110 N ROSE STPOOL PERMIT NO.
TYPE OF PERMIT
New Pool and / or Spa
SW12020-00123
DATE: 4/14/2021
JOB ADDRESS: 110 N ROSE ST
LEGAL DESCRIPTION:
PERMIT APPLICANT: HOANG DAO
OWNER INFORMATION:
DAVID NGUYEN
26546 CRAFTSMEN CT
SANTA CLARITA, CA 91350
CI
200 S. ANAHEIM BLVD.
(714) 765 - 5153
E I M INSPECTION REQUEST LINE:
(714) 765 - 4626
QUARTER SECTION: 93
CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
VINH H DAO .
13191 DEAN ST
TUSTIN, CA 92780
JOB DESCRIPTION: New Pool and / or Spa: Construct new koi pond of varying depth, 2448 inch deep. New 8 ft high water fall and new 8 ft high biofall.
VALUATION: 20,000.00 PROCESSED BY: MCE
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors 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).
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).
❑ I asi oxempt under Sec.
Date: qll ql t)_ % Owner:
WORKER'S COMPENSATION DECLARA
I hereby affirm under penalty of perjury one of the following declarations: V
❑ 1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I 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:
LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed
under provisions of chapter 9 (commencing with Section 7000)
of Divsion 3 of the Business and Professions Code.
Date: 4/14/2021 Contractor:
NUMBER: • EXPIRATION DATE:
This section need not be completed If t he permit is for one hundred dollars ($100) or less. TYPE:
❑ 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
comply with those provisions.
Date: 4/14/2021 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION 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
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: 4/14/2021
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.
Swimming Pool Size 700.00
Valuation 20,000.00
Census Code 329
Fees paid orPermit:
Total:
1,587.30
City of Anaheim
WELDING DIVISION
- } INSPECTION RECORD
SWINMNG POOL
ADDRESS: 110 N ROSE ST
OWNER: DAVID NGUYEN
PERMIT #: SW12020-00123
DATE ISSUED: 4/14/2021
DESCRIPTION: New Pool and / or Spa: Construct new koi pond of varying
depth, 2448 inch deep. New 8 ft high water fall and new 8 ft
-reerri � ignt2'lofftll� rrrs i se�i�s i�iare-arr�-
CONSPICUOUS PLACE ON THE JOB SITE
Inspection Code Date Inspector
1. Main Outlet. 504 tZl
2. Electric Bonding. 506
3. Steel. 508
4. Approval to Gunite. OgA5
DO NOT GUNITE POOL/SPA
until all the above inspections have been signed.
5. Steel and bonding. 1 508 ;"-f r
DO NOT GUNITE ROCK STRUCTURE
(water feature, rock slide, fountain, waterfall, grotto
etc.) until all the above inspections have been igned.
6. Underground elect.
512
7. Gas piping test.
514
8. P -Trap Receptor.
516 AY
It,
9. Backflow Device.
518 '
10. Deck, Deck
Drains, & accessory
bonding.
520
7
DO NOT POUR FLATWORK
until the above inspections have been signed.
11. Rough electric. 522 - , h 1 WAkA
12. Fencing. 524
13. Plaster approval. 526
DO NOT PLASTER
until the above ins ections have been si ned.
14. Final Electric.
1 528 -� -
Sub -Contractors list approved and
pool cover in place prior to final inspection.
15. FINAL
1 599 4 -
F
SC.INSPECTIONS DATE INSPECTOR
Inspectors can normally be reached between
7:30 - 8:00 A.M. and 3:30 - 4:30 P.M.
(714) 765-5153 + 0
swimcard
Inspections 1 - 5: AW
1. All plumbing to be complete 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 bonded to pool reinforcing steel
with #8 solid copper wire. Niche light shell, deck
inserts, etc., shall be bonded to pool rebar.
3. Pool equipment is not required to be set at this time.
Inspections 6 -10:
1. Underground electric inspected prior to backfilling.
2. Gas line test at 10# for 15 minutes, with 15# gauge.
3. When polyethylene gas piping is used, a certificate
from a certified installer and a metal tag at the meter
shall be provided per CPC 1211.3 APPENDIX I.
Inspections 11 -13:
1. Rough electric inspection when all wiring is
completed and ready to run prior to the plastering
of pool/spa.
2. City ordinance 6.56.010 requires that any pool, spa
or water feature containing 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 421 of the current CBC and City
of Anaheim ordinance 15.02.060.180 specifying the
height of any fence provided as barrier to the pool
shall be 60" above grade on the outside of the fence.
3. Doors from a garage shall meet the requirements
for a gate. Glass windows within 5' of 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 spas.
5. Grading complete with positive drainage to street or
public way. All exposed plastic pipe painted to
protect from sunlight.
Inspections 14 -15:
1. After pool is operating and in working condition,
approved pool cover in place.
INSPECTION REQUESTS
Inspection requests made before 5:00 pm will be scheduled
on the following workday.
To schedule your building inspection online, please go to
htti)://www.anaheim-neVinspectionReauest
You may also request your inspection by calling (714) 765.4626 and
continue with the following steps:
• Press 1 for inspection function.
• Press 1 to schedule inspection.
• Press 5 for Swimming Pool inspection.
• Enter your permit # 202000123.
• Enter the Code number for the inspection requested
(indicated in blue).
• Press 1 for next business day, or enter date preferred.
• Select time preference (Request is subject to
inspector's schedule.)
To access your inspection timeframe, please go to
www.anaheim.net/buildina after 7:30 am on the day of your
inspection. Under Online Services, click on the
"Inspection Timeframes" link or call (714) 765-5153 + 0.