HomeMy WebLinkAbout11-397 -- . . -�-.�
CITY OF DIAMOND BAR E� `�
----��` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERV
21825 Copley Drive,Diamond Bar,CA 91765 PRESS
i '� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027
���w'` SUILDING PERMIT APPLICATION FIRMLY
� JOBSITE �r���� (�/J,� APPLICATION PERMIT P/C
Q ADDRESS�U�`� HL.f/L'�.� N"'�<<X'�� DATE NUMBER �!-3R�#
� ISSUE O P)g /� CONST. GROUP
-- APN LOT TRACT DATE V
� OWNER
� ZONING SETBACKS
o ADDRESS
Z C�Ty ZIP TEL. FRONT RW ❑
REAR ❑
o APPLICANT TEL. SIDE/SIDE STREET RW ❑
Z SIDE ❑
� CONTRACTOR V ��`p "
ADDRESS r � PROPOSED USE '��''��1"R-�Gl �LS��II�I j5�l� G..0C7 f=
� CITY ��� ZIP��� TEL. ��� �f �f �in /'�., ..�
w ARCW G! ��^-��
� DESIGNER
� ADDRESS NO.DWEL. NO. NO.
UNITS STORIES BEDROOMS
� CITY 21P TEL.
� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
cr�
� OWNEFi-BUILDER DECLARATION SFR/ADD/REM
O
� I HEREBV AFFIRM UNDER PEWLLN OF PERIURV THA7 I AM EXEMPT FAOM iHE CONTRACTORS LI� G0f890/C81F10R
W CENSEI.AWFORTHEFOLLOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITVOR (n
Z CIXINTYWHICHHE�UIRESAPEHMITTOCONSTNUCT,ALTERIMPROVE,OEMOUSH,OFFEPAIRPNVSTRUC� W p8tI0IDBCk
lURE,PRIOR TO RS ISSUMICE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
STATEMENT TFIAT HE OR SHE IS UCENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRAC70RS LI�
� CENSE VAW�CHAPTEP e(COMMENCINO WITH SECTION 7 Wo)OF DIV1510N 3 OF TNE BUSINESS ANO PRO- � POOUSPB
^ FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEOED E%EMP• /��
� TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU91ECT5 THE MPLICANT TO Z Re-Roo1 W
� A CML PENALTY OF NOT A10RE 7NAN FIVE HUNDRED DOlURS(i5u0).):
� ❑t,ASOWNEROFTHEPROPERTY,ORMVEM7LOVEESWITHWAGESASTHEIR50LECAMPENSATION, � COrtlfn0fC18I
Z WIIL DO 7HE WORI(M1D 7HE S7Rl1CTURE IS NOT INTENOED OR OFFEflEO FOF SPLE(SEC.7W�,BUSI� J
NESS M!D 7ROFESSIONS CODE:THE CONTRACTORS IICENSE UW DOES NOT APGLV TO AN OWNER OF
� PROPERTV NM110 BUIIDS OR IMPROVES THEREON,AND NM1IO DOES SUCN WORK HIMSEIF OR HERSELF OR �
CC TNROUGH HIS OR FiEF OWN EMPLOVEES,PROVIDED THAT SUCM IMPROVEMENTS ARE NOT INTENDED Oq m
w OFFEREDFORS�LEIF.HOWEVERTMEBUILDINOORIMVROVEMENTISSOIDWfTFIINONEVEAROFCAMPLE�
0 TqN,THE OWNER�UI�DEF WILL HAVE THE BURDEN OF GROVINQ THAT HE OR SHE DID NOT BUILD OR
Z UA7fi6VE FOR THE PURPOSE OF SALE]. '
_ ❑I,ASOWNEROFTHEPROPEHTV.AMEXCLUSNELVCOMRACTINGWITHLICENSEDCONTRACTORS
W
� 70 CONS7RUCT TME PR0.1EC7(SEC.7oN,BUSINESS M!D PROFESSlONS CODE:THE COHTMCTOHS l4 VelU9NOn • Cr� ADJ.AFEA
W CENSE LAW DOES NOT APPLV TO AN OVMER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON.AND
Z NTIUCONTRACTSFORSUCNPq0.1ECT5WITHACON7RACTOR(S)UCENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
�— TORS LICENSE I1�W.).
Y J
� ❑I AM EXEMP7 UNDER SEC. B.8 P.C,FOH THIS REASON �
� �
LL DATE oWNER F
W
�� � UCENSED CONTFACTORS OECIARATION �j
� I HEREBY AFFIRM UNDER PENALTV OF PERJURY THA7 I AM LICENSED UNDER PROVISIONS OF CHAPTEfl � .
d e(COAIMENCWO N7TH SECTION 7000)OF DNISION 3 OF THE BUSINE55 ANO PROFESSIONS CO�E.AND Z
X MV LICENSE IS W FULL FOFCE AND EFFECT. m
L1J 2L� (� +� n
� LICENSE CLASS�� �1� J 1 LIC.NO. '1�1� 1 /�� j �
J
V DATE CONTRACTOR n-
W
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDEk PENALTV OF PERJl/RV ONE OF THE FOIIOWING DECIAPAT10N5: �
� Z
Q
� I NAVE AND WILL MAINTAIN ACERTIFICA7E OF CONSENT TO SELFdNSURE FOR WONKERS' 2
� COMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR THE 7ERFORMANCE w
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
W I HAVE AND WILL MAMTAW WOqKERS'COMPENSATION INSURMJCE.AS REQUIRED BV SECTION -
Q 3700 OF THE 1A80R CODE.FOR TH£PERFOFMANCE OF THE WOFK W R WMICH THIS PERMIT IS �
ISSUE�.MV WO`F�N-E�F�S('�COyM�PENSATION INSURAN�E�RRIER AND POLIGV NUMBER AAE: CONSTRUCTION
j CARPoER �J1 nl �� 4���v PLANREVIEW
� POLICV NUMBER A/1 'I Ll'LI �I Z� '�S_� D ELECTRIC
Z
Q
� (f/LLSSECTqNNE�NOTBEWAa�FfEDOF7FEPEPMi15FORONEHIR�DF�EDDaLARS(L�QOI��FS+`1 PLUMBING
w MECHANICAL
Z I CERTIFV T1AT IN THE PERFORMANCE�F THE WOR)(FOR WHICH THIS PERMIT IS ISSUEO.I
(,�} SHALL NOT EM7LOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATION LAWS OF CAIIFORNIA,AND��REE THAT IF I SHOULD BECOME INSPECT�ON FEE
S SU&IECT TO THE WORNERS'COM7ENSATION PROVISIONS OF SECTION 370o OF THE LABOR ISSUANCE �� �
COO 1 SHALL FORTNWITH COMPLY WIrFi THOSE PN4VIS�ONS,
0 SMIP r�
p DATE: � APPLICANT. � �
W ENERGY P/C
J WARNING:FAIL E TO SECURE WORKERS'CAAIPENSATION COV[RAGE�S UNLAWFUL,AN�SHAIL BE
J SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CNI�FINES UP TO ONE HUND0.ED Th10U5AN0
ti ENER�Y PERMIT
DOI.LARS(f100,000).IN ADDITION TO THE COST OF COMPENSATION,DAIAAGES AS PROVIDEO FOR IN
¢ SECTION 3708 OF THE LABOR CODE,INTEHEST,ANDATTORNEV'S FEES. RETENTION FEE: �� �
w CONSTRUCTION LENDING AGENCY PR •�/�-� r,�
a
� 1 HEREBV AFFIFM UNDER PENALTY OF PENURV THAT THERE IS A CONSTRUGTtON LENDING AGENCY
FOf1 THE PERFORM4NCE OF hIE WOFiK FOR WNICH TMIS PERAl1T IS ISSUED(SEC.30G7.CIV.C.).
Z
W
� IENDER'S NAA1E '
F_- LENDER5ADDRESS
� I CERTIFV THAT I HAVE FEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORIAATqN IS CARAECT. I OTAL FE ES �� ��
w I AGiiEE TO CAMPLY WITH AlL CITY AND COUNTV OROINANCES AND STATE LAWS REUTING TO BUILDINd
� CONSTRUCTION.AND HEREBY AU'�NORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON 7HE .
ZABOVE�MENTIONED PFOPERTV FOR IN57ECTION PUFGOSES. COMMENTS
�
J �
�
m PERMITTEE NAA1E(PRINn ' .
Q �
�
� SIGNATUREOFPERMITTEE DATE
RECPT.NO. PAID 8Y VALIDATION
� ,_
WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessar CoDY.GOLDENROD—File Copy.GREE Applicant's Copy
CITY OF DI�►AfiOYVD �AR , � . ,�
I�SPECT106V RECORD
:.� �Da�p�c�ooa o ��` i: :;�a��p a��p�c�ooa -; ac�a�� �aa�p�c�4oca:4� �
SET BACK , � t FLOOR JOIST
FTGS/FORMS/STEEL � FHA RE(�MTS
ELECTRIC GROUND � UNDER FLOOR DUCT
GROUND PLUMB►NG UNDER FLOOR CONDUIT
SLAB GRAOE FIREPtACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVECE MID H'i: BOND BEAM
RDOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION PQOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICAT(ONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.l. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
F�NAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
_ ,(�o
COMMEfVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
a
� . � Q
t
i��
A �,
I
=,�escri tive Certificate of Com liance: Residential Reroof Vr-�rt-AL 1-K@KOOT
'roje+ct Addras • Climate Zone Permit#
��:. � � ' � 2
� . ZOOFiNG PRODUCTS (COOL ROOFS) §151(�12
Nhen the.area of exterfor roof surface to 6e replaced exceeds 50%of the existFng roof area,or 1,000 ,whichever is less, the new
�oofng area must meet fhe roofng product"Coo/RooP'requiremenfs of§152(b)1Hf, 152(b)1Hil, or 952(6J1Hiii.
:heck appticable attemative or exception below if the roof altera6on is exempt from the roofing product"Cool RooP'requirements::
❑ Cool roofs not required in Ciimates Zones 1-12,14,and 16 with a low sloped roof pitch(less or 2:12 pitch).
�9. Cool roofs not required in Climates 2ones 1-9,and 16 with a steep-sloped roofs(greater pitch than 2:12)and product weight less than 5/1b/ft�.
4ltematives to§152(b)1 Hi and§152(b)Hii,Steep-slope roof(pifch>2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr•fi�•°FBtu or at least a 3/4 inch air-space is added to the roof deck over an attic;or
� E�asting ducts in the attic are insulated and sealed according to§151(fl10;or
❑ In dimate zones 10, 12 and 13,with 1 ft2 of free ventilation area of attic ventilation for every 150 ft2 of attic floor area,and �
where at least 30 percent of the free ve�tilation area is within 2 feet vertical distance of the roof ridge;or .
O Bulding has at least R-30 ceiling insulation;or ;
D 8uilding has radiant barrier in the attic meeting the requirements of§151(fl2;or �
❑ Building has no ducts in the attic;or
O In Gimate zones 10,11, 13 and 14,R-3 or greater roof dedc insulation above vented attic.
Exception to§152(b)1 Hiii,Low-slope roof(pitch 52:12)
❑ Building has no ducts in the attic.
Other Exceptions � -
❑ Roofing area is c�vered by building integrated;photovoltaic panels and solar thermal panels are exempt from the Cool f2oof criteria.
' ❑ Robf constructions that have thermal mass over the roof inembrane with at least 25 Ibfft2 are exempt from the Cool Roof criteria. '
NOTE:If any one of the altematives or exception is checked the Aged Solar Reflectance and Thermel Emiftance requirements for roofing
�roducts in§118(i)are not applicable. Do not fill table below.
Roof Slope Product Weight Product ,4ged Solar Thermal
� CRRC Product ID Number� <_2:12 >2:12 < 51b/fiz z 51b/ftz T e2 Reflectance3'4 Emittance SRIS
❑ 0 ❑ ❑ p4
❑ [J ❑ ❑ p4
Nofe:If no CRRC-1 label is available, fhis complrance mefhod cannot be used,use fhe Performance Approach to show compliance,
1. The CRRC Pr�duct/D Number can be obtained from fhe Cool Roof Raling Counci!'s Rafed Pr�dud Direc[ory at www.cooJruofs oro%roducts/search ohn
2 lndicate the fyps of product is being used for the mof top,i.e.single�ly roof, asphalt roof,meta!�vof,etc.
. !f the Aged Reflectance is not avaiJable in the Coo!Roof Rating CounciPs Rated.Producf Directory then use the Initial Reflectance va/ue from the same
directory and use the equation(0.2+0.7(p,,�r—0.2)to obtain a calculated aged value. Where p is the Initial SolarReflectance.
4. Check box if fhe Aged Reflecfance is a ca/culafed velue using the equafion above. . �
5. Calculate the SRl vaJue by using the SR!-VYorksheet at httnJ/www.enervv.ca.00vftitle24/and enfer the�suRing value in the SRI Column above and attach
acopy of the SR/-Worksheet to the CF-iR.
o apply Liquid Ffeld Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in§118{i�. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof Coating ❑ Cement-Based Roof Coating ❑ Other
NOTE: When a Coof Roof is required, the instal/ing confracfor sha!!complefe and submit fhe CF-6R-ENV-09 for final inspection.
Declaration Statement
• I certify under penalty of perjury,under the Iaws of the State of Califomia,the information provided on this form is aax�rate and complete.
• I certify that the energy features and perFormance specifiptions identified on this Certificate of Compliance conform to the requirements of TiUe 24,Parts
i and 6 of the Califomia Code of Regulations.
Name: Signature:
��� ����
Com an �
P Y v , �°t" 1�s Date: •� � �
Address:
� � � �� i ense:
City/State ' , h ne: ��
Z'�� � � -o ,
For assistance or questions regarding the Energy Standards, contacf the Energy Hotline at: 1-800-772-3300.
. INSTALLATION CERTIFICATE: Residential Reroof CF-6R-ENV-01
" Enforcement enc Permit Number:
Site Ad ss: � � y'
, l�O ���
If more than one person has responsibility for installation of the items on[his ceriificate,each person shall prepare and sign a certificate 'I
_-.. applicable to the portion of construction for which they are responsible:alternatively,the person with chief cesponsibiliry for construction shall
prepare and sign this certificate for the entire construction. All applicable Mandatory Measures wilh check boxes are required to be checked to ,
ensure the.mandato measures have been>rtet.
CEILING INSULATION
��d: Brand Name:
Batt or Blanket Type: Brand Name:
Loose Fill Type: Thermal Resistance(R-Value):
Spray Foam Type: Brand Name:
Installed Actual Thiclmess(inches): Contractor's min installed weight/ftz lb
Manufacturer's installed weight per square foot to achieve Thermal Resistance(R-Value):
❑ §150(a):Minunum R-19 insulation in wood-frame ceiling or equivalent U-factor.
❑ §118(a): Insulation installed meets Standards for Insulating Material.
❑ §150(g):Mandatory Vapor barrier installed in Climate Zones 14 or 16.
ROOFING PRODUCTS(COOL ROOFS)§�51�12
❑ Check this box if the newly installed roof is exempted from the roofing product"Cool Roof'requirements as indicated on the CF-1R-Alt-
. Reroof form for this project.Otherwise fill in the table below. '
Roof Slope Product Weight Aged Solar Thermal
CRRC Product ID Number' <_z:l� >2:12 < Sib/ft2 z Slb/ft2 Product Type2 Reflectance3'4 Emittance
❑ ❑ ❑ ❑ ❑4
0 ❑ � ❑ �4
I.CRRC-1 label information is available is on the package of the roofing product being installed and attach the CRRC label to this form..
2.Indicate the type of product is being used jor the roof top,i.e.single-ply roof,asphalt roof,metal roof,etc. '
. Ijthe Aged Reflectance is not available in the Cool Roof Rating Council's Rated Praduct Directory then use th2 Initial Reflectance value from the
sanee directory and use the equation(0.2+0_7(p�,;,;a�—0.2)to obtain a calculated aged value. Where p is the Initial Solar Refleclance.
4. Check box if the Aged ReJlectance is a calculated value using the equation above.
o apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thiclrness or coverage
ecommended by the coatings manufacturer and mee[minimum performance requirements listed in§118(ikl. Select the applicable coaring.
❑ Alumfnum-Pigmented Asphalt Roof Coat[ng ❑ Cement-Based Roof Coating ❑ Other
DECLARATION STATEMENT -
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and wrrect.,
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized representative
of the person responsible for construction(responsible person).
• I certify that the installed features,materials,components,or manufactured devices identified on this certificate(the installation)confotms
to all applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the enforcement
agency.
• I reviewed a copy of the Certificate of Compliance(CF-1 R)form approved by the enforcement agency that identifies the specific
requirements for the installation. I certify that the requirements detailed on the CF-1R that apply to the installation have been met.
• I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building
permit(s)issued for the build(ng,and made available to the enforcement agency for all applicable inspections. I understand that a
signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the buildiog
owner at occupancy. '
Company Name: ( stalling Subcontractor or General Contractor or Builder/Owner)
�Jc�) 1�/
Responsible Pers s ame: /�/``-v`L � Responsible P s gna .
b .._/�_ /�
N�� �i
CSLB License• Date Si ed: Position With Company(Title):
�'f 1'Z� � t e�c�c�l r�
2008 Residencial Compliance Forms August 1009