B25-0912 - 31231 AVENIDA TERRAMARPERMIT NUMBER:
ISSUED BY:
APN#:
TRACT:
LOT:
SUBDIVISION:
JOB VALUE:
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PERMIT TYPE:
BUILDING SQ. FT.:
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fOF UNITS:
JWNER NAME
>HONE
nAILING ADDRESS
:ONTRACTOR NAME
:SLB#
SLB EXPIRATION
HONE
DDRESS
CITY OF SAN JUAN CAPISTRANO
BUILDING PERMIT #: I B25-0912 I
JOB ADDRESS: 31231 AVENIDA TERRAMAR
ISSUED
12/11/2025
825-0912 DESCRIPTION OF WORK
LL1 REPLACE (2) AC, (2) COILS, (2) FURNACES & (2) 0/Cs.666-502-01
45 NO DUCTWORK. 3T & 4T. SOK & 60K.
$ 30.780
MECHANICAL
0
0
0
MALINOWSKI, VINCENT S TENANT NAME
PHONE
31231 AVENIDA TERRAMAR MAILING ADDRESS
SAN JUAN CAPISTRANO, CA 92675
CAPISTRANO AIR INC OSHA
910228 An OSHA permit is required for excavations over 5'0" deep and 09/30/2027 demolition or construction of structures over 3 stories in height.
(949)481-9605
23011 MOULTON PKWY C-13
LAGUNA HILLS, CA 92653
•WNER / CONTRACTOR DECLARATION EXPIRATION
'lave carefully examined the completed permit application and do Every permit issued shall become invalid unless the work on the
?reby certify under penalty of perjury that all information hereon site authorized by such permit is commenced within 12 months after
:;luding the declarations are true and correct and I further certify its issuance, or if the work authorized on the site J2Y. such permit lli
1d agree if a permit is issued: to comply with all City, County, and suspended or abandoned for a period of 12 months after the time
ate laws governing building construction, whether specified herein the work commenced.
not. I also agree to save, indemnify and keep harmless the City of
in Juan Capistrano against all liabilities, judgments, costs and
penses which may in any way accrue against said City in
nsequence of the granting of this permit.
UNT FULL NAME: ' 5i VY'} 'J;'2·t>/:z,), �
SIGNATURE: \ J>r.12 --
�
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. Bu.siness 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 orovinQ that he did not build or imorove for the ouroose of sale)
OWNER/BUILDER: I, as owner of the property, am exclusively contracting witr, 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.
'J WORKER'S I hereby affirm under penalty of perjury one of the following dec.larations: I have and will maintain workers' compensation , 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: EMPLOYERS PREFERRED INSURANCE COMPANY POLICY#: EIG495206003
(This section needs to be completed if the permit is for one hundred dollars ($100) or less)
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.
DATE: SIGNATURE:
IG: FAILURE TO SECURE VVORKERS'COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER Tl CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
)AND DOLLARS(S100.000) IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES
FINALED01/26/26