15020033-Sublist & Smoke AffidavitBuilding Department
City Of Cupertino
10300 Torre Avenue
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: 2 C> 3 4V 3 (;- V j
PERMIT # t 5 0 Z—O 6 3 3
OWNER'S NAME: v s. `) FA- S5 \ Aw
PHONE # 2-6>9-40-3 — Z- 'C)S
GENERAL CONTRACTOR: Cj C
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:
ignature
Please check applicable subcontractors and complete the following information:
Date
zea -s -is-
Owner / Contractor Signature Date
7XI/W
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
(0 Q�
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
zea -s -is-
Owner / Contractor Signature Date
7XI/W
Address
�SS.tysJ`
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
777 -3228 • FAX (408) 777 -3333 • building aC-- cupertino.org
PURPOSE
This affidavit is a self - certification for Ithe 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 induding 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 8314 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
Owner (or Owner Agent's) Name:
Dwip +?
Si nature ...... ......... .......... y ............ ............................... Date: - s✓�S_
Contractor Name:
Si nature.. .... Lic.# ....... ............................... Date: ..... .�
Smoke and CO form. doc revised 03118114
CUPERTINO
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 • buildinoCa2cupertino.org
Owner Name '4a4 t, "i 01-i / A�.�1 e] Permit No.`_V0_40 Z 00 3-1
Address
Please refer to the attached California Ctvil Code Sections 1101.1 = 1101.8 which are part of this Certi
1. Is your real property a.registered historical site? "A"'FILE
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and rest of e f rm
Owner' Signature: Date:
C� c�
❑ No Go to Question 2.
2. Does your real property have a licensed plumber certifying 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:
❑ No Go to Question 3.
Date:
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:
❑ No Go to Question 4.
Date:
4. Is your real property built and available for use or occupancy 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.
Owner' Signature: Date:
Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Refer to the attached.
MMyproperty 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.
SB40 7 2014.doe revised 03118114
On or before January 1,;;2019, all non - compliant plumbing fixtures shall be.replaeed with water - `conserving
plumbing fixtures throughout the building: (regardless of whether property undergoes alterations or
improvements).
UWe, the owner(s) of this property, certify under penalty of perjury that non - compliant plumbing fixtures have been replaced
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 plumbing fixtures comply w' th eq ' enients as indicated in the table below.
Owner's (or Owner Agent's) Signature: Date:
Upon completing and signing this Certificate, please return it to the Building Division in order to final your permit.
-`
Non- Compliant
Water- Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Maximum Water Usa a /Flow Rate
Fixture�Ty
Water Usage
2013 CPC Ch. 4
2013 CPC Ch. 4
2013 CPC Ch. 4
/Flow Rate
2013 CALGreen Div. 43
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
maybe used to achieve
unavailable, aerators or
reduction.
other means may be
used to' achieve
reduction:' `
1. It the existing plumbing fixture water usage /tiow rate is equal to or lower than the figure shown, it is not required to be upgraded.
SB4072014.doc revised 03118114