1863 S. Margie Ln.
SWIMMING POOL PERMIT NO. SW12004.00018 ,d.,;,,~.
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TYPE 0 PERMIT ._f,.y_.....~."-.~\'~\
New Pool and / or Spa CIT~;;. \~lB~.,..c'AH EI M
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DATE: 5/2012004
JOB ADDRESS:
1863 S MARGIE LN
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REQUEST LINE:
(714) 765 - 4626
QUARTER SECTION: 67
LEGAL DESCRIPTION: N TR 2489 LOT 105
APPLICANT: JIM MCNAMARA
OWNER INFORMATION: CONTRACTOR INFORMATION:
Canni ne J Kennedy SPLASH SPAS & POOLS
1863 S Mar9ie Ln 2275 TERMINO AVE
Anaheim, CA 92802. LONG BEACH, 90815 0000 CA
JOB DESCRIPTION:497 sq ft fiberglass pool & spa.
vALuATION: 23.000.00
ARCHITECT/ENGINEER INFORMATION:
WiLLIAM H WEAVER
5797 N BOGART LN.
BOISE, ID 83714
PROCESSED BY: MJF
OWNER.BUILDER DECLARATION
, L,~~eby,c:tffirm,under penalty of perjury that I am exempt from the Contractor's License Law for the foll01l\1ng reason (Sec. 7031.5 Business and Professions
,q:~~~:anyc:it.v~oicountYWhjCh requires a permit to oonstl1.lct, alter, improve. demolish or repair any structure, prior to its issuance, also requires the applicant
;t9:r;,suchper'mit to, file a 'signed statement that he is licensed pursuant to the previsions of the Contractor's License Law (Chapter 9)(oommencing INith Section
.,7;Qorlof Division 3'of the.Business, and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section
-'~~:?1:~ by a~y apPlican~Tor a ~rmit,subjects the applicant to a civil penartyof ~~ more than five hundred dollars ($500).
","'Cj\"{I::;~ibWn~r of p~~~~~ ,'o~ my employees INith \Y8ges as their sole compensation, INiIl do the 'hOrk, and the structure is not intended or offered for sale
:W,e,p. 7044 Business and Professions Code: The Contractor's License Law d~s not apply to an owner of property who builds or improves thereon; and who
.~~,~ _such 'hOrk himself or herself or through his or her 01M1 employees, provided that such improvements are not intended or offered for sale. If, however, the
,blJil~ing or improvement is sold \\lith one year of completion, the owner-builder will have the burden of pro'Jing that he did not build or improve for the purpose
:<' ofsaie). ,{' !
:,011, as the owner 6fthe property, am exclusively contracting with licensed cOntractors to construct the project (Sec. 7044 BusinesS and ProfeSsions Code:
' The Contractor's License Law does not apply to an owner of property who builds or improves thereon! and who oontracts for such projects wit~ a contractor(s)
~ensed pursuant to the Contractor's License Law). . '.
U I am exempt under Sec. , B & P.C. for this reason:
Date' Owner'
I WORKER'S COMPENSATION DECLARATION I LICENSED CONTRACTORS DECLARATION I
I hereby affirm under penalty of pe~ury one of the, following declarations: I hereby affirm under penalty of perjury that J am
0 I have and will maintain a certificate of consent to self-insure for worker's compensation, as licensed under provisions of chapter 9 (commendng with
provided for by Section 3700 of the Labor Code, for the performance of the 'hOrk for which this- Section 7000) of Divsion 3 of the Business and
permit is issued. Professions Code.
D I have and will maintain 'hOrker's compen$ation insurance, as required by Section 3700 of the
Labor Code, for the performance of the work for which this permit is issuecL,:My y,.orker's Date: 12/812004 Contractor:
Compensation insurance carrier and policy are:
Carrier: STATE FUND Policy Number: 1767639 NUMBER: EXPIRATION DATE:
This section need not be completed ift he permR is for one hundred dollars ($100; or less. BUS2001-00388 6/30/2006
TYPE: B
o I certify that in the performance of the work for which thispennitis issued, I shall not employ TYPE: HIC
any person in any manner so as to become subject to the V\oQrker's compensatic11am of TYPE: BUS
California, and agree that if I should become subject to the 'hOrker's compensathn provisions of TYPE: C53
Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
.- -- - - '-" --- ._-~,-'--'>..~,~- SwimminQ Pool Size
Date: 12/8/2004 Applicant: 497.00
Valuation 23,000.00
WARNING: FAILURE TO SECURE WORKER'S COMPENSATiON COVERAGE IS UNLAWFUL, Census Code 329
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL TIES AND CIVIL FiNES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF
COMPENSATioN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of pe~ury that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec.3097.Civ.C):
Lender's Information:
I certify that I have read this application and state that the above information is correct. I agree to Fees paid for Permit:
comply with all city ordinances and state lam relating to building construction, and hereby Total: 57.05
authorize representives of this city to enter upon the above mentioned property for inspection
purposes.
Date: 12/812004
Signature of Applicant or Agent
The permitshall expire by limitation and become null and void ifthe building or work
has not passed final inspectoin 365 days from the date of pennit issunace. A new permit
is required to commence or continue work.
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