HomeMy WebLinkAbout21119 SILVER CLOUD DRM-1. ND also
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
218.10 Copley Drive, Diamond Bar, CA 91765
909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027
BUILDING PERMIT APPLICATION
JOB SITE ADDRESS A
L
APN LOT TRACT
OWNER N
ADDRESS W toC-4
CITY ZIP 91 + TEL.
APPLICANT TEL.
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CONTRACTOR A z_eq-pt
nn AA
ADDRESS ' (_ A 4r (?1 rT^
q p ,gyp
CITY ( i ZIP 7-M TEL. IWO'/ S9 K 3 / t7
ARCH/ENG/DESIGNER
u ADDRESS
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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(s)
uIndicated below try the checkmark(s), 1 have placed next to the applicable item(s) (Section 70315, Business and
Professions Code: Any city or county that requires a permit to construcl, alter, Improve, demolish, or repair, any
M structure, prior to Its issuance, also requires the applicant for the permit to file a signed statement that he or she
Is Bcensed 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 sheds exempt from licensure and the basis for
o the alleged exempton.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).
CD U 1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions
U 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
u 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 it was not bullt
5 or improved for the purpose of sale.).
I, as owner o1 theU 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 the Contractors' State
License law.).
j 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 permil,l cannot legally sell a structure that I 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 Professlons Code Is available upon request when this application is submitted or at
the following Web site: http/www.leginfo.ra.gov/calaw.htmi, w.leginfo.ra.gov/calaw.htmi,
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. ''^^
V7LICENSECLASS: __0_20 LIG ND
1 DATE: CONTRACTOR: /
WOR 'S CLARATION
1 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 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
the performance of the work for which this permit is Issued. My Worker's Compensation Insurance Carrier and
Policy Number are:
r CARRIER
j POLICY NUMBER
TEAS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($700) OR LESS).
I certify that in the performance of the work fa which tfds permit is issued, I shag not employ any person in arty manner so as to
r became subject to the Worker's Compensation Laws of Californian d agree that If I should become subject to the Worker's
Compensa prwis' sof Section 370,0 of Bre Code I ag forthwith co ose provisias.
DATE: APPLICANT
i WARNIN Fallur to secure Worker >C,11 sob all is unlawful, and shall subject an employer to criminal
i penalties and civil fines up to one hundred dollars ($100,000), in addition to the cost of the compensation,
damages as provided for in section 3708 o1 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 ADDRESS:
I certlly that I have read this appllation and slate that the above information is correct. I agree to comply with all city and
county ordinances and state taws relating to building constructi n, and hereby authorize representatives of this county to
enter upon the above-mentioned property for Inspection pu
RZ,.
T-29// eJiTS
PERMEE NAME NT)
TUBE OF DATE
RESS
FIRMLY
APPLICATION
DATI:
P/C#
ISSUE DATE: PERMIT# 3 - l
TYPETYPE CONST. OCC GROUP:
42 7 -
ZONING SETBACKS
FRONT
REAR
SIDE/SIDE STREET
SIDE
RW
RW
PROPOSED USE
DWEL. UNITS # STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADD/REM
Garage/Carport
rnW Patio/Deck
LL Pool/Spa
ZRe Roof
9 Commercial
rD
Valuation: Adj. Area:
QUANTITY DESCRIPTION FEE
w
CD
J
a
C.
Z Lc.,y
x
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
INSPECTION FEE:
ISSUANCE: S Z
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
Z• DO
BSAF:
TOTAL FEES
COMMENTS:
RECEIPT PAID BY VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
COMMENTS:
CERTIFICATE OF FIELD VERIFICATION & DIAGNOSTIC TESTING CF-4R-MECH-25
Refrigerant Charge Verification - Standard Measurement Procedure (Page1 of 6)
Site Address: Enforcement Agency: Permit Number:
21119 Silver Cloud dr, Diamond Bar CA 91765 City of Diamond Bar 13-01422
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge
verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to
demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not
required for compliance, when a CID is utilized for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an
additional form(s) for any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge
verification is required for compliance, TMAH are also required for compliance, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in Su DDIv and Return Plenumc of Air 41wnAlnr
System Name or Identification/Tag System 1
System Location or Area Served". Whole House
5/16 inch (8 mm) access hole
1 upstream of evaporative coil: in the Yes Yes Yes Yes
return plenum and labeled according No No No No
to Figure,in--Section RA3.2.2.2.2:
la
Return:side of the duct system is r> t $J' r. w N.
located entirely within conditioned" Yes., Yes Yes Yes
space and return airflow temperature No ' No No Notoibe;measured1at the return grille. tet'+
i •A
5/1'6 ,inch, 8=mm --acces's hole `
downstream of evapora'tive`coil in,;the Yes Yes Yes2
supply plenum and labeled according No No No
Yes
No
to Figure in Section RA3.2.212.2.
The TMAHCompliance Option should be checked only if the HERS Rater is able to confirm that it was
physically impossible for the HVAC Installer to drill the TMAH as required by Section RA3.2.2.2.2. Using this
Compliance Option requires the: HVAC installer to annotate on the HERS Provider's data registry anexplanationastowhytheTMAHcannotbeinstalledonthesystem, and photographs of the equipment on
which the TMAH cannot be installed. Use of this Compliance Option also requires minimum airflow
verification through the direct measurement of airflow per RA3.3. For more information seehttp://www.erieray.ca.ciov/title24/2008standards/specual case appliance/
TMAH Compliance Option [3
Yes to 1 and 2, or Yes to la and 2, or
ss l3 Pass l3 PasscheckingtheTMAHComplianceOption, is Pass rO!Failapass. Fail 13Fail E3 Fail
Enter Pass or Fail
neg: Z15-AUUbbb4yA-M2500001A-M25A Registration Date/Time: 2013/08/15 03:34:22 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms
February 2013
INSTALLATION CERTIFICATE CF-6R-MECH-2I-HERS
Duct Leakage Test — Existing Duct System Page 1 of 2)
Site Address:
21119 Silver Cloud dr, Diamond Bar CA 91765 (System Enforcement Agency: Permit Number:
1) City of Diamond Bar 13-01422
Enter the Duct System Name or Identification/Tag: System 1
Enter the Duct System Location or Area Served: Whole House
Note: Submit one Installation Certificate for each duct system that must demonstrate compliance in the
dwelling.
This installation certificate is required for compliance for alterations and additions in existing dwellings to
space conditioning systems and duct systems.
Note: For existing dwellings, a completely new or replacement duct system can also Include existing parts of
the original duct system (e.g., register boots, air handler, coil, plenums, etc.) if those parts are accessible
and they can be sealed. For a completely new or replacement duct system installed In an existing dwelling,
use the Installation Certificate titled "Duct Leakage Test - Completely New or Replacement Duct System. "
Duct Leakage Diagnostic Test - existina duct system
Select one compliance method from the following four choices.
1. Measured leakage less than 15% of fan flow
17 2. Measured leakage to outside less than 10% of Fan Flow
E3 3. Reduce leakage by 60% and conduct smoke and fix all leaks
4. Fix all accessible leaks using smoke and HERS rater verify
Note: (One of Options 1, 2 or 3 must be attempted.,pefore_utilizing,Optign 4.),
Determine nominal FanFlow using one or•the following tRree' calculation methods ' '" t V
Coo ng;system rriethod: Size of condenser in Tons 4' 'x 400 = 1600. CFM
e
Heating system method 21.7")1Output Capacityin, housandofs Btur —
1
CFM { F. h
y /
O Measured system airfl&4 usmg:RA3.3 airflow/test procedures - ' CFM
1
joptidifl-'Used'then:
Allowed leakage = Fan Airflow 1600 x 0.15 = 240 CFM
Actual Leakage = 233 CFM,'
Pass if Actual Leakage is less than Allowed leakage IM Pass Fail
Option 2 used then:
2 Allowed leakage = Fan Airflow; x 0.10 = _ CFM
Actual Leakage to outside. = CFM
Pass If Actual leakage to outside is less than Allowed leakage Pass Fail
Option 3 used then:
Initial leakage prior to start of work = CFM
Final leakage after sealing all accessible leaks using smoke test = CFM
3 Initial leakage _ - Final leakage _ = Leakage reduction _ CFM
Leakage reduction _ / Initial leakage _) x 100% _ % Reduction
Pass If % Reduction >= 600/a nPassj3Fail
Option 4 used then:
4 All accessible leaks repaired using smoke test. HERS rater must verify (No Sampling).
Pass if all accessible leaks have been repaired using smoke Pass Fail
Reg: 213-A0056649A-M2100001A-0000 Registration Date/Time: 2013/08/04 16:31:19 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forms March 2010
INSTALLATION CERTIFICATE CF-6R-MECH-25-HERS
efrigerant Charge Verification - Standard Measurement Procedure (Page 1 of 6)
Site Address: Enforcement Agency: Permit Number:
21119 Silver Cloud dr, Diamond Bar CA 91765 City of Diamond Bar 13-01422
Note: If installation of a Charge Indicator Display (CID) is utilized as an alternative to refrigerant charge
verification for compliance, a MECH-24 Certificate (instead of this MECH-25 Certificate) should be used to
demonstrate compliance with the refrigerant charge verification requirement. TMAH and STMS are not
required for compliance when a CID is utilized for compliance.
As many as 4 systems in the dwelling can be documented for compliance using this form. Attach an
additional form(s) for any additional systems in the dwelling as applicable.
Temperature Measurement Access Holes (TMAH) and Saturation Temperature Measurement
Sensors (STMS)
Procedures for installing TMAH are specified in Reference Residential Appendix RA3.2. If refrigerant charge
verification is required for compliance, TMAH are also required for compliance, unless the TMAH Compliance
Option is chosen.
STMS are only required for completely new or replacement space -conditioning systems that utilize
prescriptive compliance method.
TMAH - Access Holes in SUDDIv and Return Plenums of Air Handler
System Name or Identification/Tag System 1
System Location or Area Served . Whole House
5/16 inch (8 mm) access hole
1 upstream of evaporative coil in the Yes Yes Yes Yes
return plenum and labeled according No No No No
to Figure,in-Section RA3.2.2.2.2.
Return side of the duct systemais'F'
1a located;entirely Within,conditioned Yeses l7rYes' 7 Yes 'x
x
Yes
space and return airflow teriiperature 1 No„. No' Noy No
to be;,measurediat the.return_`grille.
5/i°6 inch (8fmm)access h'ole
downstream "'of evaporative coil in the
Y
Yes Yes -" 2 Yes :;' i.,- ,Yes'
supply plenum and labeled according No No No No
to Figure in Section RA3.2.2.2.2.
The TMAH Compliance Option should be checked only if it is physically impossible to drill the TMAH as
required by Section RA3.2.2.2.2:. Using this Compliance Option requires the HVAC installer to annotate on
the HERS Provider's data.registry an explanation as to why the TMAH cannot be installed on the system,
and photographs of the equipment on which the TMAH cannot be installed. Use of this Compliance Option
also requires minimum airflow verification through the direct measurement of airflow per RA3.3
For more information see htti)://www.eneray.ca.ciov/twtie24/2008standards/special rasa annliangg
TMAH Compliance Option
Yes to 1 and 2, or Yes to la and 2, or
checking the TMAH Compliance Option, is Pass Pass Pass 123 Pass
a pass. Fail Fail ID Fail Fail
Enter Pass or Fail
Reg: 213-A0056649A-M2500001A-0000 Registration Date/Time: 2013/08/04 16:35:58 HERS Provider: CalCERTS, Inc.
2008 Residential Compliance Forma March 2013