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�I�L�IO�D Br1R
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765 ESS
(909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 FIRMLY
BUILDING PERMIT APPLICATION www.cityofdiamondbar.com building@diamondbarca.gov
JOB SITE ADDRESS
APN LOT TRACT
OWNER L
ADDRESS
CITY
APPLICANT
CONTRACTOR r
ADDRESS Commerce, CA 90022
CITY ZIP TEL.
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 Godel 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 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 the Contractors' State
License Law.).
(� 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 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 Professions Code is available upon request when this application is
submitted or at the following Web site: httpAvww.leginfo.ca.gov/calaw.html.
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.
LICENSCLA 5:�--� LIC. NO.:
DATE: CONTRACTOR:
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 or which this ermit is issued. My rker's Compensation Insurance Carder and
Policy Number are:
CARRIER
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED IF THE 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 Comp e tion Laws of Call mia. And agree that if I should become subject to the Worker's
Compensation provisions of Section 370 o Code hall forthwk comply with those provisions.
DATE:�� APPLICANT:
WARNING: Failure to secure Worker's Compensation coverage is unla and shall subject an employer to criminal
penalties and civil fines up to one hundred thousand dollars ($100,000 i ddition 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, Civ. 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
ordinances and state laws relating to building construction, and hereby authorize representatives of this county to
Sthe athe above -menti property for inspection purposes.
RMI E ME (P
SIGNATURE OF PERMITTEE DATE
APPLICATION �(DATE: /PP/C#
ISSUE DATE: PERMIT# OS1/
TYPE CONST. OCC GROUP:
Scope of Work
# DWEL. UNITS # STORIES
# BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF
ADJ. AREAIVALUATION
SFR/ADD/REM
Garage/Carport
U)
W
LL
Patio/Deck
Pool/Spa
nATrn
ZRe
7
CD
-Roof
Commercialn-ru
M11
Valuation:
Adj. Area:
QUANTITY DESCRIPTION
FEE
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CONSTRUCTION:
PLAN REVIEW:
ELECTRIC:
PLUMBING:
MECHANICAL:
4 d7
INSPECTION FEE:
ISSUANCE:2
�--
7 L y
SMIP:
ENERGY P/C:
ENERGY PERMIT:
RETENTION FEE:
PRE -ALT FEE:
BASF:
PLOT PLAN:
ZONING CLEARANCE:
TOTAL FEES
COMMENTS:
/00 ;7/
P/C: PAID BY: r,¢ �
RECEIPT # V/ PAID BY: 6. c! //�/(
t3
VALIDATION:
VALIDATION:
WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy
CITY OF, DIAMOND BAR
INSPECTION RECORD
INSPECTION
DATE
O.
SETBACK/ LETTER
COMMERCIAL HOOD
FOOTINGS FORMS
INTERCEPTER
SLAB
SEPTIC/CESSPOOL
UG. PLUMBING
DEMOLITION
UG. ELECTRICAL
ROUGH CONDUIT
LIFER GROUND
ROUGH PLUMBING
SEWER LATERAL
ROUGH MECHANICAL
MAIN WATER LINE
PRE GUNITE
SEWER CLEANOUT
P -TRAP
ROOF SHEATHING
FINAL POOL
FLOOR SHEATHING
WALL FOOTING/STEEL
SHEAR WAL 1 RI. R T j
?
SHEAR WALIJINTIJII&14 4
44 4 h ural �#
FRAMINGNENTIN-, T' '
ROUGH FIRE APPROVAL
ROUGH MECHANiQAL, -k A
FINAL PLANNING
ROUGH ELECTRICAL W( ) C ( )
FINAL COMMUNITY SERVICES
ROUGH PLUMBING
FINAL INDUSTRIAL WASTE
INSULATION WALL
INSULATION CEILING
DRYWALL
LATH (PRE)
LATH EXTERIOR
LATH INTERIOR
GAS TEST
SCRATCH COAT
ELECTRIC METER RELEASE
GAS METER RELEASE
SPECIAL INSPECTION
FINAL BUILDING
FINAL MECHANICAL
FINAL ELECTRICAL
FINAL PLUMBING
T.C. of OCCUPANCY
CERT. of OCCUPANCY
COMMENTS:
A.
INSPECTION DATE
O.
TRACT AND LEDGER
SWITCH GEAR
COMMERCIAL HOOD
T -BAR
INTERCEPTER
HOT MOP/SHOWERPAN
SEPTIC/CESSPOOL
HERS REPORT RECEIVED /
DEMOLITION
ROOF DRAINS
ROUGH CONDUIT
POOUSPA
ROUGH PLUMBING
ROUGH ELECTRICAL
ROUGH MECHANICAL
GAS TEST
PRE GUNITE
POOL PRE DECK BONDING
P -TRAP
FENCE / GATE/ ALARM
FINAL POOL
WALLS:
WALL FOOTING/STEEL
WALL STEEL 1sT( ) 2ND( ) LIFT
WALL BOND BEAM/
WALL DRAIN/ SEAL
WALL FINAL
R0. FRAMING PLANNING APPROVAL
ROUGH FIRE APPROVAL
FINAL FIRE DEPARTMENT
FINAL PLANNING
FINAL ENGINEERING/ PW
FINAL COMMUNITY SERVICES
FINAL HEALTH DEPT.
FINAL INDUSTRIAL WASTE
CERTIFICATE OF INSTALLATION
CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans
(Page 1 of 7 )
Project Name: 233 RED CLOUD
Enforcement Agency: City of Diamond Bar
Permit Number:
PR16-0817
Dwelling Address: 233 Red Cloud Dr
City: Diamond Bar
Zip Code:
91765
A. General Information
01
Dwelling Unit Name
233 RED CLOUD
02
Climate Zone
9
03
Dwelling Unit Total Conditioned Floor
1260
04
Number of Space Conditioning
1
CFA served
Area (ft2)
Installing a
Installing new SC
Systems in this Dwelling Unit.
Installing
05
Certificate of Compliance Type
Prescriptive alterations (CF1R-ALT)
06
1 Method used to Calculate HVAC Loads
NotApplicableEquipmentChangeout
07
Calculated Dwelling Unit Sensible
This field or section is not applicable
08
Calculated Dwelling Unit Heating Load
This field or section is not applicable
Name
Cooling Load (Btuh)
System (ft)ducted
(Btuh)
09
1 Dwelling Unit Number of Bedrooms
3
MCH -01b Prescriptive Alterations - Space Conditioning Systems Ducts and Fansi
B. Space Conditioning (SC) System Information
O1
02
03
04
05
06
07
08
09
10
System
SCS stem
SC System
y
CFA served
Is the SC
Installing a
Installing new SC
Installing more
Installing
Installing
Identification or
Location or Area
by this SC
systema
refrigerant
system
than 40 feet of
entirely new
entirely new SC
Alteration Type
Name
Served
System (ft)ducted
containingcomponents?
ducts?
duct system?
system?
system?
component?
Altered space
System 1
Location 1
1260
Yes
No
Yes
No
No
No
conditioning
system
Registration Number: 216--A0125642A-M0100002A-0000.. Registration Date/Time: 2016-06-'1'3_;08:59:57' . � HERSP.rovider: CaICERTS'
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CERTIFICATE OF INSTALLATION CF2R-MCH-01-E
Space Conditioning Systems, Ducts, and Fans (Page 7 of 7 )
Documentation Author's Declaration Statement
1. 1 certify that this Certificate of Installation documentation is accurate and complete.
Documentation Author Name:
Documentation Author Signature:
Vejar Salas, Angelique
CAAw
Company:
Signature Date:
MARAVILLA FOUNDATION
2016-06-13 08:59:57
Address:
CEA/ HERS Certification Identification (if applicable):
5729 E UNION PACIFIC AVE
City/State/Zip:
Phone:
COMMERCE CA 90022
323-869-4500
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 Installation is true and correct.
2. 1 am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials,
components, or manufactured devices for the scope of work identified on this Certificate of Installation, and attest to the declarations in this statement (responsible builder/installer), otherwise I am an
authorized representative of the responsible builder/installer. - -
3. The constructed or installed features, materials, components or mariufactured devices (the installation) identified oh this Certificate of Installationlconformsto all applicable codes and regulations, and the
installation conforms to the requirements given on the plans and spiecifications'approved by the enforcement agency. t
4. 1 reviewed a copy of the Certificate of Compliance approved by the enforcement agency thafidentifies the,specific requirements for the scope of construction or installation identified on this Certificate of
Installation, and I have ensured that the requirements thatapply to the construction or installation have been met
_
5. 1 will ensure that a registered copy of this Certificate of Installation shall -be posted, or made available with the building perm (s) issue' for the building and made -available to the enforcement agency for all
applicable inspections. I understand that a registered copy of this Certificate ofTnstallation is required to be included with the documentatioht n th'e builder'provides to the building owner at occupancy.
Responsible Builder/Installer Name:
Responsible Builder/Installer Signature:
Vejar Salas, Angelique
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Position With Company (Title):
MARAVILLA FOUNDATION
RME
Address:
CSLB License:
5729 E UNION PACIFIC AVE
622969
City/State/Zip:
Phone:
Date Signed:
COMMERCE CA 90022
1323-869-4500
12016-06-13 08:59:57
Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered documen4 and in noway implies Registration Provider responsibility for the accuracy of the information.
"Registration Number: 216-A0125642A-M0100002A-0000- ..... =RegisthatiorrDate/Time: 2016-06-13'08:59:57'-r
c, HERS Provider: CaICERTS_ _
pCA:Building.Energy.Efficiency Standards-_2013,Residential;Campliance < r ReportsVersion::2013aRev 1.007_.. _ t:_ _- <,. ,.;Report Generated:, 2016:05..,10 J1:45.:
Schema Version: 2013.1.007