B23-1654 - 28371 PASEO ESTABLOCITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
Permit No. B23-1654
12/22/2023
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
LL1
666-171-30
8
$ 700
BUILDING
0
2
0
JOB ADDRESS: 28371 PASEO ESTABLO
KRAMER, LAWRENCE & CHRISTINEOWNER NAME
28371 PASEO ESTABLOMAILING 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
RENEWAL BY ANDERSEN LLC
22982 ALCALDE DRIVE
07/31/2025
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__OLD REPUBLIC INSURANCE COMPANY
Policy#MWC31415823 (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.
B23-1654
Total Electrical
Total Plumbing
Total Mechanical
Total Mobile Home
990416
,
LAGUNA HILLS, CA 92653
SAN JUAN CAPISTRANO, CA 92675
(714) 259-5120
PHONE
PHONE
Date _________________ Applicant _______________________________________
MOBILE HOME PERMIT AMOUNT
REPLACE (1) WINDOW. LIKE FOR LIKE
PLUMBING PERMIT
FINALED
3.5.24
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)
$ 114.17
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.50
$0.00
$0.00
$0.00
$ 20.11
$ 134.11
2/8/2024
$ 268.89
$0.00
$ 114.17
2/8/2024
B23-1654
RENEWAL BY ANDERSEN LLC
28371 PASEO ESTABLO
98116
(860) 952-4112
$0.00