1054 S MATTHEW WAYCITY OF ANAHEIM
Permit Number: SW12023.00007
Issued: 02/06/2023
www.anaheim.neUbuilding
(714)765-4626
Quarter Section: 215
Site Address: 1054 S MATTHEW WAY, ANAHEIM, CA 92808
Legal Description: N TR 12686 BLK LOT 32
APN:35657310
BUILDING DIVISION
200 S. ANAHEIM BLVD.
17141765-5153
Project Description: New Swimming Pool/Spa: 63 sq. ft. gunite spa with electrical and plumbing for outdoor bbq and firepit.
People Associated with Project:
Contractor 'J & A POOL & SPA CONSTRUCTION PO BOX 9093200901211108298240 RANCHO CORDOVA, CA 92509
Permit Applicant Gitsell Dominguez
Owner PINEDA JAVIER G TR
1054 S MATTHEW WAY
OWNER - BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors License State taw for the following reason(s) Indicated below by the
checkmark(s) I have placed next to the applicable Items) (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 Lew Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt from Ilcensure 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).
0 I, as owner of property, or my employees with wages as their sole compensation, will do"all or (J 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
0 1, 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 properly who builds or improves thereon, and who contracts for the projects with a licensed
Contractor oursuant to the Contractor's State License Law).
I am exempt from licensure under the Contractors, State License law for the following reason:
Date Signature of Property Owner or Authorized Agent
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self -Insure for workers compensation, Issued by the Director of Industrial Relations as provided for by
Se on 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain workers 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. EVEREST PREMIER INSURANCE COMPANY Policy No.: 7600023888221 Expiretio
This section need not be completed if the permit Is for one hundred dollars (1100) or less.
❑ 1 certiy 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 I should become subject to the workers compensation,provislons of Section 3700 of the
Labor Code. I shall forthwith comoly with
Date
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 ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance I hereby afire under penalty of perjury that I am
Lenders 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: 02/06/2023
Contractor: J & A POOL & SPA CONSTRUC
�Z —0to-2023 Number:. SW12023-00007 Expiration Date 9/19/2023
Date Sign urs of Appl nt or Agen TYPE: C53
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.
Fees paid for Permit: $916.00
City of Anaheim
BUILDING DIVISION
INSPECTION RECORD
41 SWIMMING POOL
ADDRESS:
1054 S MATTHEW WAY, ANAHEIM, CA 92808
OWNER:
PINEDA JAVIER G TR
PERMIT #.
SWI2023-00007
DATEISSUED:
0210612023
DESCRIPTION:
New Swimming Pool/Spa: 63 sq. ft. gunfte spa with
DO NOT GUNITE ROCK STRUCTURE
(water feature, rock slide, fountain, waterfall, grotto etc.) until the above Inspection has
been signed.
electrical and plumbing for outdoor bbq and firepit.
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE ON THE JOB SITE
ns'
Inspection Code Date Inspector
Main D ral n
1. Main Drain 504 3�t/2g A4#Vn�'
2 Ele B nd
c c 0
- in
2. Electric Bonding --i0-6 T/yg ww�
Ftn
3. Steel
3. Steel SOB
4. Approval to Gunfte 510
DO NOT GUNITE POOUSPA
until all the above Inspections have been signed.
5 n q'.1
. BLD -Steell and Electric bon
(Rock Structures,Slides Etc)
DO NOT GUNITE ROCK STRUCTURE
(water feature, rock slide, fountain, waterfall, grotto etc.) until the above Inspection has
been signed.
6. Underground Electric
512
3W
-*f(W,
7. Gas Piping Test
514
8. P -Trap Receptor
516
JY
9. Backflow
518
jjw&�r
10. Deck, Deck Drains,
Equipotential & Accessory
Bondina
520
DO NOT POUR FLATWORK
until all the above Inspections have been signed.
11. Rough Electrical 522 jC,//jj3 I
12. Fencing/Door Alarms 524 IVI 113 J-IG�
13. Plaster approval 1 526 IG7//>3 I
DO NOT PLASTER
until all the above Inspections have been signed.
14. Final Electric 628 LV(A*
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
16. Final 599 J -Def -I.
MISC. INSPECTIONS Date Inspector
fb1djobcards
Inseecdons 14:
1. All plumbing to be completed and the system pressurized to 35 lbs. with water
or house pressure.
2. All metal within 5 feet of pool water, and all pool equipment, must be bomided
to pool reinforcing steel with #8 solid copper wka. Niche light shelf, deck Inserts,
etc. shall be bonded to pool rebar.
3. Pool equipment Is not required to be set at this time.
Inspectionse-1106
1. Underground electric Inspected prior to backfilfing.
2 ' Gas line test at ION for 15 minutes with 115# gauge.
3. When polyethylene gas piping Is used, a certificate from a cerfified Installer
ond tracer wire shall be provided per CPC 1210.1.7.2 APPENDIX 1.
Insoections 11-13:
1. Rough electric Inspection when all wiring is completed and ready prior to the
plastering of poollspa. Polling compound In place at plastic light niche.
2. Current Code requires that any pool, spa or water feature
contacting water 18 Inches or mom 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 APPDENDIX V specifying the height of
any fence provided as barrier to the pool &- shall be 60above grade on the
outside of the fence.
3. Doom from a garage shall meet the requirements for a gate. Glass
windows within Far pool water shall be tempered glass.
4. Prior to pre -plaster Inspection. streets, curbs and city sidewalks will be
Inspected for any damage due to construction of pool or spes.
5. Grading complete with positive drainage to street or public way. All
exposed plastic pipe shall be painted to protect from sunlight.
Inspections IL446:
1. Gas and Electrical completely removed and 2x2 holes at bottom of pool
and/or Isolated elements.
2. Pool backfilled:
A.) With future build - sellocompacting sand 95% with receipt
B.) No future build - any fill.
3. After pool Is operating and In working condition with approved pool cover on
eke.
Inspection requests made prior to 5:00 prin Monday - Friday
will be scheduled on the following workday.
To schedule your building Inspection online, please go to
https://aca.anahaim.noUC!tizenAccess
Inspection can normally be reached between
7:30 - 8:00 A.M.
(714)765.5153 + 0
To access your inspection tinnefrarne:
Please go to www.anahelm.net/building after 7:30arn an the day of your
Inspection. Under Online Services, dick an the link "Inspection
Timeftmes' or call (714) 765-6153 + 0