HomeMy WebLinkAbout12-307 _��_ CITY OF DIAMOND BAR ✓
� DEPARTMENT OF CONIMUNITY&DEVELOPMENT SERVICES :��
�. �W 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
���A^'� BUILDING PERMIT APPLICATION FIRMLY
N JOBSITE �-7/�//� f�� /� APFLICATIO )� l PERMIT P/C �
o ADDRESS�d //-/DL.III�� I��d��ZJ�t��1f�� DATE �"Ia�,�YoL. NUMBER�� # ����
� ISSUE 2�/Z'!Z TYPE OCC
APN . LOT TRACT DATE J � CONST.� GROUP
p OWNER
o ADD SS ZONWG SETBACKS
Z C�7y ZIP • TE . O FRONT RW ❑
� APPUCANT TEL. REAR ❑
o SIDE/SIDE STREET RW O
� CONTRACTOR SIDE �
� ADDRESS PROPOSED USE
� C�Ty ZIP TEL
w ARCH/ENG/
z DESIGNER NO.DWE Fy/ NO. NO.
a ADDRESS UNITS // STORIES �BEDROOMS_�
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION � SFR/ADD/REM
O
p �MEREBY AFFlRM UNDER�PENALTY OF PERNRY TNAT 1 A!1 E7�MPT FROA1 THE CONTRACTORS U- GHf89B/CBfPOf1
W CENSEUWFORTHEFOILOWINOREAuON(SEC.7oa1.6BUSP1ES5ANDPqOFESSION9000E:ANYCl7VOR � . (n
U ppUMVNMIpIRE0U1RE5AVERMITTOCONSTNUCT.�LTEK�M7ROVE.OEAqLISH,OHREP/JRANYSTRUG W Patio/Dedc
� T1RE,VRfOR TO RS�SSUANCE,AL50 REOUIRES THE MPLICANT FOR SUCH PERMIT TO FiLE A SIONED W
� S7ATEYENT 7HA1 HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS�OF 7HE CONTRAc.TORS U-
c CENSE lAW(ClUPTER 9(CAMMENCWG WITH SECTION 7000)OF ONtSqN 7 OF TNE BUSINESS AND PR0. � PooVSpa
V FESSIONSCOO�OR7YiATHEORSHEISE%EMPTTMEREFROMANDTHEBASISFOHTMEALlEOEDE%EMP � �7
V 7qN,ANYVIOLATIONOFSECTION7W/.6BVANYAPMICANTFORAPERMITSU&IECTSTHEAPPLIGNTTO Z RaRoof OC
� ACML VENALTY OF NO7 MORE iHNJ FIVE HUNDRED DOlLARS�fsoo)J:
� ❑I,ASOVMEROF,THEPROPERTV,ORMYF1dPlOYEESWfhIWAOE9A57HEIRSOLECOMPEN5AT10N, � COfI1ffIB�C181 . -
Z WILL DO TNE WORIC,AND THE S7qUCTURE IS NOT 1NTENDED OR OFFEREO FOR 9ALE(SEC.7ON,BU51- 'J
NESS AND PROFESSIONS CDDE TIIE CONTMCTORS IICENSE Uw DOES NO7 A7PLv 70 AN OWNER OF
� VpOPEpTYWHD&11LDSORIMPROVESiHEREON,ANDN710DOES5UCHWOWCHINSELFORHERSELFOR m
Q 7HROU011 HIS OR HEfi OWN EMPLOYEES,PROVIDED THAT SUCN IAtPROVEMEHTS AFE NOT INTENDED Ofi
W pFFEqEpFpRSALEIF,VqWEVE0.TMEBU0.DINOORiMPROVEMENTI550lDwrtHMONEYE.�ROFOOMPLE- �
� TION,TME ONRJER-BUILDER M7LL MAVE THE BURDEN OF PROVIN6 iHAT HE OR SHE DID NOT BU0.D OR � �
Z UIPROVE FOR THE PIIPPOSE OF SALE).
� ❑4ASOWNEROF7HEPROPERTY,AAIE%QUSNELVCON7RAC7WOWf�HLICENSEDCOFI7RACTOR3 � -
� TO CO/7STRUCT TME PRQIECT{9EC.7W1.BUSINE33 AND PROFESSIONS CODE:i}IE CONTRACTOR9 LI- VH}UflfIOf1 AQ).AFIEA
W CENSEUWDOESNOTAPVLYTOANOIM�EROFAPHOPERTYW/108ULL.D30RWPROVESTHEREON,AND
� W1pCONTMG75FORSUCHPRDJECf5WI7HACONTRAC70R�S)LICENSEDPURSUAM70THECONTHAC pUANTITY DESCRIPTION FEE �
� Toas ucErisE uw.). ..J
O ❑1 AY E%EMPT UNDER 6EC. B.8 P.C.FOR T}114 REASON Q
� U
� �� � ¢
� DATE � -7==���I I OwNER r
. � S' � ..e. 30
� UCENSED CONT� ORS DECLARATIO, w � ' . I
� 1 HEREBV AFFli1M UNOER PENALTY OF VERJU T IAM LICENSED UNDEN PROVISIONS OF 6R � � '
d 9�CO1dMENC7NO WfTH SECTION 7000)OF OIVI bN J OF THE BUSINE55 AND PROFESSIONS C ,�NU Z
X IAY LICENSE L4 M FU.L FORCE AND EFFECT. , m i
LLI ,�
� UCENSE CLASS LIC.NO. J' � �
V DATE COP7T�RACTOA d . .
W
� WORKERS'COMPENSATION DECIARAT N � �� � �
� U
� I HEREBY AFFIPM UNDER vENALTY OF�ERJUH'/ONE OF iHE FOLLO G DECIAMTIONS: �
N 2
� _I HAVE AND V.�LL MNNTAW A CERTIFlCATE OF CONSENf SELF-INSURE FOR WOPo(ERS � •
� COMPRlSATION.AS PROVIDED BV SECiION 37000f �LABOR CODE FOA Tl1E PERFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT 19 ISSUED. .�
�
W _I MAVE AND NALL MAINTAW WORKERS'COM T10N INSURANCE,AS REOUIRED BV SECTION �
Q 37000F THE LABOR CODE,FOR TiE PERFO �OF THE WORK FOR WMCM iHtS PEHMR IS /���O
� IS..UED.MVKDRKEAS'COMPENSATIONIN RANCECAARIER�AND.POLICYNUAIBERARE: CONSTRUCTION� L
j c�awEa PLAN AEVIEW
Z voucr rair.�eEa ELECTRIC
¢
0 �rrossEcrqn�NFIDrarge oFniEpa�.rrswqoNEt�ooun�satao�oa�E6s' PLUMBING
w MECHANICAL
Z I CERTIFY T7AT W TH ERFORMANCE OF THE.WORK FOH W WC11 THIS PEFUI�T IS ISSUED.1
(J SHALINOTEMPL 7ERSbNINANVMANNER50ASTOBECOME�SUBJECTTOTHE
� wOPo(£NS'COMP SA710N UWS OF GLIFORN�A AND AQREE TN�T IF�SHOULD BECDME INSPECTION FEE
SUBIECT T0 T WORKERS COMPENSATqN VROVISIONS OF 5ECT10N J7o00F THE IABOR /� .
OCAOE,I 5 FORTMVITH COL�PLY WITH THOSE PROVISIONS. ISSUANCE �. /V
p DA1E: APPL�GwE �SMIP .SD
w ENERGY P/C
WAiWINO� AILURETOSECUREM/OH1(EAS'CDh1PENSA710NCOVEMOEISUNLAWiUL.AN09HILLBE
� SU&lE AN EMPLOVER TO CRIMINAL PENALTIES M1�CML FlNES UP TOONE HUNDRED TMOUSNID ENEAGY�PEHMIT
.(f10o,o0D),WPDDITIONTOTHECOSTOFGOMPENSA710N.DAMA�ESASVROVIDEDFORfN � . � /�)
� S 37080F TNE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. ' RE7ENTION FEE: -(,6L ,
O . CONSTRUCTION�LENDING AGEN Y" �pRE-ALT FEE�„� � .
� IHEREBYAFFIRMUNDER�PENALTYOFPERIURYTHATTHER CONS7RUCTIONLENDWOAOENCY ��� /��Q
�Z' �FOR TME PERFORMANCE OF THE WORK FOR WHICN THI IT IS ISSUED(SEC.�oV7,CIV.G.�. _ �
W . . .. . . . . . . . . �
�� LENDERS NAME . . . .
� LENDER'SADDRE55 . � /��
Q- I CERTIFY THAT I HAVE READ TNI9 APPLICATIQN AND STATE 7HAT THE ABOVE INFOfUTATIDN IS COHRECT. TOTAL FE ES
� W I A4REE TO COMPLV WITH L CITY ANO CAUNTY ORDINANCES AND STATE UWS FELATIN(i TO BUM1DtNO �
� CONSTRUCTVDN.AND HE Y AIlTHORIZE REPRESENTATIVES OF TH�S COUMY 70 EMER UPON THE �
ZA80VE-MEMIONED P F NSPECTION FURPOSES. COMMENTS �
�
� �
m E NAME(VfUNn ' .
� 3 /L-�Z-
y E DATE
� , HECPT.NO. O PAID BY y VALIDATION
// WHITE—Deparhnent Copy.YELLOW—Finence Copy.PINK—Assessor Copy.GOIDENHOD--File'Copy.GREEN—AppllcanYs Copy
�
/
ci-rv o� oiA�norv� B��
.,
ir�sP�cTio� ��co�� �•:
, , . , :_ .. . . .
. _., , _ , .. .� _ , � o
' � . :: .. � �� '��. e� - � m� i`, ' � . �-� � � ^ �� � .
: :
-��..: �.. ' .: . 7�
SET BACK FLOOR JOIST
FTGS/FORMS/STEEL ' FHA REQMTS
ELE�TRIC GROUtdD UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHIIJG 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER �PRE-GRAQING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROU( GH GRADING _
ROUGH PLUMBING FINISH GRADING
SHOWERITUBTEST I POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALI NAILING DEDICATIONS _
SEWER FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST �FINAL ZONING
FINAL CONST. Q �FIRE DEPT.FINAL
FINAL HEATING �HEALTH DEPT.FINAL
FINAL ELECTRIC QEV.FEES PAID
FINAL PLUMBING j ENERGY
i
FINAL PLANING
FINAL ENGINEERING �
�OMMENTS �
9
.
'��� i � v .�... ��.�- �� � _
---�-��-�-�--� � -
-- z �' � 2 3 '�' ---
SEPTICTANKSIZE
SEEP PIT/U SIZE �
�
•escri Live c.e�u���d�c �� �..,�„ ........... .---•--------
ject Address: ` Climate Zone Permit#
,
� � r
OOFING PRODUCTS (COOL ROOFS) §157(fl12
'hen the area of exterior roof surface to be replaced exceeds 50%of the exFsfFng roof area,or 1,000 ,whfchever Is less,the new �
,ofing area must meet the roofing product"Coo/Roof'requfrements of§152(b)iHl, 152(bJiHTf, or 152(b)1Hfil.
heck applicable alternative or exceptton below if the roof alteration is exempt from the raofing produd`Coot RooP requirements:,
7 Cool roofs not required in Cfimates Zones 1-12,14,and 16 with a low sloped roof pitch(less or 2:12 pitch).
� Cool roofs not required in Climates Zones 1-9,and 16 wifh a steep-sloped roofs(greater pitch ti�an 212)and produd weight less than 5/IWR2.
ltematives to§152(b)1Hi and§152{b)Hii,Steep-slope roof(pltch>2:12)
❑ Insulat3on with a thermal resistance of at least 0.65 hrft�•°F/Btu or at least a 3/4 inch air-space is added to the roof dedc over an attic;or
❑ F�dsting duds in the attic are insulated and sealed according to§151(fl10;or
�L in dima4e zones 10,12 and 13,with 1 ft2 of free venffiation area of attic ventilation for every 150 ft2 of attic floor area,and
where at least 30 percent of tt�e free ventilatlon area is within 2 feet venical distance of the roof ridge;or
❑ Build'�ng has at least R-30 ceifing insulation;or
❑ Bulding has radiant barrier in t1�e attic meeting the requirements of§151(�2;or
❑ Buldng has no duds in the attic;or
0 In dimate zones 10,11, 13 and 14,R-3 or greater roof dedc insulation abov�vented attic.
=xception to§152(b)1 Hili,Low-slope roof(pifch 52:12)
❑ BuBding has no ducts in the attic.
Other Exceptions '
❑ Roofing area is covered by building integrated;pliotovoltafc panels and solar thertnal panels are exempt from the Cool Roof aiteria.
" O Roof constructions that have thermal mass over the rvof inembrane with at least 25 Ib/ft2 are exempt from the Co�l Roof criteria. '
IOTE:If any pne of fhe altema6ves or exception is checked the Aged Solar Reflecfence and Therma!Emittance requirements for roofing
�roducts in§118(i)are not applicable.Do not fiIl table below. �
Roof Slope Produd Weight Product A9ed Solar Thermal
CRRC Produd ID Number' s 2:12 >2:12 < 51b/ft� z 5lb/ftZ T eZ Reflectance3.a Emittance SRIS
❑ f�— ❑ ❑ []4
❑ ❑ ❑ ❑ p4
Nofe:If no CRRC-1 fabe/is avai/able,this compliartce mefhod cannof be used, use ihe Performance Apprr�ach to show comp/fance,
1.The CRRC Pr�duc[!D Number can be obtafned from the Cool Roof Rating Council's Rated Pradud DineMory at www.coo/roofs ory�roducts/sear�h nhn
�2 ln�cate the type of product Js being used Jor the roof fop,Le.single-ply roof, asphalt roof,meta/roof, etc.
. !f the Aged Reflectance is not evaAsble!n fhe Cool f2oo1 Rating CounciPs Rated Product Diredory then use the InRial Reflectance value from the same
directory and use the equation(0.2+0.7(p�,r-0.2)to oblaTn a calculated aged value. Whera p is the Initial Solar Reflectance.
4. Check box ff the Aged ReBecfance is a calculated vafue usfng the equation above. '
. Calculate the SRl vafue by usf�the SRI-Worksheet et httnJ/www.enervv,ca.00v/tfUe24/and enter fhe resulting value in the SRI Column above and ettach
acopy of the SR!-Worksheet to the CF-1R.
o appty Uquid Field Applied Coatings,the coating must be applied across the entire roof.surface and meet the dry mil thickness or coverage
ec�mmended by the coatings manufacturer and meet minimurn performance�equirements listed in§118(i)4. Select the applicable coaiing:
❑ Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating . ❑ Other �
NOTE: When a Cool Roof is required, the installing confractor shall complete and submit fhe C�6R-ENV-01 for frnal inspecHon.
Declaration Statement .
• I certify under penalty of perjury,under the laws of the State of Califomia,the iniormation provided on thfs fortn is accurate and complete.
• I certify that the energy features and perfortnance spedfipt�ons identffied on this Certifiqte o Compliance confortn to the requirements of Title 24,Parts
1 and 6 of the Califomia Code of R ulatl�s.
.�
Name: . Signatur
CompanY Date:
.• _ 'Z�.
Address: License:
. do - �
City/State/Zip: ' Phone:
' a "�
�-7��s�
For assisfance or questions regarding the Energy Sfandards, confact the Energy Hofline af: 9-800-772-3300.