15070022If
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 873 LILY AVE
CONTRACTOR: BUSTER BUILDING
PERMIT NO: 15070022
OWNER'S NAME: WONG SAMUEL UN SUM AND ANGELA MUN-S
298 N CRAGMONT AVE
DATE ISSUED: 07/06/2015
OWNER'S PHONE: 4089218644
SAN JOSE, CA 95127
PHONE NO: (408) 251-5446
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL COMMERCIAL ❑
DEMO (E) SWIMMING POOL AND BACKFILL (FOR
License Class Lie. # Y f� 3 2 c�
LANDSCAPE
Contractor cl).4,r Ae Ar es,- z .rt Date '7 ��'- / �_Jr_
PURPOSES ONLY)
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
Sq. Ft Floor Area:
Valuation: $4500
performance of the work for which this permit is issued.
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
APN Number: 35903019.00
Occupancy Type:
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
WITII N 180 DAYS OF PERMIT 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
180D YS FROM LAST CALLED 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
costs,
All -
s�7�'� '
Issued by: Date:
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
9.18.
-
RE -ROOFS:
Signature Date 7 - S'—
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
1, 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(x) should 1 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: -1 -
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
Compensation laws of California. If, after making this certificate of exemption, I
CONSTRUCTION LENDING AGENCY
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
CUPERTINO
SWIMMING POOL / SPA PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinq(G@cupertino.orq I50-70%9,
PROJECT ADDRESS LY -7 -3 TAPN #
PHONE E-MAIL
OWNER NAME
N �OC
STREET ADDRESS _ CITY, STATE, ZIP /7 nn FAX
[ ��I�s.ro Lar
7
CONTACT NAME PHONE q E-MAIL
��GG�t !✓�Y[ «% I �S Zq fi7 iP
STREET ADDRESSCITY, STATE, Zjp f FAX
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME / l
LICENSE NUMBEI IX/.I1 v
LICENSE TYPE
BUS. LIC #
COMPANY NAME //NN((
E-MAIL
FAX
STREET ADDRESS
CITY, STATE
�s�c
PHONE
ZtP
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
eu / l -c e We-* -r A"o
�(// a<< C3
�... / Till
❑ SFD or Duplex ❑ Multi -Family
TYPE MATERIAL TYPE (CODE)
AREA (SQ FT)
VALUATION ($)
USE OF
POOL
STRUCTURE: ❑ Commercial
POOUSPA MATERIAL TYPE CODES:
SPA
V - VINYL -LINED
F - FIBERGLASS
DEMO
O - GUNITE
P - PREFABRICATED
RECEIVED BY
TO VALUATION:
v C �]
By my signature below, I certify to each of the following: I am the property o er 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 of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating t ilding construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes.
Date: -7- 4:6 — r
Signature of Applicant>Agent:
SUPPLEMENTAL INFORMATION REQUIRED
OFFICE USE ONLY
PLAN CHECK TYPE
ROUTING SLIP
❑ BUILDING DEPT
Commercial or Multi -Family Buildings with Public Swimming Pools:
Department of Environmental Health approval required.
OVER-TIIE-COUNTER
❑ EXPRESS
❑ PLANNING DEPT
❑ STANDARD
❑ PUBLIC WORKS DEPT
❑ LARGE
❑ ENVIRONMENTAL HEALTH
❑ MAJOR
❑ SANITARY SEWER DISTRICT
SwimPooUpp_2011.doc revised 03/16/11
CITY OF CUPERTINO I �/9Wsa D
FEE ESTIMATOR - BUILDING DIVISION
FEE ID # POOLS
1DEMOPRES I
ADDRESS: 873 LILY AVE
DATE: 07/06/2015
REVIEWED BY: PAUL
Aleclr. Permil Fere:
APN: 359 03 019
BP#:
'VALUATION: 1$4,500
PERMIT TYPE: Demolition Permit
FP/AV CHECK I'YPE.
PRIMARY Swimming Pool, Res.
USE:
!'lamb. hesp. Fe,
PENTAMATION 1 SFPOOLDEM
PERMIT TYPE:
WORK
Demo E swimming pool and backfill FOR LANDSCAPE PURPOSES ONLY
SCOPE
Suppl. Insp. Fee:Q Reg. Q OT
FEE ID # POOLS
1DEMOPRES I
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff: 711/13)
,'cch. Plan Check
Plumb. Plan Check
Elec. Plan Check
Aleclr. Permil Fere:
Plumb, Permit Fe"
Elec. Permit /,,,
her a/ech. Irup
Ocher Plumb Insp.Lj
Other Elec. Insp. L I
tifech. Insp. thee:
!'lamb. hesp. Fe,
I'lec. Insp. Fee:
NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School
District, etc). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'1 info.
FEE ITEMS (Fee Resolution 11-053 Eff: 711/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
Suppl. PC Fee
"�rnr/�.%11cclr..-�Elec
Permit Fee:
$329.00
Suppl. Insp. Fee:Q Reg. Q OT
0.0
hrs
$0.00
/ ` `,
11� clr.: Elec Permit 11(.'e:
(. on':t?'rrclion TUC:
>'nrk l�ithr�arC i'
Ivanced Planning Fees:
''WITl ")oeuinenlalion Fees:
Strong Motion Fee: 1BSEISMICR
$0.59
Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC
$1.00
SUBTOTALS:
1 $330.59
$0.00 TOTAL FEE:
$330.59
Revised: 07/02/2015
bL.)tld-'jb le
FF1 C
COPY
C�OfvIMUNITY DEVELOPMENT nF:I24R:pMFN
BUILDING DIVISION - CUPER T INO
APPROVED
This set of plans and specifications MUST be kept at the
job site during construction. It is unlawful to make any
changes or alterations on same, or to deviate
therefrom, without approval from the Building Official.
The Stamping of this plan and specifications SHALL NOT
be held to permit or to be an approval of the violation
ofavisions of any City Ordinance or State Law.
131 �Vw
L� IVBDE J5
'/�.f , lu
873 L,ry .*V
-_ CUPERTINO
Building Department
JUL 0 6 2015
REVIEWED FOR CODE COMPLIANCE
Reviewed By: 61M.
CUPERTINO
Owner Name
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingO-cupertino.org
R
S1 * �L,2»
Address ��3 Lt ) ky?. I �lIr klvloI �F\
PERMIT CANNOT BE FINALED AND COMPLETED UNTIL TRIS CERTIFICATE
HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION
Please refer to the attached California Civil Code Sections 1101.1– 1101.8 which are part of this Certification form.
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date: _
No Go to Question 2. _ ,�
2. Does your real property have a licensed plumber cerd g that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Sign below and skip the rest of the form.
Owner' Signature: Date: 15
No Go to Question 3. _ o—
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
Owner' Signature: Date:
VNo Go to Question 4.
7-ID-�S
4. Is your real property built and available for use or occ pancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form.
V
Owner' Signature: Date: -7 – ID -15
Yes My real property is built an 'lable fo se or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
VMy property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing
fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1,
2017, all non-compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless
of whether property undergoes alterations or improvements).
My property is a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing fixtures.
❑■
■❑
SB407 2015.doc revised 02/04/15
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building (regardless of whether property undergoes alterations or
improvements).
I/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced
prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through
1101.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation
requirements, and that the water -conserving plunfixtures comply with the requirements as indicated in the table below.
Owner's (or Owner Agent's) Signature: !� ( Cd � i _ Date: -7-ID.- Ic:�
Upon completing and signing this Certificate, pease return it to the Building Division in order to final your permit.
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB40 7 2 015. doc revised 02/04/15
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usage/Flow Rate
Fixture Type
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2013 CALGreen Div. 5.3
Single -Family
Multi -Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons/flush
(Toilets)
Gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
0.5 gallons/flush
Gallons/flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and/or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets -
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units:
0.5 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi
Faucets -
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
60 psi
@ 60 psi
psi
Faucets
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must
1.8 gallons per minute @
default to maximum
60 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
reduction.
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB40 7 2 015. doc revised 02/04/15
CALIFORNIA CIVIL CODE SECTIONS 1101.1-1101.8
Civil Code
Division 2. Property
Part 4. Acquisition of Property
Title 4. Transfer
Chapter 2. Transfer of Real Property
Article 1.4. Installation of Water Use Efficiency Improvements ........ 1101.1 — 1101.8
1101.1. The Legislature finds and declares all of the following:
(a) Adequate water supply reliability for all uses is essential to the future economic and environmental health of
California.
(b) Environmentally sound strategies to meet future water supply and wastewater treatment needs are key to
protecting and restoring aquatic resources in California..,
(c) -There is a,pressing need to address water supply reliability issues raised by growingurban areas.
(dYEc6nomic analysis by urban water agencies has identified urbanWater conservation as a cost: -effective
approach to addressing water supply needs.
(e) There are many water conservation practices that produce significant energy and other resource savings that
should be encouraged as a matter of state policy.
(f) Since the 1991 signing of the "Memorandum of Understanding Regarding Urban Water Conservation in
California," many urban water and wastewater treatment agencies have gained valuable experience that can be
applied to produce significant statewide savings of water, energy, and associated infrastructure costs. This
experience indicates a need to regularly revise and update water conservation methodologies and practices.
(g) To address these concerns, it is the intent of the Legislature to require that residential and commercial real
property built and available for use or occupancy on or before January 1, 1994, be equipped with water -conserving
plumbing fixtures.
(h) It is further the intent of the Legislature that retail water suppliers are encouraged to provide incentives,
financing mechanisms, and funding to assist property owners with these retrofit obligations.
1101.2. Except as provided in Section 1101.7, this article shall apply to residential and commercial real property
built and available for use on or before January 1, 1994.
1101.3. For the purposes of this article:
(a) "Commercial real property" means any real property that is improved with, or consisting of, a building that is
intended for commercial use, including hotels and motels, that is not a single-family residential real property or a
multifamily residential real property.
(b) "Multifamily residential real property" means any real property that is improved with, or consisting of, a
building containing more than one unit that is intended for human habitation, or any mixed residential -commercial
buildings or portions thereof that are intended for human habitation. Multifamily residential real property includes
residential hotels but does not include hotels and motels that are not residential hotels.
(c) "Noncompliant plumbing fixture" means any of the following:
(1) Any toilet manufactured to use more than 1.6 gallons of water per flush.
(2) Any urinal manufactured to use more than one gallon of water per flush.
(3) Any showerhead manufactured to have a flow capacity of more than 2.5 gallons of water per minute.
(4) Any interior faucet that emits more than 2.2 gallons of water per minute.
(d) "Single-family residential real property" means any real property that is improved with, or consisting of, a
building containing not more than one unit that is intended for human habitation.
(e) "Water -conserving plumbing fixture" means any fixture that is in compliance with current building standards
applicable to a newly constructed real property of the same type.
(f) "Sale or transfer" means the sale or transfer of an entire real property estate or the fee interest in that real
property estate and does not include the sale or transfer of a partial interest, including a leasehold.
1101.4. (a) On and after January 1, 2014, for all building alterations or improvements to single-family residential
real property, as a condition for issuance of a certificate of final completion and occupancy or final permit approval
by the local building department, the pen -nit applicant shall replace all noncompliant plumbing fixtures with water -
conserving plumbing fixtures.
(b) On or before January 1, 2017, noncompliant plumbing fixtures in any single-family residential real property
shall be replaced by the property owner with water -conserving plumbing fixtures.
(c) On and after January 1, 2017, a seller or transferor of single-family residential real property shall disclose in
writing to the prospective purchaser or transferee the requirements of subdivision (b) and whether the real property
includes any noncompliant plumbing fixtures.
1101.5. (a) On or before January 1, 2019, all noncompliant plumbing fixtures in any multifamily residential real
property and in any commercial real property shall be replaced with water -conserving plumbing fixtures.
(b) An owner or the owner's agent may enter the owner's property for the purpose of installing, repairing, testing,
and maintaining water -conserving plumbing fixtures required by this section, consistent with notice requirements of
Section 1954.
(c) On and after January 1, 2019, the water -conserving plumbing fixtures required by this section shall be
operating at the manufacturer's rated water consumption at the time that the tenant takes possession. Aacnant shall
be responsible for notifying the owner or owner's agent if the tenant becomes aware that a water -conserving
plumbing. fixture within his or her unit is not operating at the manufacturer's rated water consumption: The -owner
or owner's agent shall correct an inoperability in a water -conserving plumbing fixture upon notice by the tenant or
if detected by the owner or the owner's agent.
(d) (1) On and after January 1, 2014, all noncompliant plumbing fixtures in any multifamily residential real
property and any commercial real property shall be replaced with water -conserving plumbing fixtures in the
following circumstances:
(A) For building additions in which the sum of concurrent building pen -nits by the same permit applicant would
increase the floor area of the space in a building by more than 10 percent, the building permit applicant shall
replace all noncompliant plumbing fixtures in the building.
(B) For building alterations or improvements in which the total construction cost estimated in the building permit
is greater than one hundred fifty thousand dollars ($150,000), the building permit applicant shall replace all
noncompliant plumbing fixtures that service the specific area of the improvement.
(C) Notwithstanding subparagraph (A) or (B), for any alterations or improvements to a room in a building that
require a building permit and that room contains any noncompliant plumbing fixtures, the building permit applicant
shall replace all noncompliant plumbing fixtures in that room.
(2) Replacement of all noncompliant plumbing fixtures with water -conserving plumbing fixtures, as described in
paragraph (1), shall be a condition for issuance of a certificate of final completion and occupancy or final permit
approval by the local building department.
(e) On and after January 1, 2019, a seller or transferor of multifamily residential real property or of commercial
real property shall disclose to the prospective purchaser or transferee, in writing, the requirements of subdivision (a)
and whether the property includes any noncompliant plumbing fixtures. This disclosure may be included in other
transactional documents.
1101.6. The duty of an owner or building permit applicant to comply with the requirements of this article shall be
postponed for one year from the date of issuance of a demolition permit for the building. If the building is
demolished within the one-year postponement, the requirements of this article shall not apply. If the building is not
demolished after the expiration of one year, the provisions of this article shall apply, subject to appeal to the local
building department, even though the demolition permit is still in effect or a new demolition permit has been
issued.
1101.7. This article shall not apply to any of the following:
(a) Registered historical sites.
(b) Real property for which a licensed plumber certifies that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible.
(c) A building for which water service is permanently disconnected.
1101.8. A city, county, or city and county, or a retail water supplier may do either of the following:
(a) Enact local ordinances or establish policies that promote compliance with this article.
(b) Enact local ordinances or establish policies that will result in a greater amount of water savings than those
provided for in this article.
CUPERTINO
Address CJ�
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
LSI
(408) 777-3228 - FAX (408) 777-3333 - buildingaecupertino.org
V.
Permit No. 1 5 o I 0 J 2 1
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 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke 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 have read and agree to comply with the terms and conditions of this statement
Or OwnSr Agent's) Name:
S�m k q q C,
Si nat .................................................................................................... Date: r.t�>...l
Contractor Name:
Signature...................................................................Licl...................................... Date:...................
Smoke and CO faa•m.doc revised 03/18/14