915 N HOLLY STPermit Number: SW1202340006
Issued: 01/31/2023
www.anaheim.neUbuilding
(714)765-4626
Quarter Section: 38
Site Address: 915 N HOLLY ST, ANAHEIM, CA 92801
Ltig®I Description: N TR 1802 BLK LOT 28
APW 07247604
CITY OF ANAHEIM
BUILDING DIVISION
266-S. ANAHEIM BLVD.
(714) 765 - 5153
Project Description: Demolition: 450 sq ft to demolish pool with shell to remain with 3 3x3 holes
People Associated with Project:
Permit Applicant Chung Pham
Owner
NGUYEN HONG ANH
11001 SONGISH ST
OWNER - BUILDER DECLARATION
I hereby affirm under penalty of penury that I am exempt from the Contractors License State Law for the following reason(s) Indicated below by the
checkmark(s) I have placed next to the applicable Item(s) (See. 7031.5 Business and Professions Code: any city or county which requires a permit to
construct, after, 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
applicant 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 (_, all or U 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 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
13 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 oursuant to the Contractors State License Law).
1 am exempt from licensure under the Contractors,,State License Law for the following reason:
of Properly Ow &VAuthorized Agent
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 workers 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.
❑ I have and will maintain workers 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 carder and policy are:
Carrier: Policy No.: Expiration Date:
This section need not be completed Ifthe permit Is for one hundred dollars ($100) or less.
❑ 1 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 1 should become subject to the workers 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 I LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance I hereby affirm under penalty of perjury that I am
Lenders Information: licensed under provisions of chapter 9 (commencing with
Section 7000) of Division 3 of the Business and
1 hereby certify that I have read this application and state that the Information above is correct. l agree Professions Code.
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: 01/31/2023
Contractor:
Date Signature of Applicant or Agen r
The premit shall expire by limitation and become null and 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.
Number: SW12023.00006
TYPE:
Expiration Date
Fees paid for Permit: $171.00
City of Anaheim
BUILDING DIVISION
INSPECTION RECORD
do SWIMMING POOL
ADDRESS:
915 N HOLLY ST, ANAHEIM, CA 92801
OWNER:
NGUYEN HONG ANH
PERMIT #:
SWI2023-00006
DATEISSUED:
01/3112023
DESCRIPTION:
Demolition: 450 sq ft to demolish pool with shell to
DO NOT GUNITE ROCK STRUCTURE
(water feature, rock slide, fountain, waterfall, grotto etc.) until Me above Inspection has
been signed.
remain with 3 3x3 holes
POST THIS CARD WH THE APPROVED PLANS
IN A CONSPICUOUS PLACE ON THE JOB SITE
ns'
Inspection Code Date Inspector
Main D 'ai n
1. Main Drain 504
Elle
2 c 0 nd
- cB im
2. Electric Bonding 506
Ftn
3. Steel 508
Ij
4. Appmval to Gunite 510
DO NOT GUNITE POOLISPA
until all the above Inspections have been signed.
5. BLD -Steel and Electric bonding
(Rock Structures,Slides Etc)
1 508
DO NOT GUNITE ROCK STRUCTURE
(water feature, rock slide, fountain, waterfall, grotto etc.) until Me above Inspection has
been signed.
6. Underground Electric
512
7. Gas Piping Test
514
8. P -Trap Receptor
516
9. Bacidlow,
518
10. Deck, Deck Drains,
Equipotential & Accessory
Bondina
520
DO NOT POUR FLATWORK
until all the above inspections have been signed.
11. Rough Electrical 522
12. Fencing/Door Alarms 524
13. Plaster approval 526
DO NOT PLASTER
until all the above inspections have been signed.
I
14. Final Electric 1 528 1 1 .
Sub-Contractom List MUST be approved and pool cover on site
PRIOR to Pool Final Inspection request
FINAL INSPECTION CODE DATE INS ECTOR
15. Rough Demo 527
1 S/5"! n a* 1) 599999 L,6z3 t+�
MI$C AASPECTIONS Date Insfibcit If
fbIdjobcards
-jW., I
Inspections 1-5:
1. AJI plumbing to be completed and the system pressurtood to 35 lbs. with water
or house pressure.
2. All metal within 5 feet of poorwater, and all pool equipment, must be bonnded
to pool reinforcing steel with #8 solid copper wire. Niche light shell, deck Inserts,
etc. shall be banded to pool rebar.
3. Pool equipment Is not required to be set at this time.
Inspection$ 6,10:
1. Underground electric Inspected prior to baddilling.
2. Gas the test at ION for 15 minutes with 150 gouge.
3. When polyethylene gas piping Is used, a certhicate from a certified Installer
and tracer wire shall be provided per CPC 1210.1.7.2 APPENDIX 1.
Inspections 1111-113m
1. Rough electric Inspection when all wiring is Completed and ready prior to the
plastering of pool/spa. Patting compound in place at plastic light niche.
2. Current Code requires that any pool, spa or water feature
contacting water 18 Inches or more in depth shall be enclosed by a border
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 pool &- shag be 6V above grade on the
outside of the fence.
3. Doom from a garage shall meet the requirements for a gets. Glass
windows within V of pool water shall be tampered glass.
4. Prior to pro -plaster Inspection, strasts, 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. AJI
exposed plastic pipe shall be painted to protect from sunlight.
inspection$ %16@
1. Gas and Electrical completely removed and W holes at bottom of pool
and/or Isolated elements.
2. Pool backfiled:
A.) Nth future build - self-compecting send 95% with recelpt.
8.) No future build - any 11.
3. After pool Is operating and In working condftlon with approved pool cover on
site.
INSPECTION REQUESTS
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
https://aca.anaheim.net/CifizenAccess
Inspection can normally be reached between
7:30 - 8:00 A.M.
(714)765-5153 + 0
To access your Inspection timeframe:
Please go to www.anahalm.net/building after 7:30arn on the day of your
Inspection. Under Online services, dick an the link 'Inspeclon
Timetrames" or call (714) 765-5153 + 0
Permit Number: 8MM340006
Issued: 01/31/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 38
ID -14i k fK01 ; F_\ `1_\:141 i,
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 915 N HOLLY ST. ANAHEIM, CA 92801.
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
iOwner -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. l 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.
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.
i 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.
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.
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.
=v 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.
10. 1 am aware of and consent to an Owner -Builder building permit applied for in m name, and understand that I am the
-�i 9 P PP � Y
+ party legally and financially responsible for proposed construction activity at the following address: 915 N HOLLY ST.
Permit Number: SW1202340006
Issued: 01/31/2023
www.anaheim.net/building
(714)765-4626
Quarter Section: 38
Permit Number: SW12023-00006
CITY OF ANAHEIM
BUILDING DIVISION
300 S. ANAHEIM BLVD.
(714) 765 - 5153
11.1 agree that, as the party Legally and financially responsible fol this proposed construction activity, I will abide by all
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
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.
f—Property wnees Signatur Date: j