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: