B23-0014 - 27905 PASEO EL CONCHOPermit Number B23-0014
CITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
Permit No. 823-0014
DESCRIPTION
ISSUED
01/05/2023
CHANGE OUT HEAT PUMP CONDENSER & AIR HANDLER LIKE FOR LIKE
CODE YEAR 2022
ISSUED BY CJ5
SITE APN 666-054-16
SITE LOT NO 22
SITE TRACT
SITE SUBDI VISION
JOB VALUE $0
OCCUPANCY TYPE
PERMIT TYPE. MECHANICAL
BUILDING SF 0
NO STORIES 1
NO UNITS 0
JOB ADDRESS: 27905 PASEO EL CONCHO
OWNER NAME GORDON, EMERSON & CATHERINE
PHONE
MAILING ADDRESS 27905 PA SEO EL CONCHO
CITY,STATE,ZIP SAN JUAN CAPISTRANO, CA 92675
CONTRACTOR NAME SERVICE CHAMPIONS LLC
799170
ST. LIC EXPIRE 10/31/2023
PHONE (714) 777-7777
ADDRESS 3150 E BIRCH ST
CITY, ST, ZIP BREA, CA 92821
TENANT NAME
PHONE#
MAILING ADDR
CITY, ST, ZIP
MOBILE HOME PERMIT AMOUNT
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 pennit 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 hannless the City of San Juan Capistrano against all Ii;, iii tics. judgments, costs and expenses which may in any way accrue against �ity in COT; Owner/Contractor J APrint Name -. J;Jr;=ng of this pennit.
�plicant's ignatw·e_ �
-
w/ (9) DUCTS
ELECTRICAL PERMIT AMOUNT
.
Total Electrical
PLUMBING PERMIT AMOUNT
.
Total Plumbing
MECHANICAL PERMIT AMOUNT
DUCT INSTALL/REPLACE/RELOC 72.27
AC/BOILR/COMP: <=3HP & IO0K BTU 16.28
FURNACE FORCED AIR<= I 00K BTU 16.39
MECHANICAL ISSUANCE FEE 27.24
Total Mechanical 132.18 ':xpiration:: Every permit issued shall become invalid unless the work on the site authorized b) uch permit is commenced within 12 months after its issuance, or if the work authorized on the ite by such permit is suspended or abandoned for a period of 180 days after the time the work
ommenced.
An OSHA pennit is required for excavations over 5'0" deep and demolition or construction of structures over 3 stories in height.
-WV Contractor: I hereby :d� 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: 1, as owner of the prope11y, or my employees with wages as their sole compensation, wil1 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 o,vner 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 ycai 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 contracto,s to consmict the p1oject (Sec_ 7044, Business and Professions Code: The Contractor's License Law docs not
Ofn owner of property who builds 01· improves thereon and who conhacts for such projecls with a contractor's) license pursuant to the Contractor's License Law. I� Wnrk<>N Con1no,,sotinn-I hereby affinn under penalty of perjury one of the following declarations:! have and will maintain workers' compensation insurance, as required by Section 3700 of th Laoor Code, for the perfonnance of the work for which this pennit is issued. My workers' compensation insurance carrier and policy number are: Carrier EVEREST PREMIER INSURANCE CQMPANY Policy#RM8WC00054221 (This section needs to be completed if the pennit is for one hundred dollars($!00) or less)
Exemption: I certify that in the performance of the work for which this pe1mit is issued, 1 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 wo1 kers' compensation provisions of Section 3 700 of the Labor Code, I shall fmthwith comply with those provisions.
Pate Applicant
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TI CRJMINAL PENALTIES AND CtVIL 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_
01/05/24