B23-0001 - 31971 VIA LA PLATA BLK 2Permit Number B23-0001
CITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
Permit No. 823-0001
DESCRIPTION
ISSUED
01/03/2023 REROOF 4sq FOR SOLAR REMOVE TILE. NEW COMP UNDER SOLAR ARRAY CODE YEAR 2022 ISSUED BY CJ5 SITE APN 666-142-10SITE LOT NO 10 SITE TRACT SITE SUBDIVISION JOB VA LUE $ 3,040 OCCUPANCY TYPE PERMIT TYPE. ROOFING ELECTRILAL PERMIT AMOUNT BUILDING SF 0 NO STORIES I NO UNITS 0 JOB ADDRESS: 31971 VIA LA PLATAOWNER NAME ERIN, DARLENE PHONE MAILING ADDRESS 31971 VIA LA PLATA CITY,STATE,ZIP SAN JUAN CAPISTRANO, CA 92675 Total Electrical CONTRACTOR NAME COWBOYS ROOFING INC PLUMBING PERMIT AMOUNT 1042452 ST. LIC EXPIRE 07/31/2024 PHONE (760) 747-6890ADDRESS 2 I 50 N CENTRE CITY PKWY #HCITY, ST, ZIP ESCONDIDO, CA 92026 TENANT NAME PHONE# MAILING ADDR Total Plumbing CITY, ST, ZIP MECHANICAL PERMIT AMOUNT 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
certify and agree if a pennit is issued: to comply with all City, County, and State laws governing Total Mechanical
building construction, whether specified herein or not. I also agree to save, indemnify and keep expiration:: Every permit issued shall become invalid unless the work on the site authorized b�
hannless 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 accn,e against said City in consequence of the granting of this permit ite by such permit is suspended or abandoned for a period of 180 days after the time the work rYV�v ;-r O(',;,--e..s ommenced. Owner/Contractor
Print Name '---An OSHA pennit is required for excavations over 5'0" deep and demolition or construction of
�
� structures over 3 stories in height,
Applicant's signature �
V--'-=T {;ontractor: I hereby affinn 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.
Owne.r./Bulldc.r: I, as owner of the property, or TTly employees with wages as their sole compensation, will do the work and the strncture is not intended or offered for sale. (Sec. 7044, Business and P1ofessions
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 arc 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/Rulldl!r: l, as ownet of the property, am exclusively contracting with licensed contractors to construct the p1ojcct (Sec. 7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor's) license pmsuant to the Contractor's License Law
� Workers Comnen<ntion-1 hereby affinn under penalty of perjury one of the following declarations:] have and will maintain workers' compensation insurance, as required by Section 3700 of1h
ode. for the perfonnance of the work for which this pennit is issued. My workers' compensation insurance carrier and policy number are: Carrier UNITED WISCONSIN INSlJRANCf.
!:;QMPANY Policy#5 l 800218 (This section needs to be completed if the perrnit is for one hundred dollars(Sl 00) or less)
Exemption: l certify that in the performance of the work for which this pcnnit is issued, I shall not employ any pc1son in any manner so as to become subject to the workc1s• compensation laws uf
Califomia and agree that if I should become subject to the workers' compensation p1ovisions of Section 3700 of the Labor Code, I shall fo11hwith comply with those provisions. )ate Applicant WARNING:FAILURE TO SECURE WORKERS-COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER Tl CR!MlNAL PENALTIES AND ClVlL FlNES UP TO ONE HUNDRED THOUSDAND DOLLARS($ I 00.000) IN ADDlTlON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES
01/22/24