________
Note to Staff: Please Fax this form to SCAQMD at 909 396-3342
6/24/2022
Jetti Outfleet
9261 Irvine Blvd, Irvine, CA 92618
959-916-4545
11 Avalon Vista
Newport Coast, CA 92657
DMO22-0093
X