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Home My WebLink About11-311� - - - � �� , CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SER IC S f7� I 21825 Copley Drive,Diamond Bar,CA 91765 �� ,..c . (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-70��{((��Y '��'` BUILDING PERMIT APPLICATION u } JOBSITE ]/�� /��D ��✓O �. APPLICATION PERMIT p/C o ADDRESS �� H DATE ' •2 -2.6� NUMBER' �I-3 I i # � ISSUE / TYPE ^/ cL OCC I APN LOT ACT DATE � Z� / I CONST. 1' ri GROUP � OWNER c � v' I O o ADDRESS� 3 ✓ � ZONING SETBACKS Z CITY w�o�.. ZIP�,� TEL. - E�.� FRONT qyy p p APPLICANT TEL. REAR p Z SIDE/SIDE STREET RW ❑ � CONTRACTOR �o✓✓tCQ� LtlLvv��O(0�(' SIDE p � ADDRESSZ2�/� .�AVi leanc�h w � CITY ✓ • Zf��,a TEL.7� PROPOSED USE o ARCH/ NG/ � z DESIGNER a ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS u� cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM 11NDER PENALTV OF PERJURV THA7 I AM EXEMPT FROM 7HE CONTRACTORS LI- G81ag0/CelPOR W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITVOF (n � U CpUNTYWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� � w TURE.PRIOR 70 I75 ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck I � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CQNTRACTORS Lb � � CENSE UW(CHAPTEfi 9(COMMENCING WI7H SECTION 7000)OF DIVISION 30F THE BUSINESSAND PRO� POOI/Sp8 � FESSIONS CADE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR 7HE ALLEGED E%EMP- (� V 710N.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS 7HE APPLICANT TO Z Re-Roof � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(SSoo).): ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, 0 Z Commercial WIIL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oI�,BUSI- _I , � NESS M1D PROFESSIONS CADE:THE CONTRACTOFS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PR07ER7Y WHO BUILDS OH IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m 0 OFFEREDFORSPLE.IF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPIE� Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR , � IMPROVE FOR THE PURPOSE OF SALE). ❑I,AS OWNEROF THE PROPERTY,AM EXClU51VELY CON7RACTING WITH LICENSED CANTRACTORS ' Q 70 CANS7RUCT THE PR0.IECT(SECJo�a,BUSINESS AND PROFESSIONS CODE:THE CONTilACTORS LI- V81118�i0f1 ADJ.AREA W CENSE LAW DOES NO7 APPLV 70 AN OWNER OF A PROPERN WHO BUILDS OR IMPROVES THEREON,AND � � NM1iOCONTRACTSFORSUCHPROJECTSWITHACANTqACTOR(S)LICENSEDPURSUANTTOTHECANTRAC� OUANTITY DESCRIPTION FEE TORS LICENSE LAW.). 0 ❑1 AM EXEMPT UNDER SEC. B.6 P.0.FOR THIS REASON Q 1 / y�r�LG� � U ¢ � DATE OWNER H � O U � LICENSED CONTRACTORS DECLARATION w I � I HEREBV AFFIFiM UNDER PENA�TV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � ' � B(COMMENCINCa WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CODE,AND Z IAY LICENSE IS IN FULL FORCE AND EFFECT. lLJ ^ (J /J (� � LICENSE CIASS�1 �,�_ LIC.NO. �—L�I / � j V DATE ��I CONTRACTOR S�✓✓�(Q- a _ �'��N•�pfvn Q 1 � WORKERS'COMPENSATION C A ION � J /F C. ✓�/ aCPv..►PH c I , � I HEREBYAFFIRM UNDEH PENALTV OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS: Z '7��K� 0 � .� ✓P �� Q � I HAVE AND WILL MAIN7AIN A CERTIFICATE OF CONSEN7 TO SELF-INSURE POR WORKERS' _ � � COMPENSATION,AS PROVIDED BY SEC710N 370o OF THE LABOR CODE,FOR 7HE PERFORMANCE U Q �THE WORK FOR WHICH THIS PERMIT IS ISSUED. � w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MV WORK S'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION j CARRIER �D(/V e'� �,A PLAN REVIEW �� I Z POLICV NUMBER W G u r'Z�'�(J I ELECTRIC / Q � (RiISSEC�IONNE�NO7BE�A�iiEfEDOF7F�PEPMfTISFOfiONEHUI�DREDDOlJA0.S(E100)ORLESS). PLUMBING I Z I CERTIFV THAT IN THE PERFORMANCE OF THE WOHN FOR W THIS PERMIT IS ISSUEO,I MECHANICAL / (f} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SOAS BECOME SUBJECT TOTHE I � (n WORKERS'COMPENSATION LAWS OF CAUFORNIA,AN GREE THAT IF I LD BECOME INSPECTION FEE I = SUBJECTTOTHEWORKERS'COMPENSATIONPROVI NSOFSEC 3700 THEUBOq , COOE,I SHAL{�FORTHWITH COMPLV WITH THOSE P VISIONS. ISSUANCE � '/ p DATE:�� APPLICANT: SMIP J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVEHAGE IS UNLAWFUL.AND SHALL BE ENERGY P/C � SUBJECT AN EMPLOYER 70 CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS(f100,000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION37080FTHEU90RCODE,INTEREST,ANDATfORNEY'SFEES. RETENTIONFEE: __ � � OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBYAFFIRM UNDEF PENALTY OF PERJURV 7HA7 THERE IS ACONS7RUC710N LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEflM1T IS ISSUED(SEC.3097,CIV.C.). Z W � LENDER'S NAME t— LENDER'SADDRESS � TOTAL FEES � ' � � I CER7IFY THAT I HAV AD THIS APPLICATION AND STATE 7NAT THE ABOVE INFORMATION IS CARRECT. w I AGREE TO COMPLV ITN ALL GTV AN NTY OqDINANCES AND STATE UWS RELATING TO BUILDING d � CANSTRUCTION, HEREBY AUTH IZE EPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE-MENTIONE GROPERTV FO NSPE ioN PuaaosEs. COMMENTS � _ ✓ p N'10:.f m PERMITTEE NAME(PRINT) ' � Q .... I . 'J/1 (,�I/ ! � SIGNATUREOFPERMITTEE DATE ��// / n = RECPT.NO. PAID BY� VALIDATION ~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GFiEEN—Applicant's Copy � ,��.-,r'-f;� s, ��}�� B�'V O IF D V�6V��9�I� �,��3 � , i� LJ�� G�1JU Ly (�,.iT�J�� IIItl�I��li�0�� i�� y_ .: i. .., tY r;j rI� ,..,t�.i ?i��i��;�?Cfi"� �+,:,�4 . � ��o �a4� oa�p��oa oa�p��oo� ; k�� `��i�� .��,: SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT ' GROUND PLUMBING ' UNDER FLOOR CONQUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID H'T. BOND BEAM ROOF SHEATHING 8 FT. BOND BEANI FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER�TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID ___ ______ FINAL PLUMBING ENERGY -- ------------ -----�------------ ---- ��o � COMMEIVTS —�,�►�.� C- 5�? µ SEPTIC TANK SIZE SEEP PIT/U SIZE a °�; � --- ----__._.------ ------ . --- � �,�, , Q , , • ' P�eseri �ive Certificate of Com Iiance: �esidential CF-IR-ALT I Residential Altercctions (Pa e 5 of 5) I Project Name: � Climate Zpne# #of Stories J!ti'�' l �Q �� P$�l�Q.e vl C� / � HERS VERIFICATION SUMMARY The eriforcwnent agencp should pa��special attentia�to the HERS Measur•es spec f ed i��this cheeklis!below. A completed and signed CF-4R Forrn for af!the measin•es specif ed shall be submitled to tlre building rnspector before f:nal iru ectiort. Duct Sealing&Testing HERS verification is required,for zhis meosure. ❑YES ❑NO YES:In Climate Zones 2 and 9-16,if more than 401inear feet of new or replaeement ducts are installed in unconditioned space,die ducts are to be sealed per§152(b)1Dii and the newly installed ducts are to be insulated per§]51(fl]0. ❑ EXCEPTION:Existing duct spstems that are extended,which are constructed,insulated or sealed with asbestos. ❑YES ❑NO YES:In Climate Zones 2 and 9-]6,if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the ducts are to be sealed per§152(b)1Di. ❑YES ❑NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler, �utdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be sealed per§152(b)lE. ❑ EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS verification in accordance with procedures in the Reference Residentiaf Appendix TiA3. ❑ EXCEPTION:Duct systems with less than 40)inear feet in unconditioned space. ❑ EXCEPTION:Existing duct systems constructed,insulated or sealed with asbestos. Ref�gerant Charge-Split System HERS��erification is required jor tliis measure. C��S ❑NO YES:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including tl�e replacement of the air handier,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the fumace heat exchanger)a refrigerant charge measurcment shall be verified per§152(b)1F. Central Fan Integrated (CFn Ventilation System and�'an Watt Draw The ventilation re uirements of§150(0)do not a ly to existin residential homes. Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verificafio�r is r•equired for thrs measure. ❑YES ❑NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is replaced,the airflow and fan watt draw shall be verified per§152(b)1Ci to meet the requirements of§l51(�7B. Documentalion Author's Declaration Statement • I certify that,this Certificate of Com liance documentation is accurate and com ]ete Name: �7 " 3ignature: �(j—v� o (�u��O✓`� , Com an ate: P Y� -�v �Z6// S, ,�'��e, C�.0 N— r a�J Address: � If Applicable�CEA or❑CEPE 'LZ(,�� i �v�c.� p(Gw (Certification#): City/State/Zip: � �� Phone: �(��7� ,n v �� L r��. Responsible Building Designer's Declaration Statement • I am eligible under Division 3.of the Califomia Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. • I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24,Parts 1 and 6 of the California Code of Regulations. s The building design features identified on this Certificate of Compliance are consislent with the information provided to document this building design on the other applicable compliance forms,worlcsheets,calculations,plans and specifications submitted to the enforcement agenc for a rova]with this building ermit a lication. Name: Signature: Company: Date: Address: License: City/State/Zip: Phone: For assistarrce or questio�:s regardirig the E��er��Sta�rdarrts,contact the Energy Hotline at:1-800-772-3300. Registration Num6er: Regish•Qtion Datell'ime.� HERS Pro��ider.• 2008 Residential Compliance Fo�rns August 1009