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521 S REVERE ST (2)Permit Number: SW12022-00129 Issued: 11/03/2022 wWw.anaheim.net/building (714)765-4626 Quarter Section: 103 Site Address: 521 S REVERE ST, ANAHEIM, CA 92805 Legal Description: N TR 1697 BLK LOT 95 APN: 08236516 Project Description: Electrical for (1) dedicated spa outlet People Associated with Project: Owner Guillermo Gonzalez GONZALEZ GUILLERMO CITY OF ANAHEIM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 765 - 5153 521 S REVERE ST OWNER - BUILDER DECLARATION I 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 70001 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 epplicant 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 (_I all or ( ) portions of the work, and the structure is not intended or offered for sale (Sec. 70" Business and Professions Code: The Contractors' Stale 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 ❑ 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 Dursuant to the Contractors State License Law). I am exempt from licens re under the heft . State License for the ng reason: Date I hereby affirm under penalty of perjury one of the following declarations. ❑ I have and will maintain a certificate of consent to sale -insure for worker's compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Cotle, 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, for the performance of the work for which this permit is issued. My workers Compensation insurance tamer and policy are: Cartier: Policy No.: Expiration Date: This section need not be completed it the permit Is for one hundred dollars (f100) 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, g I should become subject to the workers compensation provisions of Section 3700 of the Labor Code. 1 shall forthwith comply with those Dmvisions. 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 ATTORNEYS FEES. CONSTRUCTION LENDING 1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance Lenders Information: I hereby certify that I have read this application and state that the information above is cored. 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. Dale Signature of Applicant or Agen The premit shall expire by limitation and become null and void d 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: 11/032022 Contractor: Number: SW12022-00129 Expiration Date TYPE: Fees paid for Pernik: $171.00 City of Anaheim BUILDING DIVISION INSPECTION RECORD SWIMMING POOL ADDRESS: 521 S REVERE ST, ANAHEIM, CA 02805 OWNER: GONZALEZ GUILLERMO PERMIT#: SW12022-00129 DATE ISSUED: 11/03/2022 DESCRIPTION: Electrical for (1) dedicated spa outlet POST THIS CARD WITH THE APPROVED PLANS IN A CONSPICUOUS PLACE ON THE JOB SITE Inspection Code Date Inspector 1. Main Drain 504 2. Electric Bonding 506 3. Steel 508 4. Approval to Gunite 510 DO NOT GUNITE POOLISPA until all the above inspections have been signed. 5. BLD-Steel and Electric bonding (Rock Structures,Slides Elc) 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. Back00W 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 528 Stub -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 MISC. INSPECTIONS Date Inspector Imeactlona 1.5: 1. All plumbing to be completed and the system pressurized to 35 IN with water or house pa... 2. NI metal within 5 feet of pool water, and all pool equipment, must be bounded to pod reinforcing steel with tt6 solid copper wire. Nutria light shell, deck Inserts, etc. shall be bonded to pool rebar. 3. Pool equipment is not required to be sat at this lime. Insductlons 6-10: 1. Underground electric Inspected prior to backMing. 2. Gas 11. lest el 100 for 15 minutes with 150 gauge. 3. When polyethylene gas p Wig Is usa4 a cer06csta from a canihed added., and tracer wire shall be proyided par CPC 1210.122 APPENDIX I. Imos,Mm, 11-13: 1. Rough electric inspection when all wiring a completed and ready prior to the plastering of pooaspe. Potting compound in place at plastic light niche. 2. current Code requires Met any pout spa or water feature contracting water 18 Wiftes or more In depth shall be enclosed by a barrier adequate to prevent entry of small children. The bamer shall comply with Section 310 of current CBC and CRC APPDENDIX V specifying Me height of any to. provided as barrier to the pod 6- shell be 60- shove goods on the outaMe of the fence. 3. Doms from a garage shall meet the requirements for a gate. Glass windows within 5' of pool water shall be tampered glass. 4. Prior to pre -plaster inspection, streets, curbs and city sidewalks will he inspected for any damage due to construction of pool or spas. 5. Grading complete arm positive drainage to asset or public way. All exposed plastic pipe shall be painted to protect from sunlight. Insaadiona 14.16, 1. Gas and Electrical completely removed and 2x2 fides at bottom of pool scalar isolated elements. 2. Pool backfilled: A With future build - sett-tompacting sand 95% wind receipt. B ) No future build - any fill. 3. After pool Is operating and In workkg condition wind approw cl pool cover on she. PERMIT rXPI-RED I N S" T ION `NIOT C,C-`,)! ETED DATE- INSPECTION REQUESTS Inspection requests made prior to 5:00 pm Monday - Friday will be scheduled on the following workday. To schedule your building inspection dismiss. please go to , nel/CrizenAccess Inspection can normally be reached between 7:30 -8:00 A.M. (7141765-5153 e 0 To access Your inspection tlmeframe: Please go M www.anahem. ne 1building after 7:30am on the day of your Inspection. Under Calko Services, dick on the link "Inspection Tlmefeemes- or call (714) 7654163 e 0 Ibltllobcards Permit Number: SW12022.00129 Issued: 11/03/2022 wwwanaheim.net/building (714)765-4626 Quarter Section: 103 Dear Property Owner: CITY OF ANAHEIM BUILDING DIVISION 200 S. ANAHEIM BLVD. (714) 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 521 S REVERE ST. ANAHEIM, CA 92805. 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 46 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. 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. �.� 4. 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. �(2 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. L7(� 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. (f 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. 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.cslb.ca.gov for more information about licensed contractors. N 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: 521 S REVERE ST, CITY OF ANAHEIM BUILDING DIVISION Permit Number: SW12022-00129 200 S. ANAHEIM BLVD. Issued: 11/03/2022 1714) 765 - 5153 www,anaheim.net/building (714)7654626 Quarter Section: 103 Permit Number: SW12022-00129 r 11. 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. 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 owner's signature. 1 ,t� �1 r XiL 11 e3 15�v Property Owner's Sign Date: