531 N HAMPTON STSWIMMING POOL PERMIT NO. SW12021-00024 200 S. ANAHEIM BLVD.
(714) 765 - 5153
TYPE OF PERMIT
Repair or Alteration of Existing
DATE: 2/2312021
JOB ADDRESS: 531 N HAMPTON ST
LEGAL DESCRIPTION: N TR 2451 LOT 5
PERMIT APPLICANT:
CITY OF ANAHEIM INSPECTION REQUEST LINE:
(714) 765 - 4626
QUARTER SECTION: 26
OWNER INFORMATION:
CONTRACTOR INFORMATION:
ARCHITECT/ENGINEER INFORMATION:
MICHAEL RODRIGUEZ
BRIANS POOL PLASTERING
CHRISTOPHE J BIEDENBACH
531 N HAMPTON ST
701 S ESPLANADE
1201 N TUSTIN AVE
ANAHEIM, CA 92801-5006
ORANGE, 92869 CA
ANAHEIM, CA 92807
JOB DESCRIPTION: Repair or Alteration of Existing: Install new skimmer and split drain. New LED light and GFI.
VALUATION:
PROCESSED BY: MCE
i nereay ""I'm unoor penny or perjury mat i am exempt rom me Lontrectors License law, ror me Tonowmg reason (sec. ruJl.b uuslness ana Yrotessions uoae: any city
county which requires a permit to construct, after, 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 Profe
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 (S500).
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. If, 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 Contractors
License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law).
❑ I am exempt under Sec. , B & P.C. for this reason:
Date: Owner:
I WORKER'S COMPENSATION DECLARATION I
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, as provided for
by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
kI have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code,
the performance of the work for which this permit is issued. My workers Compensation insurance carrier
a policy are:
Carrier. STATE FUND
Policy Number: 9127932
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 workers compensation laws of California, and agree that if I should
become subject to the workers compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions. -I �' , /
Date: 2/23/2021 Applicant: / CO- v ' /
WARNING: FAILURE TO SECURE WORKER'S MPENSATION 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 ATTORNEYS FEES.
I CONSTRUCTION LENDING AGENCY 11
1 hereby affirm under penalty of perjury that there is a construction lending
work for which this permit is Issued (Sec.3097.Civ.C):
Lenders 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 reprewntives of this
city to enter upon the above mentioned property for inspection purposes.
6 /Z Jw�O' I`— Date: 2/23/2021
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.
LICENSED CONTRACTORS DECLARATION
under provisions of chapter 9 (commencing with Section 7000)
of Divsion 3 of the Business and Professions Code.
Date: 2/23/2021 Contractor.
NUMBER: EXPIRATION DATE:
BUS2007-04480 2/23/2022
TYPE: C53
TYPE: BUS
Swimming Pool Size
500.00
IT EXPIRE1Y00.00
434
NSPECTION
OT COMPLETED
Ai P-- 7_�Z5&z
Pees pa r elf'
Total:
884.00