1416 W CASTLE AVE (8)BUILDING DIVISION
SWIMMING POOL PERMIT NO. SW12021-00037 a�r'esrM e' 200 S. ANAHEIM BLVD.
(714) 765 - 5153
TYPE OF PERMIT �'
Repair or Alteration of Existing
DATE: 3/15/2021
JOB ADDRESS: 1416 W CASTLE AVE
LEGAL DESCRIPTION: N TR 1981 LOT 100
PERMIT APPLICANT: JOSE L PEREZ
H E I M INSPECTION REQUEST LINE:
(714) 765 - 4626
QUARTER SECTION: 65
OWNER INFORMATION: CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
MICHAEL CONNELLY SWIMMING POOL
1416 W CASTLE AVE 1233 W PRIMROSE DR
ANAHEIM, CA 92802-2143 ORANGE, 92868 0000 CA
JOB DESCRIPTION: Alteration of Existing: Remodel existing pool with split drains.New 5' faux rock formation waterslide w/ water feature.
VALUATION: 25,000.00 PROCESSED BY: ASH
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (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 such permit to file a signed
statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9)(commencing with Section 7000 of 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 7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
❑ I, as owner of property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (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 does such work himself or herself or
through his or her own employees, provided that such improvements are not intended or offered for sale. ff, however, the building or improvement is sold with one year of
completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale).
❑ I, as the owner of the 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 contracts for such projects with a contractors) licensed pursuant to the Contractor's
License Law).
❑ 1 am exempt under Sec. B 8 P.C. for this reason:
Date: Owner:
WORKER'S COMPENSATION DECLARATION LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: I hereby affirm under penalty of perjury that I am licensed
1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for under provisions of chapter 9 (y�o 1ne� cin dh Section 7000)
by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. of Divsion 3 of the Business�a eras ' ns Code.
pI have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code,
or the performance of the work for which this permit is issued. My worker's Compensation insurance carrier
and policy are:
Carrier: Policy Number: EXEMPT
Th_Is ction need not be completed if t he permit is for one hundred dollars ($100) or less.
`'�cerf that in the performance of the work for which this permit is issued, I shall not employ an
dY p p p y y person in
any manner so as to become subject to the worker's compensation laws of California, and agree that ff I should
become subject to the worker's compensation provisions ofP/i73700 f the Labor Code, I shall forthwith
comply with those provisions. ����
Date: 3/15/2021 Applicant`_
WARNING: FAILURE TO SECURE WORKER'S COWENSATION COVERAGE IS UNLAWFUL, AND
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 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES.
I CONSTRUCTION LENDING AGENCY 1
I hereby affirm under penalty of perjury 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 comply with
all city ordinances and state laws relating to building construction, and hereby authorize representives of this
city to enter upon the above mentioned property for inspection purposes.
Date: 3/15/2021
Signature of Applicant or Agent
The permit shall expire by limitation and become null and void if the building or work has
not passed final inspectoin 365 days from the date of permit issunace. A new permit is
required to commence or continue work.
Date: 3/15/2021
NUMBER:
BUS2021-00632
TYPE: C53
TYPE: BUS
Valuation
Census Code
Contractor: ` - l
EXPIRATION DATE:
3115/2022
Fees paid forPermit:
Total:
25,000.00
434
750.00
CU