HomeMy WebLinkAbout11-1725 CITY OF DIAMOND BAR �y``='����� �g
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(909)839-7020 Fax(909)861-3117 Building Inspection Hotline( )839- �?�� �� S_
"��' BUILDI G PERMIT APPLICATION �=-� ���,��
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I HEREBV AFFIRM UNDER PENALTY OF PERJURV THA71 AM EXEMPT FROM THE CONTRACTORS LI� GefBJB/CBfpOR
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w TURE.VRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE UW(CHAPTER 8(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB
� FESSIONS CADE)OR THAT HE OR SHE IS ExEMPT THEREFROM AND THE BASIS FOR THEALLEGED E7(EMP- (�
U TION.ANVVIOLATIONOFSECTION7o31.5BYANVAPPLICANTFORAPERMI75U&IECTSTHEAPPLICANTTO Z Re-Root
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(S5o0).):
Z ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEN�ED OR OfFEFiED FOR SALE(SEC.70al,BU51- J
� NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF �
PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIAISELF OR HEHSELF OR
Q 7NROUGHHISORHEROVJNEMPLOYEES,PROVIDED7HATSUCHIMPROVEMENTSARENO71N7ENDEDOR m
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Z TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NO7 BUILD OF
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W OI,ASOWNEROF7HEPROPER7Y,AME%CLUSIVELYCANTMCTINGWITHLICENSEDCONTRAC70RS
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W CENSE LAW DOES NOTAPPLY TO AN ONRJER OF A PROPER7V WHO BUILDS OR IMPROVES THEREON,AND
� NMOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
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� ❑�AM EXEMPT UNDER SEC. B.8 P.C.FOH THIS REASON Q
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DATE OWNER U .
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� IICENSED CONTRACTOFS DECLARATION w
� I HEREBY AFFIRAI UNDER PENAL7Y OF PERJURY 7HA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d B(COMMENCING WITH SECTION 7000)OF DIVISION J Of THE OUSINESS AND PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL F FCE AN�EFFECT. ;�
� LICENS C S �O LIC.NO. //��.�,��l��++��/+ j
w DATE � � CONTRACTOF�:1��/1 1 o)U 1� J
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� WORKERS'COMPENSATION DECLARATION �` Q � QDD
N I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z h n o
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Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _ � r] �)
COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U v l/
Q �F'THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � �/
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� I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS{iEOUIRED BV SECTION
QQ 3700 0F THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15
ISSUED.MV WOFq�@1 S,'�C�OM/P�EN,SA�710N INSURANC R AND PO V NUMBER ARE: CONSTRUCTION
j CARRIER �-+ VZ./If�J� ���� PLAN REVIEW
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p (�HISSECiK7NNE�NOTBECOfAR.EfEDOFTI-�PEPAYTISFORONEHUI�DREDDOLIl�AS(EtOD)ORLESS} PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL /J��T
C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT T E
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE 7H I SHO BEC ME INSPECTION FEE
= SUBJE T TO TH ORKERS'CAMPENSA710 ROVISIONS OF S I N 3 OF TH OR
D, SHALLF PTHWITHCOMP�VWITH E R IONS. �SSUANCE �
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p DATE: L /� APPLIC NT: ' SMIP
J WARNING:FAILURE TO SECURE WORKERS'COMPENSA710N CAVERAGE IS UNLA UL,AND HALL BE ENERGY P/C
� SU&IECT AN EMPLOYEF TO CFIMINAL PENALTIESAND CIVIL FMES UP TOONE HUN OUSAND ENERGY PERMIT
DOLURS(f1o0.oa0).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN J�
� SECTION37080FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. f�ETENTIONFEE: L�✓O
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEFEBY AFFIRM UNDEF PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERF-0RMANCE OF 7HE WOFiK FOR WHICH 7HIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME
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� TOTAL FEES ///'''
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. � /� ..
w I AGREE TO COMPLY WITH ALL CITY AND COUN7V ORDINANCES AND STATE L4WS REUTING TO BUILDING �
� CO TRUC710N.AND HEREBY THORI REPRESENTATIVES OF THIS COUN7V 70 ENTER UPON THE � �
� A �MENTIONED 7q07ER OR I crioN auavosEs. COMMENTS
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~ W E—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�-File Copy,'GREEN—Applicanfs Copy
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SET BACK FLOOR JOIST �
FTGSlFORMS/STEEL , FHA REQMTS
ELECTRIC GROUND • UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION '
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T.BOND BEAM • �
ROOF SHEATHING 8 FT. BOND BEAM
FRAMING/VENTILATION 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 QFF 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 QEPT. FINAL
FINAL ELECTRIC " DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMENTS —
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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�s'•�� ` Certificate of Compliance Prescriptive Method - HVAC-only Alteration CF-1 R-ALT
Proje t Titie: I,//p� Dat n �CaICERTS 2005
/ / .V ��� v �G �� � Enforcement A enc Use Onl
' Project Address: ' �� Climate Zone: =- ° Batiding Perm it#--�� �
9 �' /�'L!/L. �
Docu entation Author: Telephone: Plan Check�ate
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Co 2ny Nem � � Field Check Date
IMPORT NT: This CF-1 R-ALT form is oniy for use when an HVAC-only alte tion is made to an existing home
Use one form for each s stem bein altered. This is s stem# of s stem s altered in this house. -
Check all lines that apply. Check only lines that apolv.
Scope of Alterations:
1 ❑ Air Handler is to be installed or replaced. Duct sealing to be determined. Continue to next line. •
2 A Furnace Heat exchanger is to be installed or replaoed. Duct sealing to be determined. Continue to next line.
3 An outdoor condensing unit is to be installed or replaced. Duct Sealing and/or TXV(RCA)to be deterrni�ed. Continue to ne�line.
4 cooling or heating coil is to be installed or replaced. Duct Sealin andlor TXV(RCA)to be determined. Continue to next line.
5 More than 40 feet of new or replacement duct are to be installed in��ncnnditioned space. Duct sealing to be determined.
�Check here if the ne tire duct system is also to be new or replaced. Continue to next line.
6 ❑ If none of lines 1-5 are checked,neither Duct Sealing nor TXV(RCA)are uired. Go to Section 5.
Section 1 - Duct Sealin Onl if an of Lines 1 2 3 4 or 5 are checked. Ski if Line 6 is checked.
7 ❑
8 O 2.
9 ❑ . .
No duct sealin is uired. Attach revious CF-4R form.Go to Section 2.
. _ .
10 ❑ `This duct s" tem is sealed oririsu4afed with asbestos:�No duct''seahn "is'� uired.Go to Seeti�2:
Note:If the entire duct s stem is to be new or re laced,Lines 11-14 do not ap I .
11 ❑
12 ❑ ,
o to section 2.
�3 ❑ In Glimate Zones 9 10 11 13 14 or 15,An SEER 14 Qt,�EER a2 condenserwilf be installed with T�(RCA)
D a O.S2 AfUE fumace will be,mstalfed in lieu of.duct s�ling.-Go:to Section 2.
14 ❑ , , , , .
15 None of lines 7-14 above are checked. Duct Sealing is Required. Continue. I
Sec ion 2-TXV RCA Onl if Lines 3 or 4 are checked, otherwise ot to Section 3
16 ❑ e s stem bein altered is a acka e unit. No TXV RCA is uired. Go to Section 3. i
17 ❑ . I
to Section 3.
18 �
19 ❑ I
20 ❑ Section 3.
2� This system is in Climate Zone 2 or 8-15 and line 11,16 or 17 is not checiced. TXV(RC�is required. Go to Section 3.
Sec io 3-HERS Rater verification
22 If line 15 is checked,HERS verification is required for Duct Sealing.
23 p lf line 12,13, 14,20 or 21 are checked and not line 16 or 17,HERS veri£cation is required for TXV(RCA).
24 ❑ If line 12,13 or 14 are checked,HERS verification is required for 12 EER.
Sect' 4-E ui ment Efficiencies
25 If lines 1 t,12,13,14 or 17 are checked,upgraded equipment e�ciencies are required.List in Section 6.
� Sec'0 5-Duct R-Values
26 more than 40 feet of duct is bein installed or r laced,duct R-value must meet or exceed Package D r uirements.
27 ❑
Section 6-see next page
Version 03-10-06 Page 1 of 2
This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com
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o��w r, � �. � �
_ Gertifcate of Compiiance Prescriptive Method - HVAC-only Alteration CF-1 R-ALT
�, • Project Title� n/�} Date: ��
�v ` // O CaICERTS 2005
— -°-- IMPORTANT: This CF-IR-ALT form.is only for use when an HVAC�only alter�tion is made to a�existin�•home - -
,.. ..... ... .. .
Use one form for each system being altered. This is system#�of�systems altered in this house.
Section 6-Minimum Requirements for Equipment to be Installed/Altered.
Installed equip M must match type/locatio�and meet or exceed efficiencies/R-values.
2$ Configuration: pGt system O Padcage U ' (3
29 ❑ Air Handler fiimace..AFUE: ❑Hea�ump FAU Biy�drewicFAU ❑Other
�30 Heat Exchan er `�
31 Outdoor Condensin Unit ❑Heatpump Efficien SEE HSPF: �� ER ' re d:
32 CooGng or heating coil ❑Hea ump B4i�raAis
33 Ducts Location: � Length(ft): R_���;
All'mandato measures a I to an altered com onent. See MF-1 R-ALT form.
Compliance Statement:
This certificate of compliance lists the building features and specifications needed to comply with Title 24,Parts 1 and 6 of the
Califomia Code of Regulations,and the administrative�egulations to impiement them. This certificate has been signed by the •
individual with overall project responsibility. The undersigned recognizes that compliance using duct sealing,verification of refrigerant
charge,and TXV require installer testing and certification and verification by an approved HERS rater,
Home Owner or Authorized A ent Documentation Author
Name: Name:
NNI� l�Z-
Address Com any Name:
� �(.� �/l,�/�'CD L
City/State/Zip: Address: /
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Phone: City�ate/Zip: �/�
1,�Q ff � 2
Phone:
� - ��.�=��632
Signature: Signa re-
Enforcement A enc Buildin De artment Notes/ ments:
Name:
Title:
Department:
Phone#:
Fax#:
Signature or Stamp:
Required forms:
CF-1 R-ALT: by anyone. Required at time of permit application. Copies to home owner,enforcement agency,HERS rater.
CF-6R-ALT: by installing contractor. Required to close permit. Copies to home owner,enforcement agency,HERS rater.
CF-4R-ALT: by HERS rater. Required to close permit. Copies to home owner,enforcement agency,installer. The CF-4R forms for a
sam le rou shall not be released until all testin and verification is com leted and assed for the entire rou .
Version 03-10-06 Page 2 of 2
This form can only be used on projects being verified by CaICERTS certified raters. www.calcerts.com