B23-1189 - 26801 LARIAT CIRCITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
ISSUED
08/23/2023
Permit No. 823-1189
Permit Number B23-1189
ISSUED BY CJ5
SITE APN 650-041-07
SITE LOT NO 4
SITE TRACT
SITE SUBDIVISION
JOB VA LUE $ 75,000
OCCUPANCY TYPE
PERMIT TYPE. BACKYARD IMPROVEMENT
BUILDING SF 0
NO STORIES I
NO UNITS 0
JOB ADDRESS: 26801 LARIAT CIR
0'\1/NER NAME
PHONE
ANAPOLSK.Y, SETH & TIFFANY
26801 LARIAT CIR MAILING ADDRESS
CITY,STATE,ZIP SAN JUAN CAPISTRANO, CA 92675
CONTRACTOR NAME
ST. LIC EXPIRE
PHONE
ADDRESS
CITY, ST, ZIP
TENANT NAME
PHONE#
MAILING ADDR
CITY, ST, ZIP
RBC BUILDERS GROUP
1066904
07/31/2022
(949)374-4546
14271 JEFFREY ROAD #195
IRVINE, CA 92620
MOBILE HOME PERMIT
Total Mobile Home
AMOUNT
I have carefully examined the completed pennit 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 ifa 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.
Owner/Contractor {(� L � ,.:,\J--.erS ( J.l'?'Y .,[)
Print Name
AJ.!.Plicant's signature
DESCRIPTION
CLOSEOUT PERMIT B21-0679. 800sf POOL/SPA. BBQ w/SINK.
GAS PIZZA OVEN/F IREPLACE. WATER FEATURE.
ELECTRLCAL PERMJT
EXTEND ELECTRICAL
PRIVATE COMBO -POOL/ SPA
RECEPTACLE, SWITCH & LIGHT OUTLETS
ELECTRICAL ISSUANCE FEE
Total Electrical
PLUMBING PERMIT
GAS SYSTEMS -EACH
BUILDING SEWER
EXTEND PLUMBING
FIXTURES AND VENTS
POOL/ SPA PLUMBING
WAT ER PIPING SYSTEMS
PLUMBING ISSUANCE FEE
MECHANICAL PERMIT
FIREPLACE VENTS AND EXHAUST
POOL/ SPA -MECHANICAL
MECHAtJICAL I�SUANCE FEE
Total Mechanical
AMOUNT
5.26
38.94
1.22
27.24
72.66
AMOUNT
3.42
13.65
7.89
5.43
33.64
2.63
27.24
AMOUNT
5.90
15.03
27.24
48.17
isxpirnlivn;; Every permit issued shall become invalid unless the work on the site authorized h) uch permit is commenced within 12 months after its issuance, or if the work authorized on the ilc by such permit is suspended or aband oned for a period of 180 days after the time the work ommenccd.
An OSHA permit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
I�� Contractor: I hereby affirm .Ka:1 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.
__ Ownpr/Build(!r: I, as owner of the property, or my employees with wages as their sole compensation, wi11 do the work and the structure is not intended or offered fol' sa1e. (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)
Owp�r/JluJldc_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 conbacts for such projects with a contractor's) license pursuant to the Contractor's License Law.
___ Worker., Cpmn�M:itian-1 hereby affirm under penalty of perjury one of the following declarations:! have and will maintain workers' compensation insurance, as required by Section 3700 of th Labor Code, for the performance of the work for which this pennit is issued. My workers' compensation insurance carrier and policy number are: Carrier EXEMPT Policy# (This section needs to be c011P19.cd if the permit is for one hundred dollars($! 00) or less)
�\-..__,.:xcmntion: l certtfy that in the performance of the :�:r which this permit 1s issued, I shall not employ any person many manner so as to become subJect to the workers' compensation laws of I Cnhfom1;, and agree'\'" if l ih�uld become subject to the wor',..w;mpcn;"tion provisions of Section 3700 of the Labor Code, I shall forthwith comply With those provis,ons. )ate � \) ""3 I')) Applicant---,-,,,.,,2'/J_��:zl.!:z:•=:::===::::::====::=,,,--•�..,,,,,.. � , -
WARNING:FAILURE TO SECURE WORKERS'COMPENSAij( 'C'OVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER Tl CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSDAND DOLLARS($ l00,000) IN ADDITION TO THf}:J T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES
08/22/24