HomeMy WebLinkAboutPR17-10334CITY 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 www.cityofdiarnondbar.com building@diamondbarea.gov L 7�
APPLICATION DATE: PIC# P R ^T - 0 om
JOB SITE ADDRESSjj.�� gg
ISSUE DATE: � ®iGJ��PERMIT# : � ��I �' 10339
APIN LOT, e TRAGT_�q7
OWNER le
Al _
CITY
APPLICANT
CONTRACT
ADDRES
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DESIGNER-
ADDRESS-
CITY
ESIGNER-
ADDRESS_CITY
TEL.
TEL.
ZIP
ZIP TEL
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contmclor's State License Law for the reasor(sj
indicated below by the checkmark(s), I have placed next to the applicable item(e) [Section 7031.5, Business and
Professions Code: Any 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 statementthat he or she
is licensed pursuantto the provisions of 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 exemptfmm licensure and the basis for
The alleged exemption. Any violation of Section 7031.5 by any applicardfor a peimif subjects the appiicarrtto advii penalty
of not mare than five hundred dollars ($500).
U 1, as owner of the property, or my employees with wages as their sole compensation, will do O all of or (U portions
of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code. The
Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds
or improves the property, provided that the Improvements are not intended or offered for sale. It however, the building or
improvement is sold within one year of completion, the Owner -Sunder will 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, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuanttothe Contractors' State
License Law.).
(j I am exemptfrom licensure under the Contractor's State License law forthe following reasons):
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,i cannot legally sell a structure that I have built as an
owner-bullder if it has not been constructed In its entirety by licensed contactors. I understand that a copy of the
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: httpfwww.leginio,ca.gavlcalaw,hhnl.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
of Olvlsion 3 of the Business and Professions Cade, and my license is in full force and effect.
LICENSE Cl- LIC. NO.: -711 r -2C_
2 --
EXP. DATE: `" CONTRACTOR:-- WORKER'S IM ASATION DECLARATION
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 Coda, for to performance blithe work forwhich this permit is issued.
I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for
the perform ce the work f r which this permit is issued. My Worker's Compensation Insurance Canter and
Policy Number r
CARRIER � �
POLICY NUMBER Ij, i,.-,
(THIS SECTION NEED NOT BE COMPLETED IF THE PERMITIS FOR ONE HUNDRED DOLLARS $100 OR LESS).
I cerlifythat in the performance of the wodafor 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 Califomla And agree that If I should become subject to the Worker's
Compensation prov�slons of Section 3700 of the Labor Code, k shall forthwith comply with those provisions.
DATE; APPLICANT:
WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal
penalties and civil fines up to one hundred thousand dollars ($190,000), in addition to the cost of the compensation,
damages as provided for in sector 3708 of the Ishor code, interest, and attorney's fees
CONSTRUCTION LENDING AGENCY
I 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. 3U97, Civ, C.).
LENDER'S NAME:
LENDER'S ADDRESS:
I certifythat I have read this application and state thatthe above information is correct. I agree to comply with all city and
county ardlnances and state laws relating to building construction, and hereby authorize representatives of this county to
enter uponthve-ment€onedpr rty or inspectpurpases.
7.-i e. zA
PERMITTEF E(PRIM)
SIGNATURE OF PERMITTEE DATE
TYPE CONST
Scope of
OCC GROUP:
# DWEL. UNITS # STORIES # BEDROOMS
X11
DESCRIPTION SQ. FT, FACTOR I ADJ. AREA/VALUATION
SFR/ADD/Fl
Garage/Carport
PatiolDecic
Pool/Spa
Re -Roof
Commercial
1Valuateon: Adj. Area:
QUANTITY I DESCRIPTION
v
U
w
w
Cz
z
a
U
CONSTRUCTION:
PLAN REVIEW:.
ELECTRIC:
FEE
PLUMBING:
MECHANICAL: t
INSPECTION FEE:
ISSUANCE:
SMIP:
ENERGY PIC:
ENERGY PERMIT:
RETENTION FEE: 2.00
PRE -ALT FEE:-
BASF-.-
PLOT
EE:BASF:PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS: _.
.43
PIC: pp / PAID BY: VALIDATION:
RECEIPT it 15869 PAID BY: v L4 Z33 VALIDATION: L_ C_
WHITE — Department Copy, YELLOW — Finance Copy, PINK— Assessor Copy
COMMENTS:
W I AIS OF
ALTERATIONS m HVAC -
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A.karai.io,is - HVAC CZ 2, 381 { 3S-15 ifQrrre, y HNIAIC)r
1y}ma y 5 f -
Irn-« iip� _
NOW r1ur-tirig, Fi?nur s, �rFr ;; ! Ow4fttquipmen:�sr�w
!
f
Hoar Ar" ,sq -,Q
Packaged i,B per tar Ca=i i v'E I �
COP j i-` rz -, 8-13J Nxmli€, Ser. -sed bv sg
s t cx
f*in'4 �4YFt� r Unit i
,�ys*a M Z7-1, :: amprewlar 4
y s ! 7 3„j %tI 151
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RE ARtrfC&T'30 SUW—A-RY *--e- >.Gs Work to and :,zI she; t , one a -f ,he �, o �4isw. At pa -flt pwka°"on this
3+if3 �F�d ±o be fk{!ed out by :rand.. For "rima# !n e car a!1 warms are to he r €stFr Eno hand ii€€ef# f osrss ano vim'! and a c €8€£ a� site.
ixl,KV. ut1Rw of Reqd CWRpUw t_ to L-- 6ftl oil Me tor r uaj:
ASF rgvp pr=mrii, Cry.? -A i_ra.2_E
aa!, -HERS,
..`3r-5p;��i- iTAV,>i�SCT. ! �`�u. ASF#.?'$- v-,°e���a-.; �'tf:k'�t� C � -. '.3, I ,
Fair W" 4f!?Prto tonar--e (Cap §';Sade new �4��
I. s±ae tar c4 a a�? ie 1S'6, r €TYe q o sides tea` tl cc s� bk sea s=, f €o 3 O C, �\ Tap, Reftg�ran2
rxerapted Irorn duct 4.akage tm i.ng f
i
0 1_ iXxt system reZ!slered with HEM provider as pfev4o;'S' l or 0 2. Twere 3a less t4an 4C, Mean Feet of duct in €mcormlitioirreiz spse-�, -)r
3, xastig dtrastersr cctrriacted, t .sa,iat! seaWd- aica 4qi- rrarr tfac tart datR Cf#iidi rR---
. New KVAC Sys?rr Required raDoc-dr €4i on Ske far Final:
'! Ar! raw ui rrre€tt and tai TvW '€kcts` } r I aR- 11i
nckuding TIMI— Wit IF2R: VfEEH MEC-ji-20-� &6. NI {�3 �r �?{- ���, �E�ii-s3-3„�v3
-1ni Smits require !_FF7R-,4L -02-F, CrZR- ECH3 I, and ?CP2F-CRR)
1 x . zlqu3re r Cacti iea"Pp- < 6%., ��jn cf#'rcac [ ! fCF ;, .Air %-W �'$50 UIVIJ?-on :*r aite"Abve4, Ref geram Qlarge_
0 3.. New Duffs i 1 Regfateam nt ! Required Campli m t? gents to he 3 F m4. �
or cry a, liteutfo 3 ! K -A _T W -E
1 repl';Ked; CQfrdens- iias cuaporatur CoqCF2R;
C s €asa�i, ” XXV,_Ur _f .urm&cez Cg39�EC!i-2,7,-4?i?.9 MKIR-23 m 24f -HERS,
Wer RewiremeRr Due, Geak e - 6%, Air 0ow.�t 350 CFaVi`^ , fes= R gemt :-narg
r
T Exempted €r o-ri &ctlleakage tesu'rs 01 Esks-,�.-- duct >yttars are :.asst; uctea, !mowed Or sea �4t7- asbestos I
Q 4, .New Ducbng ova 40 fest v itequired Compfiwwe 0cau menft to be Uft on Ate #sect a
! ieve doctj'r;g bL?t!ess than A€9 dew Ducts' CF3R-4i.T-W-r, Ut:2R, MWCH-21.3 HERS, MR:
10% -r 54=--{ ail accesdb?v+' e 5j
e
EXCE6=a zt}N: wxisiii+g trate sterns constructed, insst#ateci act seated with ashes2o5.
{ ' At! d Ret rrg R 8 r eu �s`, ea rt h t € 4€7 €i irtst std �t+ten �s thaa 40 z ir;s-t;bed, This =n -6u des ;.n t�aj�, betW n " r y x,C
! `
F"eating ark system s and A anges do nat ;equine Air kcw NHCK {23 ::�- 24), ar Reff apt. h`ar e Tesiftc:at oo on -M ECH-25
a U' i ew uc s < when at ieas D to .25 re€cert rr-- -ormsr as reL';ad Raft-na--
Ir
[ 4?Wetin" g unit's ex7StiN duct-YsTern a -g- mgistorS, air har,€3ier, C'53, plei umr , dwt maateria; l
' -S (1" ter snsr:(at c1) fvs *assts 3 and 5s. R-7.5 1.5' thick in svlatdonl for 4ineses a'xer 1 Moll. _Ni t rnsg wM ri squire Stkriicr rine Miamater
with ins�Aaflwas the "ra4ow.m i.�,2 g-2�is": 2.5 -3T -Z%', 15 to 4T -ZX', ST -4X'
t�or 4�3+sa tion tbar Res r € % es ;r€ 's °arats ra t r sit
3 ce-:tilfy t"lie "S orw under Pena" ur- r thelaws of the 5tate of Gaff Iia:
L �!-�rt�.'mformatiwn. prviAded o? this €':. i� '-� of LamwrfamE 2 3s tru*' C;43 t4r`?rCi.
' # am.ri* i nEfte, :..iVS� o me Caaiifar74R 3Emn—,-.S a? -d p mil ssi3ra.� CC -de 8v-*Czerii resp o*S-EF irS Tvt tihe GTI tNs
3. Ti'Sa€',,a"r@ *!FINiB- t4ai!ar-x-. an! 5i?r4tF'•'"2r 53iaCR spec If€C3tpLl.rlS far ripe design i0eF?tifi2d or, this C@riF�SC2t€ 3i com;]ifalrYe Pt35?iE+r>r± tothe
i
req€ 4n of T;fe 24, ?parts 1 anj F of the caiif-,rrig 4Ce of R : tfars (CCR),
4, That rite energV feat m.5 and parforrrance ;pec!fi o s, ma eriaia componerts, atar; aruS rtt r 4�ev3c-es far the b� fd:rq de5%z, 'Ir
j ue gr i d -3� is certWcate of C=piarree CQrrfQ;M M the regpr--ern4rrts c T -He 24, Part A zmd Par -L6 W IN- CCP..
} 5, ; he dug direr saf; �? irae r steer design f atur €&r%of r- an this Certificate of Co pli�ce are cu s 'Stent with t� !r Eormetso
pro -Ad o� u-ther aipplicable compjarrce dov-wrre l nets, cakulabom, pans and sseclf3cations suiasrri<ted to the erafmrc�€txertt
! "�as;e�r €tee aerx vat ssi 2HiS utid"€r}e Derr at a ication.
-70_-
rr any: ' C'aq, /Zir rbc
U - s//r/i�j irk ' `{el�! 1
Rwassistwre or q46-dom regarding the Energy 3tandar.4s, contact the EneM Hottane at. 1-300-772--3300
CERTIFICATE OF VERIFICATION
CF311-MCH-25-11
Refrigerant Charge Verification
(Page 1 of 4)
Project Name: Victor Bermudez
Enforcement Agency: Diamond
Bar (City of)
Permit Number: PR17-10334
Dwelling Address: 1129 FLINTLOCK RD
City: DIAMOND BAR
Zip Code: 91765
A. System Information
HERS Rater to field -verify all system information, discrepancies to be noted by overwriting entry.
01
System Identification or Name
SYSTEM 1
02
System Location or Area Served
WHOLEHOUSE
03
Condenser (or package unit) make or brand
LENNOX
04
Condenser (or package unit) model number
XC16-060-230-05
05
Nominal Cooling Capacity (tons) of Condenser
5
06
Condenser (or package unit) serial number
5817GO3549
07
Refrigerant Type
_R -410A
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 RD 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
2017-08-30
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
HERS rater
16
reported on this Certificate of Installation
17
HERS Verification Compliance Requirement Status
System does not qualify for group sampling
1 8
Refrigerant charge verification method used by HERS Rater.
Subcooling
g
Registration Number: Registration Date/Time: 2017-09-01 23:27:36 HEKS Provider: CHEEKS
417-A020106017A-004-000-M 25000A -M 25A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-09-01 23:27:36
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 2 of 4)
MCH -25b - Refrigerant Charge Verification - Subcooling Method
B. Metering Device Verification
HERS Rater is required to visually field verify all information from CF2R. Subcooling Method can only be used on
systems that have a variable metering device.
01 1 Refrigerant metering device
02 1 Subcooling Method applicability status
Thermostatic Expansion Valve (TXV)
Subcooling Method is applicable to this system.
C. Instrument Calibration
HERS Raters are required to calibrate their diagnostic tools. 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
2017-08-01
02
Date of Digital Thermocouple Calibration2017-08-01
03
Digital Refrigerant Gauge Calibration Status
Calibration is current
04
Digital Thermocouple Calibration Status
Calibration is current
D. Measurement Access Hole (MAH) Verification
HERS Raters are required to visually field,
verify MAH.,procedures for installing MAH are specified in Reference
Residential Appendix RA3.2.2.3
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)
1500
System complies using the alternative remedial actions
02
System Airflow Rate Verification Status
specified in RA3.3.3.1.5. This System does not qualify for
group sampling
F. Data Collection and Calculations
HERS Rater must independently collect all data in this section. Procedures for determining Refrigerant Charge using
the Standard Charge Verification Procedure are given in Reference Residential Appendix RA3.2.2 and RA3.2.2.2
Lowest Return Air Dry Bulb Temperature that occurred 74
01 During the Refrigerant Charge Verification Procedure (°F)
Registration Number: Registration Date/Time: 2017-09-01 23:27:36 HERS Provider: CHEERS
417-A020106017A-004-000-M 25000A -Ni 2SA
CA Building Energy Efficiency Standards Report Version: 2016,1.006 Report Generated: 2017-09-01 23:27:36
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 3 of 4)
F. Data Collection and Calculations
HERS Rater must independently collect all data in this section. Procedures for determining Refrigerant Charge using
the Standard Charge Verification Procedure are given in Reference Residential Appendix RA3.2.2 and RA3.2.2.2
02
Measured Condenser Air Entering Dry -Bulb Temperature
91
02
(Tcondenser, db)
140
03
Outdoor Temperature Qualification Status
Outdoor temperature is within range for using Subcooling
Digital Gauge or P -T Table using Line G02 (`F)
refrigerant charge verification method
04
Measured Liquid Line Temperature (Tiiq.Td) (`F)
97
05
Measured Liquid Line Pressure (Piigo d) (psig)
311
Condenser Saturation Temperature (Tcondenser, sat) from
99
06
Digital Gauge or P -T Table using Line F05 ('F)
Yes, documentation to be provided upon request
07
Measured Subcooling (Line F06 - Lilne F04 (°F)
2
08
Target Subcooling from Manufacturer (°F)
5.
09
Compliance Statement:
System complies with Subcooling Method Must also pass
metering device verification, next section
O. Metering Device Verification
HERS Rater must independently collect all data in this section. Procedures for the verification of proper metering
device operation are specified in RA3.2.2..6.2,,
01
Measured Suction Line Temperature (Tsuction) (°F)'
63
02
Measured Suction Line Pressure (Psuction) (psig)
140
03
Evaporator Saturation Temperature (Tevaporator, sat) from
49
Digital Gauge or P -T Table using Line G02 (`F)
04
Measured Superheat (Line G01- Line G03) (°F)
14
05
Measured Superheat (Line G04) is between 37 and 26°F
Passes CEC requirement
(inclusive)
06
Measured Superheat (Line G04) is within Manufacturer's
Yes, documentation to be provided upon request
Specifications ( if known)
07
Compliance Statement:
Metering device verification passes
H. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
01 9 Complies: All specified verification protocol requirements on this document are met.
Registration Number: Registration Date/Time: 2017-09-01 23:27:36 HERS Provider: CHEERS
417-A020106017A-004-000-M 25{}OOA-M 25A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-09-01 23:27:36
2016 Residential Compliance Schema Version: rev 10/16
CERTIFICATE OF VERIFICATION CF3R-MCH-25-H
Refrigerant Charge Verification (Page 4 of 4)
Documentation Author's Declaration Statement
1. I certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Garrett Williams
(i �rewWa'`a*%
Company:
Date Signed:
I Permit E Raters
2017-09-01
Address:
CEA/ HERS Certification Identification (if applicable):
31225 La Baya Drive
RCN13056
City/State/Zip:
Phone:
Westlake Village CA 91362
818-735-7876
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. 1 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,applicai le regy rements 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 Certificates)"of Installation (CF 2R) signed and submitted by the person(s} responsible for the
construction or installation conforms to the requirements ,specified;nn th,e=Certificate(s) of Compliance (CF1R) approved bythe enforcement agency.
S. I will ensure that a registered copy of this Certificate of VerrFicationshall be posted, or made available with the building permit(s) issued far the
building, and made available to the enforcement agencyfor all applicable inspections. I understand that a registered copy of this Certificate of
Verification is required to be included with the documentationthe'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, dr guilder)Owner):
Service Champions
Responsible Builder or Installer Name:
C5LI3 License:
Austin Smith
799170
HERS Provider Data Registry Information
Sample Group Number (if applicable):
Dwelling Test Status in Sample Group {if applicable}
N/A
HERS Rater Information
HERS Rater Company Name:
I Permit E Raters
Responsible Rater Name:
Responsible Rater Signature:
Garrett Williams
Cycu-rettW%7x+.dffW
Responsibie Rater Certification Number w/this HERS Provider:
Date Signed:
RCN 13056
2017-09-01
Registration Number: Registration Date/Time: 2017-09-01 23:27:36 HERS Provider: CHEERS
417-A020106017A-004-000-M 25000A -M 25A
CA Building Energy Efficiency Standards Report Version: 2016.1.006 Report Generated: 2017-09-01 23:27:36
2016 Residential Compliance Schema Version: rev 10/16