The URL can be used to link to this page

Home My WebLink AboutPR16-2876„,” �,- 1::._.- CITY OF DIAMOND BAR FW DEPARTMENT OFCOMP-'[UNITY.& DEVELOPMENT SERVICES At.WD u ,ti 2181,ty�pley 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 ✓ toW Vv D APN LO TRACT OWNER ADDRESS CITY DV a 64 ZIP TEL. !V 0Ei APPLICANT TEL.(62,6y 35—:277A CONTRACTOR ADDRES V CITY R 1 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 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 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 pursuantto 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 cry signature below I acknowledge that, except for my personal residence in which I must have residedZan year prior to completion of the improvements covered by this permit,) cannot legally Sella structure that I owner -builder if it has not been constructed in its entirety by licensed contractors. I understand tha,..olicable law, Section 7044 of the Business and Professions Code is available upon request when th s f miffed or at the following Web site: http/www.leginfo.ca.gov/calaw.htmi. LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencin ith Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. LICENSE CLASS: LIC. NO.: 9 ic O / Y 0 EXP.DAT { A017 CONTRACTOR: WORKER'S COMPENSATION DECLARATION II HEAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARA/this I have and will maintain a Certificate of Consent to Self -Insure for Wompensation, as provided by Section 3700 of the Labor Code, for the performance of the work for whiermit 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 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 Compensation Laws of Califomia. And agree that if I should become subject to the Worker's Compensatio provis n of Section 3700 of the Labor C,00,dee,�,,. I��sh��al�ll forthwith omply with thp�e provisions. DATE APPLICANT: 1 �w'- � r �i Ate I Z 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. PE_ RMITTEE� AM(PRINT) �SSIII NAMIEOOFFPP•ERRMIITT�•EEE1 �/1• DATE APPLICATION DATE: d ISSUE DATE: PERMIT# : TYPE CONST. P/C# Pic OCC GROUP: �Q (J Scope of Work / 1 /�i 5 / ✓ G H A /V G-P' D # DWEL. UNITS # STORIES /- U "r. # BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport wPatio/Deck ATCD w w Pool/Spa ZRe -Roof Commercial m Va ation: Adj. Area: QUA ITY DESCRIPTION FEE U U c� z in J a < D zd w TU CONSTRUCTION: PLAN REVIEW: ELECTRIC: PLUMBING: MECHANICAL: pe INSPECTION FEE: ISSUANCE:a- SMIP: ENERGY P/C: ENERGY PERMIT: RETENTION FEE: PRE-ALT FEE: BASF: PLOT PLAN: ZONING CLEARANCE: TOTAL FEES COMMENTS: P/C: PAID BY: RECEIPT # 4411 , W PAID BY: L�U f�y VALIDATION:_ VALIDATION: �F; WHITE — Department Copy, YELLOW — Finance Copy, PINK — Assessor Copy CITY OF DIAMOND BAR t (JOUA014 INSPECTION RECORD COMMENTS: STATE OF CALWORNIA ALTERATIONS - HVAC >> -;;;a CEC-CF1R-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) Sss' I ' h^ Enforcement Agency: �teP epar d: Permit#: w wO` quipment Type / I7�5w Equipment Efficiency New Ducting, Plenums, Lineset: Conditioned Thermostat Required R-value Floor Area (sq ft) ❑ Packaged System Evaporator Coil AFUE COP ❑ R-6 (CZ2, 8-13) Ducting Served by system ❑ Setback Split System Condensing Unit , ❑ R-8 (CZIl, 14, 25) Ducting sgft (if not alread y ❑ Mini Split P ❑ Compressor P SEER HSPF ❑ R-6 (all CZ's) Plenums present, must ❑ Furnace ❑ Lineset EER ❑ R-5 or R7.5) Lineset a be installed ) ❑ TXV 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. . HVAC hangeout/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)Z-HERS, MECH-25-HERSZ Compressor, TXV, Lineset, CF3R: MECH-20-HERS, MECH-(23 or 24)-HERS2, MECH-25-HERS2 Air Handler/FurnaceZ (Can include new ducting) Installer Requirement: Duct leakage L15%, or < 10% to outside, or seal all accessible leaks), Air Flow>: 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 space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ❑ 2. New HVAC System Required Compliance Documents to. be left on site for Final: All new equipment and All New Ducts3 CF1R-ALT-02-E including Mini Split CF2R: MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, MECH-25-HERSZ CF3R: MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24)-HERSZ, 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 >_ 350'CFM/ton (or alternative), Refrigerant Charge ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: All New.Ducts3 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 >_ 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 Ducts3 I CFiR-ALT-02-E, CF2R: MECH-20-HERS, CF3R: MECH-20-HERS Installer Required to: Duct leakage (< 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. Z Heating only systems and Air Handler/Furnace changes do not require Air Flow MECH-(23 or 24), or Refrigerant Charge verification MECH-25 3 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-23%', 3.5 to 4T-231.", 5T-4Y.." 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 the requirements of Title 24, Part 1 and Part 6 of the CCR. S. 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: ORE[,- Responsibl esigner Signature: , D Dates' gn d: o o License: D D Company: G Address: d -fD 4 V r o` Z c in t� C tate/Zip• _ Cc.� Phon For assistance or questiort,,fegarding the Energy Standards, contact the Energy Hotline at: 1-800-77i'-3300.. in