3108 W BALL RDPermit Humber: SW12023-00018
Issued: 03/06/2023
www.anaheim.net/building
(714)7654626
Quarter Section: 11
Site Address: 3108 W BALL RD, ANAHEIM, CA 92804
Legal Description:: N TR 2264 BLK LOT 2
APN:07957203
CITY OF ANAHEIM
BUILDING DIVISION
20(1 S. ANAHEIM BLVD.
(7141765 -5153.
Project Description: Demolition: 426 sq. ft. gunite pool demo with shell to remain.
People Associated with Project:
Permit Applicant Huyen ThiPham
Owner
VO KATIE
3108 W BALL RD
OWNER - BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law for the following reason(s) Indicated below by the
checkmark(s) I have placed next to the applicable Item(s) (Sec. 7031.5 Business and Professions Code: any city or county which requires a permit to
construct, alter, Improve, demolish or repair any structure, prior to Its Issuance, also requires the applicant for the permit to file a signed statement that he
or she is licensed pursuant to the provisions of the Contractors' State License Law Chapter 9 (commencing with Section 7000) of Division 3 of the
Busloiss and Professions Code) or that he or she Is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any
app cant for a permit subjects tin applicant to a civil penalty of not more than five hundred dollars (6500).
I, as owner of property, or my employees with wages as their sole compensation, will do lL0111 or (_) portions of the work, and the structure is not
intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through
employees' or personal efforts, builds or Improves the property, provided that the Improvements are not Intended or offered for sale. If, however, the building or
I, as the owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sec. 7044 Business and Professions Code:
The Contractors' State License Law does not apply to an owner of p perry who builds or Improves thereon, and who contracts for the projects with a licensed
Contractor pursuant to the Contractor's State License Law). ,/
I am exempt from tic
ensure under the Contractors, State Licen w r e WoOng reason -
COMPENSATION
I hereby affirm under penally of perjury one of the following
Q i have and will maintain a certificate of consent to self -Insure for worker's compensation, Issued by the Director of Industrial Relations as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
0 1 have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this
permit is Issued. My workers Compensation Insurance carrier and policy are:
Cartier. Policy No.: Expiration Date:
This section need not be completed N the permit Is for one hundred dollars (6100) or less.
Q 1 certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the
workers compensation laws of California, and agree that, If 1 should become subject to the workers compensation provisions of Section 3700 of the
Labor Code. I shall forthwith comoly with those provisions.
Date Signature of Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
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 OR THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY II LICENSED CONTRACTORS DECLARATION j
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance
Lenders Information:
I hereby certify that I have read this application and state that the information above is correct. I agree
to comply with all city ordinances and state laws relating building construction, and hereby authorize
representives of this city to enter upon the above mentioned property for Inspection purposes.
Date Signature of Applicant or Agen
The premit shall expire by limitation and become null and void If the building or work has not passed
final inspection 365 days from the date of permit Issuance. A new permit is required to commence or
continue work.
I hereby affirm under penalty of perjury that I am
licensed under provisions of chapter 9 (commencing with
Section 7000) of Division 3 of the Business and
Professions Code.
Date: 03/06/2023
Contractor:
Number: SWI2023-00018
TYPE:
Expiration Date
Fees paid for Permit: $170.00
City of Anaheim
•;<.2 R 'BUILDING DIVISION
INSPECTION RECORD
SWIMMING POOL
ADDRESS:
3108 W BALL RD, ANAHEIM, CA 82804
OWNER:
VO KATIE
PERMIT #:
SWI2023.00018
DATE ISSUED:
03/0612023
DESCRIPTION:
Demolition: 426 sq. ft. gunite pool demo with shell to
DO NOT GUNITE ROCK STRUCTURE
(water feature, rock slide, fountain, waterfall, grotto etc.) until the above Inspection has
been signed.
remain.
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE ON THE JOB SITE
Inspection Code Date Inspector
1. Main Drain 504
2. Electric Bonding 506
3. Steel 508
4. Approval to Gunite 510
DO NOT GUNITE PODUSPA
until all the above inspections have been signed.
5. BLD -Steel and Electric bonding
(Rock Structures,Slides Etc)
508
DO NOT GUNITE ROCK STRUCTURE
(water feature, rock slide, fountain, waterfall, grotto etc.) until the above Inspection has
been signed.
6. Underground Electric
512
7. Gas Piping Test
514
S. P Trap Receptor
516
9. Backflow
518
10. Deck, Deck Drains,
Equipotential & Accessory
odia
520
DO NOT POUR FLATWORK
until all the above inspections have been signed.
11: Rough Electrical 522
12. Fenclng/Door Alarms 524
13. Plaster approval 526
DO NOT PLASTER
until all the above inspections have been signed.
14. Final Electric r 528
Sub -Contractors List MUST be approved and pool cover on site
PRIOR to Pool Final Inspection request
FINAL INSPECTION CODE DATE INSPECTOR
15. Rough Demo 527 Jkj
16. Final 599
MISC. INSPECTIONS Date Inspector
fbldjobards
Inspections 1.5:
1. All plumbing to be completed and the system pressurized to 35 lbs. with water
or house pressurs..
r.'All metal"i ffifeet of poWwater, and all pool equipment, must be bonded �� v
to pod reinforcing steel with 06 solid copper wire. Niche light shell, dedk inserts,
etc. shall be bonded to pool rebar.
3. Pod equipment is not required to be set at this time.
Inspecttonr6.10:
1. Underground electric Inspected prior to badddling.
2. Gas line teal a1100 for 15 minutes with 150 gauge.
3. When p*athyhme gas piping is used, a ca0flate from a cer05ed Instatier
and tracer who shall be provided per CPC 1210.1.7.2 APPENDIX I.
Msceeebns 11.tac
1. Rough electric Inspection when all wiring is completed and ready prior to the
plastering of podlaps. Potting compound In plow at plastic light niche.
2. Current Code requires that any pod, spa or water feature
connecting water 16 Inches or more In depth shall be enclosed by a barrier
adequate to prevent entry of small children. The baffler shall comply with
Section 3109 of current CBC and CRC APPDENDIX V specifying the height o1
any fence provided as baffler to the pod tt- shall be 60' above grede on the
outside of the fence.
3. Doors from a garage shay meet the requirements for a gate. Glass
windows within V of pod water shall be tempered glass.
4. Prior to pre•ploster Inspection, streets, curbs and city sidewalks will be
Inspected for any damage due to construction of pod or spas.
S. Grading complete with positive drainage to street or public way. All
exposed plastic p1pe shall be pointed to protect from suntigh6
Inspections 14.16:
1. Gas and Electrical completely removed and 2x2 holes at bottom of pool
andfor Isolated elements.
2. Pad baddiled:
A.) with future build - self compacting send 95% with receipt.
8.) No future build - any PoI.
3. After pod Is operating and In working condition with approved pool cover on
sfte.
Inspection requests made prior to 5:00 pm Monday - Friday
will be scheduled on the following workday.
To schedule your building inspection online, please go to
httpsJ/aa.anaheim.neUCitizenAccess
Inspection can normally be reached between
7:30 - 8:00 A.M.
(714)7655153 t 0
To access your Inspection timeframe:
Please go to www.anaheim.netfbuilding after 7:30am on the day of your
Inspection. Under Online Services, dick an the link "Inspection
Timeframes' or cell (714) 7655153 + 0
CITY OF ANAHEIM
` BUILDING DIVISION
`ice`' 11' Numbar: SW 023-00018
200 S. ANAHEIM BLVD.
Issued: 03/06/2023 (714) 765 - S153
www.anaheim.net/building
(714)765.4626
Quarter Section: 11
OWNER -BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION FORM
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements
specified at 3108 W BALL RD. ANAHEIM, CA 92804.
We are providing you with an Owner -Builder Acknowledgement and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder.
We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this
form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner,
obtain the prior approval of the permitting authority.
Directions: Read and initial each statement below to signify you understand or verify this information.
�f P 1.1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building
permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an
Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. My homeowners insurance may not provide coverage for those
injuries. I am willfully working as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to
H69 2.1 understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
pip 3.1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect
Q -J myself from potential risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.
4.1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5.1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
6.1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers's compensation disability insurance, and contribute to unemployment
compensation for each "employee". I also understand my failure to abide by these laws may subject me to serious financial
risk.
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
An under contract with a licensed general building Contractor.
8.1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial
or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
9.1 understand I may obtain more information regarding my obligations as an "employer" from the internal Revenue Service,
the United States Small Business Administration, the California Department of Benefit Payments; and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at
1400-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
_ 10.1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and financially responsible for proposed construction activity at the following address: 3108 W BALL RD.
CITY OF ANAHEIM
Permit Number: SWI2023.000*' `' BUILDING DIVISION
:4:0 y-- fiM�..
200 S. ANAHEIM BLVD.
Issued: 03/06/2023 (714) 765 -5153
www.anaheim.net/building
(714)765-4626
Quarter Section: 11
Permit Number: SW12023-00018
11.1 agree that, as the party Legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govem Owner -Builders as well as employers.
12.1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract_ with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any
financialloss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil
court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is
injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and
wish to hire
Contractors, you will be responsible for verifying whether or not those Contractors are property licensed and the status of
their workers' compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the
agency responsible for issuing the permit.
Note: A copy of the property owners driver's license, form notarization, or other verification acceptable to the agency is required
to be presented when the p rmit is issued rify the property owners signature.
Property Owner gnature i Date:.
_ _ - _ --_...-11
tar .
A
CITY OF ANAHEIM
PLANNING DEPARTMENT
- - - BUILDING DIVISION
AUTHORIZATION OF AGENT TO ACT ON BEHALF OF PROPERTY OWNER FORM
"Per California State Law, if you, the property owner, will be coming to our office to get a permit, we do not
require you to complete this form, however, if you are sending someone on your behalf (your agent), please
complete and sign the information below.
Also make sure that you have provided your agent with a signed Owner -Builder Acknowledgment and
Information Verification Form.
Scope of Construction Project (or Description of Work):
Project Location or Address:
3 10 119 B -A Ll 9 1) �")Ae I tA CA I W4
Name of Authorized Agent: -
Address of Authorized Agent:
1479 1 6-j) Y �ZS% IIYS� r'12 CA 6)7 g�
Phone Number of Authorized Agent:
-r
-7
Required Form of Identification Attached: (Please check one of the forms of identification below in addition
to the required California State Issued ID)
Property Owner's California State Issued ID with:
Property Deed Property Tax Bill _ Closed escrow document
Title Search Mortgage Bill —IL
I declare under penalty of perjury that I am
personally filled out the above informati
Property Owner's Signature:
Go -
Office Use Only:
ID Verified_
Ownership Verified
Documents
Planning Info
owner for the address listed above and I
.i_a_-1-3
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax OCT 2013
www.anaheim.net/building B720
CITY OF ANAHEIM
PLANNING DEPARTMENT
BUILDING DIVISION
OWNER -BUILDER ACKNOWLEDGMENT AND INFORMATION VERIFICATION FORM
*Per California State Law, if you, the property owner, will be coming to our office to get a permit, we will provide
you with this form when you arrive. If you are sending your agent, please complete, initial, and sign the
information below. Also make sure that you have provided your agent with a signed Authorization to Act on
Behalf of the Property Owner Form with the required forms of identification.
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified at x3148 141 I31l J )- 1, �
We are providing you with an Owner -Builder Acknowledgment and Information Verification Form to
make you aware of your responsibilities and possible risk you may incur by having this permit issued in
your name as the Owner -Builder.
We will not issue a building permit until you have read, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot
execute this notice unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify you understand or verify this
information.
1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an
'Owner -Builder" building permit that erroneously implies that the property owner is providing his or her
own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious
financial risk for any injuries sustained by an unlicensed person and his or her employees while
working on my property. My homeowner's insurance may not provide coverage for those injuries. I am
willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to
workers on my property.
2. 1 understand building permits are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
S3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I
understand that I may protect myself from potential financial risk by hiring a licensed Contractor and -
having the permit filed in his or her name instead of my own.
�4. 1 understand Contractors are required by law to be licensed and bonded in California and to list
their license numbers on permits and contracts.
QJ 5. 1 understand if I employ or otherwise engage any persons, other than California licensed
ontractors, and the total value of my construction is at least five hundred dollars ($500), including
labor and materials, I may be considered an "employer' under state and federal law.
6. 1 understand if I am considered an "employer' under state and federal law, I must register with
MARCH 2000
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax B721
the state and federal government, withhold payroll taxes, provide workers' compensation disability
insurance, and contribute to unemployment compensation for each "employee;" I also understand my
failure to abide by these laws may subject me to serious financial risk.---_...�:...r •.
c 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds
single-family residential structures cannot legally build them with the intent to offer them for sale,
unless all work is performed by licensed subcontractors and the number of structures does not exceed
four within any calendar year, or all of the work is performed under contract with a licensed general
building Contractor.
8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be
he liable for any financial or personal injuries sustained by any subsequent owner(s) that result from
any latent construction defects in the workmanship or materials.
Q9.
1 understand I may obtain more information regarding my obligations as an "employer"from the
nal Revenue Service, the United States Small Business Administration, the California Department
of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may
contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or
www.cslb.ca.gov for more information about licensed contractors.
L10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and
understand that I am the party legally and financially responsible for proposed construction activity at
the following
address:310
o '1 R D 44FIUSfJ
SL11. 1 agree that, as the party legally and financially responsible for this proposed construction
activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as
employers.
L12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to
any of the information I have provided on this form. Licensed contractors are regulated by laws
designed to protect the public. If you contract with someone who does not have a license, the
Contractors' State License Board may be unable to assist you with any financial loss you may sustain
as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is
also important for you to understand that if an unlicensed Contractor or employee of that individual or
firm is injured while working on your property, you may be held liable for damages. If you obtain a
permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or
not those Contractors are property licensed and the status of their workers' compensation insurance
coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner
and returned to the agency responsible for issuing the permit.
Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable
to the agency is required to be presented when t p rmit is issued to verify the property owner's
signature.
Property Owner's Signature: Date: I
PAGE 2 OF 2
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax B721