HomeMy WebLinkAboutPR 14-5041DIVIOND BAR,
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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
JOB SITE ADDRESS 2 ~�
APN LOT TRACT
OWNER
ADDRESS I / h
CITY r ZIP 6j 1,7 1` TEL. Me W i
APPLICANT A &01rMQ-LJ TEL.
CONTRACTOR
ADDRESSJ I f i>
CITY _)(4e q G.lir)a ZIP Vk TEL. —7 q !, a
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 reason(s)
Indicated below by the checkmark(s), I have placed next to 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, 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. 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 built
or improved for the purpose of sale.).
U 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 pursuant to the 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 pennit,l cannot legally sell a structure that I have built as an
owner -builder if it has not been constructed In Its entirety by Ilcensed contractors. I understand that a copy of the applicable
law, Section 7044 of the Business and Professions Code is avallable 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 andProfessions Cade, and my license is in full force and effect
LICENSE CLA : Com"2 b LIC. NO.: _
DATE: l CONTRACTOR:A ?^
WORKER'S COMPENSATION 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 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 -
CARRIER
l
CARRIER � `llp, r
POLICY NUMBER �,L ) P3AAA ^`x !7�
(THIS SECTION NEED NOT BE COMPLETED IFTHE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS).
I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to
become subject to the Worker's Compensation Laws of California And agree that if I should become subject to the Workers
Compensato pro 'ions of Section 3700 of the or Code, I shall forthwith comply with those provisions.
GATE: �: APPIJCANT:
WARNIN : Failure to secure Worker's Com nsatio coverage is unlawful, and shall subject an employer to criminal
penalties and civil fines up to one hundred thousa d dollars ($100,000), in addition to the cost of the compensation,
damages as provided for in section 3708 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, Cly. C.).
LENDER'S NAME:
LENDER'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.
604
PERMITTEE NA PRI
r
SIGNATURE OF E DATE
PRESS
FIRMLY
APPLICATION DATE: P/C#
ISSUE DATE: {,/IOI;WIIIA PERMIT# pR%y - -5 041
TYPE CONST. OCC GROUP:
ZONING SETBACKS
FRONT RW
REAR
SIDE/SIDE STREET RW
SIDE
❑
❑
❑
❑
PROPOSED USE
# DWEL. UNITS If STORIES If BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
Garage/Carport
rA
LU
Patio/Deck
LL
PooVSpa
ZRe
-Roof
D
J
Commercial
m
Valuation: Adj. Area:
QUANTITY DESCRIPTION
FEE
U
J
w
co
i
_0
dz
f
CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
d Q 44
INSPECTION FEE:
ISSUANCE:
3
SMTP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
2-00
BSAF:
TOTAL FEES
COMMENTS:
7
RECEIPT # !� PAID BYVALIDATION:_
WHITE — Department Copy, YELLOW — Finance Copy, PINK —Assessor Copy, GOLDENROD — File Copy, GREEN — Applicant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
�9103k,filkyliggs. `c/ .mtiiir, -
Al 4
Sv F CALIFORNIA
A ,_W_AATIONS - HVAC
GEG-CHR-ALT-04-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION
CERTIFICATE OF COMPLIANCE CF1R-ALT-04-E
- Alterations - HVAC CZ 2, and 8-15 (formerly CF -IR -ALT -HVAC) (Page 1 of 1)
Site -Address' . -
Enforcement Agency:
Date Prepared:
Pe`r'rnit#:
`
Equipment Type
Equipment Efficiency
New ucti g, Plenums, Lineset:
Conditio ed
Thermostat
Required R -value
Floor Area (sq ft)
❑ Packaged System
❑ Evaporator Coil
AFUE
COP
❑ R-6 (CZ 2, 8-13) Ducting
Served by system
❑ Setback
❑ Split System
❑ Condensing Unit
❑ R-8' (CZ 11, 14, 15) Ducting
'qft
(If not already
❑ Mini Split
❑ Compressor
SEER
HSPF
❑ R-6 (all CZ's) Plenums
present, must
Furnace
❑Lineset
EER
❑ R-5 or R7.5) Lineset'
be installed)
❑
HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this
form is allowed 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.
❑ 1. HVAC Changeout/Repair
Required Compliance Documents to be left on site for Final:
All Equipment,
CF1R-ALT-02-E
Condenser Unit, Evaporator Coil,
CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24)2 -HERS, MECH-25-HERSZ
Compressor, TXV, Lineset,
CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS'
Air Handler/Furnace2 (Can include new ducting)
Installer Requirement: Duct leakage (:<_151%, or < 10% to outside, or seal all accessible leaks), Air Flow z 300 CFM/ton, Refrigerant Charge.
Exempted from duct leakage testing if:
❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned or
space,
❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building 1
❑ 2. New HVAC System Required Compliance Documents to be left on site for Final:
All new equipment and All New Ducts' CF1R-ALT-02-E
including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS', MECH-25-HERS2
CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2
Mini Splits require CF1R-ALT-02-E, CF2R-MECH-01, and (CF2R-CF3R) MECH-25-HERS
Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow z 350'CFM/ton (or alternative), Refrigerant Charge
❑ 3. All New Duds with Replacement Required Compliance Documents to be left on site for Final:
All New Ducts' and one or more of the following CF1R-ALT-02-E
replaced: Condenser Unit, Evaporator.Coil, CF2R: MECH-01, MECH-20-HERS, MECH-(23 or 24) -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 Flow z 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 on site 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 (:S_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-6 when less than 40 ft installed. This includes in walls, between floors etc.
2 Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25
' All New Ducts is when at least 75 percent of the duct system is new duct material, 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, plenums, duct material)
" R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" 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%", 5T-4'/."
Contractor (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.
3. 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 therequirements 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:
Responsible Designer Signature: Date Signed: License:
. i
fr
1720
Company:
.1704
Addres . City/State ip: Phone:
C
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