B22-0151 - 27952 GOLDEN RIDGE LN 2Permit Number B22-0151
CITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT
Permit No. 822-0151
DESCRIPTION
ISSUED
05/11/2022
595sfDETACHED ADU. 142sf ADDITION. 574lsf REMODEL. CODE YEAR 2019 ISSUED BY CJ5 SITE APN 650-581-05SITELOTNO 5SITE TRACT 11753 SITE SUBDIVISION JOB VA LUE $ 1,000,000 OCCUPANCY TYPE PERMIT TYPE. BUILDING BUILDING SF 0 NO STORIES 0 NO UNITS 0
JOB ADDRESS: 27952 GOLDEN RIDGE LN 2
OWNER NAME TONA, CORY & CHELSEY PHONE MAILING ADDRESS 27952 GOLDEN RIDGE LN CITY,STATE,ZIP SAN JUAN CAPISTRANO, CA 92675
CONTRACTOR NAME TRIVEST BUILDERS INCORPORATED 667190 ST. LIC EXPIRE 03/31/2023 PHONE (949)413-9395ADDRESS 28 EVENING LIGHT LNCITY, ST, ZIP ALISO VIEJO, CA 92656
TENANT NAME PHONE# MAILING ADDR CITY, ST, ZIP '
MOBILE HOME PERM1T AMOUNT
Total Mobile Home
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 c
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·1y • consequence of the granting of this permit.
Owner/Contractor / ev1,v ..S-c/-11{ U�
Print Name -k� Applicant's signature
�I El TRlCAL PlfDM n AMIIIINI
EXTEND ELECTRICAL 21.04 LIGHTING FIXTURES 127.27 RECEPTACLE, SWITCH & LIGHT OUTLETS 178.30 ELECTRICAL ISSUANCE FEE 27.24
Total Electrical 353.85
PLUMBING PERMIT AMOUNT BUILDING SEWER 27.29 FIXTURES AND VENTS 455.70 WAT ER PIPING SYSTEMS 42.08 PLUMBING ISSUANCE FEE 27.24
Total Plumbing 552.31
MECHANICAL PERMIT AMOUNT APPLIANCE VENTS 16.06 DUCT INSTALL/REPLACE/RELOC 240.90 EXHAUST FAN WI SINGLE DUCT 58.80 FIREPLACE VENTS AND EXHAUST 35.37 VENTS AND EXHAUST HOOD/DUCTS 23.58 MECHANICAL ISSUANCE FEE 27.24
Total Mechanical 401.95
l<: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 permit is required for excavations over 5'0" deep and demolition or construction cf
structures over 3 stories in height
\� Contractoc; I hereby nffiny'llml 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 !heir sole compensation, will do the work and lhe structure 1s not intended or offered for sale. (Sec.7044, Business and Professions
Code: the Contractor's License Laws docs not apply to and owner of property who builds or improves thereon, who docs such work himself or lhrough his employees, provided lhat such improvements are not intended or offered for sale. If however, Jhe building or improvement is sold wilhin one year of completion, lhe owner-builder will have lhe burden of proving lhat he did not build or improve for Jhe purpose of sale)
__ Ownor/Ruilder; I. as owner of the property, am exclusively contracting with licensed contractors to construct lhe 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 lhe Contractor's License Law,
Workers Comecnsntiqn-1 hereby affirm under penalty of perjury one of the following declarations:! have and will maintain workers' compensation insurance, as required by Section 3700 oftb
Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier EXEMPT Policy# (This section needs to be
compl_;t!d if the permit is for one hundred dollars($ I 00) or less)
[�1 and agree Jhat if I should become subject to lhe I rkers' co �nsaHon provisi�ection 3700 of \e Labor Code, I shall forthwilh comply wilh !hose provisions. l' -""Exemption: I certify lhat in Jhe perfonnan�
�
e oft 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
Dal G111 loZZ Applicant -=::::--"'--, J / / W1\RNING:FAILO'RE TO SECURE WORl(£RS'C��1 'ENS,\TION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TI CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREDTHOUSDAND DOLLARS(S100,000) IN ADDITIO, THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES
08/14/24