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Home My WebLink About11-548 _ �„`_ CITY OF DIAMOND BAR � �� . DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVI � � � 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 ��$ "°"'� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE D� J� ADDRESS r �/S' DATEICATIO g �l NUMBER��!��/C �� ISSUE TYPE y� OCC APN��J�OT TRACT DATE CONST.--��/�ROUP p OWNER L�R � p ADDRESS ZONING SETBACKS gCITY ZIP�I �7 TEL. � ,� FRONT qyy � APPLICANT TEL. REAR � zd _ SIDE/SIDE STREET q�ry p � CONTRACTOR SIDE ADDRESS � e / � C�TY ZIP ` ZTEL. � PROPOSED USE o ARCWENG/ � z DESIGNER a ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION OC OWNER•BUILDER DECLARATION O SFR/ADD/REM p I HER�V AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FROM THE CONTRACTORS lb GBfegB/CBfPOff W CENSEUWFORTHEFOLLOWINQREASON(SEC.7031.SBUSINESSANDPqOFESSIONSCODE:ANVCITYOR (n ZCOUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,A�TEq,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC• W patlo/Deck w TURE,PRqq TO RS ISSUANCE,AL50 REWIRES h1E APPLICANT FOR SUCH PERMIT TO FILE A SIONED w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE lAW(CHAPTER B(CAMMENCINO WITH SECTION 70oa)pF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB . � FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALlEOED E%EMP- � TION.ANV VIOLATION OF SECTION 7031.6 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPUCANT TO Z Re-Roof � A CML PENALTV OF ryp7 MOFE THAN FIVE HUNDRED DOLURS(S5ao).): � OI,ASOWNEROFTHEPROPERTV,ORMYEMPIOVEESWITHWAOESASTHEIR50LECOMPENSATION, 0 COfI1RIBfCIeI Wlll DO THE WORK,AND 7NE STRUCTURE IS NOT IMENDED OR OFFERED FOR SALE(SEC.70l1,BU51� J � NESS AND PROFESSIONS COOE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY WFIO BUfLDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF Oq Q TMROUGH HIS OR HER OWN EMPLOVEES,PHOVIDED THAT SUCN IMPROVEMEMS ARE NOT INTENDED OR m Q OFFEREDFORSPLEIF,HOWEVEq,7HEBUILDINGORIMPROVEMENTISSOLDWITMINONEVEAROFCOMPLE• z TION,THE OWNERAUILDER WILL HAVE THE BUqDEN OF PROVINO THAT ME OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). � w ❑I.ASONMEROFTHEPROPERTV,AMEXCLUSIVELVCOMRACTINGWITHLICENSEDCONTRAC70R5 Q TO CONSTRUCT h1E PHOJECT(SEC.7Wa,BUSINE35 AND PROFESSIONS CODE THE CONTqACTORS LI� V8IU8�i0f1 ADJ.AREA � CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND NM1�OCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(S)LICENSEDPUPSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � � TORS LICENSE IAW.). ❑I AM E%EMPT UNDEH SEC. J � B.8 P.C.FOR THIS REASON U LL DATE OWNER H U � LICENSED CONTRACTORS DECLARATION � Q w OC I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � Y(COMMENCINO WITH SECTqN 70a0)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� A/Y UCENSE IS IN FULL FOR FFECT. O60 m � LICENSE C LIC.NO. � � U DATE CONTRACTO � W �j,� � WORKERS'COMPENSATION D A A ��W Q f,� 1 N U �J c � 1 HEREBY AFFIRM UNDER PENALTV OF PE0.IURV O7JE OF hIE FOLLOW WO DECLARATIONS: Z � IS � I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUqE FOR WORKEFS' 2 � �` rI � �MPENSATION,AS 7ROVIDED BY SECTION 37a0 OF THE LABOR CODE,FOR THE PERFORMANCE U �, J THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � w _I NAVE AND WILL MAIMAW WORHERS'CAMPENSATION INSURANCE,AS REQUIFED BV SECTION �4 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOq WHICH 7HI5 PEFMIT IS ' ISSUED.MV WORKE `CO,MP SATION INSU CE C RIER AND P V NUMBER AREr CONSTRUCTION � CARRIER M' �� `� PLAN REVIEW � POLICV NUMBER�� 2 � � ELECTRIC 0 (iHISSEC�qNNE�NOT8E07MPLEfEpOFT}¢pEpMTgFpqp.fEµ,rpqEppp�LAfiS(f�pp�pq��SS� PLUMBING W Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE WOR)(FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL CJ SHAIL NOT�EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE (/j WORKERS' PENSATIONlAW50FCALIFORNI0.ANDAGREETHATIFISHOULDBECAME INSPECTIONFEE ' 1--= SU CT TO T WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR �� O , F� O THWITH COMPLY WI HOSE PR� �� ISSUANCE __ p �A�: � APPLICANT. SMIP W J WARNING: AILURE O SECURE M/ORKERS'CqMPENSATION CAVERAGE IS UNLAWFUL,qND SHALL BE ENERGY P/C � J �y SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOILARS(f10o,000),IN�DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEI"S FEES. RETENTION FEE: �� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CQ45TRUCTION LENDING AOENCY � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). Z W � LENDEFYS NAME F— LENDER'SADDRE55 w I CERTIFV THAT 1 HAVE READ THIS MPLICATION AND STATE THAT THE ABOVE INFORAIATION IS CORAECT. TO�AL FE ES ' � i y/ � I AGREE TO CAMPLY WITH ALL CITY AND NTV ORDINANCES ANO STATE LAWS REI.ATWO TO BUILDINO � CONS UCTION,AND HEREBV.UTHORI R PqESENTATIVES OF THIS CWNTV TO ENTER U70N THE Z � ENTIONED PROPER FOq W EC ION PURPOSES. p � / � COMMENTS J � m PE NAM INT) Q OFPE ITTEE DA E � RECPT.NO. PAID BY 2 �VAUDATION WHITE—Depanment Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—AppNcanYs Copy �r��'�� CITY �� D9AiViO�D ��►R ,''� �� ' �: tt� 'c�� `�� Of�S�EC�'AO�! �i�CORD � �.aJ�� rt ' " '" . . .. y .. -. :,. �OG9�P�C�400�} � �1��'l "¶ 0�1�P@�G3 .. � OC]�PCC�40� � -DGJ4C` OG�1�pGC��G�a " SET BACK � FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT ' GROUND PLUMBING UNDER FLOOR COf�DUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM, WATER SERVICE MID H'L BOND BEAM ' ROOF SHEATHING � 8•FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRAOING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERlT'UB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCIfVG WALL INSULATION POOL FINAL CEILING 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 QEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY C��c,e ' . COMMENTS —�. - - �-1�CL 6l' ��. SEPTIC TANK SIZE SEEP PIT/U SIZE a � " a ��. ��, �� f Certificate of Compliance Prescriptive Method - VAC nly Alteration CF-1 R-ALT ; Project Title; / �� Dat� �� // �CaICERTS 2005 .�-n i / / W Enforcement A Use Onl ' Proj t Address: Clima Zone: ° sottdng Perm it#=-- � � �,� �� Do entation Author: T le hone: Plan Cneck Date � -z ��2P1�-�632 , CO ny am • � �� /� �� Feld Check D�e �J 1MPORTANT: This CF-1R-ALT form is only for use when an HVAC-Qnly alteration 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 lings that appiv. Check on►y lines that au�ly, Scope of Alterations: 1 Air Handler is to be instailed or replaced. Duct seaiing to be defertnined. Continue to ne�d line. 2 Fumace Heat exchanger is to be instalied or replaced. 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 detertpined. Continue to next line. 4 coolin or heaUn cofl is to be installed or r aced. Duct Sealin and/or TXV RCA)to be determined, Cq-,tinue to ne�line. 5 More than 40 feet of new or replacement duct are to be installed in space. Duct sealing to be determined. ❑ Chedc here if the entire duct system is also to be new replaced. Continue to next line. 6 ❑ If none of lines 1-5 are checked,neither Duct Sealin nor TXV RCA)are w . Go to Section 5. Section 1 -Duct Seali Onl if an of Lines 1 2 3 4 or 5 are checked. Ski if Line 6 is checked. 7 ❑ 8 9 ❑ . No duct sealin is uired. Attach �ous CF-4R fortn.Go to Section 2. 10 O ' 's dtict eiin is sealed or insufated with asbestos. No duct seali is: uifed.Go to Sec6ai 2. Note:If the entire duct s stem is to be new or re laced,Lines 11-14 do not a I . 11 ❑ 12 ❑ . o to Sec,yion 2. 13 ❑ In Climate Zories 9 10;11 13 14,or 15.An SEER 14 gyg EER 72 condensei wiii be instailed with T)(�/�RCA) U`a 0.92'AfIIE fumace.will be instalted in lieu of.duct sealing:Co to Section 2. 14 'O , . . , . 15 None of lines 7-14 above are checked. Duct Sealing is Required. Continua Section 2-TXV RCA Onl if Lines 3 or 4 are checked,otherwise ot to Section 3 16 O e em bein altered is a e uniL No TXV RCA is uired. Go to Section 3. 17 0 . o to Section 3. 18 ❑ 19 0 20 ❑ . . . . . • Section 3. 21 is system is in Climate Zone 2 a 8-15 and line t i, 16 or 17 is not checked. TXV(RC�is required_ Go to Section 3. Section - HERS Rater verification 22 ine is checked,HERS verificadon is required for Duct Sealing. 23 e 72,13, 14,20 or 21 are checked and not line i6 or 17,HERS verificaHon Is required far TXV(RCA). 24 If line 12, 13 or 14 are checked,HERS verificadon Is required for 12 EER. Section 4-E ui ment Efficiencies 25 ❑ �f lines 1 t,12, 13,14 or 17 are checked, upgreded equipment efficiencies are required.List in Section 6. � Section Duct R-Values 26 If more than 40 feet of duct is bein installed ac ,duct R-value must meet or exceed Packa e D uirements. 27 ❑ Secfron 6-see ne#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