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2638 E CARNIVAL AVECITY OF ANAHEIM Permit Number: SW12023-00021 Issued: 04/03/2023 www.anaheim.net/building (714)765-0626 Quarter Section: 122 Site Address: 2638 E CARNIVAL AVE, ANAHEIM, CA 92806 4; Legal: Deserlption: N •.TR 3390 BLK LOT 15 APN: 26829602 BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765-5153 Project Description: Pool Demo 550 sq. ft. shell to remain with (3) x 3 holes People Associated with Project: Permit Applicant Donny Tran Owner DO DANG MINH 2638 E CARNIVAL AVE OWNER - BUILDER DECLARATION 1 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 Business 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 appllcent 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 (_) all 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 properly 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 13 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 property who builds or Improves thereon, and who contracts for the projects with a licensed Contractor Du ant to the Contractor's State License Law). 1 am ex4pt Min liceAure under the Contractors, State License Lpwtor the following reason: I WORKER'S COMPENSATION DECLARATION I I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 peril is Issued. ❑ I 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 worker's Compensation insurance carrier and policy are: Cartier. Policy No.: Expiration Date: This section need not be completed If the permit Is for one hundred dollars (6100) or less. ❑ I 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 worker's compensation laws of California, and agree that, If I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code. I shall forthwith comDly with those Drovlsions. 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. CONSTRUCTION LENDING AGENCY I LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that there is a construction lending agency for the performance I hereby affirm under penalty of pedury that I am Lender's Information: licensed under provisions of chapter 9 (commencing with Section 7000) of Division 3 of the Business and I hereby certify that I have read this application and state that the information above is correct. I agree Professions Code. 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: 04/03/2023 Contractor. 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. Number: SWI2023-00021 Expiration Date TYPE: Fees paid for Permit: $171.00 City of Anaheim BUILDING DIVISION INSPECTION RECORD 41 SWIMMING POOL ADDRESS: 2638 E CARNIVAL AVE, ANAHEIM, CA 92806 OWNER: DO DANG MINH PERMITM SWI2023-00021 DATE ISSUED: 04/03/2023 DESCRIPTION: Pool Demo 550 sq. ft. shell to remain with (3) x 3 DO NOT GUNITE ROCK STRUCTURE (water feature, rock slide, fountain, waterfall, grotto etc.) until the above Inspection has been signed. holes POST THIS CARD WITH THE APPROVED PLANS IN A CONSPICUOUS PLACE ON THE JOB SITE ection Code Date Inspector 504 g 506 508 FApproval nite 510 DO NOT GUNITE POOUSPA until all theabove 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 8. P -Trap Receptor 516 9. Backflow 518 10. Deck, Deck Drains, Equipotential & Accessory Bondino 520 DO NOT POUR FLATWORK until all the above Inspections have been signed. 11. Rough Electrical 522 12. Fencing/Door Alarms 524 13. Plaster approval 526 DO NOT PLASTER until all the above inspections have been signed. 14. Final Electric 1 528 Sub -Contractors List MUST be approved and pool cover on site PRIOR to Pool Final Inspection request FINALIUMCTION CODE DATE I INSPECTOR 15 ough Demo 527 .. 16. Final 599 MIS"NSPECTIONS Date Ins pei tdr fbldjobcards Insosctan 14: 1. All plumbing to be completed and the system pressudzed to 35 lbs. with water or house pressure. 2. All metal within 5 feet of pool water, and all pod equipment, must be bonded to pod reinforcing steel with #8 solid copper wire. Niche light shell, deck inserts, etc. shall be bonded to pod rebar. 3. Pool equipment is not required to be set at this time. 1. Underground electric inspected prior to becidaing. 2. Gas line test at 100 for 15 minutes with 150 gauge. 3. When polyethylene gas piping is used, a certificate from a certified Installer and tracer wire shall be provided per CPC 1210.1.7.2 APPENDIX I. Inspections 11.13: 1. Rough electric inspection when all wiring is completed and ready prior to the plastering of poollspa. Potting compound In place at plastic light niche. 2. Current Code requires that any pod, spa or water feature contacting water 18 Inches or more in depth shall be enclosed by a barrier adequate to prevent entry of small children. The barrier shall comply with Section 3109 of current CBC and CRC APPOENDIX V specifying the height of any fence provided as barrier to the pod R- shall be Sir above grade on the outside of the fence. 3. Doors from a garage shell meet the requirements for a gate. Glass windows within 5' of pool water shall be tempered glass. 4. Prior to pre ester Inspection. streets, curbs and dry 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 pipe shag be painted to protect from sudighL Inspection 1418: 1. Gas and Electrical completely removed and 2x2 holes at bottom of pool andlor Isolated elements. 2. Pod bald fled: A.) With future build - sell compacting send 95% with receipt B.) No future build - any 911. 3. After pool Is operating and In working condition with approved pod cover on sits. INSPECTION REQUESTS 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 htpsY/aca.anaheim.noYCitizenAccess Inspection can normally be reached between 7:30 - 8:00 A.M. (714)765-5153 + 0 To access your Inspection timeframe: Please go to www.anaheim.netlbuilding after 7:30am on the day of your Inspection. Under Online Services, dick on the link -Inspection Timeframes' or call (714) 785.5153 + 0 Permit Number: SIM12023-00021 Issued: 0t/0W023 www.anaheim.neUbuilding (714)765-4626 Quarter Section: 122 Dear Property Owner: CITY OF ANAHEIM BUILDING DIVISION 200 S. ANAHEIM BLVD. 117141 765 - 5153 OWNER -BUILDER ACKNOWLEDGEMENT AND INFORMATION VERIFICATION FORM An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at 2638 E CARNIVAL AVE. ANAHEIM, CA 92806. 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. I 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 homeownees 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 X2.1 understand building permits are not required to be signed by property owners unless they are responsible for the ler/ construction and are not hiring a licensed Contractor to assume this responsibility. 3.1 understand as an "Owner -Builder" I am the responsible party of record on the pe'mit. I understand that I may protect — 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 J 1 V permits and contracts. 5.5.1 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. _understand if 1 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. 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 under contract with a licensed general building Contractor. _!gy,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. - _. I 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 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. _ 10. I 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: 2638 E CARNIVAL AVE. CITY OF ANAHEIM BUILDING DIVISION Permit Number: SWI202340021 200 S. ANAHEIM BLVD. Issued: 04/03/2023 (714) 765 - 5153 www.anaheim.neUbuilding (714)765-4626 Quarter Section: 122 Permit Number: SW12023-00021 1A,1 1.. 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. I 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 properly 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 the permit is issued to verify the property owners signature. 'Property Owners Signature % Da -e: J -CITY-OF ANAHEIM PLANNING DEPARTMENT ; •-� BUILDING DIVISION AUTHORIZATION OF AGENT TO ACT ON BEHALF OF PROPERTY OWNER FORM F 1'W' 1 rf ! \r t �, F. r �'� rr �. f. w 4 f�: s-. (.'s ( /� (f�• fel (r4f L t f.r• (F,- r -f',' eF ealifdState Lb% if yoii; the pV60e'ty o�rher;'Will 6p wmin6 6 ba office to get � peniilf; eve do not !—' F 'I f FI rf+ f (n! i �� i wef rf_ I iri- Co. r—r+{, /.. '- C /,iS (! F fr.� 1�,; ,E..( �. vdobire�ou to conipl�ete ttii's for'r 6�re�`ei:; if you are'se j sonileonb on roiSr bie a f (jrouF agent ;Blease f'.;. comp-i' IAC C -L 1. { - , e,• f • cornplIs and sl hr ttie infdrhiation be1oW: Also hiake 1S that jioij f'at'e pKdvid'e'd j'bur Qbnt iiViith a sighed Qwner-Builder Acknowledgment and Informati6h Verification PorM. Sco :e of*Co _ tru0ion Pro'ect or Descri ,tion -of o�cr c �- _P_ _j_ (_ P_ )�_� - Project Location or Address: vz)' Name_ of Authorized Agent: Address of Authorized Agent: 31 Phone Number of AuthorizedAgent: ^7%_. Required F=orms 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 DeedProperty Tax Bill Closed escrow document Title Search Mortgage Bill I declare under penalty of perjury that I am the property owner for the address listed above_ and I personally filled out *the above information and certify its accuracy. Property Owner's Signature: Date: 23 Office Use Only: 'Ownership Verified Document Planning Info -.� Permit # WIM23—MmI 200 S. Anaheim Blvd., Suite 145Anaheim, California 92805(714)765-5153'Phone (7.14)765-4607 'Faz 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 7-L J!? 17=�- p, j JCAL fvye_ �cr�. e.,+0(2 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. W1. 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. T&2. I 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. �3. I 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. D4. 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. W6. I understand if I am considered an "employer' under state and federal law, I must register with MARCH 2009 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. VD.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. W8. I 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. th 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the In lernal 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-CSL13 (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:) Cz Pa& Ji VA -L A-"Gt _W11. 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. 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 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 properly 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 the permit is issued to verify the property owner's signature. Property Owner's Signature: Al 3 PAGE 2 OF 2 200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax 672 -- -