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B20-0344 - 27424 VIA PETRACITY OF SAN JUAN CAPISTRANO BUILDING PERMIT Permit No. B20-0344 04/06/2020 ISSUED JOB VALUE NO UNITS Permit Number ISSUED BY SITE APN SITE LOT NO SITE TRACT SITE SUBDIVISION PERMIT TYPE. OCCUPANCY TYPE BUILDING SF NO STORIES RS1 934-59-112 5 12829 $0 MECHANICAL 0 0 0 JOB ADDRESS: 27424 VIA PETRA DOTSON, DAVIDOWNER NAME 27424 VIA PETRAMAILING ADDRESS CITY,STATE,ZIP CONTRACTOR NAME ST. LIC EXPIRE ADDRESS CITY, ST, ZIP TENANT NAME PHONE # MAILING ADDR CITY, ST, ZIP I have carefully examined the completed permit application and do hereby certify under penalty of perjury that all information hereon including the declarations are true and correct and I further certify and agree if a permit is issued: to comply with all City, County, and State laws governing building construction, whether specified herein or not. I also agree to save, indemnify and keep harmless the City of San Juan Capistrano against all liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. Applicant's signature Owner/Contractor Print Name SERVICE CHAMPIONS LLC 3150 E BIRCH STREET 10/31/2023 AMOUNT MECHANICAL PERMIT AMOUNT Expiration:: Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 12 months after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 180 days after the time the work commenced. An OSHA permit is required for excavations over 5’0” deep and demolition or construction of structures over 3 stories in height. _____Contractor:I hereby affirm that I am licensed under provisions of Chapter 9 of Division 3 of the Business and Professions Code, and my license is in full force and effect. _____Owner/Builder:I, as owner of the 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 Laws does not apply to and owner of property who builds or improves thereon, who does such work himself or through his employees, provided that such improvements are not intended or offered for sale. If however, the building or improvement is sold within 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) ______Owner/Builder:I, as 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) license pursuant to the Contractor’s License Law. _______ Workers Compensation-I hereby affirm under penalty of perjury one of the following declarations:I 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 number are: Carrier__A I U INSURANCE COMPANY Policy#015990363(This section needs to be completed if the permit is for one hundred dollars($100) or less) AMOUNTELECTRICAL PERMIT DESCRIPTION _______Exemption: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 workers’ 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 comply with those provisions. WARNING:FAILURE TO SECURE WORKERS’COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TI CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSDAND 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. B20-0344 Total Electrical Total Plumbing EXTEND DUCTWORK 48.18 MECHANICAL ISSUANCE FEES 27.24 Total Mechanical 75.42 Total Mobile Home 799170 , BREA, CA 92821 SAN JUAN CAPISTRANO, CA 92675 (949) 388-9347 (714) 777-7777 PHONE PHONE Date _________________ Applicant _______________________________________ MOBILE HOME PERMIT AMOUNT DUCT REPLACEMENT (6) - LIKE FOR LIKE PLUMBING PERMIT NO FINAL INSPE C T I O N C A L L E D EXPIRED 04/06/2 0 2 1 Date: Permit No. Applicant: Phone/E-Mail Job Location: CITY OF SAN JUAN CAPISTRANO BUILDING PERMIT FEES Account # Type Cost 01-44221 Building Permit 01-44223 Mechanical 01-44224 Plumbing 01-44225 Electrical 01-44221 Mobile Home Permit 01-44222 Grading Permit Fee 01-44231 Grading Plan Check 01-44222 On-Site Residential Permit 01-44231 On-Site Residential Plan Check Subtotal 01-44230 Bond Processing 01-44230 Building Plan Check 01-44230 Additional Plan Check 01-44230 Digital Record Fee ($1.00 per sheet) 01-44221 C & D Administrative Fee 01-44221 Special Inspection-Reinspection 01-44222 On-Site Commercial/Tract Permit Fee 01-44231 On-Site Commercial/Tract Plan Check Fee 01-44214 Geotechnical Soils Plan Review 10-44320 Ordinance 211 10-42510 Ordinance 364 01-45354 Copies @ .20 Each 90-23331 SMIP Fee 33-44370 H.O.P.E. Fee (Housing in Lieu) Other Fees TCA Fees Date Received HOA Approval Date Received School Fees Date Received Engineering Fees Date Received Water Division Fees Date Received 01-44221 01-44221 01-44240 90-23000 90-23000 TOTAL FEES PAYABLE TO CITY OF SAN JUAN CAPISTRANO Receipt # _________ Date: ______________ Cashier: _____________________________ Refundable Bond/Deposit Posted by ______Owner_____Contractor ________Type Title 24 Energy Provision (20% Permit Subtotal & Bldg Plan Check)) Title 24 ADA Fee (10% Permit Subtotal & Bldg Plan Check) Refundable Bond/Deposit Posted by ______Owner_____Contractor ________Type NPDES Permit Fee (10% Permit Subtotal) $0.00 $0.00 $ 75.42 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $ 11.40 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $7.54 $0.00 9/25/2023 $ 94.36 $0.00 $ 75.42 9/25/2023 B20-0344 SERVICE CHAMPIONS LLC 27424 VIA PETRA 75217 (818) 735-7876 $0.00 BUILDING DEPARTMENT PERMIT APPLICATION - 32400 Paseo Adelanto San Juan Capistrano, CA 92675 949-493-1171 JOB VALUATION DESCRIPTION OF WORK $ Name Address City/State/Zip Name Address City/State/Zip Phone Phone ( ) ARCHITECT / ENGINEER / DESIGNER CONTRACTOR Name Address City/State/Zip ( )) State License # Phone ( QTY QTY QTY QTY Light Fixtures/Fans FAU < 100k BTU's Fixtures/Hose Bibs New/Setup Outlets/Switches FAU > 100k BTU's Water Heater Carport Meters/Main Panel AC/Comp BTU= Water Piping Sub Panels Gas Systems Awning Signs Exhaust Fans Building Sewer Temp Power Motors > than 1 HP Motors < than 1 HP Duct/Register/Grill Pool/Spa Pool/Spa Extend Plumbing SIGNATURE DATE Porch ISSUANCE ( ) ELECTRICAL PLUMBING Phone MECHANICAL Name City/State/Zip ISSUANCEISSUANCE Fireplace ISSUANCE Fire Sprinkler Heads Miscellaneous () PROPERTY OWNER Address Appliance Vent MICROFILE INT. ALT. SF ADDITION SF POOL/SPA SF MOBILE HOME JOB ADDRESS APPLICANT NAME CONTACT PHONE # EMAIL ADDRESS Extend Electrical Cabana OCCUPANCY TYPE PATIO SF PERMIT NUMBER HOA REQUIREDTARGET DATE YES  NO TENANT Pool/Spa Mechnical Hood Miscellaneous Grease Interceptor Earthquake Bracing Electrical Wiring Gas Piping Sewage Disposal Water Piping State License #