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HomeMy WebLinkAboutPR16-2663s w rz z 0 a w U) J 0 rn 00 0 0 CD 0 BIALNON .BAR tits CITY OF DIAMOND BAR �INrR��MdED 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.cityofdiamondbar.com building@diamondbarca.gov JOB SITE ADDRESS APNR�C&011011 LOT TRACT OWN RIjA ADDRESS CITY l ZIP TEL. APPLICANT l TEL. V1 Lk VW CONTRACTOR ADDRESS / CITY ZIP 404x TEL. ARCH/E G/ p-, DESIGNER RYA& IW�BY��M ADDRESS CITY ZIP TEL. Z 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 70DO 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.). L) 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.). U I am exempt from licensure under the Contractor's State License law for the following reason(s): Date: Sign: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at east one year prior to completion of the improvements covered by this permitl cannot legally sell a stmcture that had uilt as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that/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. 'f 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. LICENSE CL� CO NO.: �'7 Zi �s i —r ir7 EXP.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 ofrthe work for which this permit is issued. I have and will maintain Worker's Compensation Insyrance, as required by Section 3700 of the Labor Code, for the performance of the work for which this perm' is issued. My Worker's Compensation Insurance Carrier and Policy Number are: , I CARRIER �(�G�i POLICY NUMBER (THIS SECT ON NEED NOT BE COMPLETEDF IF THE PMlff 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 Worker's Compensation provisions of Section 3700 of the Labor Code, I 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 ($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, 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 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. rn`1 PERMITTEE NAME (PIN SIGNATURE OF P#nMMEE DATE APPLICATION DATE: — I i f 2 ISSUE DATE: (� PERMIT#: TYPE CONST. P/C#BPS �� - c o FRl (Q— (�G3 OCC GROUP: Scope of Work —�I C`-% # DWEL. UNITS # STORIES STORIES If BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF J. AREAIVALUATION SFR/ADD/REM Garage/Carport w Patio/Deck W LL Pool/Spa ZRe -Roof Commercial m Val tion: Adj. Area: QUA DESCRIPTION FEE a U cc w co z m a ZU_ Q U CONSTRUCTION: PLAN REVIEW: FSat ELECTRIC: PLUMBING: MECHANICAL: INSPECTION FEE: ISSUANCE: SMIP: S g ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE-ALT FEE: A . Oo BASF: 1 • O.1 PLOT PLAN: ZONING CLEARANCE: TOTAL FEES b9 COMMENTS: P/C: 31bCk��]S]PAID BY: `(0. RECEIPT # .3Z'i 1 Z PAID BY: 115'4 VALIDATION: _ VALIDATION: WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF DIAMOND BAR INSPECTION RECORD •" COMMENTS: AMER115 OP ID: AL "PC" -CERTIFICATE OF LIABILITY INSURANCE DA11/30/201'Y) 11 /30/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER VERITY Insurance Services Inc. 1906 VV.;Garvey Ave. South #108 West Covina, CA 91790 CONTACT NAME: a/oNN Ell: 626-956-4048 n/c N, ; 626-956�050 E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURERA:State Compensation Ins. Fund INSURED` AMERICAN GREENERGY COMPANY DBA: Green Engineering Solar Corp DBA: GESC 17890 Castleton St., Ste 112 INSURER B : INSURER C : INSURER D : INSURER E : City of Industry, CA 91748 INSURER F : THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLrUBR INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MMIDD/YYYY LIMITS �'COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence - $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ AGGREGATE LIMIT APPLIES PER: PRO- POLICY ❑ JECT LOC GENERAL AGGREGATE $ GEN'L PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED 'AUTOS AUTOS - BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AN D,EMPLOYERS' LIABILITY Y / N ANY,PRR/MEMBER EXCLUCOPRIETOR/PARTNERI ECUTIVE X❑ OFFICE(Mandatory N /A 9170376-16 11/30/2016 11/30/2017 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 in If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All terms and conditions are based upon actual policy. PROOF,OF INSURANCE ONLY License' 993368 R� vcr� r mrvn r r= nvwr=r% _ GANkoll I LUN Contractors State License f, Board P.O. Box 26000 Sacramento, CA 95826 25 (2014/01) CONTRAC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY_ PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Assembly Bill 2188 applies only to residential rooftop solar energy systems that are no larger than 10 kilowatts or 30 kilowatts thermal. This form conforms to Assembly Bill 2188. Residential Photovoltaic Power Systems Permit Issuance Checklist Please complete the following information to submit for Building & Safety plan check. APPLICANT completes this box. Address: 16xi- 0! Icy APN• rak Zone: Lot Size: S.F. Average Slope: Technology: (check one): Building Integrated Roof -Mounted Panel Ground -Mounted Panel System size and power: Number of panels: Total square feet: sq.ft. _ kW (if electric) Are the property lines correctly dimensioned on the plans? (circle one) Yes No If Ground -Mounted: Max. height of system, (i.e. distance from top of panel to natural or finished grade): If Roof -Mounted: Max. height above roof, (max.distance from top of roof to top of panel): If framing is over eight inches (8") off roof or ground; is it screened? (circle one) Yes ZV N/A Are the panels proposed on a permitted structure? (circle one) d!3R No N/A Panel directional orientation, (check one): West Southwest South Southeast East System visibility from nearby public streets, parks, or trails, (circle one): Not Visible, Low, Medium, High If "no" to any of the above, see the Planning Division. COUNTER PLANNER completes the remaining form. 1. Zoning Ves ❑No a. Does the proposed project meet the setback requirements (or is it an allowed encroachment)? Front setback ft. interior setbacks ft. ❑N/A ❑Yes ❑No b. If ground -mounted: Does the project comply with setbacks and lot coverage requirements? Q' Ies ❑No C. Are the panels proposed on a permitted structure? ❑Yes ❑No d. Are the property lines correctly dimensioned on the plans? 2. Design Il7(Yes ❑No a. Is there an open/pending project for the property? []Yes []No b. Will the system be obscured from public view, i.e. as viewed from a public street, sidewalk, park, beach or trail, is it completely hidden by a parapet, located behind a residence, down a private driveway not visible off site, etc.? Consider all potential public views of the site, especially on hillside properties. If "yes", then skip to item No.6 below. If "no", continue to item 3. 3. Is the proposed project affiliated with a historic resource (Check historic resource list)? (byes ❑No Page 1 of 3 4. Is the proposed project on a site which includes a potentially sensitive visual resource, such as: UYes []No a. Hillside property (regardless of slope)? 5. Is the proposed project located in a restricted use area? ClYes ❑No 6. The plans cannot be approved over the counter and must be routed to staff for further review. If there are Zoning concerns ("no" to question No. 1), indicate those in the zoning activity. Ves ❑No 7. Applicant proceeds to Building & Safety Counter to continue the review (add approval notes in Zoning Clearance file, stamp and initial three (3) sets of B&S plans and add a review fee.) [des ❑No Building and Safety requirements. Applicant shall complete the remaining form. (Please check the correct answer for each question) 1. Applicant submitted (3) sets of plans minimum 11"x17", attach all manufacturer's specification sheets, installation instructions, and listings. Ves ❑No 2. exposed conduits painted to match the roof is noted on the plans. EYYes ❑No 3. In submittal, provided electrical single -line diagram clearly identifying all devices installed in the PV system and indicating total kW rating of system. UYes ❑No 4. Applicant acknowledges correct circuit sizing and current calculations based off 2013 California electrical Code Article 690.8 on plans from California state licensed electrical engineer or a California licensed contractor classification C-46 or C-10. bYes ❑No 5. Applicant acknowledges photovoltaic source and output circuits have a maximum photovoltaic of up to 600 volts based off 2013 California electrical Code Article 690.7 on plans from California state licensed electrical engineer or a California licensed contractor classification C-46 or C-10. ()Yes ❑No 6. Applicant acknowledges wet -stamped and signed submittal of structural calculations for wind uplift based of ASCE 7-10 from State license civil or structural engineer. All Structural Elements shall be identified on existing roof framing members on plans. kpYes ❑No 7. Applicant acknowledges rooftop mounted photovoltaic systems shall be tested, listed and identified with a fire classification in accordance with UL 1703. The fire classification shall comply with Table 1505.1 of the California Building Code based on the type of construction of the building Effective January 1, 2015, Ves ❑No . Page 2 of 3 t 8. Applicant acknowledges installation of the photovoltaic system shall be in compliance based off 2013 California electrical Code Article 690. U,Yes ❑No 9. Applicant acknowledges installation of the interconnected electric power production source shall be in compliance based off 2013 California electrical Code Article 705. Ryes ❑No 10. Applicant plans are to be signed by a California licensed contractor classification C-46 or C-10. Provide signature and license number on each sheets. Contractor who signs the document must be the one doing the work, Business and Professions Code Section 7031.5. ayes ❑No 11. Applicant acknowledges that the photovoltaic system may only be installed on a permitted structure. UYes ❑No 12. Applicant acknowledges that the photovoltaic system meets the "California Solar Permitting Guidebook": http://opr.ca.gov/docs/California Solar Permitting Guidebook.pdf ]Yes ❑No 13. Proposed project meets state fire marshal set -backs for roof mounted photovoltaic system requirements and code section R908 CRC 2013. Ives ❑No Signature of Applicant: Z��Date: ) i- 1 z Print Name: 04— Page 3 of 3