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B24-0867 - 27980 VIA DE COSTACITY OF SAN JUAN CAPISTRANO BUILDING PERMIT Permit No. B24-0867 10/01/2024 ISSUED JOB VALUE NO UNITS Permit Number ISSUED BY SITE APN SITE LOT NO SITE TRACT SITE SUBDIVISION PERMIT TYPE. OCCUPANCY TYPE BUILDING SF NO STORIES DF4 934-53-492 4 13865 $0 ELECTRICAL 0 0 0 JOB ADDRESS: 27980 VIA DE COSTA GREAUX, KENNETH & JENNIFEROWNER NAME 27980 VIA DE COSTAMAILING ADDRESS CITY,STATE,ZIP CONTRACTOR NAME ST. LIC EXPIRE ADDRESS CITY, ST, ZIP TENANT NAME PHONE # MAILING ADDR CITY, ST, ZIP I have carefully examined the completed permit application and do hereby certify under penalty of perjury that all information 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 building construction, whether specified herein or not. I also agree to save, indemnify and keep harmless the City of San Juan Capistrano against all liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. Applicant's signature Owner/Contractor Print Name OWNER/BUILDER AMOUNT MECHANICAL PERMIT AMOUNT Expiration:: Every permit issued shall become invalid unless the work on the site authorized by such permit is commenced within 12 months after its issuance, or if the work authorized on the site by such permit is suspended or abandoned for a period of 12 mounths after the time the work commenced. An OSHA permit is required for excavations over 5’0” deep and demolition or construction of structures over 3 stories in height. _____Contractor: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. _____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 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/Builder:I, 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 apply 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 maintain workers’ compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers’ compensation insurance carrier and policy number are: Carrier__ Policy# (This section needs to be completed if the permit is for one hundred dollars($100) or less) AMOUNTELECTRICAL PERMIT DESCRIPTION _______Exemption: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. WARNING:FAILURE TO SECURE WORKERS’COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TI CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSDAND DOLLARS($100,000) IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY’S FEES. B24-0867 Total Electrical Total Plumbing Total Mechanical Total Mobile Home , , SAN JUAN CAPISTRANO, CA 92675 (949) 429-9565PHONE PHONE Date _________________ Applicant _______________________________________ MOBILE HOME PERMIT AMOUNT INSTALL NEMA 14-50 240V ON 60a CIRCUIT IN GARGAE. CHARGEPOINT HOMEFLEX LEVEL 2. PLUMBING PERMIT Ken Greaux 10/02/2024 10/04/24 Date: Permit No. Applicant: Phone/E-Mail Job Location: CITY OF SAN JUAN CAPISTRANO BUILDING PERMIT FEES Account # Type Cost 01-44221 Building Permit 01-44223 Mechanical 01-44224 Plumbing 01-44225 Electrical 01-44221 Mobile Home Permit 01-44222 Grading Permit Fee 01-44231 Grading Plan Check 01-44222 On-Site Residential Permit 01-44231 On-Site Residential Plan Check Subtotal 01-44230 Bond Processing 01-44230 Building Plan Check 01-44230 Additional Plan Check 01-44230 Digital Record Fee ($1.00 per sheet) 01-44221 C & D Administrative Fee 01-44221 Special Inspection-Reinspection 01-44222 On-Site Commercial/Tract Permit Fee 01-44231 On-Site Commercial/Tract Plan Check Fee 01-44214 Geotechnical Soils Plan Review 10-44320 Ordinance 211 10-42510 Ordinance 364 01-45354 Copies @ .20 Each 90-23331 SMIP Fee 33-44370 H.O.P.E. Fee (Housing in Lieu) Other Fees TCA Fees Date Received HOA Approval Date Received School Fees Date Received Engineering Fees Date Received Water Division Fees Date Received 01-44221 01-44221 01-44240 90-23000 90-23000 TOTAL FEES PAYABLE TO CITY OF SAN JUAN CAPISTRANO Receipt # _________ Date: ______________ Cashier: _____________________________ Refundable Bond/Deposit Posted by ______Owner_____Contractor ________Type Title 24 Energy Provision (20% Permit Subtotal & Bldg Plan Check)) Title 24 ADA Fee (10% Permit Subtotal & Bldg Plan Check) Refundable Bond/Deposit Posted by ______Owner_____Contractor ________Type NPDES Permit Fee (10% Permit Subtotal) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 10/1/2024 $0.00 $0.00 $0.00 10/1/2024 B24-0867 GREAUX, KENNETH & JENNIF 27980 VIA DE COSTA (949) 429-9565 $0.00 OWNER/BUILDER REV 0/ PAGE 1 of 2 PROPERTY OWNER'S PACKAGE DEVELOPMENT4&37*$&4 Building and Safety [Disclosures and Forms for Owner-Builders Applying for Construction Permits] IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at . We are providing you with an Owner-Builder Acknowledgment and Verification of Information to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER-BUILDER ACKOWLEDGMENT AND VERIFICATION OF INFORMATION Please read and initial each statement below to signify you understand or verify this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an Owner-Builder building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an Owner-Builder I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an “employer” under state and federal law. 6. I understand if I am considered an “employer” under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each “employee.” I also understand my failure to abide by these laws may subject me to serious financial risk. 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 27980 Via De Costa, San Juan Capistrano CA 92675 KG KG KG KG KG KG KG KG REV 0/ PAGE 2 of 2 PROPERTY OWNER'S PACKAGE 9. I understand I may obtain more information regarding my obligations as an “employer” from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner-Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage.'VSUIFS ZPVBSFBEWJTFEUIBUFBDIDPOUSBDUPSPSTVCDPOUSBDUPSNVTU IBWFBDVSSFOUBOEWBMJE$JUZPG4BO+VBO$BQJTUSBOPCVTJOFTTMJDFOTFJOPSEFSUPQFSGPSNXPSLJOUIF$JUZ BOEJO XIJDIXFNBZBTLZPVUPWFSJGZ Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. NOTE: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. PROPERTY OWNER SIGNATURE DATE NOTE: The following Authorization is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project: SCOPE OF CONSTRUCTION PROJECT OR DESCRIPTION OF WORK PROJECT LOCATION OR ADDRESS AUTHORIZED AGENT NAME PHONE AUTHORIZED AGENT ADDRESS I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. /05& " DPQZ PG UIF PXOFShT ESJWFShT MJDFOTF  GPSN OPUBSJ[BUJPO  PS PUIFSWFSJGJDBUJPO BDDFQUBCMFUPUIFBHFODZJT SFRVJSFEUPCFQSFTFOUFEXIFOUIFQFSNJUJTJTTVFEUPWFSJGZUIFQSPQFSUZPXOFShTTJHOBUVSF PROPERTY OWNER SIGNATURE DATE nted when the perm d t b l t d KG KG KG KG 09/24/2024 27980 Via De Costa, San Juan Capistrano CA 92675 27980 Via De Costa, San Juan Capistrano CA 92675