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Home My WebLink AboutPR 13-1638.pdfDIAL IO II BAR v xG t•,•x CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION /I./ JOB SITE ADDRESS ; APNLOT TRACT OWNER NG LIt ADDRESS CM 7_3 3S— got -04g" SDK11455 CITY VIA W016.e pf 95$& ZIP TEL. APPLICANT,YC,6h Z,aX*_Z7 TEL.Mo C_2 :NXZ CONTRACTO R``Z/0*—_G • 'T7* HT#1e ADDRESS 122 • Rg % CJS 6 P CITY /i ,aCAtl/ ZIP 7 I TEL. 32, 62x`3/32 ARCH/ENG/DESIGNER 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 reasons) indicated below by the chackmark(s), I have placed next to the applicable ilem(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, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she Is licensed pursuant to 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 exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a 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 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. H however, the building or improvement is sold within one year of completion, the Owner -Bulkier will have the burden of proving that it was not built or improved for the purpose of sale.). U I, 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 pursuant to Die Contractors' State License Law.). U I am exempt from licensure under the Contractor's State License law for the following reason(s): 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,l cannot legally sell a structure that 1 have built as an owner -builder If 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 Professions Code Is available upon request when this application is submitted or at the following Web site: http/www.leginfo.ca.gov/calaw.html. DATE: SIGN: 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 Division 3 of the Business and Professions Code, and my license is in full force and effect. - IJCENSE CLASS: L ZHh. LIC. NO.: DATE: '" 3 CONTRACTOR: 7 WORKER'S COMPENSATIO&ICL.AATION 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 Compersation, as provided by Section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for Me performance of the work for which this permit Is issued. My Worker's Compensation Insurance Carrier and Policy Number are: CARRIER S'rw-T`i_ fZ J, POLICY NUMBER 171p, 44 ! "2tD THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS). I ceAl(y that in the performance of the work for which this permit is issued, I skill not employ any person in any manner so as to become subject Lato the Worker§ Compensation Laws of California. And agree that it I should become subject to the Worker's Comppensation provisions of Section 3700 of the e, I shall forthwith comply with those provisions. DATE.—( 3 APPUCANT: 1 WARNING: Failure to secure Worker's CompensatiM c erage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the cost o1 the compensation, damages as provided for In section 3768 of the labor 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. 3097, Civ. C.). LENDER'S NAME- LENDER'S AMELENDER'S ADDRESS: I certify that I have read this application and state 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 this county to enter upon the above-mentioned property for inspection purposes. PERMITTEE NAME (PRINT) 31 SIGNATURE OF PERMITTEE PATE PRESS FIRMLY APPLICATION DATE' ISSUE DATE: 3 TYPE CONST. P/C# PERMIT# AlIf t/438 OCC GROUP: ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE RW RW PROPOSED USE DWEL. UNITS If STORIES # BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport c/1LU LL c7Z m Patio/Deck Pool/Spa Re -Roof Commercial Valuation: Adj. Area: QUANTITY DESCRIPTION FEE f C i ko` w w cozm Jd tum Co w CONSTRUCTION: PLAN REVIEW: ELECTRIC: Q PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: r Q SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE -ALT FEE: BSAF: TOTAL FEES COMMENTS: QG• . 7 '28J ( A / RECEIPT # PAID BY: V VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD— F le Copy, GREEN — Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD COMMENTS: Simplified Prescriptive Certificate of Compliance: 2008 Residential HVAC CF -IR -ALT -HVAC Climate Zones 2, 9 Site Address: — 6 Enforcement Agency: Date: Permit #: 23 Conditioned Equipment T eI List Minimum Efficiency 2 Floor Area Duct insulation requirement Thermostat Packaged Unit Furnace AFUE COPSetbackBServedbysystem Over 40 ft of ducts added or replaced in unconditioned Indoor Coil EER / 3RIE HSPF Q- sf space' not already present, Condensing Unit ER Resistance p R 6 (CZ 2 and 9) must be installed) Other R, Ctimd L Equipment Type: Choose the equipment being installed; if more than one system, use another CF -1 R -ALT -HVAC for each system. 2. Minimum Equipment Efficiencies: 13 SEER, 78%AFUE, 7.7HSPF for typical residential systems. HERS VERIFICATION SUMMARY Listed below are four HVAC alteration Options. The installer decides what work is being done and picks one of the appropriate Options. Each Option lists the HERS measures that must be conducted. A copy of the forms shall be left on site for final inspection and a copy given to the homeowner. At final, the inspector verifies that the work listed on this form was in fact the work completed by the installer. ,The inspector also verifies that each appropriate CF -6R and registered CF -4R forms (no hand filled CF-4Rs allowed) are filled out and signed. Beginning October 1, 2010,•a registered copy of the CF -1R and CF -611 shall also be on site for final inspection. HVAC Changeout Required Forms: All HVAC Equipment replaced CF -6R forms: MECH-04, MECH-2I-HERS and (for split systems) MECH-25-HERS CF -4R forms: MECH-21 and fors lits stems MECH-25 Condenser Coil and/or CF -6R forms: MECH-2I-HERS and (for split systems) MECH-25-HERS Indoor Coil and/or CF -4R forms: MECH-21 and (for split systems) MECH-25 Furnace For Split Systems: Duct leakage < 15 percent; RC, CCA > 300 CFM/ton, TMAH For Packaged Units: Duct leakage < 15 percent Exempted from duct leakage testing if: 1. Duct system was documented to have been previously sealed and confirmed through HERS verification, or 2. Duct systems with less than 40 linear feet in unconditioned space, or Existing ducts stems are constructed, insulated or sealed with asbestos 2. New HVAC System Required Forms: Cut in or Changeout with new ducts: (all CF -6R forms: MECH-04, MECH-20-HERS and (for split systems) MECH- 25 -HERS new ducting and all new equipment) CF -4R forms: MECH-20 and (for split systems) MECH-25 For Split Systems: Duct leakage < 6 percent; RC, CCA > 300 CFM/ton, TMAH. For Packaged Units: Duct leakage < 6 percent 3. New Ducts with Replacement Required Forms: Includes replacing or installing all new ducting and/or outdoor condensing unit CF -6R forms: MECH-04, MECH-20-HERS,and (for split systems) MECH-25-HERS and/or indoor coil and/or furnace. Not all CF -4R forms: MECH-20 and (for split systems) MECH-25 equipment chan ed. For Split Systems: Duct leakage < 6 percent, RC, CCA > 300 CFM/ton, TMAH. For Packaged Units: Duct leakage < 6 percent 4. New Ducting over 40 feet Required Forms: Includes adding or replacing more than 40 CF -6R forms: MECH-04, MECH-2I-HERS linear feet of duct in unconditioned space. CF -4R forms: MECH-21 For splits stem or packaged units: Duct leakage < 15 percent EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos. Contractor (Documentation Author's /Responsible Designer's Declaration Statement) I certify that this Certificate of Compliance documentation is accurate and complete. I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the design identified on this Certificate of Compliance. 1 certify 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. The design features identified on this Certificate of Compliance are consistent with the information documented on other applicable compliance forms, worksheets, calculations, plans andspecifications submitted to the enforcement agency fbj approval with the permit application. Name: J0AV, 2*0#- 4- Signature: Company: V 7,4,f 77,4 H-76--; Date: Address: P -'V - ec "6 License: J City/State/Zip: J L71f? Z-Cioly e-* • %d ` Phone: 3z3 6 2 7-3/-? 2008 Residential Compliance Forms July 2010