HomeMy WebLinkAbout12864 (6) � � CITY OF DIAMOND BAR ,/
-.�— _ '-----�— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES b�
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
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PROVERTY Vh10 BUILDS OR IMPROVES THEREON,PND WHO DOES SUCH NqRK HIMSELF OR NERSELF OR '
W7HROU6H WS OH HER OWN EAIPLOYEES,PROVIDED THAT SUq11MPROVEAIENTS ARE NOT PITENDED OR m .
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�j� MY LICENSE IS W FULL FORCE AND EFFECT.
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� WORKERS'COMPENSATION DECLARATION � � � - � � �� �,
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, � 1 HEREBV AFFUiM UNDER PENALTV OF PERtt1M ONE OF THE FOILOWING DECURATIONS: Z ' � � � ,
� _1 HAVE�AND WILL MAINTAW A CEf7fIFlCATE OF CONSENT TO SELF•INSURE FOR WOR!(ERS' � �
COMPENSATION,AS PROVIDED BY SECTION 37000F 7HE LABOR CODE,FOR THE PERFORMAHCE w
THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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Qw �wVE AND wILL MAIMAIN WORKERS'COMPEf15ATION P1SUqANC��pg RE�UIHED BY SECTION
37000F THE LABOR CODE,FOR E PERFOflMANCE OF THE WOPo(FOR WHIb7 iH15 PERNIT IS � ��/ y)
ISSUEA.MV � CAOMPE ATIO{�NI RANCECAARIER'ANDVOLICYNUMBER�ARE CONSTRUCTION �����/�/
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C,�} SHALL NOT EMVLOV ANV PERSON IN ANY NER 50 AS TO BECAME SU&IECT TO THE, � �
(n N'ORKERS'CAMPENSA710N IAWS OF CALI IA AND AOREE THAT IF I SHOULO BECOME INSPECTION FEE
SUBJ CT TO THE WOHKERS COMPENSA VROVIS 5ECTION�7o00F THE LABOR ' ' ,.r��
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� SUBJECf AN EMPIOYER TO CRIM WAL PENALTIES AND CML FWES UP TOONE HUNDRED 7}KKISAND ENERGY PERMIT
OOILARS(5100,Ooo),�iN ADDITION TO THE COS7 OF COMPENSA710N,DMfAGES AS PROVIDED FOR IN
J SECTION 37oe OF THE LABOR CODE,WTEREST,AND ATTORNEV'S FEES. � � ' ' ^�
oC . � RETENTION�FEE: - YJ
O� . CONSTRUCTION LENDING AGENCY l _ �
� 1 HER�Y AFFIRM UNDER PENALTY OF PERIURY THA7 THERE fS A CONS7RUC710N LENDIMO AOENCY r�.•�� L � .
dZ' FOR THE PERFORAIANCE OF THE wORK FOR NRiICH THIS PERMfT IS ISSUEO�SEC.3uB7,qV.C.J. .
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�� LENDER'SNMIE . . ._ . . . .
� IENDER'SADDRESS -
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� CONSTRUCT ,AND HEREBV AUfHORIZE REPRESEN7ATNE5 OF hIIS COUN7V TO EMER UPON TiE �
Z �BWE-A/ D PROPERTY FO�s PECTION 7URPOSES.
— / '���N� COMMENTS �
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¢ VERMITTEE NAME(RINn �]� I � . . . . .
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S�IiNATURE OF PERMITTEE DATE-6 f-F -
RECPT.NO. PAID BY VALIDATION
WHITE-Depertment Copy,YELLOW—Flnence C ,PINK—Assessor Copy,GOLDEN OD--FIIe Copy;GREEt�Appl{canYs Copy
CITY fJF DIAlUIUtVD BA�R �
It`lSPECTION REC4RQ �
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ELECTRIC GROUNO UNDER FLOOR OUCT _ � - �
GROUND PLUMBING llNDER FLOOR CONQUIT
SLAB GRADE FIREPIACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHIRlG 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC � ROUGH GRAD(NG
ROUGH PLUMBING I FINISH GRADING
SHOWERITUB TEST POOL ELKTRlC
EXT.LATH/SIDING � POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. Otd SITE IMPS.
GAS AIR TEST FINAL ZOfVING
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAI ELECTRIC DEV.FEES PAID
fINALPLUfd1BING � �"� '� f ENERGY
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SEPTIC 7ANK SIZE
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escr.9ptive rertificate of Compliance: Residen ia eroo ��_�-� _ - -----
{ �' �;;t Address: Climate Zone Permit#
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OOFING PRODUCTS (COOL ROOFS) §151(�12
�hen the area of exferfor roof surface fo be replaced exceeds 50%of the exFsfing roof area,or 1,000 , whichever is less, the new
►ofing area musf ineef che roofng product"Cooi RooY'requirements of§152(b)1Hf, 152(b)1Hit, or 952(b)1Hiil.
heck applicable alternative or exception below if the roof atteration is exempt from the roofing produd aCool RooY requirements::
7 Cool roofs not required in Climates Zones 1-12, 14,and 16 with a low sloped roof pitch({ess or 2:12 pitch).
� Cool roofs not required in Climates Zones 1-9,and 16 with a steep-sbped roofs(greater pitch than 212)and product weight less tt�an 5/Ib/ftz.
ltematives to§152(b)1 Hf and§152{b)Hii,Steep-slope roof(pitch> 2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr•fl•°FBtu or at least a 3/4 inch air-space is added to the roof deck over an atGc;or
❑ E�6sting duds in the attic are insulated and sealed according to§151(fl10;or
O In dimate wnes 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 ventifation area is within 2 feet vertical distance of the roof ridge;or
❑ Bulding has at least R-30 ceiting insutation;or
❑ Building has radiant barrier in the attic meeting the requirements of§151(fl2;or
❑ Bulding has no ducts in the attic;or .
0 In climate zones 10,11, 13 and 14,R-3 or greater roof deck insulation above vented attic.
�cception to§152(b)1 Hiii,Low-slope roof(pFtch <_2:'12)
❑. Bulding has no ducts in the attic.
Other Exceptions �
O Roofing area is cQvered by building integrated;photovoltaic panels and solar#hermal panels are exempt from the Cool Roof criteria.
O Roof constructions that have thermal mass over the roof inembrane with at least 25 Iblft2 are exempt from the Cool Roof criteria. �
IOTE:If any pne of the alfematives or exception is checked the Aged Solar Reflectance and Therma!Emiifance reGuirements for roofing
�roducts in§118(i)are nof applicable. Do not fr!1 table below.
Roof Slope Produd Weight Product Aged Solar Thermal
CRRC Product ID Number' S 2:12 >2:12 � 51b/ftZ �Slb/ft� T eZ Reflectance3'4 Emittance SRIS
❑ � ❑ ❑ ❑4 �
❑ O ❑ ❑ ❑4 .
Note:If no CRRC-1 label is available,this compliance method cannof be used, use the Performance Approach to show compliance,
I 1. The CRRC Pr�duct!D Number can be obfained from the Coo!Roof Raling Counci!'s Rafed Pr�duct Directory at www.coo)�ofs o�/vroducts/sear�h ohn
�2/n�cate the fyPe of product is being used for the roof top,i.e. single-ply roof, asphaft roof,metal roof, efc.
. !f the Aged Reflectance is not avaifabla in the Cool Roof Rating CounciPs Rated Product Diredory then use the Inifial Reflectance value fr�m the same
drectory and use the equation(0.2+0.7(p„�,-0.2)to obtain a calculated aged va/ue. Whe2 p is the lnifia!5o/ar Reflectance.
4. Check box if the Aged Re/lectance is a calculafed va/ue using the equation above.
5. Calcufafe the SRI vafue by using the SRI-Worksheef at httnJ/www.enerov.ca.qov/tffle24/and enter the resuRing value in the SRI Column above and a[tech
acopy of the SRl-Worksheet to the CF-1R.
o appfy Liquid Field Applied Coatings,the coating must be applied across the entire roof.surface and meet the dry mil thickness or coverage
recommended by the cflatings manufacturer and meet minimum perfonnance requirements listed in§1 i8(i)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof Coafing � Cement-Based Roof Coating ❑ Other
NOTE: When a Cool Roof is required, fhe installing corrtracfor shall comp/efe and submit the CF-6R-ENV-01 for final inspecSon.
Declaration Statement
• I certify under penalty of perjury,under the laws of the State of Cal'rfomia,the information provided on this form is aa�rate and complete.
• I certify that the energy features and perFortnance speafications iden6fied on this Certificate of Comptiance confortn to the requirements of TiUe 24,Parts
1 and 6 of th lifomia Code of Regulations.
Name: `lu� • �Qh� Signature: L�
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Company: �KJV �d ,n Cr� A�'1'1 Wli � l�G6 �/l,�i Date: � /lo/I�Z
Address: � `I q � � �`m�� �� License: //2 // �
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City/State2ip: �n ��� ',n� � Phone:
ldtrl �l d�- ��7—���rl/
For assistance or questions regarding the Energy Sfandards, contacf fhe Energy Hotline at: 1-800-772-3300.
+ Aug 13 12 0�:38p C�
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