HomeMy WebLinkAbout10-1179 � .. ,, ^ _�F� CITY OF DIAMOND BAR � ���� {ri(��[ ��
DEPARTMENT OF COMMUNITY&DEVELOPMENT SE S ��s �� ��U15 lJ
T, 21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)83 �j7 ������E$$
�'°"'� BUILDING PERMIT APPLICATION FIRMLY
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p� OWNER-BUILDER DECLARATION �
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p I HEREBY AFFIRM UNDEH PENALTV OF PEFLRIRV THAT 1 MI E%EMPT FqOM THE CANTRACTORS LI- G918 6/CE R
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w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FI�E A SIONED w
g STA7EA/ENT THAT HE OR SHE IS LICENSED PURSUANi TO 7HE PROVISIONS OF 7HE CONiRAC70RS LI�
� CENSE LAW(CHA➢TER Y(CAMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB
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TION.ANV VIOLATION OF SECTION 7031.5 8V ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
� A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLAHS({500).);
� ❑I,ASONRJEROFTHEPROPERTV,ORMVEMPLOVEESWITHWA6ESASTHEIRSOLECOMPENSATION, COrt1/flBfClel
WILL DO 7HE WORK,AND THE STRUCTURE IS NO7 INTEN�ED OR OFFERED FOR SALE(SEC.7o�t,BUSI- �
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF �
PqOPERTY NM1iO BUIIDS OR IMPROVES THEREON,AND WHO OOES SUCH WORK HIMSELF OR HERSELF OR
w iHROUGH HIS OR MER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSPIEIF,MOWEVERTNEBUILDIN(iORIMPROVEMENT1550LDWITHINONEYEAROFCQNPIE�
z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINQ THAT HE OR SHE DID NOT BUILD OR
� IMPFOVE FOR TME PURP0.5E OF S�LE).
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❑I,AS OWNER OF THE PROPERTY,AM E%CLUSIVELV CONTRACTINO WITH UCENSED CONTRACTOqS
Q TO CONSTRUCT TME PRQIECT(SEC.7W1,BUSINESS AND PFOFESSIONS CODE:THE CONTMCTORS LJ- V8II1flIIOR ADJ.AREA
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Z WFIOCONTRACTSFORSUCHPROJECTSWITHACANTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE I
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBYAFFIRM UNDER PENALTV OF PERIUHY THAT IAM LICENSED UNDER PROVISIONS OF CHA7TER�,
� D(COMMENCINO N7TH SECTION]000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CO�E,AND �,, Z C /�Q � \C�
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� WORKERS'COMPENSATION DECLARATION � YD Cy�U T(.f
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N I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DEClAf7ATIONS: �
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�Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WOR)(ERS' a
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COMPENSATqN,AS PROVIDED BY SECTION 37000F THE IABOR CODE,FOR THE PEFPoRMANCE U
OF THE WORN FOR NM1iICH THIS PERMIT IS ISSUED. W
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w ✓I HAVEAND WILL AIAINTAIN WOHI(ERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WOR�K-E�R^S'CAMP NSATION INSUPANCE CAARIER AND POLICV NUMBERARE: CONSTRUCTION
� CARRIER /P NGp� �L� PLAN REVIEW
Z POLICV NUMBER O / �O Y - •� �0
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� (iH155ECIlONNE�NOTBEWNPIFfEDOFTHEPERAYTISFORONEFR.DDREDOCUAilSR10010R1E5S�
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Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOq WHICH THIS�ERMIT IS ISSUED,I HANICAL
�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE
(,/) WORNERS'COMPENSATION LAWS OF CALIFORN10.AND AGREE THAT IF I SHOULD BECAME IN FEE
S SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37o00FTHEUBOR
CODE,I SHALL FORiHWITH COMPLY WITH TH SE VISIONS. /W
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p DATE: /I �Z�I' I� APPIICANT. _� SMIP
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� WAANINO:FAILURE TO SECURE WOflKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � �
� SU&IECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FMES UP TOONE HUNDRED TFIOUSAND ENERGY PERMIT
OOLLARS(f100,o00),IN/�DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEVS FEES. � `�
w RETENT ON FEE:
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBV AFFIRM UNDER PENALTV OF PERJURY THATTHEFE IS ACONSTRUCTION IENDINO ADENCY
FOR TME PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED(SEC.3oe],CIV.CJ.
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� LENDER'S NAME
'F-- IENDERSADORE55
W ICERTIFVTNATIHAVEREADTHISAPPUCATIONANDSTATETHATiHEABOVEINFORMATIONISCARRECT, TOTAL FEES ��/�
� 1 A(iREE TO COMPLV N7TH ALL CITY AND COUNTV ORDINANCES ANO STATE LAWS REUTINO TO BUILDINO
� CONSTRUCTION,AND HEREBV AUTHORIZE REPFESENTATIVES OFTHIS CWNTV TO ENTER UPON THE '
Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS '
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� RECPT.NO. - P/UD B � � VALIDATION
WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GR EN—Applicant's Copy
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SET BACK ' '. FLOOR JOIST
FTGS/FORMS/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. B�ND BEAM
ROOF SHE,4THING 8 FT. BOND BEAM
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 fVAII.ING DEDICATIONS
SEWER FINAL ENG..
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE lMPS.
GAS AIR TEST � �o FINAL ZONIfJG
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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� FRUM :AIRTRO FAX N0. :6263589580 Jan. 03 2011 09:17AM P2
CEftT�FICATE�F FlELD V�RIfICATION �.DIAGNOSTTC TESTIN� CF-4R-MECH-21
PuCt Leakage 7est- Existing Duct System (Page 1 of 2)
S te Addraf�: EnforCemOnt A en
3352 FALCON RTDGE RD�, Diamond Bar CA 91765 9 �Y� Permlt Number:
(Lal} Clty af Diamand Bar id-1179
Enter the Duct System Name or ldentificatlon/Tag: I,ai
Enter the Duct System Location ar,4rea Served: Attic
Noter Subm;t one Insta!!aClon CertifrcaCe for each duct system that must demonstrate compliance in the
dwe!ling.
']hls Installation certlflcate is requlred fiar compllance for alteratlons and additions in existing dwel!ings to
space conditloning systems and duct systems.
Alote: For exlsting dwe!lings, a completeJy new or rep/acement ducC system can also include exls[Ing parts of
the origina!duct system (e.g., negister boots, air handler, coil,'p/enums, etc,)IP those parts are accessible
and they can be sealed. For a completely new or replacemenr duct system installed!n an exisring dwe!ling,
use the InStallatlon Certifrcate tltled "Duct Leakaqe Test- Completely New or Replacement Duct SysCem."
Puct Loakage Dillgnostic Test-existlnp duct 9}rmte�xM
Select one compli�nCe m6thod fram the following faur chaices-
�1. Measured leakage less dlan 15% of fan fiow �
��2. Measured leakage to.outside less than 10°k of F�n Flow
n 3. Reduce leakage by so�io and conduce smoke and fix all leaks �
n a. Flx all acce95ible Icaks using smoke and HERS rater verify
Note: (4ne oP 4Ptlons 1, 2,ar 3 must be attefrlpted before utllizing Optioll 4,).. ,. ,.
Petel'mine mtirt5indl Piit1 Flow using ottie of the followliig three Calculatlon meth'ti,.,. •
✓0 Coollli�5ystem method: Size Of'condenser in TOnS,,,;,;�x 400 =.,:.:.�OOLIr.,.'CFM .
��HeaEing 5y5Cem method�:31.7;X_.,,,;_Output Capacity In 7liousands o�gtu/hr=�CFM
✓�MeasWred.sy5ti'etYf'.-�h`flow•usfrig'RA3.3 alrFlow test proCedur'es:�.._.CFM: �
dptlon 1 used then:
1 AlioW@d leakage = Fan Flow 200� x 0.15 d 300 CFM
, Actual Leak2rge = 242 GFM
Pasa if Loakaga ACtudl i�IeSs than Allowed Pass Fail
Option 2 used then:
2 Allowed feakage � Pan Flow_x 0.�,0��CFM '
Actual Leakage to outslde =_CFM
Pa�s�f L�akage Actual Is la�s tltan Allowed Pass Fall
Optlon 3 used then:
Initial leakage prior to sttlrt of woric =_CFM .
Flnal leakage after sealing all atteSslble leaks using smoke te5t= CFM
3 Initial leakage_- Fnal leakege_= Leakage reductlon_CFM
((Leakage reducti0n,�/Initlal leakdge�J x 100% __�rp,Reductlon
Pasa If°,b Raductlon >60aYo Pass Fail
optlo�a used then:
a All accessible ieaks repaired u5ing smoko. HERS rater musC verlPy(No sampling). No smoke
alloWed ta leak from 5ystem. Including duCts, plenums, alr handler and d0or panel.
paaa If all acCemsible le�lkS have ba�n r8paired uBillg 9roOke Pass Fall
Rpg: 21U-A0035179A-OOOVOOOOD-�21A Regiatxz�h�p�1 Date/Time: 2010/7.2/70 1b:5G:33 HERS Biovirler Ca1C!ERTB, Ine_ i
2008 Residel�r,ia1 Compliar�LP Porme ntarch 2010
. ERGM :AIRTRO FAX N0. :6263589580 Jan. 03 2011 09:18AM P3
CERTIFICATE OF FIELD VER�FTCATION &PIAGNOSTIC T�5TING CF-4R-MECH��i
Dutt Leakag�7est- Existin�g Duct System �P8�9� Z of Z�
S[te Addremm: @nfprcemen!Agency: Permlt Num6ar:
3352 FALCON RIDG� Rb., Diamond Bar CA 91765 �ity of Dlamond Bar 10-1179
(��)
� C�Outside alr (OA) ducts for Central Fan InCegrated (GFI) ventllation system5, shall not be sealed/taped off
during duct leakage Cesttng, CFT OA ducts that utilize controlled motorized dampers, that open only when OA
venNlstion is.,requir,�d to meet ASNRAE Standard 62,a,.and.close..evhen oA yentllatlon,.ls notrequired, may
be configure'tP to the dosed posltlon during duct leak�ge testing.. .
F�1 All supply and reCurn;�E'�i�ter iaoots must be sealed to.fhe drywall=l�`smoke'��5t is utilited for compliance
- applies,.td ducC leakage:cqmpflance option 3 (leakage reductfdn'by',60%) and;aption 4 (�Ix�tl aecessible
leaks) de3crlbecl abave.,� � ,
,.
hJ New duct installatlons cannat utfllze building cavitles as plenums or plaCForm reCums In lieu of ducts.
F71 Mastic and drdw bands must be used In combination wlth cloth backed rubber adhestve duct tape to seal
leaks at all new duct connections
`. D�CLARATION STATEMENT
♦ I certlfy under penatty af perjury,Under the laws af ttle State of Callfomfa,the informsGOn pr6Vlded on thls farm Is true and corract.
� I am thC Certlfled HERS YeY,Cr who pertormetl N1C veriflCd[�On servlces identifitd&rld reported on thfs eertificate(rospO�Sible reter).
. TF�e fnstalled feature,mnCerJal,component,or manufactured devica raqufring I1ER5 verlFlcation that is idenGRed on thls certlflcate(the
Ins�IlatiOn)CO�npl�es with thE eppllcable requir�nl8nts In Refefence Residential AppendlCes RA2 and RA3 and the requiraments SpCclfled
, on the CeRIPiCAte(S)of CamplianCe(CF-iR)approved by the local enforcement agency, '
. Tho in�ormatlon reported on appllca6le sections of the installatlon Certificata(s)(CF-6R},slgned and submltted by the person(s}
resporkSible(Or the Installati6n COn}orms m the rAquirErrlCnCS 5peclfled on the Certificate(S)Of COnlpllance(CF-iR}approved by the
enfnrcement egency,
Bililder or In�taller Infonnatlon as shown on tfie Lnetallation CertiAcate(CF6R)
CompBtty Nd1Y12: (Installing 5u COntYeCto�of Gef1p1'211 C4ntreCtOf'O�6ullde�/QWIIEC)
AYR TfiO INCORPQRATED
Re5ponsible Person's Namo; CSIB l.icense:
Tlrnmothy Miller 25827$ . .
WERS Provldor DaYd Reglatry Infornfation
Sample GrOup# (lf applicable): N/A 0 tested/verifled dwelling ❑not-tested/verified dwellirtg in
a HERS sample group
HERS RAter Informatlon CdIC!'RTS CertYWcat�yF CCi-179B533394
HERS Rater Campany Name:
Rapld DUct Testlng&Air 9alancing
Rosponslble Ratmr�s Name: Responsinle Rater's Slgnature:
Mh�r T4rosyan AAher Torosyan
ftESpPnBible Rater's CCrCiHr�non Number w/thi3 I1ER5 provlder: DBt6 51JI1Ed: 1Z/30/�Oib
' CCZOd46$4
R�g: 210-A0435179A-OUOOUOODO-M21A Regiatrata,o�l nate/xime: 2oin/i�%�n 15:56:33 xsx8 Fzova.dex•: cale�xs, ino.
2008 Reeidontisl Couc�+lias+r,.•r. Porme March ?,0�,0
.