1537 W. Palais Rd.
,
SWIMMING POOL PERMIT NO. SW12004-00087
TYPE OF PERMIT
New Pool and / or Spa
DATE:
JOB ADDRESS:
1537 W PALAIS RD
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200 S. ANAHEIM BLVD.
(714) 765 - 5153
INSPECTION REOUESTLlNE:
(714) 765,4626
QUARTER SECTION: 56
LEGAL DESCRIPTION: N TR 1979 lOT 57
APPLICANT: STEFFENIE ElUSON
OWNER INFORMATION:
William W Tangemann
1537 W Palais Rd
Anaheim, CA'92802
JOB DESCRIPTION New pool and spa (HI H) ,
VALUATION: 11,:l10.00
CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
SWAN POOLS OF SOUTHERN CAUFOR DAWN M PASOl
24512 BRIDGER RD 1201 N TUSTIN AVE
LAKE FOREST, 92630 0000 CA ANAHEIM. CA 92807
PROCESSED BY: CAL
OWNER.BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License aw or the following reason (Sec. 7031.5 BUSiness and
Professions Code: any city or county which requires a permit to construct, B'lter, 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
9Hcomrnencing with Section 7000 o,f Divisic:lrl 30f the Business and Profess,ions Code) or that he is exf.;!mpt therefrom and the basis for the alleged
exemption. Any" violation of S'ection 7031.5 by airy applic~nt for a permit subjects the applicant to a civil penalty of not more trian'five hundred dollars
($500).
o I, as,owner of property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for
sale (Sec. 7044 Business and Professions Code: The Contractor's License Law does not apply to an owner Of property who builds or improves
thereon)and who does sum work himself or herself or through hi's or her own employees, provided that such improvements are not intended or offered
for sale.} If, however, the building or improvement is sold with one year of completion, the owner-builder will have the burden of proving that he did not
build or Improve lor the purpose 01 sale).
o Uils the owner ofthe property, am exdusively contracting with licensed contractors to construct the project (Sec. 7044 Business and Professions
Code'{ The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with
~ontractor(s) licensed pursuant to the Contractor's License Law).
U I am exempt under Sec. , B & P .C. for this reason:
Date. Owner:
I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
o I have and will maintain a certiflcate of consent to self-insure for worker's compensation,
as provided for by Section 3700 of the Labor Code, for the performanoo of the work. for which
this perm~ Is Issued. .
o I have and will maintain worker's compensation insurance, as required by Section 3700 of
the Labor Code, for the performance of the work for which this permit ,is issued. My worker's
Compensation insurance carrier and policy are:
Carrier: STATE COMPENSATION FUND Policy Number 175795804
This section naed not be completedil! he permit is for one hund"'d dollars ($tOO) or less.
o I certify that in the perfonnanceofthe work for which this permit is issUed, I shall,not .
employ any person in any manner so as to become subject'to.the'wO'fK'e~compensation laws
of Califomia, and agree that if I should become subject totheworl<er's compensation
provisions of Section 3700 of the Labor Code, I shall forthwith c?mp!Y ,~Lt,h those provisions,
LICENSED CONTRACTORS DECLARATION I
I hereby affirm under penalty of perJury_ that I am
licensed under provisions of chapter 9 (commencing
with Section 7000) of Oivslon 3 of the Business and
Professions Code.
Dale: 51712004
Contractor
NUMBER:
BUS1998.043040
TYPE: C27
. TYPE: C53
TYPE: HIC
TYPE: BUS
EXPIRATION DATE:
3/31/2006
Date: 5/7/2004 Applicant:
WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS
UNLAWFUL, AND SHAll SUBJECT AN EMPlOYER TO CRIMINAL PENALTIES AND CIVil
FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDrnON 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
J hereby affirm under penalty of perjury that there is a construction lending agency for the
performance of the work for whim this permit is issued (Sec. 3097 .Civ,C):
Lender's Information:
:
Swimminq Pool Size
Valuation
Census Code
573.00
17,310.00
329
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 representlves of this dty to enter upon the above mentioned property for
inspection purposes.
Fees paid for Permit:
Total:
1,73
Date: 5/7/2004
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.