132 W WILKEN WAYPermit Number: SW12021-00157
Issued: 12/30/2021
www.anaheim.net/building
(714)765-4626
Quarter Section: 89
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765- 5153
SlteAddress: •132.W. WILKEN WAY, ANAHEIM, CA 92802
r'.....yr.r ..
L6ia1,Description: N�TR 1965 8LK.LOT 67
APN: 23310404
Project Description: Demolition: Pool 540, demo entire pool.
People Associated with Project:
Permit Applicant Rafael Salgado
Owner
SALGADO RAFAEL
132 W WILKEN WAY
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, atter, 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
apWlicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
I, as owner of property, or my employees with wages as their sole compensation, will do (—i 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
0 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 pursuant to the Contractor's State License Law).
I am exempt from licensure under the Contractors, State License La
r forme f911ovp rypson:
or AuthoWAd Agent
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 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.
❑ 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 worker's Compensation insurance carrier and policy are:
Carrier: Policy No.: Expiration Date:
This section need not be completed If the permit Is for one hundred dollars ($100) 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 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 11 LICENSED GONTKAGTUKb utt:ULAKA 1 wN I
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance
Lender's 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 Applicant or Agen C/
The premit shall expire by limitstion and be me null end 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: 12/30/2021
Contractor:
Number: SWI2021-00157
TYPE:
Expiration Date
Fees paid for Permit: $172.00
City of Anaheim
BUILDING DIVISION
INSPECTION RECORD
4) SWIMMING POOL
ADDRESS:
132 W WILKEN WAY, ANAHEIM, CA 92802
OWNER:
SALGADO RAFAEL
PERMIT #:
SWI2021-00157
DATE ISSUED:
12/30/2021
DESCRIPTION:
Demolition: Pool 540, demo entire pool.
I
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE ON THE JOB SITE
nspection Code Date Inspector
504
ding 506
508
FBLD-Steel
Gunite 510
DO NOT GUNITE POOLISPA
until all the above Inspections have been signed.
nd 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
FINAL INSPECTION CODE DATE INSPECTOR
15. Rough Demo 527
k-;FIna1--) 99. INSPECTIONS Dat Inspe or
ibldjobcards
tnaaections 15:
1. All plumbing to be completed and the system pressurized to 35 lbs. vlkrwater „T
or house pressure.
2. All metal within 5 feet of pool water, and all pool equipment, must be bounded
to pool reinforcing steel with #8 solid copper wire. Niche light shell, deck Inserts,
etc. shag be bonded to pod rebar.
3. Pod equipment is not required to be set at this time.
Inepedlope 1140:
1. Underground electric inspected prior to backfilling.
2. Gas Ilse test at 109 for 15 minutes with 159 gauge.
3. When polyethylene gas piping Is used, a certificate from a certified Installer
and tracer wire shell 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 pod/spe. Potting compound in place at plastic light niche.
2. Current Code requires that any pod, spa or water feature
conteding 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 APPDENDIX V specifying the height of
any fence provided as barrier to the pod 8- 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 F 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 shall be painted to protect from sunlight.
Inspections 1416:
1. Gas and Electrical completely removed and 2x2 holes at bottom of pool
and/or Isolated elements.
2. Pool backfilled:
A.) With future build - self -compacting send 95% with receipt.
B.) No future build - any fill.
3. After pool is operating and in working condition with approved pool cover on
site.
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
https9/aca.anaheim.neVCifizenAccess
Inspection can normally be reached between
7:30 - 8:00 A.M.
(7141765.5153 + 0
To access Your inspection timeframe:
Please go to www.anahelm.net/bulkling after 7:30am on the day of your
Inspection. Under Online Services, dick on the link *Inspection
Timeframes' or call (714) 7655153 + 0
Permit Number: SWI2021-00157
Issued: 12/30/2021
www.anaheim.net/building
(714)765-4626
Quarter Section: 89
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765-5153
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 132 W WILKEN WAY. ANAHEIM, CA 92802.
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.
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 working as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to
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.
�S 3. 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 risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.
C 4.1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
J 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.
V3 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.
%ZC 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
7 `j or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials.
�s 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
1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
S10.1 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: 132 W WILKEN WAY.
Permit Number: SW12021-00157
Issued: 12/30/2021
www.anaheim.net/building
(714)765-4626
Quarter Section: 89
CITY OF ANAHEIM
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 - 5153
Permit Number: SW12021-00157
11.1 agree that, as the party Legally and financially responsible for this proposed construction activity, I will abide by all.
1429 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
i someone who does not have a license, the Contractors' State License Board may be unable to assist you with any
1'.. 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 drivers license, form notarization, or other verification acceptable to the agency is required
to be presented when the p rmit is 'ss d to verify the property owner's signature.
Prope rs SiV a re Date:
• i