207 S WESTERN AVE (6)CITY OF ANAHEIM
Permit Number: SW12023-00107
Issued: 11/01/2023
www.anaheim.net/building
(714)7654626
Quarter Section: 5
Site Address: 207 S WESTERN AVE, Anaheim, CA 92804
Legal Description: S TWP 4 RGE 11 SEC 14 SEC 14 T 4 R 11 N
APN: 13530110
BUILDING DIVISION
200 S. ANAHEIM BLVD.
(714) 765 -5153
Project Description: Demolition: 600 sq It demolition of pool with shell to remain. REF: INV2023-00317
People Associated with Project:
Contractor STAR LANDSCAPE INC 350 E ORANGETHORPE AVE #C PLACENTIA, CA 92835
Owner 207 S WESTERN LLC 10071 SYCAMORE ST
OWNER - BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law for the following reasons) 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 Ole 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 ( 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 far sale. If, however, the building or
❑ 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 pursuant to the Contractor's State License Law).
I am exempt from licensure under the Contractors, Stale 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.
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
ermit is issued. My worker's Compensation insurance career and policy are:
Carrier: TECHNOLOGY INSURANCE COMPANY INC Policy No.: TWC4266358 Expiration Da
This section need not be completed If the permit is for one hundred dollars ($100) or leas.
❑ I 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 California, and agree that, if I should become subject to the workers compensation provisions of Section 3700 of the
Labor Code. I shall forthwith comolw*lth Aos/ orallisi.Ai —.�
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 ATTORNEYS FEES,
CONSTRUCTION LENDING AGENCY
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 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.
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 Division 3 of the Business and
Professions Code.
Date: 11/01/20213 r
Contractor:
Number: SW12023-00107
TYPE: C27
Fees paid for Permit:
Expiration Date 5/1/2024
$175.00
City of Anaheim
BUILDING DIVISION
INSPECTION RECORD
0 SWIMMING POOL
ADDRESS:
207 S WESTERN AVE, Anaheim, CA 92804
OWNER:
207 S WESTERN LLC
PERMIT#:
SW12023-00107
DATE ISSUED:
11/01/2023
DESCRIPTION:
Demolition: 600 sq 0 demolition of pool with shell to
remain. REF: INV2023-00317
POST THIS CARD WITH THE APPROVED PLANS
IN A CONSPICUOUS PLACE ON THE JOB SITE
Inspection
Code
I Date
Inspector
1. Main Drain
504
2. Electric Bonding
506
3. Steel
508
4. Approval to Gunite
510
DO NOT GUNITE POOLISPA
until all the above inspections have been signed.
5. SLD-Steel and Electric bonding
(Rock Structures,Slides 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. Back00W
518
10. Deck, Deck Drains,
Equipotential & Accessory
Sontlinq
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 1 528
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
I
16. Final
599
MISC. INSPECTIONS
Date
Inspector
Inspections 1-5,
1. All plumbing to be completed and the system pdessurized to 35 cs. Win water
or house pressure.
2. All metal whin 5 feel of pool water, and all pod equipment, must be bounded
to pod reinforcing steel with 08 solid nipper wire. Niche light shell, deck Inserts,
.to shall be broiled to pool radar.
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 Leda for 15 minutes Win 15# gauge.
3. When polyethylene gas piping Is used, a certificate from a caddied Installer
and tracer wire shall be provided Par CPC 1210.1 ] 2 APPENDIX 1.
Insoactlons 11-13,
1. Rough electric inspection when all wiring is completed and ready prior to the
plastering of poollspa. Polling compound in place at plastic light niche.
2. Cunenl Code requires that any pool, spa or water feature
contacting water 18 inches or more in depth shall be enclosed by a barrier
adequate to prevent entry of small children. The banner shall comply with
Section 3109 of current Cl and CRC APPDENDIX V specifying the height of
any fence provided as banner to the pool &. shall be 60" above grace 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, culls and city sidewalks will he
inspected for any damage due to construction of pool or spas.
5. Gradirg complete with Positive drainage to street or public way. All
exposed plastic pipe shall be painted to protect from sunlight.
Impactions 14.161
1. Gas and Electrical completely removed add 2x2 holes at bodom of pool
antllor Isolated elements.
2. Pool backnlled:
A,) With future build - self -compacting sand 95% with receipt.
8J No future build - any fill.
3. After Pool Is operating and In "Ming condition with approved pool rover 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
hdps:Nacaanaheim. neVCtlizenAccess
Inspection can normally be reached between
7:30 - 8:00 A.M.
(714)7655153 a 0
To access your inspection timeframe:
Please go to www.anall neVbudding after 7:30am on the day of your
Inspection. Under Online Services, click on the link 9nspection
Timefnames' or call (714) 765-5153 t D
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