1645 W PALAIS RDPermit Number: SWI2022-00140
Issued: 11/29/2022
www.anaheim.neUbuilding
(714)765.4626
Quarter Section: 56
Site Address: 1645 W PALAIS RD, ANAHEIM, CA 92802
Legal Description: N TR 3840 BLK LOT 10
APN:12920211
CITY OF ANAHEIM
BUILDING DMSION
200 S. ANAHEIM BLVD.
(714) 76S - S1S3
Project Description: Demolition: 450 sq ft pool with shell to remain and (3) 34 holes.
People Associated with Project:
Permit Applicant Donny Tran
Owner
NGUYEN JENNY PHAN
1645 W PALAIS RD
OWNER - BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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) (Sec. 7031.S 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 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).
0 I, as owner of property, or my employees with wages as their sole compensation, will do U 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
6I, 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 Contractor's State License law).
I am exempt from lij ensure under the Contractors, State License Law for the fplowing reason:
Date 1, Signature of Property Owner or Authorized Agent
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
iB—t have and will maintain a certificate of consent to self4risure-for workers compensatiorh4ssued 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.
0 1 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 carrier and policy are:
Cartier. Policy No.: Expiration Date:
This section need not be completed N the permit Is for one hundred dollars (11100) or loss.
Q 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
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 cemDly 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 hereby affirm under penalty of perjury that there is a construction lending agency for the performance
Lender's Information:
I hereby certify that I have read this application and state that the Information above Is correct. 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.
Date Signature of Applicant or Agen
The promit 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.
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: 11/29/2022
Contractor.
Number. SW12022-00140
TYPE:
Expiration Date
Fees paid for Permit: $170.00
City of Anaheim
BUILDING DIVISION
INSPECTION RECORD
`' D
SWIMMING POOL
ADDRESS:
1645 W PALAIS RD, ANAHEIM, CA 92802
OWNER:
NGUYEN JENNY PHAN
PERMITS:
SWI2022-00140
DATE ISSUED:
11/29/2022
DESCRIPTION:
Demolition: 450 aq ft pool with shell to remain and (3)
DO NOT GUNITE ROCK STRUCTURE
(water feature, rock slide, fountain, waterfall, grotto etc.) until the above inspection has
been signed.
3x3 holes.
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 POOUSPA
until all the above inspections have been signed.
5. BLD -Steel and Electric bo
(Rock Structures,Slides nding Etc)
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. Backflow
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.
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
MISC. INSPECTIONS Date Inspector
fbldjobcards
Inspections 14:
1. All plumbing to be completed and the system pressurized l0 35 lbs. with water
or house pressure.
2. NI meed within Sleet of pod water, and sit pool equipment, must be bomded
to pod reinforcing steel with #8 solid copper wire. Niche light shell, deck inserts,
etc. shall be bonded to pool rebar.
3. Pod equipment Is not required to be set at this time.
1. Underground electric Inspected prior to baddaing.
2. Gas line test at 100 for 15 minutes with 15111! gauge.
3. When polyethylene gas piing Is used, a aAMcate from a 00Ailled Installer,
and tracer win shall be provided per CPC 1210.1.7.2 APPENDIX I.
Inspections 11.13•
1. Rough slectrk Inspection when so wiring is completed and reedy prior to the
0190MO of POMP. Po" impound In phos at plastic tight nkhe.
2. Current Code requires that any pool, spa or water feature
contacting water 18 Inches or more In depth shell be enclosed by a banter
adequate to prevent entry of and children. The banler shall comply with
Section 3109 of current CBC and CRC APPDENDIX V spedying the height of
any 118000 provided as barrier to the pool a- shall be 60- above grade on One
outside of the lence.
3. Docs from a garage shd most the requirements for a gate. Glass
windows within 5' of pool water shall be tampered gists.
4. Prior to pro -plasty 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 pips shall be painted to protect from sunlight.
Inspections 14.16:
1. Gas and Electrical completely removed and 2x2 hales at bottom of pod
and/or Isolated elements.
2. Pool baddilled:
A.) With Ntun build - self -compacting sand 95% with recelpt.
B.) No AMrs build - any rel.
3. After pool Is operating and In working condition with approved pool cover on
dte.
Inspection requests mads prior to 5:00 pm Monday - Friday
will be scheduled on the following workday.
To schedule your building inspection online, please go to
hapsJ/ace.anaheim.neUCltizenAccess
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.anahelm.netlbuikiing alter 7:30am on the day of your
Inspection. Under Ondine Services. dick on the link 'Inspection
Tknefremee or call (714) 765.5153 + 0
CITY OF ANAHEIM
PLANNING DEPARTMENT
BUILDING DIVISION
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 atlGlt S _ VJ X.4 0A q"42,.
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
DIRECTIONS: Read and initial each statement below to signify you understand or verify this
information.
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
workers on my property.
2. I 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 financial 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
theirrllicense .numbers on permits and contracts.
�I/ 5. 1 understand if I employ or otherwise engageany 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.
42V/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)7654607 Fax B721
....... --.L �:�.
the state and federal government, withhold payroll taxes, provide workers' compensation disability
insurance, and contribute to unemployment co*rnpensation for each "employee." I also understand my
failure to abide by these laws may subject me to serious financial risk.
A. understand under California Contractors' State License Law, an Owner -Builder who builds
ingle`-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.
8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be
eld 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.
W9'I understand I may obtain more information regarding my obligations as an "employer" from the
ternal 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.csib.ca.gov for more information about licensed contractors.
0. 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
�- 1
,1. I 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.
t12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to
any of he 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 thepermit is issued to verify the property owner's
signature.
Property Owner's Signature:PQA9=�� Date: 2,Z
Signature: -.
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200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax B721