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1507007617 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10184 VISTA DR CONTRACTOR: RAN LU & YUNQING XIA PERMIT NO: 15070076 OWNER'S NAME: RAN LU & YUNQING XIA 10184 VISTA DR DATE ISSUED: 07/10/2015 OWNER'S PHONE: 6502881671 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL CONVERT CLOSET TO SHOWER TO MAKE HALF BATH A License Class Lic.# FULL BATH. Contractor Date 1 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: $1000 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: 31624042.00 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 WITHIN 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 180 DAYS 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 granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 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. ❑ 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) 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. 1 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 �l tl Vl permit is issued. Owner or authorized agent: Date: 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 indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION 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. / f V" Ll6( / Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 "7 (408) 777-3228 • FAX (408) 777-3333 • building Qcuper ino.org I 7&90 ❑ NEW CONSTRUCTION ❑ ADDITION . ISI ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT n PROJECT ADDRESS t h ` n / r y yQ Vr . / ger40' -19177# ' aA 3(6,_ Z � _ OWNER NAME 'l1i Il f 0 1 V (, t/A PHONE 5P-2kE-167 E- LAIL rQj�. C.�cCiT[U ��� (D V STREET ADDRESS r CITY, STATE, ZIP Ca `y�o - �iA v' (A 6 o l l/ FAX CONTACT NAME V N �e, !` I PHONE / / h ./ 2-g f E-MAIL l STREET ADDRESS / O R4- V �e f r CITY, STATE, ZIPv %�I FAX OWNER ❑ OWNER -BUILDER ❑ O'ANTER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK j ( L 1 /A ['P 10et d /^ ci Ce -'t V,�,/ re^&def eoT n 7(-A C EXISTING USE PROPOSED USE CONSTR TYPE 4 STORIES USE TYPE I OCC, SQ.FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NTET AREA ... BATHROOM KITCHEN AREA / 2 rj REMODEL AREA OTHER REMODEL AREA _ 12 - 2PORCREMODEL H AREA PORCH DECKAREA TOTAL DECK/PORCH AREA GARAGE AREA: DETACH ❑ ATTACH DWELLING UNITS: IS A SECOND UNIT E] YES SECOND STORY ❑YES BEING ADDED? []NO ADDITION? ❑NO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑'YES '..RECEIVED B -. _ -_:. TOTAL L VALUATION: PLAN'INGAPPL# [3390DN NNO PLANNING EICHLERHOME? ❑NO - ROOD - 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 of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: ! I loll 5 - SUPPLEMENTAL SUPPLEMENTAL INFORMATION REQUIRED -�- PLAT\ CHECK,TIPE � - BOUTIIiG SLIP New SFD or Multifamily dwellings: Apply for demolition permit for OR 00 R T�col>nTER existing building(s). Demolition permit is required prior to issuance of building for building. ori �� erEss Bunr.cPL4?ZREVILSY permit new E: �� ❑SPI AI.TL.GrL i. REVIEW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure d sTArDARD sL7,rTiBL7Cv�oRlcs} _ form if any Hazardous Materials are being used as part of this project. L4ItG ©FrRE�Pi Copy of Planning Approval Letter or Meeting with Planning prior to _ submittal of Building Permit application. SATvTTARY SER IsR DISTRICT -- - - _ .�❑ EA'YlI20R'MENTALITEALTH ...,t�. B1dgApp_2011.doc revised 06/21/11 �A e 4 CITY OF CUPERTINO Fm FEE ESTIMATOR - BUILDING DIVISION NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS fFee Resolution 11-053 Eff.' 7/1/13) 10184 Vista Dr DATE: 07/10/2015 REVIEWED BY: Sean JimADDRESS: APN: BP#: *VALUATION: $1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE. Alteration / Repair PRIMARY USE: SFD or Duplex Plumb. Insp. Fee: PENTAMATION PERMIT TYPE: 1R3SFDRE i WORK I Convert closet to shower to make half bath a full bath. SCOPE Suppl. Insp. Fee:Q Reg. 0 OT NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS fFee Resolution 11-053 Eff.' 7/1/13) iblech. Plan Check Plumb. Plan Check Elec. Plan Check Mech. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: Other Mech. Insp. Other Plumb Insp. 11 1 Other Elec. Insp. Mech. Insp. Fee: Plumb. Insp. Fee: Elec. Insp. Fee: NOTE: This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the preliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS fFee Resolution 11-053 Eff.' 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 12 s.f. Remodel, Other $431.001IREMRESOTH Suppl. PC Fee: (j) Reg. 0 OT 0.0 lirs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee:Q Reg. 0 OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee. $0.00 Select a Non -Residential 0 Building or Structure i Travel Documentation Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative [tem 1 Bldg Stds Commission Fee: 18CBSC 1 $1.001 SUBTOTALS: 1 $1.50 $431.00 TOTAL FEE: $432.50 Revised: 07/02/2015 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(a.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: /,_ /_Z&/l �;,1? SITE ADDRESS 1084 � /15floa 1)! V IAPN 2 (/_ L� 2 T BP# OWNER NAME YU1\IL IN( -f X(A OWNER ADDRESS 10 1/15�a fir" DESCRIPTION OF WORK: a 4 -CI de ( J1,f icer K -a-< bc-.t ct t( ✓c r tG cZ i1C��tl �7�LS[G' i� 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.) �1. 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. 1 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. 'Z4 3. 1 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. Y,� 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. Y5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. 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. YL 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential 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 is performed under contract with a licensed general building Contractor. I�L& I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial 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 04/14/10 (9. I 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 contractors. L10. 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. Y; K 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable 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 i ormation I have provided on this form. Licensed contractors are regulated bylaws 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 acceptable to the city may be required to be presented when the permit is issued to verify the property owner's si n ture. Property Owner's Signature: Date: 7 / t7 f S --------------------------------------------------------------------------------------------------------------------------------------------- (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: OwnerBuilderForm 2010.doc revised 04/14/10 It LXiSi�i�lC1 NJn4ll ;i�; /",Vf� F T tO(6 — UiSf-x 1)r , t't�1J 316 2 �G$ COM guILDING DIVIS`OPM 'IONE CUPERTINO �" New APF'ROVIED 5l bwQ- .This set of plans and specifications MUST be ,ept at the Job site during°alterations ontsame unlawful fto d viale any chant approval from the Building therefrom, without app The stamp!ng of this plan and specifications SHALL NOT e mit or to be an aparova► of the v, ,iation be held to F r' Cit Ordinance or at Law. of any provisions of any BY DATE % PERMIT NO. VOL k,,.+y Ibl eq ,i I I; I �\ REC ,I -v ��� 10 2015 0FjzjCE C opy w, /56 70076, 10184 Windows - Google Drive 7/10/15, 2:35 PIVi, 10184 Vista Or, Cupertino, Cly 95014 1 sit Floor Site Map p � � :y. �^'�, � ,� '"� ➢ • naj :^mak ' Y t 7 ice— I 2'-- iy' a Kitchen a,) CJ) i_ivina Roam Dining Room Yr Rid'do = " U C) t To remove this watermark, pease purchase SmartDraw r: at www.smartdraw.com or tail 1-800-769-3729 10184 Vista Dr, Cupe&jjl;jg, CA Second Floor Master edroorrETwo Ne v Windclivs Pian (blue orint) rttps://drive.google.com/drive/u/O/folders/OBI VFTKozDu3Cdk16MjBgRUJMN2c Page 1 of 1 CUPERTINO COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION CITY HALL 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 SCOPE OF WORK: Kitchen and Bathroom Remodel. Project shall comply with the 2013 California Building (Base code 2012 IBC), 2013 Residential (2012 IRC), Plumbing (2012 UPC), Mechanical (2012 UMC), Electrical (2011 NEC), Fire (2012 IFC) and Energy Codes (2008 Building Energy Efficiency Standards) Energy code mandatory lighting measures: 1. All permanently installed high efficacy luminaires shall be switched separately from low efficacy luminaires. (150(k)(7)) 2. Permanently installed lighting in Kitchens shall be high efficacy luminaires. Up to 50% of the wattage of permanently installed lighting in kitchens may be in lights that are not high efficacy. (150(k)(8)) 3. Permanently installed luminaires in bathrooms, garages, laundry rooms and utility rooms shall be high efficacy luminaires OR are controlled by an occupant sensor(s) certified to comply with Section 119 that does not turn on automatically or have an always on option. (150(k)(10)) Plumbing plan notes: 4. Water closets shall have an average water consumption of not more than 1.28 gallons per flush. (CPC 403.2) 5. Showerheads shall have a maximum flow rate of 2.0 gallons per minute measured at 80 psi and must comply with CALGreen. (CPC 408.2) 6. Kitchen faucets shall have a maximum flow rate not to exceed 1.8 gallons per minute at 60 psi. (CPC 403.6) 7. Residential lavatory faucets shall have a maximum flow rate not to exceed 1.5 gallons per minute at 60 psi. (CPC 403.7) 8. Shower compartments, regardless of shape, shall have a minimum finished interior of 1024 square inches and shall also be capable of encompassing a 30 inch circle. These clearances shall be maintained up to a height of 70 inches above shower drain. (CPC 408.6) 9. Shower compartments and walls above bathtubs with installed shower heads shall be finished with a smooth, nonabsorbent surface to a height not less than 72 inches (6 ft). (CRC R307.2) 10. The maximum hot water temperature discharging from the bathtub, shower and whirlpool bathtub filler shall be limited to 120 degrees Fahrenheit. The water heater thermostat shall not be considered a control for meeting this provision. (CPC 408.3 & 409.4) 11. A 30 -inch clear width for water closet compartment and 24 inch clearance in front of water closet. (CPC 402.5) Electrical Plan Notes: 12. The installation of smoke alarms in all of the following areas shall be provided: (R314.3) a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. b. In each room used for sleeping purposes. 13. The installation of carbon monoxide alarms in the following areas shall be provided: (R315.1) a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on every level including basements in dwelling units that have fuel -fired appliances or attached garages. 14. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets in the kitchen, dining room, pantry, or other similar areas. (CEC 210.11(C)(1)) 15. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets. Such circuits shall have no other outlets. (CEC 210.11(C)(3)) 16. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines, dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC units, built-in heaters or any other fixed appliance with a motor of'/ h.p. or larger shall be on a separate 20 amp. branch circuit. 17. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished basements, kitchens (where receptacles serve counter top surfaces), laundry, utility, wet bar sinks (within 6 feet of the edge of the sink), shall have ground -fault circuit interrupter (GFCI) protection. (CEC 210.8(A)) 18. In all areas specified in 210.52, all nonlocking type 125 -volt, 15- and 20- ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.12) Electrical Plan Notes: 12. The installation of smoke alarms in all of the following areas shall be provided: (R314.3) a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. b. In each room used for sleeping purposes. 13. The installation of carbon monoxide alarms in the following areas shall be provided: (R315.1) a. Approved carbon monoxide alarms shall be installed outside of each separate sleeping area in the immediate vicinity of the bedrooms and on every level including basements in dwelling units that have fuel -fired appliances or attached garages. 14. A minimum of two 20 amp small appliance branch circuits shall be provided for all receptacle outlets in the kitchen, dining room, pantry, or other similar areas. (CEC 210.11(C)(1)) 15. At least one 20 amp branch circuit shall be provided to supply bathroom receptacle outlets. Such circuits shall have no other outlets. (CEC 210.11(C)(3)) 16. In every dwelling unit, fixed appliances such as food waste grinders, dishwashers, washing machines, dryers, laundry tray locations, built-in refrigerators or freezers, furnaces, AC units, built-in heaters or any other fixed appliance with a motor of'/ h.p. or larger shall be on a separate 20 amp. branch circuit. 17. All receptacles in bathrooms, garages, accessory buildings, outdoors, crawl spaces, unfinished basements, kitchens (where receptacles serve counter top surfaces), laundry, utility, wet bar sinks (within 6 feet of the edge of the sink), shall have ground -fault circuit interrupter (GFCI) protection. (CEC 210.8(A)) 18. In all areas specified in 210.52, all nonlocking type 125 -volt, 15- and 20- ampere receptacles shall be listed tamper-resistant receptacles. (CEC 406.12) SI1�lOKE / CARBON MONOXIDE ALARIIlIS ��� � I OWNER CERTIFlCATE OF COMPLIANCE '_�� < COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION S��. �, CUPERTIh10 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 � (408)777-3228 • FAX(408)777-3333 • buildinq a(�,cupertino.orq + '�t� Permit No. C ������C Address 1 ���� �tS�C2 ,�Y' . � ey�iuU,��� �S i � #of Alarms Smoke• �- Carbon Monoxide � P�RIYI�'�' �CANNQT BE FINALED AND CQMPLETED4UNTIL THIS CERTIF���,'�'E ;� i' ' � �r�S BEENrfiT(;N ,D AND RFTLTRNF�TO �HE BUILDIl�G B�V,mISIO1�T � -�, i ` � � ,;= �..�' � �._�-,� � .�4 . ,. -z.y } . � �-,.' ;F .��. , � .,.a.�: . ..:.. .:. �..,..«_. -s. -o-C �_ �" - �-.�-.+--�--��- .�...�. mm � c...d. „�-�. ..n., r,.?. �...� c�..-.,.-w ..�s�`F l� �� \ 5 . ..,_,._.. ......_. . ......_ ........... :.....�_.. :. .�.__... .,,...:_. __..-..._-.._.�- '. PURPOSE � This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for i compliaxue with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for ��I inspections are required. � ; GENERAL INFORMATION Existing single-fainily a�Zd multi-fa.mily dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of addition s, alterations, or re airs to existin dwellin units exceed �:, � p g g s $1000.00, CRC�ection 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 X X �i bedroom(s) On everv level of a dwellin unit including basements � X �' Within each slee in room X - i Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burnin a liances anci that I g PP 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: I�Z dwelling units with no commercial power supply, alarm(s)may be solely baitery operated. In existing dwelling units, alarms are permitted ta 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 Sec�Eion 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 o�n�ner of the above-referenced properiy,I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions a�.id in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. l have read and a ree to com I with the terms and conditions of this statement Owner(or Owner Agent's) Name: , �l l/'4V`� �f�} �_ !� �i� Si nature.......................... r�._.................................................Date:7` f�`�s .......................... ................... ontractor Name: Sinature...................................................................Lic.#......................................Date: Smoke mid CO for»i.doc r�evised 03/18/14 � - VVATER-C�P�S�RV�NG PLU�B[BIf�G FIXTUR�S �.5, OWfVER CERTI�ICATE �� COIV�PLIAI�CE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION � ���,��.�.��� 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 ' (408)777-3228•FAX(408)777-3333•buildinaCa�cupertino orq Owner Na�ne ���/1,0(� /N ��-- X ( � Pennit No 1 .S a�7 o a`�� Address < < �� 1� J 5��'� �1" , ' � �����f� �- � � � ���� �� _ _ _ �-, l�lE�Zi�'� CAI�tI�T�'I'�E.I�INALEI)ANl)C011��,E'I'E��JN'�'IL TI�S CEIZT�����7ClE IE�r�����+1�' �ID�E'�'i7����,7C� '�Tt�[IE]���)LJI��I�T���`4?����� Please refer to the attached California Civil Code Sections 1101.1-1101.8 which are part of this Certificatiou foim ' 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 fonn. Owner' Signature: /� Date: � / '� %L�1, No Go to Question 2. L 0�'�'�"�'`� � ( l D � (� 2. Does your real properiy have a licensed lumber certi � p fying that,due to the age or configuration of the property or its plumbing,installation of water-conseiving plumbing fixtures is not technically feasible? � ❑ Yes Civil Code Sections 1101.1 tluough 1101.8 do not apply. ❑ The licensed pluinber's certification has been provided to the Building Division. ! Sign below and skip the rest of the fonn. Owner' Signature: ` � Date: `��( D � l S � l�No Go to Question 3. 3. Is water service peimanently disconnected for your building? I ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: � - (� Date: . / � ' I�No Go to Question 4. � �� / U t S 4. Is your real property built and available for use or occupancy on or before Januaiy 1, 1994? ❑ No My real properiy is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through,l 101.8 do not apply. Sign below and skip the rest of the fonn. Owner' Signature: L�� � Date: �71 � �� �-� � � Yes My real property is built and available for use or occupancy on or before Januaiy 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached. ❑ Myproperty is a single fa»aily��esidential real property. See Civil Code Section 1101.4. On and after January 1, 2014, building alterations or unprovements shall require all non-compliant pliuilbing fiYizues to be replaced with water-conseiving plumbing fiYtures throughout the building. On or before Januaiy l, 2017, all non-compliant pltunbing fixhues shall be replaced with water-conseiving plumbing fixtures (regardless � of whether property undergoes alterations or iinproveinents). Myproperiy is a»zultifa»zily J�esidential real property. See Civil Code Section 1101.5. On and after January l,2014, specified building alterations or unprovements shall requu�e non-compliant phunbing fixtules to be replaced with water-conseiving plumbing fiYtures. y' On or before Januaiy l,2019, all non-compliant plumbing fixtlues shall be replaced with water- conseiving plwnbing f�tures tYu•oughout the building(regardless of whether properiy undergoes alterations or unprovements). ❑ Myproperty is a conamef�cial real property. See Civil Code Section 1101.5. On and after Januaiy l,2014, specified building alterations or unproveinents shall requu•e non-coinpliant - pluinbing fu�tzues to be replaced with water-conserving phunbing fixtlues. SB407 201 S.doc revised 02/04/I S