B22-1138 - 29441 AVOCADO LNPermit Number B22-1138
CITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
Permit No. 822-1138
ISSUED
08/23/2022
CODE YEAR 2019
DESCRIPTION
REPLACE (4) WINDOW & (I) PATIO DOOR. LIKE FOR LIKE
ISSUED BY CJ55
SITE APN 650-031-27
SITE LOT NO 14
SITE TRACT
SITE SUBDI VISION
JOB VA LUE $11,382
OCCUPANCY TYPE
PERMIT TYPE. BUILDING �LECTKICAL PERMIT AMOUNT
BUILDING SF 0
NO STORIES 1
NO UNITS 0
JOB ADDRESS: 29441 AVOCADO LNOWNER NAME TOTARO-GILSON, MASSIMILANO & AMANDA
PHONE
MAILING ADDRESS 29441 AVOCADO LN
CITY ,STATE,ZIP SAN JUAN CAPISTRANO, CA 92675 Total Electrical
CONTRACTOR NAME HOME DEPOT U SA INC PLUMBING PERMIT AMOUNT 602331
ST. LIC EXPIRE 09/30/2022
PHONE (770) 433-8211
ADDRESS PO BOX 105451
CITY, ST, ZIP ATL ANTA , GA 30348
TENANT NAME
PHONE#
MAILING ADDR Total Plumbing
CITY, ST, ZIP MECHANfCAL PERMIT AMOUNT 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 Total Mechanical ,orufy �,...., ••"°"""'''""fl .;o all c;cy, c-."" '"" I••• go�rni,,
b•i"•• -•-oo, wh--IBod ,.;, Mom I
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i-rufy .,, k°" �xpiration:: Every permit issued shall become invalid unless the work on the site authorized b)
hannless the City of San Juan Capi. o ng��
-ib ilics, ju cats, costs and expenses ucb permit is commenced within 12 months after its issuance, or if the work authorized on the
which may in any way accrue ,igains md Cit in consequ · nc of c ting of this pennit. ite by such permit is suspended or abandoned for a period of 180 days after the time the work
ommenced. Owner/Contractor A
Print Name
(c\�
( Y. An OSHA permit is required for excavations over 5'0" deep and demolition or construction of e) structures over 3 stories in height.
Applicant's signature
-� ContrMl!!r; I hereby affirm 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
'-"l'iwncriBuildcr: 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 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 pwpose of sale)
Owner/Builder. 1, 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 np� 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.
!�Workers Compensation-I hereby affirm under penalty of perjury one of the following declarations:I have and will mai ntain workers' compensation insurance, as required by Section 3700 of!l1
de, for the performance of the work for which this pennit is issued. My workers' compensation insurance carrier and policy number are: Carrier ACE AMERICA� rNSURANCE COMPANY
Policy/lWC!,!C689 l 6446 (This section needs to be completed if the pennit is for one hundred dollars($ I 00) or less)
.F.�cmption: 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
California and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. bate Applicant
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER Tl 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.
10/01/24