B23-0192 - 27858 GOLDEN RIDGE LNCITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
Permit No. 823-0192
Permit Number B23-0192 DESCRIPTION
(3)BATHROOM REMODEL. NON-STRUCTURAL
ISSUED BY CJS
SITE APN 650-571-11
SITE LOT NO 29
SITE TRACT
SITE SUBDIVISION
JOB VALUE $ 15,000
OCCUPANCY TYPE
PERMIT TYPE. BUILDING ELECTRICAL PERMll
BUILDING SF 0
NO STORIES 0 LIGHTING FIXTURES
RECEPTACLE, SWITCH & LIGHT OUTLETS NO UNITS 0 ELECTRICAL ISSUANCE FEE
JOB ADDRESS: 27858 GOLDEN RIDGE LN
OWNER NAME PAKSHIR, FARHAD & ROUDABEH
PHONE
MAILING ADDRESS 27858 GOLDEN RIDGE LN
CITY,STATE,ZIP SAN JUAN CAPISTRANO, CA 92675 Total Electrical
CONTRACTOR NAME OWNER BUILDER PLUMBING PERMIT
BUILDING SEWER ST. LIC EXPIRE EXTEND PLUMBING PHONE FIXTURES AND VENTS ADDRESS PLUMBING ISSUANCE FEE
CITY, ST, ZIP .
TENANT NAME
PHONE#
MAILING ADDR Total Plumbing
CITY, ST, ZIP . MECHANICAL PERMIT MOBILE HOME PERMIT AMOUNT EXHAUST FAN WI SINGLE DUCT
MECHANICAL ISSUANCE FEE
Total Mobile Home
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 Total Mechanical certify and agree ifa permit is issued: to comply with all City, County, and State laws governing
ISSUED
02/09/2023
AMOUNT
18.30
3.66
27.24
49.20
AMOUNT
54.58
10.52
97.65
27.24
189.99
AMOUNT
25.20
27.24
52.44
building construction, whether specified herein or not. I also agree to save, indemnify and keep f:xpiration:: Every permit issued shall become invalid unless the work on the site authorized b}
harmless the City of San Juan Capistrano against all liabilities, judgments, costs and expenses uch permit is commenced within 12 months after its issuance, or if the work authorized on the
which may in any way accrue against said City in consequence of the b'fanting of this permit. ite by such permit is suspended or abandoned for a period of 180 days after the time the work
)J.,L ,.. � r,.." I� /q
ommenced. Owner/Contractor
Print Name ,r An OSHA pennit is required for excavations over 5'0" deep and demolition or construc tion of /µ � structures over 3 stories in height.
Applicant's signature -�
--Contract!!r: I hereby affinn that I am licensed under pro,• ns-of"C..1iapter9 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 so1e compensation, wil1 do the work and the structure is not intended or offered for sa]c.. (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 thtough his employees, provided that such improvements are not ini;rulfd or offered for sa1e. If however, the building 01 imp1ovement is sold within one year of completion, the owner-builder wi11 have the burden of proving that he did not build or improve for the purpose of sale) 1/J-sJ Qw,u:r/Buildcr: 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 appl) 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
\Vorkus Conrnen�ation-I hereby a/Tinn 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 performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier_ Policy# (This section needs to be completed if
the permit is for one hundred dollars(S l 00) or less)
-�.{j Excmllfion: l certify that in ihe perfonnance of the work for�tll.is perrnit is issued, I shall not employ any person in any manner so as to become subject to the workers' compcnsarion laws of
L",1l1fo111io and agree that if! should become subject to the workers' copn at ion p1 ,·islani of Sccrion 3700 of the Labor Code, I shall forthwith comply with those provisions
)ate ? /q I 7 '1 Applicant / .ft
�-�
WARNING:FAILURE TO SECURE ll'ORKERS'COMPENSATl�VER)\,Q_E IS UNLA �. AND SHALL SUBJECT AN EMPLOYER Tl CRtMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUS.D,\ND DOLLARS($ IQ0,000) IN ,\OOITION TO Tl-lE C�MP"""" ,v.,. DAMAGES AS PROVIDED FOR TN SECTION 3706 OF Tl-lE L,\BOR rCJDE, INTEREST, AND ATTORNEY'S FEES.
03/30/24