HomeMy WebLinkAboutPR-17230/
.::..:: CITY OF DIAMOND BAR
I DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES%
— 21810 Copley Drive, Diamond Bar, CA 91765 PRESS
i' (i09) X39-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 �•�� FIRMLY
�`788q RITTii,n]NIl PF.RMiT APPI KATION vnvw.citvofdiamondbar.com building@diamoiidbarea.gov
JOB SITE ADDRESS Q C _ S 'J"
APN LOT TRACT
OWNER i^'€ Vb
ADDRESS CS� T
CITY I ZIP %fEL. V A-
APPLICANT r TEL. I L —
CONTRACTOR "
ADDR
CITY IV -15- ' ZIP _f/ -471S EL.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TFL,
OWNER -BUILDER DECLARATION
1 hereby affirm under penally of perjury that I am exempt from the Contractor's State License Law for the reason(s)
Indicated below by the checkmadc(s), I have placed next 10 the applicable item(s) (Section 7031,5, Business and
Professions Code: Any city or county that requires a permit to construct, alter, Improve, demolish, or repair,any
structure, priurto Its issuance, also requires the applicant for the permit to file a signed statement that he or she
is licensed pursuant to the provisions at the Contractor's State License Law (Chapter 9) Commencing with Section
7000 of Division 3 of the Business and Professions Code] or that he or she Is exempt from licensure and the basis for
the alleged exemption. Any violation of Section 7035.5 by any applicant fora permit subjects the applicant to a civil penalty
of not more than five hundred dollars ($500).
U I, as owner of the property, or my employees with wages as their sole compensation, will do U all of orU portions
of the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professions Cade: The
Contractors' State License Law does not apply to an ownaroi property who, through employees' or personal effort, builds
or improves the property, provided that the 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 Itwas not built
or improved for the purpose of sale.).
(-) I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section
7044, Business and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who
builds or improves iherebn, and who contracts for the projects with a licensed Contractor pursuant to the Coolraciors' State
License Levi.).
(� I am exempt from licensure ander the Contractor's State License law for the following resson(s):
Date: Sign:
By my signature below I acknowledge that, except for my personal residence In which I must have resided for at least one
year prior to completion of the improvements covered by this permit,[ cannot legally sell a structure that i have built as an
owner -builder if it has not been constructed In its entirely by licensed contractors. I understand that a copy of the
j applicable law, Section 7044 of the Business and Professions Code Is available upon request when this application Is
submitted or at the following web site: httplvnvw.leginfo.ca.gavlcalaw.€ tml.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under prwdsOns of Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code, and my license Is in full force and effect.
LICENSE CLASS LIC. NO.: r ��
EXP. DATE: cGNriwcrGR: r
WORKER'S M ENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I I have r!I maI tale a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by
C on 3700 of the tabor Code, for the performance of the work for which this permit is issued.
€ have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for
2 the performance ofthe work for which this permit Is Issued. My Worker's Compensation Insurance Carrier and
Policy Number a :
CARRIER
3 POLICY NUMBER 4 k11CS
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT B FOR ONE HUNDREO DOLLARS 3100 OR LESS).
j I codify that in the performance of the work for which this permit Is Issued, I shall net employ any person In any manner so as 10
n become subject to the Worker's Compensation Laws of Calibrate. And agree that if I shooks become subject to the Worker's
JCompeosaflon provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
C DATE: APPLICANT:
WARNING: Failure to secure Worker's Compensation coverage Is uoiawful, and shall subject an employer to criminal
C penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost of the campansatlon,
L damages as provided for In section 3708 of the labor rade, Interest, and attorney's fees.
rw
CONSTRUCTION LENDING AGENCY
u I hereby aMrm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for
which this permit Is Issued (Sec. 3997, CN. C.).
s LENDER'S NAME:
r
LENDERS ADDRESS:
Ju
i I certify that I have read this application and slate that the above information Is correct. I agree to comply with all city and
county ordina cos and state laws relating to bottling construction, and hereby authorize representatives of this county to
3 enterupont bove-menlicnedproperty for Inspection purpose
s.
33
n P MITTEE NAME (PRINT}
= SIGNATURE OF PE EE DATE
6
APPLICATION DATE: �'77
ISSUE DATE:PFRMIT#i
TYPE CONST.
P/C#
OCC GROUP:
Scope of Work (
# DWEL. UNITS # STORIES
44
# BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF
ADJ. AREA/VALUATION
SFRIADD/REM
Garage/Carport
Patio/Deck
PATIM
Pool/Spa
z
Re -Roof
11 go Lo
O
Commercial
m
Valuation:
Adj. Area:
QUANTITY DESCRIPTION FEE
J
w
m
ii
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING.
MECHANICAL:
INSPECTION FEE:
ISSUANCE:
SMTP:
ENERGY PIC;
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE;
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
/r
P/C: PAID BY: r
RECEIPT# PAID By. A '!
VALIDATION:
f� VALIDATION
WHITE— Department Copy, YELLOW — Finance Copy, PINK—Assessor Copy
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ETBACK/ LETTER7'M'�7
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TRACT AND LEDGER
FOOTINGS FORMS
SWITCH GEAR
_
_
COMMERCIAL HOOD
UG. PLUMBING
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UG. ELECTRICAL
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INTERCEPTER
FER GROUND
HOT MOP/SHOWERPAN
SEWER I ATERAL
SEPTIC/CESSPOOL
MAIN WATERLINE
HERS REPORT RECEIVED
SEWER CLEANOUT
DEMOLITION
OF SHEATHING
ROOK" DRAINS
FLOOR SHEAT KING
ROUGH CONDUIT
SHEAR WALLS EXTERIOF;
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POOL/SPA
SHEAR WALLS INTERIOR
ROUGH PLUMBING
FRA(VIINGNENTINCx
ROUGH ELECTRICAL
ROUGH MECHANICAL
ROUGH MECHANICAL
ROUGH ELECTRICAL W( ) C (1
GAS TEST
ROUGH PLUMBING
PRE GUNITE �
INSULATION WALL
_
POOL PRE DECK BONDING
INSULATION CEILING
-TRAP
DRYWALL
_P :._.
FENCE / GATE/ ALARM
LATH PR
FINAL POOL
LATH EXTERIOR
WALLS:
LATH INTERIOR
-_ _F_
. — . ", — -_
WALL FOOTING/STEEL
GAS TEST
_ — —
_ sr
WALL STEEL 1 () 2ND( LIFT
SCRATCH COAT
-
WALL BOND BEAM
ELECTRIC, METER RELEASE
WALL DRAIN/ SEAL
GAS METER RELEASE
�. _�.
WALL FINAL
SPECJAL INSPECTION
R0, FRAMING PLANNING APPROVAL
FINAL BUILDING'
FINAL
t
ROUGH FIRE APPROVAL
MECHANICAL
FINAL FIRE DEPARTMENT
FINAL ELECTRICAL
_r
FINAL PLANNING
FINAL PLUMBING
FINAL ENGINEERING/ PW
T.G. of OCCUPANCY
FINAL COMMUNITY SERVICES
CERT. ®4 OCCUPANCY
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FINAL HEALTH DEPT.
IND-USTRIAL
FINAL INDU5TRIAL WASTE
COMMENTS:
_. _
CERTIFICATE OF INSTALLATION
CF2R-MCH-25-14
Refrigerant Charge Verification
(Page 1 of 4)
Project Name: Veloso
Enforcement Agency: Diamond
Bar (City of)
Permit Number:
PR17-17230
Dwelling Address: 1065 Canyon Spring Ln
City: Diamond Bar
Zip Code:
91765
A. System Information
Each system requiring refrigerant charge verification will be documented on a separate certificate.
01
System Identification or Name
Veloso
02
System Location or Area Served
house
03
Condenser (or package unit) Make or Brand
LENNOX
04
Condenser (or package unit) Model Number
14ACX-036-23OA20
05
Nominal Cooling Capacity (tons) of Condenser .
3
06
Condenser (or package unit) Serial Number
19161`37056
07
Refrigerant Type
11410A
08
Other Refrigerant Type (if applicable)
This field or section is not applicable
Liquid Line Filter Drier Installed According to Manufacturers .
Yes
09
Specifications (if applicable)
10
System Installation Type
Alteration
Fault Indicator Display (FID) Status (Note: Even systems with
This system does not have a FID device installed
11
a FID must have refrigerant charge verified by installer).
Is the system of a type that the minimum airflow can be
Yes, this is a ducted system and one of the system airflow
12
verified using an approved measurement procedure (RA3.3
rate measurement procedures in RA3.3 or RA3.3.3 can be
or RA3.3.3)?
used to verify system airflow rate requirements,
Is the system of a type that approved refrigerant charge
Yes, one of the Refrigerant charge verification procedures
verification procedures can be used to verify compliance
from RA3.2.2 or RAI is applicable to this system and can be
13
with the refrigerant charge verification requirements when
used to verify compliance
temperatures are >= 55°F (RA3.2.2, or RAI)?
14
Date of Refrigerant Charge Verification for this system
2017-09-21
Refrigerant charge verification method used.
Subcooling (outdoor temperature must be equal to or
15
greater than 55 degF)
Person who performed the Refrigerant Charge Verification
HVAC system installer
16
reported on this Certificate of Installation
17
HERS Verification Compliance Requirement Status
System qualifies for group sampling
Registration Number: Registration Date/Time: 2017-09-25 18:10:16 HERS Provider: CHEERS
417-A020116812A-002-000-M25000A-0000
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-09-25 18:10:17
2016 Residential Compliance Schema Version: rev 4/7/2017
CERTIFICATE OF INSTALLATION CF2R-MCH-23-H
Space Conditioning System Airflow Rate (Page 3 of 3)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name;
Documentation Author Signature:
Barry Palmer
&WryVaUrner
Company:
Signature Date;
All Pro Air
2017-09-25
Address:
CEA/ HERS Certification identification (If applicable):
1280 Palmyrita Avenue, Suite D
City/State/Zip:
Phone:
Riverside CA 92507
1951-684-0880
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The Information provided on this Certificate of Installation is true and correct,
2, I am either: a) a responsible person ellgibie under Division 3 of the Business and Professions Code in the applicable classification to accept
responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work
identified on this Certificate of Installation and attest to the declarations in this statement, or b) € am an
authorized representative of the responsible
person and attest to the declarations in this statement on the responsible person's behalf.
3. The constructed or installed features, materials, componentsor manufactured devices (the installation) identified on this Certificate of Installation
conforms to all applicable codes and regulations and the €hstallation conforms to the requirements given on the Certificate of Compliance, plans, and
specifications approved by the enforcement agency.
4, 1 understand that a HERS rater will check the installation to verify compliance and If such checking determines the Installation falls to comply, I am
required to offer any necessary corrective action at no charge to the building owner.
5, 1 will ensure that a registered copy of this Certificate of Install' adon t Kaill be posted, or made available with the building permit(s) issued for the
building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy ofthis Certificate of
Installation is required to be included with the documentation the builder provides to the building owner at occupancy.
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Barry Palmer
BarrypaLrre*-
Company Name: finstalling Subcontractor or General Contractor or
Position With Company (Title}:
Builder/Owner)
Contractor/Installer
All Pro Air
Address:
CSLB License:
1280 Palmyrita Avenue, Suite D
9346Q1
City/State/Zip:
Phone:
Date Signed:
Riverside CA 92507
951-684-0880
12017-09-25
Third Party Quality Control Program (TPQCP) Status:
Name of TPQCP (if applicable):
Digitally signed by CHEERSTm, This digital signature is provided in order to secure the content of this registered
document, and in no way Implies Registration Provider responsibility for the accuracy of the information.
Registration Number: Registration Date/Time: 2017-09-25 18;06:07 HERS Provider: CHEERS
417-A020116812 A-002 -000- M 23000A-0000
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-09-25 18:06:08
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF INSTALLATION CF2R-MCH-25-H
Refrigerant Charge Verification (Page 2 of 4)
MCH -25b - Refrigerant Charge Verification - Subcooling Method
B. Metering Device Verification
Subcooling Method can only be used on systems that have a variable metering device.
01
Refrigerant metering device
Thermostatic Expansion Valve (TXV)
02
Subcooling Method applicability status
Subcooling Method is applicable to this system.
C. instrument Calibration
Procedures for instrument calibration are given in Reference Residential Appendix RA3.2.2 and RA3,2.2.2
01
Date of Digital Refrigerant Gauge Calibration
2017-08-31
02
Date of Digital Thermocouple Calibration
2017-08-31
03
Digital Refrigerant Gauge Calibration Status
Calibration is current
04
Digital Thermocouple Calibration Status
Calibration is current
D. Measurement Access Hole (MAH) Verification
Procedures for installing MAH are specified in Reference' Residential Appendix RA3.2,23
01 Method Used to Demonstrate Compliance with the MAH installed and labeled consistent with Figure 3.2-1
Measurement Access Hole (MAH) Requirement
E. Minimum System Airflow Rate Verification
Procedures for verifying minimum system airflow are specified in Reference Residential Appendix RA3.3.3.
01
Minimum Required System Airflow Rate (cfm)
900 `
02
System Airflow Rate Verification Status
System complies with minimum airflow rate requirements
F. Data Collection and Calculations
Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in
Reference Residential Appendix RA3,2.2.
01
Lowest Return Air Dry Bulb Temperature that Occurred
87
During the Refrigerant Charge Verification Procedure (°F)
02
Measured Condenser Air Entering Dry -Bulb Temperature
90
(Tcondenser, db)
03
Outdoor temperature Qualification Status
Outdoor temperature is within range for using Subcooling
refrigerant charge verification method
Registration Number: Registration Date/Time: 2017-09-25 18:10:16 HERS Provider: CHEERS
417-A020116812A-002-000-M25000A-0000
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-09-25 18:10:17
2016 Residential Compliance Schema Version: rev 4/7/203.7
CERTIFICATE OF INSTALLATION CF2R-MCH-25-H
Refrigerant Charge Verification (Page 3 of 4)
F. Data Collection and Calculations
Procedures for determining Refrigerant Charge using the Standard Charge Verification Procedure are given in
Reference Residential Appendix RA3.2.2.
04
Measured Liquid Line Temperature (Tiiquid) (°F)
89
05
Measured Liquid Line Pressure (Pliquid) (psig)
329
06
Condenser Saturation Temperature (Tcondenser, sat) from
Digital Gauge or P-TTable using Line F05 (°F)
97
07
Measured Subcooling (Line F06 - Lilne F04 (°F)
8
08
Target Subcooling from Manufacturer (°F)
10
09
Compliance Statement:
System complies with Subcooling Method - Must also pass
metering device verification, next section
G. Metering Device Verification
Procedures for the verification of proper metering device operation are specified in RA3.2.2.6.2
01
Measured Suction Line Temperature (Tsuction) (°F)
68
02
Measured Suction line Pressure (Psuctim) (P -Sig)
142
03
Evaporator Saturation Temperature (Tevaparator,sat) from
Digital Gauge or P -T Table using Line G02 (°F)
48
04
Measured Superheat (Line G01- Line G03) (°F)"
20`
05
Measured Superheat (Line G04) is between 4'F and 257
(inclusive)
Passes CEC'requirement
06
Measured Superheat (Line G04) is within Manufacturer's
Specifications ( if known)
Yes, documentation to be provided upon request
07
Compliance Statement
Metering device verification passes
MCH -25d - Refrigeration Charge Verification - Fault Indicator Display (FID)
H. Fault indicator Display
This section does not apply to this project.
I. Fault Indicator Display Additional Requirements
This section does not apply to this project.
Registration Number: Registration Date/Tirne: 2017-09-25 18:10:16 HERS Provider: CHEERS
417-A020116812A-002-000-M25000A-0000
CA Building Energy Efficiency Standards Report Version: 2016.1,006 Report Generated: 2017-09-25 18:10:17
2016 Residential Compliance Schema Version: rev 4/7/2017
'CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 4 of 4)
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Jose Cervantez
J°ae cer vavi
Company:
Date Signed:
JC HERS Services, LLC
2017-09-25
Address:
CEA/ HERS Certification Identification (if applicable):
11390 Doverwood Drive
RCN13132
City/State/Zip:
Phone:
Riverside CA 92505
951-217-0805
Responsible Person's Declaration statement
I certify the following under penalty of perjury, under the laws of the State of California:
1. The information provided on this Certificate of Verification is true and correct.
2. l am the certified HERS Rater who performed the verification Identified and reported on this Certificate of Verification (responsible rater).
3. The installed features, materials, components, manufactured devices, or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicable requirements in Reference Appendices RA2, RA3, and the requirements
specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sections of the Certificate(s) of Installation (CF2R) signed and submitted by the person(s) responsible for the
construction or Installation conforms to the requirements specified on'the Certificate(s) of Compliance (CF1R) approved by the enforcement agency.
S. I will ensure that a registered copy of this Certificate of Verification shall be posted, or made available with the building permit(s) issued for the
building, and made available to the enforcement agency for all app[icable inspections. I understand that a registered copy of this Certificate of
Verification is required to be included with the documentation the'builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of installation
Company Name (Installing Subcontractor, General Contractor,* Builder/owner):'
All Pro Air
Responsible Builder or Installer Name:
CSLB License;
Barry Palmer
934601
HERS Provider Data Registry Information
Sample Group Number (€f applicable):
Dwelling Test Status in Sample Group (if applicable)
N/A
HERS Rater Information
HERS Rater Company Name:
JC HERS Services, LLC
Responsible Rater Name:
Responsible Rater Signature:
Jose Cervantez
JCWCevva 1tV1k
Responsible Rater Certification Number w/ this HERS Provider
Date Signed:
RCN13132
2017-09-25
Digitally signed by CHEERS", This digital signature is provided In order to secure the content of this registered
document, and in no way implies Registration Provider responsibility for the accuracy of the information.
Registration Number: Registration nate/Time: 2017.09-25 18:10:56 HERS Provider: CHEERS
417-A020116812A-002-000-M 25000A-M25A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-09-25 18:10:57
2016 Residential Compliance Schema Version: rev 10/16