B23-0006 - 78 PLAZA CUESTAPermit Number
CODE YEAR
ISSUED BY
SITE APN
SITE LOT NO
SITE TRACT
SITE SUBDI VISION
JOB VALUE
OCCUPANCY TYPE
B23-0006
2022
CJ5
938-05-525
2
$ 0
CITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
Perm it No. 823-0006
DESCRIPTION
CHANGE OUT (!)AC & (!) FURNACE w/ DISCONNECT
ISSUED
01/03/2023
PERM IT TYPE. MECHANICAL ELECTRICAL PERMIT AMOUNT
BUILDING SF 0
NO STORIES 0 RECEPTACLE, SWITCH & LIGHT OUTLETS 1.22
ELECTRICAL ISSUANCE FEE 27.24 NO UNITS 0
JOB ADDRESS: 78 PLAZA CUESTA
OWNER NAME KAMBESTAD, JANE D
PHONE
MAILING ADDRESS 78 PLAZA CUESTA
CITY,STATE,ZIP SAN JUAN CAPISTRANO, CA 92675 Total Electrical 28.46
CONTRACTOR NAME ALISO AIR INC PLUMBING PERMIT AMOUNT 526420
ST. LIC EXPIRE 03/31/2024
PHONE (949) 589-2021
ADDRESS 29736 AVENIDA DE LAS BANDERA:
CITY, ST, ZIP RANCHO SANTA MARGARITA, CA 92688
TENANT NAME
PHONE#
MAILING ADDR Total Plumbing
CITY, ST, ZIP '
MOBILE HOME PERMIT AMOUNT MECHANICAL PERMIT AMOUNT
AC/BOILR/COMP: <=3HP & IO0K BTU 16.28
FURNACE FORCED AIR<= I 00K BTU 16.39
MECHANICAL ISSUANCE FEE 27.24
Total Mobile Home
I have carefully examined the completed pennit 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 permit is issued: to comply with all City, County, and State laws governing Total Mechanical 59.91
building construction, whether specified herein or not I also agree to save, indemnify and keep :xpiration:: 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 accrue against said City in consequence of the granting of this pennit. ite by such permit is suspended or abandoned for a period of 180 days after the time the work
lei I , V'.:; -l¼e.Y4-ommenced. ---Owner/Contractor <--
Print Name 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
"Y,,t;¢ Contractor: 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
__ Owner/Builder: I, as owner of the property, or my employees with wages as lheir 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 app1y 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)
__ ()wncr/Ruilder: I, as owner of the property, am excJusively contracting with licensed contractors to construct the project (Sec. 7044, Business and P1ofessions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who conhacts for such projects with a contractor's) license pursuant to the Contractor's License Law.
� Workers Comnen,<otjnn-1 hereby affinn 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 LlfH:;RTY MUTUAL INSURANCE
CQMPANY PolicyltWC2Z6 I 030218092 (This section needs to be completed if the pennit is for one hundred dollars($ 100) or less)
Exemption: I certify that in the performance of the work for which this pe1mit is issued, l shall not employ any person in any manner so as to become subject to the workers' compcnsalion laws of
California and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shal1 forthwith comply with those provisions.
)ate Applicant
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAW FUL, AND SHALL SUBJECT AN EMPLOYER TI CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSDAND DOLLARS(SI00,000) IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES
01/03/24