B23-1468 - 32943 PASEO DEL LUCEROFINAL
01/18/2024
Permit Number ISSUED BY SITE APN SITE LOT NO SITE TRACT SITE SUBDIVISION JOB VA LUE OCCUPANCY TYPE PERMIT TYPE. BUILDING SF NO STORIES NO UNITS JOB ADDRESS: OWNER NAME PHONE MAILING ADDRESS B23-1468
CITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
Permit No. 823-1468
DESCRIPTION
ISSUED
11/02/2023 REROOF 7sq. TIO SHINGLES & UNDERLAYMENT. REPLACE PLY AS NEED CJ5 INSTALL UNDERLAYMENT & SHINGLES. 4sq FLAT ROOF TORCH DOWN 668-184-2764 $ 9,350 ,. ROOFING ELECTRICAL PERMIT ,AMOUNT 0 2 0 '< ,. 32935 PASEO DEL LUCERO . -... . ..PA ClNO, VALERIE AIMEE .. ' 25951 AVENIDA MARIPOSA : : CITY,STAT E,ZIP SAN JUAN CAPISTRANO, CA 92675 Total.Electrical ,. CONTRACTOR NAME HEXAGON ROOFING INC .PLUMBING PERMIT 1085614 .. ST. LIC EXPIRE 01/31/2024 -.PHONE (760)902-3240 ..ADDRESS 21515 HAWTHORN BLVD#200CITY, ST, ZIP TORRANCE, CA 90503 TENANT NAME PHONE# MAILING ADDR Total'Plumbing
•" CITY, ST, ZIP .. MECHANICAL PERMIT MOBILE HOME PERMIT AMOUNT
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Total Mobile Home
I have carefully examined the completed permit application and do hereby certify under penalty of
perjury that all infonnation hereon including the declarations are true and correct and I further Total Mechanical
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'AMOUNT· '·· _, , .
AMOUNT
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certify and agree if a l"'nnit 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 :xpirntion:: t,•o.ry permit issued"shall become invalid unless the work on the site autho0ri'zed h}
harmless the City of San Juan Capistrano against all liabilities, judgments, costs and expenses uc\1 permit is commenced within 12 months after its issuance, or if'the work anthorized·on the
which may in any way accrue against said City in consequence of the granting of this permit, rte by such p_ermit is sus pended or a.l!andoned for a period .of 180 �/1.):S after the.time the work
ommenred. Owner/Contractor ( �j, l,✓ c� 1:, 1, 1\., c .. Print Name J/� An OSHA permit is required for excavations over 5'0" deep and demolition or_ construction of
structures over 3 stories in height.
Applicant's signature
ILD 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.
Qwncrfflulldcr; I. as owner of the property, 01 my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale.. (Scc.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 01· 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)
Qwncr/Build�r: 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 Contractol"s License Law
I:'.'.' -L Workers Comnen£olilln-l hereby affirm under penalty of perjury one of the following declarations:! have and will maintain workers' compensation insurance, as required by Section 3700 ofth
Labor Code, for the perfonnance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier
FUND Policy#9309158 (This section needs to be completed if the permit is for one hundred dollars($IO0) or less)
SI6IE �OMf6lmATIQ!?! l�li!.!l!,ANCE
f;xcmntion: 1 certify that in the perfonnance of the work for which this permit is issued, T shall not employ any person jn any manner so as to become subject to the workers' compensation Jaws 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.
bate Applicant WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER Tl 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 SEE REV1
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