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HomeMy WebLinkAbout12-107 CITY OF DIAMOND BAR I�,�;�--��— DEPART1Vi[ENT OF COMMUIVITY&DEVELOPMENT SERVICES � 21810 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �""'. BUII..DING PERMIT APPLICATION FIRMLY o� JOBSITE c �r.� ADDRESS J-�V N•�GOIdGY1 �r1C�s� DATE'CATION NUMBEF� � � #/C � ISSUE TyPE �] pCC � APN LOT TRACT DATE � CONST. /// GROUP V/ p OWNER GL o ADDRESS O G ZONING S CKS Z CITY ZIP�Q� TEL - ZE{ FRONT pyy_T � o APPLICANT TEL. S DE/SIDE STREET' pW ❑ � CONTRACTOR C� � ' G SIDE p ADDRESS � CITY Cwr�ne�ci(IO ZIP Z TEL $Q�, PROPOSED USE o ARCH/ENG/. z DESIGNER w NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY . ZIF TEL. � DESCRIPTION SQ.FT. FACTOR PSF AW.AREANALUATION p� OWNER-BUILDER DECIARATION p SFR/ADD/REM I HER�Y AFFlRM UNDER'PENALTY OF PERJURV THAT I A/I EXEAIPT FROM THE CONTMCT0R4 L6 G0f88B/CBfpOII W CENSELAWFORTHEFOILOWINOREA50N(SEC.7031.6BUSWESSANDPROFESSIONSCOOE:ANYCITVOR (n U COUNfYWHK]1REOUIRESAPERMITTOCONSTRUCT,ALTER�PFIOVE.DEMOl.ISH,OflREPAIRMIYSTRUG W P8fi0/DgCI( L NRE,PRIOq TO�RS�ISSUANCE,ALSO REOUIHES THE APPIICAN(WR 6UCH pERM1T TO FILE A SIONED w � STATEYENf THA7 HE OR SHE IS LICENSED.PUHSUANT TO THE PROVISIDNS�OF 7HE CONTRACTORS LF . CENSE UW(CiUVTEA Y(COMMENCIIJO N7TH SEC770N 7oDo)OF DIVISION 3 OF THE BUSINE55 AND PRO- �'�' POOI/Sp8 , 0 FE5310N3 COO�OR THAT HE ORSHE IS DIEMP7TNEREFROM AND iHE BA515 FOR THEALtEOED E%EMP• C7 V TqN.ANYVIOLATI0NOF5ECTION7W/.68YANYMVLICANTFORAPERMITSU&IECTSTHEAVPLICANTTO Z Rg.Root � ACIVIL PENALTY OF NOT hWfiE�TF1AN FIVE HUNDRED DOLWiS(iboo).�: � ❑I,A40WNEROFTHEPROPERTY,ORNYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, O CpmmBfClal � Z WIIL DO THE WORK,AND THE BTRUCTURE IS NOT INTENDED.OR OFFERED FOR SALE(SEC.7ou,BUSF J - � NESS ANO VROFESSIONS CODE:THE CONTRAC70RS UCENSE�LAW DOES NOT APPLv 70 AN OWNER oF j PROPEHfY NTID BUILDS OR UdPROVES 7HEREON,M1D NM1fO DOES Sll(71 WORN HIAISELF OR HEqSELF OR - W THROUGHH130RHERONMENPLOYEES.PROVIDmTHAT�SUCHWPROVEMENTSARENOTWTENDEDOR m � Q OFFE77mFOR9ALEIF,HOWEVER7NEBUp.qNOORIMPROVEMfMIS� ��W�7Hp.IpNEYEAROFODMP�E- Z TIDN.THE OWNERAUILDER WILL MAVE TME BURDEN OF.VROVINO iHAT'HE OR SHE DID NOT BUILD OR . . � fMPROVE FOR THE PURP0.SE OF SALE� . . W O�ASOWNEROF�THEPROPERT�;AME7((XU$NEIYCONTRACTP1UWfTHIICENSEDCONTFiAGTORS � TO CONS7RUCT THE PR0.IECT(SEC.7wA,BUSINE59 AND PROFESSIONS CODE:hIE CONTRAC70R9 IJ- V81U8tI0fl ADJ.AREA�. � CENSELAWDOESNOTMPLYTOANOWNEROFAPROPERTYYAID&1p.0.9ORIMPROVESTHEREON,AND '� � NM1IOCOMAACTSFORSUCHPROJECfSWRHACOHiRACTpR�S)LICENSEOPURSUANTTOTHECONTRAG QUANTITY DESCRIPl10N Toas ucerose uw.�. FEE � pO 1 AM D(EMPT UNDEA SEC. B.8 P.C.FOR THIS REASON � � U _ � DATE � OWNER f- ' �Q LICENSED CONTRACTORS DECIARATION W � � � � � � 2 1 HEREBY AFFIiW UNDER PEIULTV OF PERJURY THAT IAM�LICENSED UNDER PROVISqNS Of CHAPTER � � ' � � p(COMAIENCDq WIhI 5ECT10N 70oD)OF DMSION�OF THE BUSINESS AND PROFESSIONS CODE,AND Z ' ��� MY LICENSE IS W FULL FORCE AND EFFECT. m � UCENSE C �SJS G�� LIC.NO.: I � � -- I V DATE_��`� I L.. . CONTRAC70R �_ d . . ... W � WORKERS'COMPENSATION DECLAiiAT10N � � � � � � I HEREBYAFFIRM UNOER PENALTY OF PERtt/HY ONE OF THE fOLLOW W6 OECLARATIONS: � (� ZQ � _�IUVEAND�Wtt1MAINTAWACERTIFlCA7EOFCONSEMTOSELF-INSUREFOHVloR1(ERS' T - . .� COMPENSAT%7N.AS PROVIDm BV SECT70N 370D OF THE U80R CODE,FOR THE PEqFpqA1�WCE U' OFTHE WORN FOR W WCH TH19 PERMIT 19155UE0. W - � � �1 W`VEµ�WtL�MAIPlT/�W WpRKER3'COM?FNS�T�ON RISUMNCE,ti4 REWIRED BY SECTIDN Q 370D OF THE UBOA CODE,GOR THE PERWRMANCE�OF THE WORK FOR WHICH THIS pERA1R IS � ISSUm.MY{y,,p���RKEAS'COMP NSATAION 1INSURANCE CARRIER-AND POLICY NUMBER ME: CONSTRUCTION�� j c�aAiEa {.-V�C�� ,�1 0.��O�fIQ� PLAN REVIEW 0 POLICY NUMBER . . Zd . ELECTRIC p fn�sEcnoHr�nuTeEoo�rmoFnfa�r.irswaor��uro�noa�uuK�ama+�ss1 PLUMBING w Z 1 CEHTIFY THAT IN THE PERFORMNJCE OF THE WOW(FOR W WCH THIS PERMI7IS ISSUED,1 MECHANICAL �_ CJ SHALL NOT EMPLOY ANV 7ERSON W M1Y NANNER SOAS TO BECOME�SU&1ECT TO THE � � (n WORNERS'CAMPENSATION LAWS OF CALIFORNIA,AND A(iREE 7HAT IF I SHOVIp BECAME �NSPECTION FEE S SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOF�SECTION97000FTMELABOR ' ' � e,i s wRr�nnn�coup�r wm�nwsE aqov�swNs. ISSUANCE f / O y ��'t��� ` p DATE: I `Z APPLICANT:: �i �SMIP ' W J WAiUlINQ��FA4URETOSEWREWORKERS'G0IAPENSATqNCOVERAGEiSUNUWFUL,ANDSHALLBE ENERCiYP/C � J SUBJECTAN EMPIOYEH TO CRIMPUL PENALTIES ANO GVIL FWES UP TOONE HUNDRED TFIOUSAN� � OOILARS,(5100.000),W ADDITION TO THE COST OF CAMFENSATION,DAMAOES AS GROVIDED FOR IN ENERGY�PERMIT J BECiqN 370L OF hIE LABOFi CODE,WTEREST,ANUATfORNEYS FEES. � ' ' � � w � - AETENTION�FEE: O . CONSTRUCTIO,N LENDINGAGENCY � PRE-ALT FEE �. 1 HERFBYAFFlRM Ut�ER PENALTY Of PERIURV iHAT TtIERE�IS A CONSTRUCTION LENDWO AOENCY FOR T1E VERFORMANCE OFTHE WORK FOR WHICi1 TH15 PERAIIT IS ISSUED(SEC:3ov7,ClV.G} Z w ��. LENDERSNAME � - ' F— LENDERSADDRES3 � w� ICERTIFYTHATIHAVEREADTif9APPLICATIONAND5TA7E7HATTiEABOVEPIFORMAT10N19CORRECT. TO 1'AL FEES ��.9� p 1 A6REE TO COMPLY N7TH ALL CfTV AND CWNTY ORDINANCES AND STATE UWS FEUTWO TO BUUDIN(i � CONSTRUCTION,AND HEREBV AUT/iORIZE REPRESENTATIVES OF TWS COUDlTY 70 EMER UPON iHE � Z ABOVE-MENTIONED CROPER7Y FOR INSPEC710N FURPOSES. COMMENTS �� � _ �w eh �L.�l 1�a"�'r � m FERMI EE NAA/E(PRIIlf�� � � � .�� �-=-_ ��z>��z. - � 'SIONANREOFPEAMITTEE DA7E Ov� � RECPT.NO. �/°'� PAID BY VALIDATION WHITE-Depertment Copy,YELLOW—Finar�ce Copy,P�NK—Assessor Copy,GOLDENROD—File Copy,(iREEN-- Applicant's'Copy C1TY OF DIAMOND BAR _ ,, � . . INSPECTIOM REC4RD , ,�. . , , �a' ° 8 • ia.. � � ..� o 'r�°'`"� j � ���` � ,�,b�i'� � - � � �� .�� y c' SET BA�K �F LOOR J 01 ST fTGS/FORMS/STEEL 'FHk REQMTS ELECTRIC GROUND I UNDER FLOOR DUCT GROUND PLUMBING I UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNOATION TEMP POWER �FIREPLACE BOND BEAM WATER SERVICE MID HT.BOND BEAM ROOF SHEATHIfVG 8 FT.BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM � ROOF COVER f PRE-GRADING ROUGH HEATING BEN�HING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TE5T POOL ELECTRIC EXT.LATH/S101NG POOL FENCIPJG WALL INSULATION �POOL FINAL CEILING 1(JSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTICTANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAI ZONING FINAL CONST. FIRE DEPT.FINAL FINAL HEATING -� "� ;HEALTH DEPT.FINAL FINAL ELECTRIC aEV.FEES PAID FIN,4L PLUMBING ENERGY FINAL PLANING FINAI ENGINEERING . 0 m C�MMENTS SEPTICTANK SIZE SEEP PITIU SIZE �- — �v- + � - h �i � _ - - — ; �=� _r t ;��` }� .� .� - 'Sa ,� „� ��� � k �\ ' ' Prescri tive Certificate of Com liance: Residential ' CF-IR-ALT Residential Alterativns (Pa e 5 of� Project Name: Climate Zone# #of Stories 3D N • c�1d�r S �'i�n 5 l.�r �� �7 HERS VERIFICATION SUMMARY The enforcement agency should pa�+special attenlion 10 the HERS Measvres specified in this checklisf below. A completed and signed CF-4R Forrn for al!lhe rneasures specifed rhall be submilted Jo the building inspeclor befa•e f nnl iru eclion. Duct Sealing&Testing HERS verif:cation is req:iired for this measure. ❑YES �NO YES:In Climate Zoncs 2 and 9-16,if more than 401inear feet of new or replacement ducu are insta]]ed in unconditioned , space,the ducts are to be sealed per§152(b)IDii and the newly installed ducts aze to be insulated per§]51(fl10. ❑ EXCEPTION:Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos. ❑YES �NO YFS:In Climate Zones 2 and 9�16,if the existing space-conditioning system(HVAC equipment,and ducting)is replac,�d,the ducts are tobe sealed per§152(b)1Di. �YES ❑NO YES:In Climate Zones 2 and 9-16,if the existing HVAC equipment is replaced(including the replacement of the air handler,. outdoor condensing unit of a split system,cooling or heating coil,or the fumace heat exchanger)the ducts are to be sealed per§152(b)lE. ❑ EXCEPTION:Duct systems that are documented to have been prevfously sealed confirmed through HERS ver�cation in accordance with procedures in the Reference Residential Appendix RA3, ❑ EXCEPTION:Duct systems with less than 40 linear feet in unconditioned space. ❑ EXCEPT'ION:Ezistin duct s stems constructed,insulated or sealed with asbestos. Refrigerant Charge-Split System HERS verificarion is required for lhis mearure. �YE.S 0 NO YFS:In Climate Zones 2 and 8-15,when the existing HVAC equipment is replaced(including the replacement of the air handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the fumace heat exchan er a refri erant char e mcasurcment shall be verified per 152(b)1F. Central Fan Integrated (CF�Ventilation System and Fan Watt Draw The ventilation uirements of§150(0)do not a 1 to existin residential homes. Ducted Split Systems-Air Conditioners and Fieat Pumps: Airflow HERS verifrcarion rs requrred jor rhis measure. ❑I'ES �''NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is re laced,the airflow and fan watt draw shall be verified per§152(b)1Ci to meet ihe requirements of§151(�7B. Documentarion Author's Declaration Statement � 1 certi that this Certificate of Com liance documentation is accurate and com lete. Name: 5ignature: � ��'ev eh ���r; �r� ��L � Company: Date: �c.c���c. A�re �•�� ��Z'7 � IZ Address: ' 1 If Applicable�CEA or�CEPE �'1�3C� CG11� CAr' 4 (Certification#): City/State/Zip: Phonc: C0.m0.r� 110 � CA q3olz 50.5-650-48aZ Responsible Building Designer's Declaration Statement • I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on • this Certificate of Compliance. � • I certify that the energy features and performance speciFications for the building design identified on this Certificate of Compliance conform to the requiremenu of Title 24,Parts 1 and 6 of the California Code of Regulations. s The building design features identified on this Certificate of Compliance are consistent with the information provided to document this building design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcemeot agen for a roval with this buildin ermit a lication. Name: Signature: Company: Date: Address: License: City/State/Zip: Phone: � For assistarrce or queslions regarding the E��er�Standards,contact the Energy Hotli�re at:I-800-77Z-3300. � Registration Number: Registration Datell'ime.• HERS Provider: 2008 Residential Cnmpliance Forms August 2009