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CITY OF ANAHEIM PLANNING DEPARTMENT BUILDING DIVISION POOL/SPA PERMIT APPLICATION DATE: PROJECT ADDRESS: DESCRIBE WORK TO BE DONE: VALUATION OF JOB PRINT YOUR NAME: I am the: Property Owner Contractor* Employee of*: Owner Contractor *Verification of Worker’s Comp. Required (including Carrier, Policy # and Expiration Date, Name and Phone Number of Agent) PROPERTY OWNER: Name: _ Address: _ City: _ Phone Number: E-mail: CONTRACTOR: Company Name: Address: City: Phone Number: E-mail: State License City License#: ARCHITECT/ENGINEER: Company Name: Address: City: Phone Number: E-mail: State License WORKER’S COMPENSATION CERTIFICATE: Policy Carrier: Expiration Agent Name: Exempt, No Employees Policy Agent Phone Number: SPECIFICATIONS POOL: New Demo Pool Type: Gunite Lined Fiberglass Other: Pool Size in Square Feet: Is this a public facility? Yes No SPA: New Demo Spa Type: Gunite Lined Fiberglass Other: Spa Size in Square Feet: Is this a public facility? Yes No FIRE PIT: Gas Line Yes No BARBEQUE: Gas Line Yes No Electrical Outlet Yes No (Continued Next Page) 200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax www.anaheim.net/building OCT 2013 B712 ---PAGE BREAK--- 200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 (714)765-5153 Phone (714)765-4607 Fax www.anaheim.net/building PAGE 2 OF 2 B712 CHECKLIST FOR SELF-EXEMPTION FROM NPDES RELATED STORM WATER INSPECTION REQUIREMENTS Please fill in the following boxes based on the activities that will be performed on site during the term of the building permit for which you are applying. Soil Movement (i.e. earthwork, excavation, etc.). Uncovered materials (dirt, sand, fertilizer, etc.) that could be carried offsite by wind or rain. Exterior mixing of cementaceous products onsite (concrete, mortar, stucco, etc.). If all three boxes are not checked, the applicant is indicating they are exempt from NPDES related storm water inspection requirements. REQUIREMENTS • Plot Plan must have wet stamp and signature of California Registered Civil or Structural Engineer. • Plans must have owner’s signature and date of approval on the plan with the following information: o Excavated material shall not be spread on the lot without City Approval. o Property Owner and/or Contractor are responsible for locating property lines. o Owner understands that the pool barrier, including house doors (if applicable) shall comply prior to pre-plaster inspection. WRITE QUANTITY In Box Next to the Item(s) To Be Included In Permit. POOL/SPA FEES Fee Square Feet Sub Total Structural Less than 100 s.f. $147.67 101 s.f. – 500 s.f. $295.49 501 s.f. – 1000 s.f. $443.23 Greater than 1000 s.f. $590.98 Plan Check (not required for fiberglass spa) Less than 500 s.f. $147.67 Greater than 500 s.f. $221.62 Pool/Spa Pre-Site Inspection $147.67 Plumbing (includes all pool piping, except solar) One gas outlet, backwash lines, backwash receptor/p-trap, pool fill line and back flow protection. $147.67 Electrical Residential $147.67 Commercial $221.62 Demolition Including combo utility capping $147.67 TOTAL * Minimum Permit Fee $147.67 * Supplemental Permit Fee $36.94 * Planning Plan Check Fee assessed when applicable MAXIMUM CREDIT CARD TRANSACTION IS $2,000 The above schedule covers most common and straight forward permit types. Fees for projects outside of the listed items shall be estimated by the Building Official based on degree of complexity and size. In addition, the Building Official may require a specific amount into a Building Division Depositor's Trust Fund (DTF) account in advance of the Building Division processing a request for regulated activities. These projects will be processed in accordance with procedures outlined in Resolution No. 2008-121. Where no fee is specified or there is an unusual circumstance, that fee shall be determined by the Building Official and/or as specified in Resolution 2008-121.