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HomeMy WebLinkAboutPR17-420IrlHOND BAD CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 PRESS (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY BUILDING PERMIT APPLICATION wnvw.cityofdiamondbar.com buildingrcdiamondbarea.gov JOB SITE ADDRESS Ll- a • 1'19( F APN LOT TRACT OWNER i a'04 £,=t ADDRESS CITY W ZIP TEL. APPLICANT n'__ ;.a z TEL. .4 CONTRACTOR, A iOi.e ADDRESS CITY-` ' ZIP TEL. ARCH/ENG/ DEStGNER ADDRESS 'CITY ZIP TEL, OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the reason(ii) indicated below by the checkmark(s), I have placed next to the applicable Rom(s) [Section 7031.5, Business and Professions Code: Arty city or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement thathe or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter9) 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 7031.5 by any applicant for a permit subjects the appficantto a civil penalty of not more than five hundred dollars ($500). (-) I, as ewneref the property, army employees with wages as Iheirsele compensation, will do j_j all of orCJ portions of the work, and die structure is not intended or offered for sale (Section 7044, Business and Professions Cade: The Contractors' State License Law does not apply to an owner of properly who, through empldyees' 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 wilt have the burden of proving that it was not built or Improved for the purpose of sale.). ()1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Rusiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts farthe projects with a licensed Contractor pu€suantto the Contractors' State License Law). U 1 am exempt from licensure under the Contractor's State License law for the bellowing reasen(s): Date: Sign: By my signature below I acknowledge that, except for my personal residence in which t must have resided ferat feast one year prior to completion of the improvements covered by this permit€ cannot legally sell a structure that I have bulltas an owner -builder it it has not been constructed In its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and P€ofusstons Coda is available upon request when this application is submitted or at the following Web site: httpfwww.loginfo.co.gavlcalaw.himi. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE CLASS: LIC. NO.: EXP. DATE: CONTRACTOR: <_ WORKER'S COMPENSATION DECLAHA ION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Worker's Compensation, as provided by Section 3700 of the Labor Code, for the performance of Ore work for which this permit Is Issued. ,6�­ fHave and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work forwhich thisp rmit is issued. My Worker's Compensation Insurance Carrier and Polley Number are: CARRIER_ a,T"€E n.:^,....L' POLICY NUMBER (PHIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS $300 OR LESS). I codify that in the performance of the work for which this permit is issued, I shall not employ any person in any mannerso as to become subject to the Worker's Compensation Laws of Cafifomia. And agree that if I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Cade, I shall forthwith comply with those previsions. DATE: APPLICANT: WARNING: Failure to secure Worker's Compensation coverage Is unlawful, and shall subject an employer to Criminal penalties and civil tines up to one hundred thousand dollars (S10D,000), in addition to the cost of the compensation, damages as provided forin section 3708 of the labor code, interest, and attorneys fees. CONSTRUCTION LENDING AGENCY € hereby affirm under penalty of perjury that there is a Construction Lending Agency for the performance of the work for which this permit is issued (Sec. 3x97, Cly. Q. LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and stato that the above information Is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of ibis county to enter upon the above-mentioned prop" for inspection purpose i PERMITTFENAM NT) `. SIGNATURE OFPERMITfEE -- DATE APPLICATION DATE: I zt $ 1 yq7 P/C# )r PERMIT# : F _ 4 Z q ISSUE DATE: d 1V --- TYPE CONST, DCC GROUP: Scope of Work # DWEL, UNITS # STORIES # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFH/ADD/REM Garage/Carport 10 Patlo/Deck tai. PooVSpa zRe -Roof Commercial m Valuation: Adj. Area: QUANTITY DESCRIPTION FEE J a cs us w n llff` z M a U 7d' t f V", CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: Sia SMTP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: -6r Oz. BASF: PLOT PLAN: ZONING CLEARANCE: ' -,* I,JYJY- V— l.�i '1A. TOTAL FEES COMMENTS: : F rim: 7 £p (:;-ea3€- ; %, �•r r,crp r PIC: PAID BY: RECEIPTN_��$a— PAID BY: r �ia VALIDATION: VALIDATION:9G' WHITE ---- Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy 0 119, M 22M I f • l COMMENTS: eD E + : CALIFORNIA At-TERATIONS - HVAC z. CERTIFICATE OF COMPLIANCE Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) CF1R--ALT-04-E (Page 1 of 1) Site Addfe : - - bi&cemehtAge[itiy! pate pftairedi p6eirfiiM: Equipment Type Equipment Efficiency New Ducting, Plenums, Lineset: Conditioned Thermostat Requ€red R -value Floor Area (sq ft) ❑Packaged System D Evaporator Cnl€ AFUE COP 0 R-6 (CZ 2, 813) Ducting Served by system © Setback ❑ Split System ❑ Condensing Unit ❑ Mini Split ©Compressor 0 R-8' (CZ 11, 14,15) Ducting s ft q (If not already SEER HSPF ❑ Furnace ❑Lineset ❑ R-6 (ail CZ's) Plenums present must El TXV EER 11R-5 or R7.5) Lineset4 be Installed) HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form IsAfowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: All Equipment, CF3.R-ALT 02-E Condenser Unit, Evaporator Coll, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)z -HERS, MECH-25-HERS' Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERS' Air Handler/Furnace' (Can include new ducting) Installer Requirement: Duct leakage (¢ 155�, or < IN to outside, or seal all accessible leaks), Air Flow >_ 300 CFM/ton, Refrigerant Charge. Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or D 2. There is less than 40 linear feet of duct In unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos "(list ma nuf cture date of building • ❑ 2. New HVAC System Required Compliance Documents ta.be left on site for Final: All new equipment and All New Ducts' CFIR-ALT-02-E including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERS' CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS, MECH-25-1-1�RS2 Mini Splits require CFiR-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350'CFM/tan (or alternative), Refrigerant Charge 113, All New Ducts with Replacement ' Required Compiiance Documents to be left on site for Final: All New. Ductsa and one or more of the following CFIR-ALT-02-E replaced: Condenser Unit, Evaporator Coil, CF2R; MECH-01, MECH-20-HERS, MECH-(23 or24)-HERS, MECH-25-HERS Compressor, TXV, Lineset, Furnace' CF3R: MECH-20-HERS, MECH-(23 or 24) -HERS, MECH-25-HERS installer Requirement: Duct leakage :< 6%, Air Flaw e- 350 CFM/ton (or alternative), Refrigerant Charge Exempted from duct leakage testing if: ❑ 1. Existing duct systems are constructed, insulated or sealed with asbestos ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left onsite for Final` New ducting but less than All New Ducts' CF1R-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS Installer Required to: Duct leakage (<,15% or, < 10% to outside or, or seal all accessible leaks) ❑ EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6when less than 40 ft installed. This includes In walls, between floors etc. ' Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25 a All New Ducts is when at least 75 percent of the duct system is new duct mater€al, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, coil, plenuri-is, duct material) ° R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.51' thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-2%", 2.5-3T-2%`, 3.5 to 4T -2%s', 5T-4%" Cohtlractor (Documentation Author's /Responsible Designer'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 Compliance is true and correct, - 2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. B. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy features and performance specifications, materials, components, and manufactured devices for the building -design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. 5. The building design features or system design features Identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: q Responsible Designer Sig re: Signed: License; Cs° °pate Company: gg Address ,� C€ty/State/(ZiP j /Ph"one':} [/ } p 9tSGL For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: -1-804-772-3300..