964 S MATTHEW WAY (6)City of Anaheim
BUILDING DIVISION
INSPECTION RECORD
SWIMMING POOL
ADDRESS: 964 S MATTHEW WAY
OWNER:
PERMIT #: SW12021-00090
DATE ISSUED: 7/15/2021
DESCRIPTION: New Pool/Spa: 651 sq It new gunite pool and 50 sq ft gunite
spa. Plumbing and Electrical for new fire pit and barbeque.
POST THIS CARD WITH THE APPROVED PLANS IN A
CONSPICUOUS PLACE ON THE JOB SITE
Inspection Code Date Inspector
1. Main Outlet. 504
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2. Electric Bonding. 506
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3. Steel. 508
4. Approval to Gunite. 510
DO NOT GUNITE POOL/SPA
until all the above inspections have been signed.
5. Steel and bonding. 1 508
DO NOT GUNITE ROCK STRUCTURE
(water feature, rock slide, fountain, waterfall, grotto
etc.) until all the above inspections have been signed.
6. Underground elect.
512
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7. Gas piping test.
514
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8. P -Trap Receptor.
516
9. Backflow Device.
518
10. Deck, Deck
Drains, & accessory
bonding.
520
511/ �22
DO NOT POUR FLATWORK
until the above inspections have been signed.
11. Rough electric. 522
12. Fencing. 524
13. Plaster approval. 526
DO NOT PLASTER
until the above ins ections have been si ned
14. Final Electric. 1 528 1
1
Sub -Contractors list approved and
pool cover in place prior to final inspection.
15. FINAL
599
MISC. INSPECTIONS
DATE INSPECTOR
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, 2
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-
Inspectors can normally be reached between
7:30 - 8:00 A.M. and 3:30 - 4:30 P.M.
(714) 765-5153 + 0
swimcard
Inspections 1 - 5:
1. All plumbing to be complete and the system
pressurized to 35 lbs. with water or house pressure.
2. All metal within 5 feet of pool water, and all pool
equipment, must be bonded to pool reinforcing steel
with #8 solid copper wire. Niche light shell, deck
inserts, etc., shall be bonded to pool rebar.
3. Pool equipment is not required to be set at this time.
Inspections 6 -10:
1. Underground electric inspected prior to backfilling.
2. Gas line test at 10# for 15 minutes, with 15# gauge.
3. When polyethylene gas piping is used, a certificate
from a certified installer and a metal tag at the meter
shall be provided per CPC 1211.3 APPENDIX I.
Inspections 11 -13:
1. Rough electric inspection when all wiring is
completed and ready to run prior to the plastering
of pool/spa.
2. City ordinance 6.56.010 requires that any pool, spa
or water feature containing water 18 inches or more
in depth shall be enclosed by a barrier adequate to
prevent entry of small children. The barrier shall
comply with Section 421 of the current CBC and City
of Anaheim ordinance 15.02.060.180 specifying the
height of any fence provided as barrier to the pool
shall be 60" above grade on the outside of the fence.
3. Doors from a garage shall meet the requirements
for a gate. Glass windows within 5' of pool water
shall be tempered glass.
4. Prior to pre -plaster inspection, streets, 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. All exposed plastic pipe painted to
protect from sunlight.
Inspections 14 -15:
1. After pool is operating and in working condition,
approved pool cover in place.
INSPECTION REQUESTS
Inspection requests made before 5:00 pm will be scheduled
on the following workday.
To schedule your building inspection online, please go to
hfp://www.anaheim.neVinspectionReciuest.
You may also request your inspection by calling (714) 765-4626 and
continue with the following steps:
• Press 1 for inspection function.
• Press 1 to schedule inspection.
• Press 5 for Swimming Pool inspection.
• Enter your permit # 202100090.
• Enter the Code number for the inspection requested
(indicated in blue).
• Press 1 for next business day, or enter date preferred.
• Select time preference (Request is subject to
inspector's schedule.)
To access your inspection timeframe, please go to
www.anaheim.net/buildina after 7:30 am on the day of your
inspection. Under Online Services, click on the
"Inspection Timeframes" link or call (714) 765-5153 + 0.
BUILDING DIV151ON
SWIMMING POOL PERMIT NO. SW12021-00090 -i�R1 • 200 S. ANAHEIM BLVD.
. *!;
see (714) 765 -5153
TYPE OF PERMIT
New Pool and / or Spa
DATE: 7/15/2021
JOB ADDRESS: 964 S MATTHEW WAY
LEGAL DESCRIPTION: N TR 12686 LOT 41
PERMIT APPLICANT: RUDY LOPEZ
OWNER INFORMATION:
RAQUELLGOMEZ
964 S MATTHEW WAY
ANAHEIM, CA 92808-1460
,'i'
CITY.FANbHEIM INSPECTION REQUEST LINE:
(714) 765 - 4626
..
OQUARTER SECTION: 215
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CONTRACTOR INFORMATION: ARCHITECT/ENGINEER INFORMATION:
PALAZZO POOLS
3312 HAMNER AVE
NORCO, 92860 0000 CA
JOB DESCRIPTION: New Pool/Spa: 651 sq ft new gunite pool and 50 sq ft gunite spa. Plumbing and Electrical for new fire pit and barbeque.
VALUATION: 80,000.00 PROCESSED BY: AEG
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason (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 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 Professions
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 ($500).
❑ 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. lf, 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 Contractor's
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).
❑ 1 am exempt under Sec. B & P.C. for this reason:
Date: Owner:
WORKER'S COMPENSATION DECLARATION LICENSED CONTRACTORS DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: I I hereby affirm under penalty of perjury that I am licensed
❑ 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.
I have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code,
or the performance of the work for which this permit is issued. My worker's Compensation insurance carrier
and policy are:
Carrier. STATE COMP INSURANCE FUND Policy Number. 9249854
This section need not be completed if t he 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 it
any manner so as to become subject to the worker's compensation laws of Califomia, and agree that if I should
become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 7/15/2021 Applicant:
WARNING: FAILURE TO SECURE WORkER9COMPENSATION 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 ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec.3097.Civ.C):
Lender's 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 representives of this
city to enter upon the above, mentioned property for inspection purposes.
Date: 7/15/2021
Signet of Applicant or Agent
The permit shaliteoffire 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.
under provisions of chapter 9 (commencing with Section 7000)
of Divsion 3 of the Business and Professions Code.
Date: 7/15/2021
NUMBER:
BUS2021-01499
TYPE: C53
TYPE: BUS
Contractor:
EXPIRATION DATE:
6/1512022
Swimming Pool Size 701.00
Valuation 80,000.00
Census Code 329
Fees paid for Permit:
Total:
1,443.95
1.
CITY OF ANAHEIM
PLANNING DEPARTMENT
BUILDING DIVISION
RECEIVED
APR 14 2021
CITY OF ANAHEIM
PLANNING & BUILDING DEPARTMENT
AUTHORIZATION OF AGENT TO ACT ON BEHALF OF PROPERTY OWNER FORM
*Per California State Law, if you, the property owner, will be coming to our office to get a permit, we do not
require you to complete this form, however, if you are sending someone on your behalf (your agent), please
complete and sign the information below.
Also make sure that you have provided your agent with a signed Owner -Builder Acknowledgment and
Information Verification Form.
Scope of Construction Project (or Description of Work):
Gar4d Gi Pow�l.
Project Location or Address:
10 N (Lose. Sir . WI41-Mi lux . fiA 1%40s-,
Name of Authorized Agent: �b
RoMirer L,* ,,�^ 1 An
Address of Author',tZr� q2ftr
Phone Number of Authorized Agent:
f ,-7.2-/ r --
Required Forms of Identification Attached: (Please check one of the forms of identification below in addition
to the required California State Issued ID)
Property Owner's California State Issued ID with:
Property Deed Property Tax Bill Closed escrow document
Title Search Mortgage Bill
I declare under penalty of perjury that I am the property owner for the
personally filled out the above information and cuts accuracy.
Property Owner's Sig
Office Use Only:
ID Verified j .E
Ownership Verified
Documents /NCE
Planning Info Mee-
Permit
GE
Permit # S&W20A0 —401 "--S
listed above and I
200 S. Anaheim Blvd., Suite 145 Anaheim, Callomia 92805 (714)765-5153 Phone (714)765-4607 Fax OCT 2013
www.anaheim.netlbuilding 8720
RECEIVED
CITY OF ANAHEIM APR 14 2021
PLANNING DEPARTMENT
BUILDING DIVISION CITY OF ANAHEIM
PLANNING & BUILDING DEPARTMENT
OWNER -BUILDER ACKNOWLEDGMENT AND INFORMATION VERIFICATION FORM
"Per California State Law, if you, the property owner, will be coming to our office to get a permit, we will provide
you with this form when you arrive. If you are sending your agent, please complete, initial, and sign the
information below. Also make sure that you have provided your agent with a signed Authorization to Act on
Behalf of the Property Owner Form with the required forms of identification.
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 j 10 Q IZd 56 0! & Alk HE i M1 Oft 7 7,, -ft
We are providing you with an Owner -Builder Acknowledgment 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.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIR CTIONS: Read and initial each statement below to signify you understand or verify this
info mation.
�1. I 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 acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to
wo kers on my property.
2.1 understand building permits are not required to be signed by property owners unless they are
re ponsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
V3.1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I
u 'derstand that I may protect myself from potential financial risk by hiring a licensed Contractor and
h ving 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
teir li ense 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
I bor' nd materials, I may be considered an "employer' under state and federal law.
6. I understand if I am considered an "employer' under state and federal law, I must register with
MARCH 2009
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax B721
'. ?
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the state and federal government, withhold payroll taxes, provide workers' compensation disability +
insurance, and contribute to unemployment compensation for each "employee." I also understand my
fa' u/re to abide by these laws may subject me to serious financial risk.
V 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
+� uilding Contractor.
X `� 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
ny atent 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
c" ntact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or
.cslb.ca.gov for more information about licensed contractors.
L/ 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
tpe following _ _ _ _ _ _ -*�
a 11.1 agree that, as the party legally and financially responsible for this proposed construction
ac ivity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as
erpployers.
V1 2. 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 financial loss 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.
Property Owner's Signature: Date:I OF
L
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200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax B721