HomeMy WebLinkAbout12-320 CITY OF DIAMOND BAR � (� �� �� �/— !��
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21810 Copley Drive,Diamond Bar,CA 91 O
(909)839-7020 Fax(909)861-3117 Buil���� �)839-7027 PP�ESS
����9R'� BUILDING PERNIIT APPLICATION FIRMLY
� JOBSiTE �f�^�J !'' APPLICATIO i /� PERMIT P/C
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a ISSUE TYPE pCC
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� OWNER-BUILDER DECLARATION SFq/ADD/REM
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p f HEREBV AFPIRM UNDER PENAL7V OF PERIURY THAT I AM E%EMVT FROM 7NE CONTHACTORS 11- GefBgB/CBfpOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC.70.31.58USINESSANDPROFESSbNSCODE:M1VqTYOR (n ,
U CpUNTYYM�CHREIXlIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.OEMOlISH,ORREPAIRMNSTRUG W PatiolDeck
w TURE,PRIOR TOITS ISSUANCE,AL50 REQUIRES THE AGPLICANT FOR SUCH PERMIT TO FILE A SI�NED W
� STATEMEHT THAT HE OR SHE IS LICENSED PURSUANT TO h1E PROVISIONS OF THE CONTRACTOR+U-
� CENSE LAW(GHAPTER B(COMMENCIN6 N7T15ECTION 7000)OF DtVI510N 3 OF 7HE BUSINESS/WD PR6 � PooVSpa
_ � FESSIONSCOOE)OpTHATHEORSHEISEXEMPThiEREFROMANDTHEBASISFORTHEALLE6EDE%EMP• �
V TION.ANY VIOf.ATION OF SECTION 7037.5 BV M1V ACGLICANT FOR A PENMIT SUBJECTS TiE APPLIGWT TO Z Re-Roo1
� ACML VENALTV OF NOT MORE THAN F1VE HUNORED DOI.URS(i5oo).�: -
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWI7HINAGESASTMEIRSOLECOMPENSATION, � � CORI(f18fC131� '
Z WILL DO TNE WORK�D THE S7RUC7URE IS NOT INTENDED OR OFFERED FOR 9ALE(SEC.7oa�,BU51- J .
NE55 AND PROPESSIONS CODEi TME CONTRACTORS UCENSE lAW DOES NOT MPIY TO AN OWNER OF
� PROPER7YWF108UILOSOPIMPROVESTHEREON,M1DNhfODOESSUCHWONKHIMSEiFORHERSEIFOR �
Q 7HROUGH HIS OR HER OWN EMVLOYEES,PRDVIUED 7HA7 SUCH IMPROVEMENTS ARE NOT INTENDED OR �
w OFFEREDFORSAlE1F,HOWEVER7ME9UILDIN00RiMVROVEMENTI550LDWfTHINONEVEAROFCOMPLE-
0 TION,THE OWNER�BUILDER WILL HAVE TNE BURDEN OF PRONNG THAT HE OR SHE DID HOT BUIID OR � -
Z IMPROVE FOR TME PURPQSE OF SALE). -
� ❑I,ASONMEROFTHEPPOPEHfY,/UAEXCIUSNEIYCANTMCTW(iWfTHUCENSEDCONTMCTORS �
Q TO CONSTRUCT THE 7RQIECT(SEC.7oa1,BUSINE55 AND PROFESSIONS CODE:iHE CANTMCTORS LI- V81U0f10l1 ADJ.AREA �
W CENSEUWDOESNOTAPCLY70ANOWNEROFAPROPER7YWHOBU1LD50PIMPf10VES7HEREON,AND . ..
� NM11000tiTRACT5FOR5UCHPR0.fECiSWITHACONTMCTOR(S�LICENSEDPURSUANT70TiECONTMG QUANTITY DESCRIPTION FEE �
� TORS LICENSE UW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON �
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� DATE OWNER V .
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� LICENSED CONTRACTORS DECLARATION w
CL 1 HEREBV AFFINM UNOER PENALTY OF PERIURV THAT IAM LICENSED UNDER PROViSIONS OF CHAPTER Ur
d Y(COMMENCINO WITH SECTION 7000)OF DIVISION J OF iHE BUSINESS ANO PROFESSIONS CODE,AND Z
MY LICENSE IS IN FULL FORCE AND EFFECL m
0 UCENSE CqL45S C-2� LIC.NO. � 1 •I O � .
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V DATE "'f�I�'/2- CONTRACTOR ����«e a - -
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� WORKERS'COMPENSATION DECLARATION U V�� j/�,P [�� _ p�,�
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� 1 HEREBY AFFIRM UNDER PENALT'OF VER1UfiV ONE OF THE FOLLOWING DECL�M7ION5:
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0 _IHAVEAND�WILLMAINTAINACEFiTIFICATEDFCONSENTTOSELF•INSUREFORVqRKERS' _
� COMPENSATION,ASPAOVIDED9YSECTION37000FTHEUBOACOOE,FORTHEPEiifOAMA1JCE IU . .
OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w �1 HAVE AND WILL MAIMAIN�WORKERS`COMPENSATION INSUHANCE,AS REDUIRED BY SECTION
Q 37000F THE LABOR CODE.FOR THE PERFORM�WCE OF THE WORN FOR WHICM THIS PERMIT IS
ISSUED.MY WORANER/S'COMPENSATION INSURANCE CARRIER�AND VOLiCY NUMBER ARE: �CONSTRUCTION
jCARRIER ��/���e�� PUW REVIEW
Z PouCV rruMeER W G G[�'Z$D II ELECTRIC
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� (IHISSECf10NNE�NOTBE00APLETIDOF7NEPEfUTfISFOHONEF�1rDRE�0aU17�1S10DlORLES51 PLUMBING . .
►+� MECHANICAL �"��
Z I CERTIFY THAT IN 7HE PERFORMANCE Of 7HE YlORK FOR V/HICH iH15 PERMIT IS ISSUED,1
(� SHALL NOT EMVLOY ANV PERSON IN ANY MANNER SOAS TO BECOMESU&IECT TO THE
� WDRNEAS'COMPENSATION UWS OF CALIFORNIA.AND AGREE TMA7 IF I SNOULD BECAME INSPECTION FEE
5UBIEC7 TO THE WORKERS'COMVENSA710N PROVIS� OF SECTION 97000F THE UBOR
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CADE,1 SHALL FORTHINTH COMPIY WItN RiOSE P S NS
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p OAiE:. � APPLIGANL . .
w ENERGY P/C
J WAFWINO:FAILURE TO SECURE WOFKERS'COMPENSATION CAVE E IS UNLAWFUL,AND.SHALL BE -
�y SUBJECTANEMPLOYERTOCRIM�NAPENAL71ESM1DGYtLFWESUPTOONEHUN�REDTFIbUSAND ENERGYPERMIT
DOLURS(5100.000),M ADDIiION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN �
¢ 6ECTION 370E OF hIE LABOR CODE,INTEREST,ANO ATTOfWEYS FEES. ' RETENTION FEE: 4 .
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:.
� I HEREBYAFFIRM UNDER PENAI.TV OF PERIURY THAT 7HERE IS A CONSTRUCTION LENDINO AGENCY
� �FORTHE PERFOkMANCE Of TNE WORK FOP NAf�CH TF95 PERMtT IS ISSUEO(SEC.3aW.GIV.CJ. . �
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F- LENDER'SAD�RESS �
� ICERTIFVTHATIHAVEREADTHISAPPIICATIONANOSTATETHATTHEA80VEINFORMATIONISCORRECT. TOTAL FEES. �� 7
W 1 AGHEE TO COMPLY WITH ALL CI'fV AND CAUNTV ORDiNANCES AND 51ATE UWS REUTING TO BUILDiN6
� CONSTFUCTION,AND HEREBY AIJTHORIZE REPRESENTATNES OF THIS CIXINTV 70 ENTEA UPON THE
ZA90YE�MElRfONED PR�ERTY FOR iNSPECTION VURPOSES. COMMENTS `
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m FERMITTEE NAME(P �
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� S�GNATUR£OGPER TT DATE
= RECPT.NO. PAID BY ���[l7,� VALIDATION
~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Capy,GOLDENROD--File Copy,GREEN--Applirant's Copy I
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SET BACK FLOOR JOIST
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FTGS(FORMS/STEFL FHA REQMTS
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ELECTRIC GR�UND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAE3 GRAUE FIREPLACE FOUNDATION
TEMP POUJER FIREPLACE BONQ BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING!VENTILATION :FINAL BOND BEAM
ROOF COVER ,PRE-GRADING
-------------....-------------------------------- �----------------------._-- ---------- --------
ROUGH HEATING BENCHING
____------..._.________._._._...----.___._..__ ._..-----------._._._.----.._._...--- ,_---._._.__-----------...----.._._.__— .._._.._.___.._._..._—._.._._..___._.._._ .-- --
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUMBING 'FINISH GRADING
SI-IOWER/TUB TEST POOL ELECTRIC
EXT.LATH!SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING IR�SULATION OFF SITE IMPS.
DRYWALL NAILING �DEDICAI�IONS
SEWER `FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG.
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SEEP PIT/L.L. ON SITE IMPS.
GAS AIRTEST 'FINAL ZONING
FINAL CONST. 'FIRE DEPT.FINAL
FINAL HEATING �HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAID �
FINAL PLUMBING ENERGY
FINAL PLANING
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FINAL ENGINEERING _ __ __ • m e ��{'�',,� ` _______ ____
COMME NTS --------------------.-------------__-------------------- ----______----- -------------___._--- ____._____-----_________....____.._ _------_ _---
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��Simplifed Prescriptive Certificate of Comp�iance:2008 Residentiall4'VACAlterations CF-1R-Ai.T-HVAC
Climate Zones 8 - --
SiteAddresx � �'77.,�� - - Date: Permit#:
2..5?,S" �a o�-. � :�G t,�✓ <<-E o �' 1�i�t�o� a�- ?� i�l �
ui ment T List Ivimimum Effici Conditioued Floor Atea • T6ermostat
_ Packaged Unit . '
Fumace Q AFtJE �COP
� Indoor Coil �EER �HSPF• s��by�� �Setba�k .
Condensin$linit EER �Resistance � �D � (1Jnor alreadv psese,u must be in.sralled)
Other (�v l F �
1.Equlpment Type:Choose t1�equipmeut being instatied sf more ttian one system use enothq CF-IR-ALT-HVAC for each system.
2.Minimum Equipment Eiticiencies:l3 SEER,78%A�'IIE,7.7ASPF for typical residea�al systems.
HERS VERIFICATION S�UMMMARY Listed below aze three AVAC atteration Options. The instalirs decides what work is being
done and picks one of the appropriate Options. Each Optian lists the HQiS measures that must be conducted.A copy of tlie forms shall
be left on site for final iaspection and a copy given to the homeowner. At fiaai,the inspeaar vcsi.fies that ihe wo�listed on this f�m
was m fact the work completed by the installer. T�inspector aL�verifies thst each appropriaie CF-6R and regstered CF�R forms(no
hand fillcd CF-4Rs ailowed)arc filled out and signed Begumning October 1,2010,a re�istered copy of the CF-1R and CF-b12 shnll
uLso be�on sie for fmal ias ectioa.
�1.gTVAC Changeont Requtred For�es: �
,• All HVAC Equipment � GR6R foffis: MECH-04,MECFi 25-I�R.S
�ced CF-4R forms: IvfECFI 25
. o Candenser Coil and/or CF-6R fams: 1v�CH-ZS-HERS
• Indoor Coil and/or CF-4Ft fmms: MECII 25
• g�nace �
For Split Systems: RC,CCA>3Q0 CFMftoq TMAH � � �
For Packaged Un[ts: No tesan
�Z.Ne�v HVAC System flteqaired 1Rorms:
� Cat in or Changeout with CF�R focros: MECH-04,MECH-25-HERS
new ducts:(all new ducting CF-4R fonms: MBCH=25 � �
and alI new mt !
For Sptit Systems:RC,CCA>304 CFM/ton,TMAH. - '
For Packaged Units:Na testing r ired I
�3.New Ducts with Repiacement ufred Rorms: .
e Includes ieplacing or instailing aIl new CF-6R forms: MECH-25-�IItS .
ducring and/or outdoor condeusing�mit CF-4R fonns: MECH-35
andlor indoor ooil andLor fiunacz. Not all
_ �t . -
Bor Split S�stems: RC,CCA>_300 CFMhon,T1VlAH �
Bor Packa Units:No trstin r �
Contractor(Documentatian Author's/Respons�bk Designer's De�aration Stateuient)
� I cxrtify thai this Cer�ficate of Camgliarice dnaunentatia�is accauate and co�let� .
o I am eligible under Divisiou 3 of tlx CaIifoaua Bus�ess and Professioas Code w accept responsibility for thc design identified on
this Certificate of Complience_
• I certify that the�ergy features and perfoimance specifications for the design identifitd on this Catificatc of Compliance confocm
to the requimnents of Titie 24,Pauts.l and 6 of the Califomia Code of Re�ons,
• The desiga fea2ures identified on this CertiScate of Compliaace are congisteat with thc information docutnentcd on othes app[icable
compliance forms,worksheets,calwlations,plans and specifications submitted w ageney for appmval with the
rmit a lication. .
Name: ���o. Z���� _ Signadue: -
Company:. /' Data .
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Addness: • License:
ZZ�i� I ( 5�.� � �a�.�, 1�'i�w- � ?�-l9� 7 0
City/StateJZip: ��/(o � li C t'L G�.Gl Z Phane: �?l� �7 7 7
20a8 Residential Compliance Forms March 2010