B23-0777 - 25986 FARM RD.
CITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
Permit No. 823-0777
Permit Number B23-0777 DESCRIPTION
3'-6"H BBQ & PORTABLE FIREPIT.
ISSUED BY CJ5
SITE APN 121-531-49
SITE LOT NO 94
SITE TRACT 19063
SITE SUBDIVISION THE FARM -ANDALUSIA
JOB VALUE $4,900
OCCUPANCY TYPE
PERMIT TYPE. BACKYARD IMPROVEMENT El EC 'r Rlf AL PERMIT
BUILDING SF 0 RECEPTACLE, SWITCH & LIGHT OUTLETS NO STOR1ES 0 EXTEND ELECTRICAL NO UNITS 0 ELECTRICAL ISSUANCE FEE
JOB ADDRESS: 25986 FARM RD
OWNER NAME BURCKLE, JOHN & CRYSTAL
PHONE
MAILING ADDRESS 25986 FA RM RD
CITY,STAT E,ZIP SAN JUAN CAPISTRANO, CA 92675 Total Electrical
CONTRACTOR NAME PLUMBING PERMIT
EXTEND PLUMBING ST. LIC EXPIRE
OWNER BUILDER
GAS SYSTEMS -EACH
PHONE PLUMBING ISSUANCE FEE
ADDRESS
CITY, ST, ZIP
TENANT NAME
PHONE#
MAILING ADDR Total Plumbing
CITY, ST. ZIP MECHANICAL PERMIT MOBILE HOME PERMIT AMOUNT
Total Mobile Home I have carefully examined the completed permit application and do hereby certify under penalty of perjury that all in formation hereon including the declarations are trne and correct and I further Total Mechanical certify and agree if a pennit is issued: to comply with all City, County, and State laws governing
ISSUED
06/30/2023
AMOUNT
7.32
5.26
27.24
39.82
AMOUNT
10.52
6.81
27.24
44.57
AMOUNT
building constrnction, whether specified herein or not. I also agree to save, indemnify and keep ixpiration:: 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
�:�::/�:n:t:::;::e against saJ;h ;sequc/) �:;�n
l �f:s F-rmit. ite by such permit is suspended or abandoned for a period of 180 days after the time the work
ommenced.
Print Name ()� k_ce An OSHA permit is required for excavations over 5'0" deep and demolition or constrnction of slrnctures over 3 stories in height.
Applicant's signature
--�!!ntr•£!!!r: I hereby a� that I am licens�er provisions of Chapter 9 of Division 3 of the Business and Professions Code, and my license i s in full force and effect. __ Owner/Builder: I, as owner of the property, or my employees with wages as their 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 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 int�nded 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) I� .()wner/Builder: I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not an owner of property who builds or improves thereon and who contracts for such projects with a conb'actor's) license pursuant to the Contractor's License Law. Worke� Comnen,s,,tjon-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 perfonnance of the work for which this pennit is issued. My workers' compensation insurance carrier and policy number are: Carrier Al.AS.KA NATIO��I. !��URA�CE CO Policy#23DWSI0825 (This section needs to be completed if the pennit is for one hundred dollars($!00) or less) (/ I J Rx<:rnntiim: I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of
. y11omm and agree that if! should become subject to the Wu compcn'"'Eio�700 of the Lahm Code, I shall forthwith comply with those provisions.
Dote /..-j 6 r--J... '3 Applicant /vf__ �
/ , WARNING:FAILURE TO SECURE WORKERS'COMP�ONCOVER�� UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER Tl CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSDAND DOLLARS(SI00.000) TN ADDITION TO COST OF co� E 'SATION. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES
07/18/24
& PORTABLE FIREPIT
3'-6"