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14080069YJ CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10408 MENHART LN CONTRACTOR: BRENT BARDSLEY PERMIT NO: 14080069 OWNER'S NAME: BRENT BARDSLEY 10408 MENHART LN DATE ISSUED: 08/11/2014 OWNER'S PHONE: 4082524019 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL TEAR OFF PORTION OF (E) ASPHALT ROOF OVER SFD & License Class Lic. # ATTACHED GARAGE. INSTALL (N) ASPHALT CLASS A ROOF Contractor Date SYSTEM I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $4000 1 have and will maintain Worker's Compensation Insurance, as provided for by APN Number: 37516004 00 Occupancy Type: Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAY ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS LED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I Date: granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Sectio 9 18. RE- ROOFS: Signature Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. � j � / Date: V/ CJ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applic .7-- the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, S ions 255 5 ,2 and 25 34. I have and will maintain Worker's Compensation Insurance, as provided for by , Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: � 1 e permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C ) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point tioe Cupertino Municipal Code, Section Licensed Professional 9 18. R%�A-E_ j Date Signature CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10408 MENHART LN CONTRACTOR: RICK PISANO ROOFING PERMIT NO: 14080069 OWNER'S NAME: BRENT BARDSLEY 15148 DICKENS AVE DATE ISSUED: 08/11/2014 OWNER'S PHONE: 4082524019 SAN JOSE, CA 95124 PHONE NO: (408) 377 -9519 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑ TEAR OFF PORTION OF (E) ASPHALT ROOF OVER SFD & License Class C 3 Lic. # 1178 y ATTACHED GARAGE. INSTALL 26SQ (N) ASPHALT CLASS A Contractor ?((� IG �ill�d PRr—Date 7 i� ROOF SYSTEM I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self - insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. Sq. Ft Floor Area: Valuation: $4000 ve and will maintain Worker's Compensation Insurance, as provided for by ction 3700 of the Labor Code, for the performance of the work for which this APN Number: 37516004.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT E IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 80 DAYS O ERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS ROM L ALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, y/ costs, and expenses which may accrue against said City in consequence of the Issued by: Date: GG granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations er the Cupertino Municipal Code, Section 9.18. �J RE- ROOFS: Signature Date V I� All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER - BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self - insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this pen-nit is issued, I shall not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date iry'f. t sss �J i r� O REROOF PERMIT APPLICATION V COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION h� 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 \ '(408) 777 -3228 • FAX (408) 777 -3333 • building(cDcupertino.org PROJECT ADDRESS o /� p/ �f L APN # 00 OWNERNANM ' PHONE 2 j� n •' 1 E-MAIL STREET ADDRESS _J0 . (,� �© (1 V r< (� y CITY, STATE, ZIP /` Q ( / j/ L / a• FAX CONTACT NAME PHONE E-MAIL STREET ADDRESS , CITY, STATE, ZIP FAX ❑ OWNER' ' OWNER - BUILDER ❑ - OWNERAGENT ❑ -CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME u f� /J / LICENSENUMBER LICENSE TYPE BUS. LIC. # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHrrECT/ENGINEER NAME LICENSE NUMBER BUS. LIC. # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi - Family STRUCTURE: El Commercial ROOF AREA.- Z , V VALUATION: I L106 EXISTING ROOF TYPE:. 00I.T -UP ROOF PHALT SHINGLES ❑ WOOD SHAJ ❑ WOOD SHINGLES ❑ OTHER (SPECIFY) REMOVE /REPLACE NO IF NO, I # LAYERS: PLYWOOD ❑ W- ❑ THICKNESS: ❑ 5/8" PLYWD ❑ OSB TYPE: ❑ CDX PITCH: 12 ROOF CLASS: A PROPOSED ROOF TYPE :BUILT -UP ROOF ASPHALT SHINGLES ❑ WOOD SHAKES 11 WOOD SHINGLES ❑ OTHER ICC -ES REPORT # DESCRIPTION OF WORK: (� �1 w CL �k A5 f f S >^ 01- � Pi�rll Ivy VA�� Iti ityv-4.. By my signature below, I certify to each of the following; I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct- I have, read the Description kfWork. and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatin building co tructio I autho ' represen ive f Cupertino to enter the above -i entifiieed pro for inspection purposes. Signature of Applicant/Agent: Date: I - /��' SUPPLEMENTAL INFORMATION REQUIRED If building is associated with a Home Owner's Association, provide letter of approval from HOA. Provide Planning approval to verify if there any restrictions. Provide copy of Manufacturer's Installation Specifications. - Provide signed copy of Cupertino's Tear -Off Policy. _ otF9 c y P ReroofApp_2011.doc revised 03116111 CITY OF CUPERTINO [0—AW VVIP. V1QT1_N4 A TnJ2 — RIT11,DING DIVNION ADDRESS: 10408 MENHART LN FEE DATE: 0811112014 "VIEWED BY: MELISSA APN: 375 16 004 1 BP#: *VALUATION: [$4,000 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex USE: I PENTAMATION I PERMIT TYPE: 1SFDWLR00F WORK TEAR OFF PORTION OF (E) ASPHALT ROOF OVER SFD & ATTACHED GARAGE. INSTALL (N) SCOPE ASPHALT CLASS A ROOF SYSTEM n� IF 2 go f,!A& kc Plan 'he( k llhewh, Plan 'heci 1;leh. Nan I i I I Check 11Z ,P Ifil Fee.- Plumb, Perrnii 7e(, 0 "U"m, 1""', ofiwf� L"cc. h�s�r, Fee: Ins. NOTE: This estimate does not include fees due to other Departments (i. e. vianning, FuDuc works, rare, aamiary Sewer unarict, achuut --- --- rn"tart the I)Pnt for a.ddn'l info. FEE ITEMS (Fee Resolution 11-053 ff 7111113) FEE QTY/FEE L MISC ITEMS Permit Fee: $442.00 Pi-wn P/unib" Perwif Fec": C011R,"blCi "()yj 7',,,,t: P'ee: Work Without Permit? 0 Yes (j) No $0.00 ,I(Jvancvcl Plar',"I'ing P'ees: . ation Fees: Tr,tvol Doctwnetlj Strong Motion Fee: IBSEISMICR $0.52 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 J" $443.521 s0. 00 $443.52 Revised: 07/10/2014 F CUPERTINO REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 - FAX (408) 777 -3333 - building(cDcupertino.ong PROJECT ADDRESS % / 1 D� t ^ V APN # 3 ` ( (0 O 0 OWNER NAME PHO if ��j D� E -MAM STREET ADDRESS � C1, &SaE� FAX CONTRACTOR NAME - / V LICENSE NUMBER LICENSE TYPE BUS. LIC. # COMPANY NAME E -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re -roof project shall comply with all applicable provisions of the 2013 California Codes. 2. An inspection request can be scheduled up to one business day before the requested inspection date. Please schedule inspections online or call (408) 777 -3228 from 7:30- 3:30pm (Mon - Thurs) or 7:30 - 2:30pm (Friday) to schedule inspection. For Tear -Off and Nailing Inspections, you must also call on the day of the inspection only after that phase of the work is completed. The building inspector will be available within one hour. The hours for this service are: 7:30- 10:30am and 12:30 -3:30 (Mon - Thurs) and 7:30- 10:30am and 12:30 -2:30 (Friday). Final Inspections will be given a two hour window. 3. Tear -Off Inspection is required. Any and all dry -rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails /fasteners shall be either completely knocked -down or removed prior to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material down to the sheathing so a proper inspection can be performed. 6. A Final Inspection and approval shall be obtained from the building inspector when the re- roofing is completed. To receive a final sign -off, the following items will be verified: a. Flat roofs shall have a minimum of 1/" per foot of slope and demonstrate there is no ponding. b. Listings from approved testing agencies for all pre - manufactured products used shall be available on -site to review at the time of the inspection. c. Proper spark arrestor installation, vents painted, gutter /downspouts installed, debris removed. 7. NOTE: If you call for a tear -off or plywood nailing inspection and the work is not complete, you will be charged a re- inspection fee. The re- inspection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I understand and agree to comply with the re -roof policy stated above. I also understand that smoke detectors and carbon m ride detector ar ired to b ' stalled in accordance with Sections R314 and R315 of the 2013 California Res. entia ode. Signature of AvOicant/Agent: Dater Re7-00fP01icy_2014.doc revised 01115114 Building Department City Of Cupertino 10300 Torre Avenue LM Cupertino, CA 95014 -3255 Telephone: 408 - 777 -3228 C U P E RT I N O Fax: 408 - 777 -3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 0 0 PERMIT # o -0-C26 OWNER'S NAME: I PHONE # Z O GENERAL CONTRACTOR: dw,- DW. BUSINESS LICENSE # ADDRESS: CITY /ZIPCODE: , *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile •�� �-241 Date CUPERTINO OWNER- BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building(@cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESSJo v0 bb ) r_ �,/` 'QPN _ p0 B `K c8006 OW NAME % _ (7 OW��R D RE e� `� V i. DESCRIPTION OF WORK: �7 G We are providing you with an Owner - Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner - Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) RX1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner - Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner - Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. &L13. I understand as an "Owner- Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. &L4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. her than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may pe considered an "employer' under state and federal law. W6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. r"� re 7. 1 understand under California Contractors' State License Law, an Owner - Builder who builds single - family sidential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work Wninan ormed under contract with a licensed general building Contractor. . I underst and as an Owner - Builder if I sell the property for which this permit is issued, I may be held liable for ay fcial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. OwnerBuilderForm 2010.doc revised 04114110 %9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800 - 321 -CSLB (2752) or www.cslb.ca.gov for more information about licensed W ntractors. 10. 1 am aware of and consent to an Owner - Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide Vapplicable laws and requirements that govern Owner - Builders as well as employers. 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the mation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner - Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptab le t . may be required to be presented when the permit is issued to verify the property owners si n t e. Property Owner's Signature: W4 hWA CA Date: ---------------------------------------------------------------------- ---------------------------------------------------------------------- (NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner - Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner - Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: OwneYBuilderForm 2010.doc revised 04114110 Address J oy)la SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255 (408) 777 -3228 • FAX (408) 777 -3333 • building cupertino.orq A Lv\. PURPOSE This affidavit is a self - certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907 .11.2 where no interior access for inspections are required. FILE GENERAL INFORMATION j Existing single- family and multi- family dwellings shall be provided wit S o e Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and /or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel- burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above - referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I haves marl and AarPP to comoly with the terms and- r,Dnditions of this statement Owner (or w 'er Agent's) me ............ .................Dater' ► 2yZCi. Signature .... ...... c. ILA Contractor Nam: e� Date: a tw Signature ......... ............. .......... .......... Licl .25..1.7, . .0b ....... Smoke and COform.doc revised 03118114 I�(/