HomeMy WebLinkAbout13-906 �� .,_��__ CITY OF DIAMOND BAR
•- � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
' 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Notline(909)839-702 PRESS
��'""', BUILDING PERMIT APPLICATION FI�MLY
' } JOBSITE C� p APPLICATION� � � � PERMIT p/C
o ADDRESS J J DATE NUMBER.��#
�. � ISSUE � I ( � f^� TypE OCC
APN LOT TRACT DATE � �CONST. GROUP
p OWNEFS
� ADDR S ZONING SETBACKS
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v� DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREA/VALUATION
O OWNEF-BUILDER DECLARATION SFFUADD/REM �
1 HEREBY AFFIRM UNDER PENALT(OF CERIURY THAT I AM EXEMPT FROA1 7HE CANTMCTORS LI- � Garage/CarpoR. j p < r � �
W CENSEUWFORTHEFOLLOWIN6REASON(SEC.7031.68USINESSANOPROFESSIONSCOOE:ANYCITYOR /�
U COUPJfYyV1{ICHREOUIpESAPERMITTOCONSTRUCT,ALTER,IMVROVE,DEMOIISH,ORREPAIRANYSTRUG v-J � � I
w TURE,PRIOR TO RS ISSUANCE,ALSO RE�UIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIONED �w Pa�10/DBCI(
� STATEMENT 71UT HE OR SHE IS LICENSED PURSUANT TO hIE PHOYISIONS OF THE CONTRACTORS LI- �
� CENSE UW(pU7TER Y(COMMENCIN6 WI7H SECTION 7000)OF OIVISION 3 OF THE BUSINE55 AND PRO- POOUSPB
� fESSIONS COO�ORTHATHE OR SME IS EXEMPTTHEREFROM AND THE BAS�S FOR THEALLEGED EXEMP- (�
TION.ANVVIOUTIONOFSECTION7o31.5BYANYAPPLICANTFORAPERMI75U&IECTSTHEAPPLICANTTO Z qe-Root
A CML PENAL7Y OF NOT MORE THAN.FIVE HUNDRED DOLURS(f500)J:
0 ❑I,ASOVINEROF.THEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial�
Z VALL DO THE WORK M10 THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�(BU51- J � �
� NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSEUW DOES NOT APVLY 70 AN OWNER OF � - �
PipPERfY W/i0 BU�LDS OR IMPROVES THEREON,AND NMO OOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMVLOYEES,CROVIDED THAT SUCH IMPROVEMEMSARE NOi INTENDED OR . m I
Q OFFEREDPoRSALEIFHOWEVERTMEBUIlDIN60RiMPROVEMENTISSOtDWlTHINONEYEAROFCOM7LE•
Z TION,.7HE�OWNER-BUILDER WILL HAVE TME BURDEN OF VROVING 7HAT HE OR SHE DID NOT BUIID OR I
� IMPROVE FOR THE PURP0.5E OF SALE). � , . ,
w ❑I,ASOWNEROFiHEPROPEHfV,AAIEXCLUSNELYCANTMCTWaWfTH�ICENSEDCONTRACTOliS � _ _ . _ . _
� TO COHSTRUCT THE PROJECT(SEQ�01/,BUSINESS AND PHOFESSIONS CODE:THE CONfRACTOHS LI- V81U8II011 /��J,/�(a� - �
W CENSE UW DOES NOTMPLY TOAN ONRIER OFA PROPER7V WHO BUILDS OR IMPROVES THEREON,AND - - - �
MM1fO CONTRACTS FOR SUCH PRQIECTS WRH A COHTRACTOR(5)LICENSED PURSUANTTO THE CONTRAG
� QUANTITY DESCRIPTION FEE I
� TORS LICENSE LAW.).
Q ❑I AM EXEMPT UNDER 6EG B.6 P.C.FOR THIS REASON Q
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� DATE � OWNER ��
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� LICENSED CONTRACTORS DECLARATION W I
� I HEREBY AFFIRM UNDER PENALTY OF PERIURV 7HAT IAMlICEN5E0 UNDER PROVISIONS OF CHAPTER � � � - �
d Y(COMMENCIMO�WITHSECTION.7000)OFDIVISION70FTHEBUSINESSANDPROFESSIONSCODE,AND Z �
X IAY UCENSE IS IN NLL F�E dyD EFFECL � � I
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� LICENSE CLASS LIC.NO 'r � � ,
WDATE_ �Tr�� . CONT . ~ � � d . .. . .
� WORKERS'COMPENSATION DECLARATIO�bv Q ' O w.it /� , � �
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� 1 HEREBYAFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLLAWING DECLARA710N5: Z ' /�/� K[� �� Q 1
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� _I HMEAND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFdNSURE FOR WORKERS' _ � , �
COMPENSA710N,AS PROVIDED BY SECTION 37o00F THE UBOR CODE,FOR THE PERPDFMANCE �U
Q � OFTHE WORN FOR NM1iICH TH�S PERMIT IS ISSUED. � � �
w 1 HAVE AND WILL MAINTAIN�WORKERS`COMPENSATION INSURANCE,AS REOUIRED BY SECTION -
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COMPENSAT ON INSURANC CARRIER AND tCY NUMBER ARE: CONSTRUCTION
� —' �e,reS� �1�,'�ac f°`
j CARRIER PLAN REVIEW
� POIICY NUMBER IO O � . ELECTRIC
� �nrssEcrqriNFIDrqTeEoon�rIDOFn�a�tsror�a+E�noouusmm)oq�ss} PLUMBING
Z 1 CERTIF'/THAT IN THE PEFFORAIANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL S-1� I I
C} SHALL NOT EMPLOY ANY PERSON IN ANY NER SO AS TO BE E SU&IECT TO THE
� WORNERS'CAMPENSATIONLAWSOFC FO IA,ANDAGREE IFI BECAME INSPECTIONFEE 3+'t,;�
? SU&IECT TO THE WORKERS'COMVENSA ION OVISKKJS OF SE �7 OF THE LABOR
�E,I FOiffM41TH COAAPLY WI TH OVI oNs. ISSUANCE
� SMIP
p DATE: � APPLICA �
J 1YARNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UN , D SHALL BE ENERGY P/C .
� SUBJECr AN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNDPED TFIOUSAND ENERGY PERMIT
DOLLAHS(5100,0o0),�IN ADDITION TO THE CO57 OF CAMPENSATION,DMIAGES AS PROVIDED iOR IN
¢ SECTION370EOFhIELA80RCODE,INTEREST,ANDATTORNEY'SFEES. � RETENTIONFEE: �la�
OCONSTAUCTION LENOING AGENCY PRE-AlT FEE:
� 1 HEREBY AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDINO AGENCY
FOR T11E PERFORMANCE OF THE WORK FOR WHICi1 THIS PERMfT IS ISSUED(SEC.7oD7,pV.C.).
Z
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�� LENDER'SNAAIE
F- LENDER'SADDRE55.
w ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATE7HATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES
� I AGHEE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS PELhTING TO BUILDIN6
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATNES OF 7HI5 CWNTV TO EMER UPON THE �
Z E-MENTIONED GROPERTY FOR SPECTION PURPOSES. COMMENTS �'
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m PE EE N E( NT) � �
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� S E OF PERMITTEE DATE
= RECPL NO. PAID BY VALIDATION
~ WHITE�epartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
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CI'TV O� C11AM()ND �AR ~ -
IN�PECTIOE� RECORD ,
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SET BACK ' FLOOR JOIST ,
----- -- ---- ----- —� --------- -- ------- ----- - - -
FTGS/FORMS/STEEL � FHA REQMTS " - ---` �
----------------------- ------------ -- ------- --....---------- . ------ ----- _-----.._ - --- ----- ---__ _------ -._._._.-------
ELECTRIC GROUND i UNDER FLOOR OUCT
GROUNDPWMBING I UNDERFLOORCONDUIT -
SLAB GRADE FIREPLACE FOUNDATION
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TEMP POWER i FIREPLACE BOND BEAM _
WATER SERVICE � :MID HT.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 PLUMaING FINISH GRADING
SHQWER/TUB TEST 'PQOL ELECTRIC
EXT.LATH;SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION 'OFF SITE IMPS.
QRYWALL NAILING DEDICATIONS
----._..—_.._-----___----------------------- -- ------------------------. ,..__...—.____.....------------------------....._._.._. ------_._.__._.__._._..----------
SEWER �FINAL ENG.
SEPTICTANK �LANDSCAPEIIRRIG.
SEEP PIT/L.L. — ---- -- --------------- `ON SITE IMPS----------- - --------- -------
GAS AIR TEST ':FINAL ZONING
FINAL CaNST. FIRE DEPT.FINAL
FINAL HEATING ` /1 � HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID
FINAL PLUMBING ENERGY
FINAL PLANING
..----------...------------ ------------------ --...-------- -- '. �, - 'is�,-�+ '��' ---- ----- --_..._ ._...—_._.. .._
FINAL ENGINEERING a B
�OMMENTS -_ ___ -
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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' ' �Certificate of Compliance Prescriptive Method -HVAC-only Alteration CF-1 R-ALT
� Project Title: Dat O CaICERTS 2005
��� � t I� Enforcement A enc Use Onl
' Project Address: Climate Zone: �=- ' sailding Permit#=-�- � .
353 � C���c, �� 12� � _ __
umentation Auth : �. Telephone: Plan Chec�c��te
n i e. �e�Z -���by d
Corx�pany Na , . �`I. ( /'� Field Check Date
U T� l�l!
IMPORTANT: This CF-1 R-ALT form is only for use when an HVAC-only alteration is m ade 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. •
�heck all lin�s that auplv Check o�lv lines that apolv.
Scope of Alterations:
1 ❑ Air ndler is to be installed or replaced. Duct sealing to be determined. Continue to next line. .
2 A rna eat exchanger is to be installed w replaced. Duct sealing to be determined. Continue to next line.
3 An outdoor ndensi unit is to be installed or reptaced. Duct Sealing and/or TXV(RCA)to be detertriined, Continue to next line.
4 ling heating coil is to be installed or replaced. Duct Sealin and/or TXV RCA)to be detertnin�, Continue to next line.
5 Mo an 40 feet of new or replacement duct are to be installed in�mr.onditioned space. Duct sealing to be determined.
_ Check here if the entir 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 2.
9 ❑ •
No duct sealin is uired. Att�h. re>iious CF.,4R fortn.Go to Section 2 _
... . ..� . � � �.:;�r�.,. �:.:.: . _. . ., ��..... - - .
10 ❑ ; ' :duct -.��em-is'sealed or.insutated�wiUi asbesfus. No dnct sealm `is uired..Go to Section 2.. .-'
Nofe'If the entire duct s stem is to be new or re laced,Lines 11-14 do not ap I .
11 ❑
�2 a ,
I� ,._. . _..: ;,,
o to section 2.
�3 ❑ ln Cl�mate Zones 9 10 1 t 13 i4 or 15 M SEER 14�y.Q;EER 12 condenser;will be installed;with 7�/�RCA)
,:;. _�: ::: ; - ;_
D a 0 92`A'FUE,fumaca wdl be mstatled'in lieu of:dud sealing.Go`to Section 2.''
14 ❑ . , . , • i
�5 None of lines 7-14 above are checked. Duct Sealing is Requlred. ConGnue.
S ion 2-TXV RCA Onl if Lines 3 or 4 are checked,otherwise ot to Section 3 I
i 16 ❑ e stem bein altered is a cka e uniL No TXV RCA is uired. Go to Section 3.
17 ❑ • .
o to Section 3.
' 18 ❑ -
19 � �I
20 ❑ Section 3. '
2� is system is in Climate Zone 2 or 8-15 and line 11, 16 or 17 is not checked. TXV(RC/�is required, Go to Section 3.
S tio 3-HERS Rater verification !
22 If line 15 is checked,MERS verification is required for Duct Sealing.
2 ❑ If line 12,13, 14,20 or 21 are checked and not line 16 or 17,HERS ver�cation is required for TXV(R�q�,
24 ❑ If line 12,13 or 14 are checked,HERS verificadon is required for 12 EER.
Section 4-E ui ment Efficiencies
25 � If lines 11,12,13,14 or 17 are checked,upgraded equipment efficiencies are required.List in Section 6.
� Section 5-Duct R-Values
26 f mwe than 40 feet of duct is bein installed or taced;duct R-value must meet or exceed Packa e D uirements.
27 ❑
Section 6-see nent 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
�
�'� ..�q�y( y ; . '
� �d' �
� Certifcate of Compliance Prescriptive Method - HVAC-only Alteration CF-1 R-ALT
,,f Project Title: 1 Date:
� � v� � l l 3 O CaICERTS 2005
- ---- IMPORTANT: This CF-1 R-ALT form•is only for use when an HVAGonly alteration is made t�a�existing 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.
Insblled equipmeM must match type/location and meet or e�eed efficiencieslR-values.
2$ Configuration:�SpGt system ❑ Padcage Unit
29� Air Handler as fumace,AFUE: OpHeatpump FAU B�ewi�FAU ❑Other
�30 ❑ Heat Exchan er `�
31 � Outdoor Condensin UnR C ❑Hea�ump E�cien SEER/FiSPF: EER if re d:
32 CooGng or heating coil AIC OHeatpump Bi�rAis.
33 Ducis Location: LengN(ft): R-value:
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 implement 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 DocumentaGon Author
Name: Name: �
- '� I Y`f Z
Address: Comp y Name:
W � �� `-�I���� Wr ' �
City/State/Zip: Address:
I c�l-� W. ��`I�`� � � ���vd
Phone: City/StatelZip:
U�/� � I �D�
Phone:
Z(o --� I �- 1� �2
Signature: Signatur . .
Enforcement A enc Buildin De artment Note
Name:
TiUe:
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 instalting 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 cert�ed raters. www.calcerts.com