HomeMy WebLinkAbout10-1001 � � CITY OF DIAMOND BAR , �
' `----��-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
` I
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
,"��'� BUILDING P�RMIT APPLICATION FIRMLY
� JOBSITE � �L ,,1� J � �
Q ADDRESS ���? (..� LC��/J Li(J APPLICATION / PERMIT /�/ p/C
p DATE �D�'{p ��� NUMBER� #
� ISSUE /�1 TYPE OCC
APN LOT TRACT DATE /v�"'��_CONST. GROUP
°C OWN L
O
o ADD S Z 'E.�,L7 ' ZONING SETBACKS
Z CITY ZIP TEL. -
� FRONT RW p
� APPLICANT TE . REAR p
� � SIDE/SIDE STREET RW ❑
¢ +
� CONTRACT � _ SIDE p
� ADD
� CI ZIP TE . - PROPOSED USE
o ARCH/ENG/ _
iz DESIGNER NO.DWEL. • NO. NO.
a ADDRESS
� CITY ZIP TEI. UNITS STORIES BEDROOMS
�
I v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
Q I HEREBV AFFIRM UNDEH PENALTY OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G3f890/CBfp011 �
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.5BU51NE55ANDPROFESSIONSCOOE:ANVCITYOR (�
U COUNTyWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� W P8i10/DBCk
w TURE,PRIOR TO ITS ISSUANCE.ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- �
� CENSE UW(CHAPTER e(COMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB
, 0 FESSIONS CADE)OF THAT HE OR SHE IS EXEMPT THEREFFiOM AND THE BASIS FOR THEALLEGED ExEMP-,..-. (�
V TION.ANV VIOUTION OF SECTION 7031.5 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTI OF NOT MORE THAN FIVE HUNDRED DOLURS(i5ao).): '
Z ❑I,ASON?JEROFTHEPROPER7V,ORMYEMPLOYEESWI7HWAGESASTHEIHSOLECOMPENSATION, � COfIlfnBfCi01
WILL DO 7HE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70��,BUSI� J �
N NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOES NO7 APPLV TO AN OWNER OF � �
PR07ER7Y WHO BUILDS OR IMPROVES THEREON,AND VMO OOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMVLOVEES,PROVIDED THA75UCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREOFORSrLEIF,HOWEVEf�7HEBUIL0INGORIMPROVEMENTISSOIDWITHINONEVEAROFCAMPLE- �
Z TION,THE OWNEF-BUILDER WILL HAVE THE BURDEN OF FROVING 7HAT HE OR SHE DID NO7 BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE). �
w ❑I,AS OYJNER OF 7HE PROPERTV,AM EXCLUSIVELY CON7RAC71NG WITH LICENSED CONTRACTORS
Q TO CQNS7RUC7 THE PR0.IECT(SEC.70�1,BUSINE55 AND PROFESSIONS CADE:7HE CANTRACTORS LI- V21U2�1Of1 ADJ.AREA
W CENSE UW DOES NOTAPPLV 70AN OWNER OFA PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACON7RACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑1 AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q �
� U
� �
DATE OWNER H
� w
� LICENSED CONTRACTORS DECLARATION W
� 1 HEREBYAFFIRM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z
LLI �Y LICENSE IS IN FULL FORCE AND EFFECT. J m
� UCEN$EFIA�S/�L�� LIC.NO. �C�`� �/ �
V DATE O 3 CONTRACT � d
W
� WORKERS'COMPENSATI N D ARATION Q
� I HEREBV AFFIRM UNDER PENALIY OF PERIURV ONE OF THE FOI.LOWING DECURATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEN770 SELF�INSURE FOR WORKERS' a
S
CAMPENSA710N,AS PROVIDED BY SEC710N 370o OF THE LABOR CODE.FOR 7HE PERFORMANCE U
Q (]G-THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
� �HAVE AND WILL MAINTAIN WORKEFIS'CAMPENSATION INSURANCE,AS REdUIHED BY SEC710N
Q 37ooOFTHEUBORCODE,FORTHEPERWRMANCEOFTHEWORKFORWHICHTHISPEHM1715
ISSUED.MV W PKERS' MPENSATION�INS�/gp N�CE�CAFFIE ND POLICY NUMBERARE: CONSTRUCTION
j—' �'9��f�, /y5��
CAFiRIEfi �I�!- �� PLAN REVIEW
Z POLICV NUMBER_ � F�d � . —U ELECTRIC
¢ �
0 (fHISSECfqNNE�NOTOECOMREfEDOFTFIEPEFUNTISFOFONEMJI�DREDDp1PAS(f100)ORLESS} PLUMB
W /�
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I ECHANIC ��SL
C} SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE �
(n WORNERS'COMPENSATION LAWS OF CALIFORNIA,Atj_D AGREE THAT IF I SHOUID BEC r.1E INSPECTION FEE
= SUBJECT TO THE WORNERS'COMPENSATION PRO f61bNS RF SECT ON 370o OF THE ,BOR_ - _ y -p�
CADE.I SHALL FO/R^T�HWITH COMP H 5 6VI ONS. ISS AN �C--�J V
p DATE:!����,�—F= APPLICANT: � SMIP
J WARNING:FAIIURE TO SECURE WORKER CAMP SATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C
� SU&IECTAN EMPLOVER TO CRIMINAL PE . AN�CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PE
DOLLARS(f 700.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN A
� SEC710N 37o80F THE LABOR CODE,IN7ERE5T,ANDATTORNEv'S FEES. ETENTION FEE' ��� v
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER 7ENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH TMIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
Z
W
� LENDER'S NAME
H LENDER'SADDRESS {
w I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �/ ��
� I AGREE TO CAMPLV WITH ALL CITY AND fAUNTY ORDINANCES AND STATE UWS FEUTING TO BUILDING -
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO EN7ER UPON 7HE
Z ABOVE-MF,pIAONED GROP RTV FOR INSPECTION PURPOSES.
� / COMMENTS
_ ��ri�`
m PERMI E E(PRI ) �
lO-�--lC�
GN TUREO PERMITTEE DATE
RECPT.NO. PAID B VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
co�v �� �oa�o�� �,�� . . � .
. .�._..�
0����'li U ��iCl ��'li��� r . ^ . .
.� oa�p�c�400a y o ��r���rv � o��a�c�o� oa�p�c��o�a � � � o���� . ,oa�a��F� ��F�
SET BACK � ' ' � • � ' � � � � � FLOOR JOIST � "' - • �
FTGS/FORMS/STEE� - ,, ' , FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT � ' � � �
GROUND PLUMBING UNDER FLOOR CONDUIT,_ � ` ' �
SLABGRADE FIREPLACE�FOUNDaTI�N '
TEMP POWER FIREPLACEBONQ BEAM �
WATER SERVICE MID HT. BOND BEAM� ' • . � • ,
ROOF SHEATHING � 8 FT.��OND�BEAM. � ' '
FRAMINGNENTILATION' ' ' � �� FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING � BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERrfUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEI�ING 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
C�'1 �o � ,
COMMEfVTS J�/����o, �°� �a — —
. ,_ . �� .
SEPTIC TANK SIZE -
SEEP PIT/U SIZE
a — -
� �
a
.; . .
^INSTALLATION CERTIFICATE CF-4R-MECH-25 �
Refrigerant Charge Verification -Standard Measurement Procedure (Page 5 of 5)
Site Address: Enforcement Agency: Permit Number:
21227 Cottonwood Lane, Walnut CA 91789 City of Diamond Bar PR11-372 I
Standard Charge Measurement Summary:
System shall pass both refrigerant charge criteria, metering device criteria (if applicable), and minimum cooling coil j
airtlow criteria based on measurements taken concurrently during system operation. If corrective actions were taken,all
applicable venfication critena must be re-measured and/or recalculated.
System Name or ldentification/Tag System 1
System meets all refrigerant charge and airFlow
requirements. PASS
Enter Pass or Fai
,:. .
�, ;
_ ,_.. yw >.
_..,:.
,s; ` .
� ;.
v ;
iaqy '�T,
� .4 � 41t�
» r�i�}� �/s,- ��Y r �s 3i C �� �� i�c��� � '�� 1��`r'��� Y ��" x4��;���}�s*:
� ���.'n tiY�[� �,1�- s± �;..
�j� �, .yl.. . i . �'
! t. t
x'i:�:..� �� � �� F ��' . .. y 4��.. , ��pxt..� �� A�_ � -
����: � -'. 1� ,�. ��. t. (.� t� �s�'� �� - j � _ _ .
1 b � ` k i } i�� a -3� �.�fi 4 �t
Nc ti t C J � �: {'� T� j,�yq� 4.�'� �) �t �Y�S�<,
5 �� �k� ��� ��a�� �' ����M � � fl� !����, � �; � � .,,,������ '��
/� t r
t t��, >�7 'f%� � R ,..i,!C }°�'� ��";r"!� ���1��5�s.� .'�� ��f.,� yl n�Sii �lx _'Y-��r k''� .�; ,�`�,.� ' Y . },t�,,. . � 1.�.1�'{�k.
. .. . �� . .. . . . . .. .
r�' ke r.��i_ ��i
P�.._ t�., r
��". � e �t...._.�.�:
DECLARATION STATEMENT��
. I certify under penalty of perjury un`derithe laws of the State of California,the information provided on this form is true and correct.
. I am the certified HERS rater who perfo�med the verification services identified and reported on this certificate(responsible rater).
. The i�stalled feature, material,component,or manufactured device requiring HERS verification that is identified on this certificate(the
installation)complies with the applicable requirements in Reference Residential Appendices RA2 and RA3 and the requirements specified
on the Certificate(s)of Compliance(CF-1R)approved by the local enforcement agency.
. The information reported on applicable sections of the Installation Certificate(s) (CF-6R),signed and submitted by the person(s)
responsible for the installation conforms to the requirements specified on the Certificate(s)of Compliance(CF-1R)approved by the
enforcement agency.
Builder or Installer information as shown on the Installation Certificate(CF-6R)
Company Name: (Installing Subcontractor or General Contractor or Builder/Owner)
Homeowner
Responsible Person's Name: CSLB License:
Susan Heil 999999
HERS Provider Data Registry Information
Sample Group# (if applicable): N/A 0 tested/verified dwelling ❑not-tested/verified dwelling in
a HERS sample group
HERS Rater Information Ca10ERTS Certificate#CCi-1798552598
HERS Rater Company Name:
The Energuy CA LLC
Responsible Rater's Name: Responsible Rater's Signature:
Patrick Thomas Putrick Thomas
Responsible Rater's Certification Number w/this HERS Provider: Dete Signed: 4/7/2011
CC2005746