1038 S MATTHEW WAYCity of Anaheim
BUILDING DIVISION
INSPECTION RECORD
SWIMMING POOL
ADDRESS:
1038 S MATTHEW WAY, ANAHEIM, CA 92808
OWNER:
DOMINGUEZ ADAM 8 TAWNY
PERMIT 0:
SWI2022-00134
DATE ISSUED:
11/15/2022
DESCRIPTION:
New Swimming Pool/Spa: 398 sq. R. gunite pool with
NOT GUNITE ROCK STRUCTURE
ter feature, rock slide, fountain, waterfall, grotto etc.) tint) the above Inspection has
been signed.
49 sq. ft. spa.
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE ON THE JOB SITE
nspection Code Dat Inspector
rain 504
c Bonding r 506
508
val to Gunite 510
DO NOT GUNITE POOLISPA
until all the above Inspections have been signed.
FSWdures,Slides
teel and Electric bonding
ctures,Slides Etc)DO
NOT GUNITE ROCK STRUCTURE
ter feature, rock slide, fountain, waterfall, grotto etc.) tint) the above Inspection has
been signed.
round Electric
512
i-2!{ 23
d
7. Gas Piping Test
514
S. P -Trap Receptor
516
9. BackIlow
518
10. Deck, Deck Drains,
Equipotential & Accessory
ondino
520
3 II
DO NOT POUR FLATWORK
until all the above inspections have been signed.
11. Rough Electrical 522 101;1/1,3 g -
12. Fencing/DoorAlarms 524y3 (3p
13. Plaster approval 526 t}
DO NOT PLASTER
until all the above inspections have been signed.
14. Final Electric 528
Sub_ -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 %r%L3-
MISC. INSPECTIONS Date Inspector
fbld)obcards
Inswetions 1d:
1. All plumbing to be completed and the system pressurized to 35 lbs. with water
or house pressure.
2. All metal within 5 feet of pool water, and all pod equipment, must be bounded
to pod reinforcing steel with 08 sold 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 0.10:
1. Underground electric Inspected prior to boddilling.
2. Gas tine test at 100 for 15 minutes with 150 gauge.
3. When polyethylene gas piping is used, a certificate from a certified Installer
and tracer wire shag be provided per CPC 1210.1.72 APPENDIX I.
Inspections 11.13:
1. Rough electric inspection when all whing Is completed and ready prior to the
plastering of poWspa. Potting compound In place at plastic light niche.
2. Current Code requires that any pod, spa or water feature
contacting water 18 Inches or more in depth shall be enclosed by a bonier
adequate to prevent entry of small children. The barrier shell comply with
Section 3109 of current CBC and CRC APPDENDIX V specifying the height of
any fence provided as border to the pod 8- shall be 60- above grade on the
outside of the fence.
3. Does from a garage shag meet the requirements for a gate. Glass
windows within S of pool water shall be tempered glass.
4. Pdor to pra-plaster inspection, streets, curbs and city sidewalks will be
e
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 shall be pointed to protect from surdight
Insoactions 1440:
1. Gas and Electrical completely removed and 2x2 holes at bottom of pool
andfor Notated elements.
2. Pool backfilled:
A) With future build - self-compecting sand 95% with recelpt.
B.) No future build - any fill.
3. After pool Is operating and In working condition 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://ace.anaheim.neUCitizenAcress
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.anaheim.net/building after 7:30am on the day of your
Inspection. Under Online services, dick on the link 'Inspection
Timeframes- or call (714) 765.5153 + 0
CITY OF ANAHEIM
Permit Number: St kgM2-00134
Issued: 11/15/2022
www.anaheim.neUbuilding
(714)765-4626
Quarter Section: 215
Site Address: 1038 S MATTHEW WAY, ANAHEIM, CA 92808
Legal Description: N TR 12686 BLK LOT 34
APN:35657312
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765-5153
Project Description: New Swimming Pool/Spa: 398 sq. ft. gunite pool with 49 sq. ft. spa.
People Associated with Project:
Permit Applicant Hunter Ellison
Owner DOMINGUEZ ADAM & TAWNY 1038 S MATTHEW WAY
Engineer - Civil CHRISTOPHER J BIEDENBACH 1201 N TUSTIN AVE201107051050079050 ANAHEIM, CA 92807
OWNER - BUILDER DECLARATION
1 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 7000) of DMalon 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).
0 1, 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
0 1, 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 oursuent to the Contractor's State License Law).
I am exempt from licensure under the Contractors, State License Law for the following reason:
Date Signature of Property Owner or Authorized Agent
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for worker's 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.
❑ 1 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:
Cartier. Policy No.: Expiration Date:
1y e
fcoon need not be completed K the permit is for one hundred dollars (1700) or less.
certify that in the pertormance 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
era compensation laws of Celitomia, and agree that, if I should become subject to the worker's compensation provisions of Section 3700 of the
IV
forthwith comoN
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 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
I hereby certify that i have read this application and state that the information above is correct. I agree Professions Code.
to comply with all city ordinances and state laws relating building construction, and hereby authorize
represenWes of this city to enter upon the above mentio%d property for Inspection purposes.
vz
of Applicant or Agen
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.
Date: 11/15/2022
Contractor: ORANGE COUNTY POOLS INC
Number: SWI2022-00134 Expiration Date
TYPE: C53
Fee's paid for Permit: $1,113.75