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150801392 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11627 CEDAR SPRING CT CONTRACTOR: AMERICAN HOME PERMIT NO: 15080139 RENEWAL INC OWNER'S NAME: DMITRY VYSHETSKY 310 SHAW RD STE A DATE ISSUED: 08/19/2015 OWNER'S PHONE: 4089969838 S SAN FRANCISCO, CA 94080 PHONE NO: (650)553-9054 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL F] COMMERCIAL ❑ 2INSTALL G t % 7 `'4 O S 19 REPLACEMENT WINDOWS & 2 License Classy I Lic. # REPLACEMENT "V f DOORS (NON-STRUCTURAL) & INSTALL (N) HARDIE Contractor/�,yl��_ w1. t,cJ. Date SIDING I hereby affirm that I am licensed under the provisions of Chapter 9 TO REPLACE (E) WOOD SIDING (1900 S.F., SAME LOOK) (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 C pensation, as provided for by Section 3700 of the Labor Code, for the Sq. Ft Floor Area: N":iluation: $50000 leerfo ceof the work for which this permit is issued. I h e will maintain Worker's Compensation Insurance, as provided for by ion 00 of the Labor Code, for the performance of the work for which this APN Number: 36654069.00 Occupancy Type: it i issued. APPLICANT CERTIFICATION I certi that I have read this application and state that the above information is PERMIT EXPIRES ORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WIT"II F 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 S F 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 Issu Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. t RE -ROOFS: Signature I Signature j Date / S All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agreeto remo new materials for inspection. ❑ OWNER- ER DECLARATION r/ Signature of Applicant: Date: 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: A OOF COVERIN T E 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 ' trict I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, C er 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 255 Section 3700 of the Labor Code, for the performance of the work for which this 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 CONSTRUCT 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. Signature Date CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERTINO (408) 777-3228 - FAX (408) 777-3333 - buildin-ga—cuaertino.ora 1 I NRW (YINSTRI Ir'TICrN I 1 A11111T1ON I—I Ai.TF.RATION / T1 I—I REVISION /DEFERRED ORIGINAL PERMIT #/ PROJECT ADDRESS l 16 - l # 36/ — ;tfOWNERN G ET INE <gO_ ��7APN -MAIL STRE T ADDRESS 2"7 G IA) 67 -GU CrrY, ATE, ZlP 'z I O e -A >1 FAX CONTACT NAME EILEEN BAUGHMAN PHONE 707-527-7727 EMAIL eileen@permitservices.com _7STREET ADDRESS CrrY,STATE, ZIP IAx ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT 11CONTRACTOR W CONTRACTOR AGEN"I- ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS. LIC # Nataly Gutierrez 740587 B C17 COMPANY NAME AMERICAN HOME RENEWAL 1 E-MAIL FAX 650-553-9053 STREET ADDRESS 310 SHAW ROAD STE A CITY, STATE, ZIP SOUTH SAN FRANCISCO CA 94080 PHONE 650-553-9054 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME F -MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE < j DESCRIPTION OFWORKN )�NY f�'"r /"10 v �P"JK l IICrr,&A� 1A� -7tYI_ /^)5-T,4-1 C1�G / I . T- /b -?-D 1C 5 1 D i,A - —TE- /-)z � � I/1'�- r"1S-WI1*71'0J iNGN-SrkWC-1 V R-ftL-) EXISTING USE PROPOSED USE CONSTR. TYPE I # STORIES Z USE TYPE OCC. SQ.FI'. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA I REMODEL AREA PORCH AREA DECK AREA TOTAL DECKIPORCH ARE GARAGE AREA: 0 DETACH ❑ ATTACH I N DWELLING UNrrS: IS A SECOND UNIT ❑VES BEING ADDED? 0 SECOND STORY OYES ADDITION? ONO / RE(�E} , TOTAL VALUATION: c j arm PRE -APPLICATION OYES IF YES, PROVIDE COPY OF PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER IS THE BLDG AN EICHLER HOME? By my signature below, I certify to each of the following: I am the property owner or authorized agent to a he property owner's behalf I have read this application and the information I have provided is correct. I have read the Description of Wo erlfy is aw-urate. I agree to comply with all applicable local ordinances and state laws relating to building construction. I authorize representa ' upertino to enter the abo- -id—tiff—I fnr inspection purposes. /9 / Signature of Applicant/Agent: Date: D PLAN CHECK TYPE ROUTING SLIP SUPPLEMENTAL INFORMATIO Zlition New SFD or Multifamily dwellings: y fo permit for ❑ OVER-THE-COUNTER ❑ BUILDING PLAN REVIEW existing building(s). Demolition permit ' prior to issuance of building permit for new building. ❑ EXPRESS ❑ PLANNING PLAN RFVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD ❑ PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ LARGE ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR ❑ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B1dgApp_201 Ldoc revised 06121/11 CITY OF CUPERTINO ffim FEE ESTIMATOR — BUILDING DIVISION im,ADDRESS: 11627 CEDAR SPRING CT DATE: 08/19/2015 REVIEWED BY: MELISSA :6111111. Permit Fire APN: 366 54 069 BP#: `VALUATION: 1$50,000 YPERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: Ia,p. Fed PENTAMATION 1GENRES PERMIT TYPE: WORK INSTALL 19 REPLACEMENT WINDOWS & 2 REPLACEMENT DOORS NON-STRUCTURAL & SCOPE INSTALL (N) HARDIE SIDING TO REPLACE (E) WOOD SIDING (SAME LOOK) 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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1!13) Xlech. Plan Check Phuul>. flan Checi Llec. Plan Check :6111111. Permit Fire Plumb. Permit Fee: Elec. Permit Fire: Other Mech. Inst, Other Plumb Insp olhe1- Elec. In p. 1-tcl2 Trash F"', Ia,p. Fed 'cr(. Its", Fec 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 nreliminary information available and are onlv an estimate. Contact the Dept for addn'l info. FEE ITEMS (Fee Resolution 11-053 Eff 7/1!13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,900 s. f. $1,291.00 Siding 1SIDEOTHER All Other Suppl. PC Fee: (F) Reg. 0 OT 0.0 hrs $0.00 PME Plan Check: $0.00 =# $717.00 Window / Sliding Glass Door IWINREP Replacement Permit Fee: $0.00 Suppl. Insp. Fee -0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tax: Administrative Fee: O 0 Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure 0 Iwc•ccrnentaiiurt Fees:� Strom Motion Fee: IBSEISMICR $6.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $8.501$2,008.00 TOTAL FEE: $2,016.50 Revised: 07/02/2015 SeNen Springs (h%ners Association application for Appro%al of Architectural Changc/Addition Q5 CATIPGOR i U ('ategory C - \loditications that are exterior moditicaticatS Muhl nu chan!?es ui the ori`,inal huildrrtg structure or flout plan. fill rootinv. siding, window material change. c\terior paint color cham_e. addition of a roof attic fan. or garaee dour. tall inns thi: catceor} . Date: 07 05 2015 Request for 1pproval of Proposed ( hangc PLEASE PKIN i' THE FOLLOWING 1NI'ORNIA I iON Nanic: Dmitry and Marina Vyshetsky �ridte" 11627 Cedar Spring ct., Cupertino CA 95014 Flonte Phone: 408-996-9838 \1 of Phone 916-509-2147 email: mvyshetsky@gmaii.com Description of Proposed Change: 1) Paint ('Dior ('hanger Please choose Irom -approved list" tGarage dont ower triol should he dianxmd ++hitt if twzsi i ;pe itiedcolurJamesHardie -"Monterey Taupe",1H40-20 [run color: diartnuod %%hi(t X or tr0%1 Front door color dianumd tthite X bust natural oak of spccOwd ' approi ed color _ http://www.jameshardie.com/pdf/)ames-hardie-siding-brochure-north,pdf rhe same materials and colors are used on 11670 Timber Spring ct. 2) Roofing Material ("hange (please check fine choice) a I ightvveight ('oncrete file from `lomerl.itctilc - atvlc color "\iuuvvuoel" h. (IAF Larninated Fiberglass Asphalt -,tyle '-(,rand (.tnjou c0101 -NhNsutn liroan.. c. GAF Laminated Fiberglass Asphalt - ,tvlc'Giand ( ativort • Color ".'Stonce+o0d' d. Decra Stone Coated Swel Rood Sv stem- sive '-Decra -Ylake•' colo, '-Shadm+ood.. e Ula,,N "A" Fire Retardant Routing S} Stein using pressured heated cedar wood >Ittngles ++ith fire retardant fiber las: cap sheet underlay Need to have a Uity of 0ipertims Permit accompany rut, till,, application t6r all %wod shmule roots. 3) Siding Material Change (Please check one choice) Siding Material: Nardiplank CedarmiII (wood arnn tinishi X or i fardiplank Smooth Finish 14 hich sides are you are changing material" (front X hack X Icli X riiht X I 4) N indon Material and Design change: (Please check that 1i0\) � int I "indows - cutoi N hire X 'y, 4sl include manuticture disci Include cut sheet fitr type antl style of windows Retiotit Ncva ('ortstt X � 5) adding a roof attic fan, tubular Sky light, Air( mtditioner (luca tion of ('ondenseri. and Satellite Dish Please attach information regarding the proposed .haiwc application must include dimension, color (if the proposed Ian and its location on the roan. Please include detailed drawings. SI—fWticauunS. and product brochures it available I ithulur +A-t-lighi up to 14 " dicrnterc•r run• roof alm- h►rt tip t;, 20 nr i, tllrh al'- !r Mali h t'(ru! 6) Garage doors: a. Recessed wood panel, not raised in .:enter same siv lc tin windows (" PL Alts" nun decorative[ St}le 84 (9 panels across. 64 (6 pastels across). 44 to panels acro -s-1. Style +vith windo\ks fir Y% le rto wntdov+, b. Insulated wood, insulated metal n wood facing fit "( :►o si c I lousy ' di It- 30 R w nulo+v s 101 nu window 7) Solar System: Adding solar panels tt+ the roo(of home. (Requires drawing indicating placement ootf,pi►tn is and photo for tv pe 01 panel to he installud) **kx.xnskkk*K*k*iib*.<:ww:nn .s:,/3.�/� .., <�k<".�rtw- nxx nx xx k*, x;.F..Rnxx.<Rxrx xick xcxx.,xn .+ct kr: < , 77 Y � - - I lomecxvner's Signature: l -- i he request is ill complimtek; +%41) "Pring, 10) \ lrchttcctmal t andchnc,. hop seen -apt llfu, uru, filer arclntrrtuat-cunlrlun:,.tnlf \rchitecuu-al Control ('ommittee board -4ppntvc(f I'endint, Denied Pending -lirchitectural Control ( otnmi(tee lioard 5i`�nattti;r ' �.. �'!' ` 'l r COMMUNITY MANAGEMENT SERVICES, INCORPORATED July 28, 2015 Dmitry Vyshetsky Marina Vyshetsky 11627 Cedar Spring Court Cupertino, CA 95014-5139 Re: SEVEN SPRINGS OWNERS ASSOCIATIONS 11627 Cedar Spring Court Dear Homeowners: Enclosed you will find a copy of your Architecture Application for the residing of your home, with the approval from the Board of Directors, as well as any restrictions or conditions that the Board deemed necessary. According to your application you will be residing with the "Hardiplank Select Cedarmill" (Wood Grain Finish).The board has also approved the installation of your new milgard white vinyl windows. Please fill out and return the included final completion form which will begin the completion process. Please keep in mind that any deviation from your approved application will require you to resubmit your application for review. If you utilize an unapproved material you will be required to remove and replace the material with an approved selection. The approval of your project's architectural compatibility with the Seven Springs Owners' Association's complex does not constitute or imply, that the Architectural Committee and/or the Association Board of Directors deem your project as meeting City of Cupertino /County of Santa Clara codes. The approval is given contingent upon you and /or your contractor(s) obtaining the required construction permits and meeting all code requirements, if any. Sincerely, Community Ma gement Services, Inc. �2; !v �s Heredia, enior Association Manager, CCAM j SEVEN SPRINGS OWNERS ASSOCIATIONS LH/nm cc: Board of Directors File #4 & #16 1935 Dry Creek Road, Suite 203 9 Campbell CA 9 95008-3631 . voice (408) 559-1977 • fax (408) 559-1970 PLOT PLANS CHECKED BY CRATE �9,1-2vlE 1/4XOX _ + P LAN N I N i D E P IXO Picture (Mid) RTPW (TOP) CUPERTINO SH ,. �,1titUNITY DEVELOP' DEPARTMENT BUILDING DIVIS►CPERTINO APPROVED This set of plans and specifications MUST be kept at the job site during construction. It is un%wful to make any changes or alterations on same, or to deviicaW therefrom, without aPpro�al from the Building The Stamping of this plan and specifi;rations SHALT. NOT ra�al of th violation be held to permit cr to be an a� State Law. of any pro Round ATE PERMIT # ---- 11627 Cedar Spring Crt Cupertino, CA Bay PDxo Lv Rm Room Lom Entry 'I I J XO PW X0 X0 X0 CUPER i IINO Building Department i REVIEWED FOR CODE COMPLIANCE Pd#v!%f508 YT 1 /4XOX MSTR BR i I Upper Level MSTR Bath Office Front BR Bath Front BR XO Round XO PW OFFICE COPY SH xo CUPERTINO l%ems/ WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE M. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building o)cupertino ong PERNIIT CANNOT BE FINALED AND COAIPLETED UNTIL THIS CERTIFICATE HAS BEEN S GNE 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. 00 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: J No Go to Question 2. Date: 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: ,KNo Go to Question 3. Date: ' Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Z_26_.. No Go to Question 4. Date: e��"/ 00 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 11011.11 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature:c�lTG�� Date: •®• Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 110 1. 1 through 1101.8 apply. Refer to the attached. y 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-cornpliant plumbing fixtures to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non-cornpliant 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-conseiving plumbing fixtures. SB407 2015.doc remised 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 plu fixtures comply with the requirements as indicated in the table below. Upon completing and signing this Certificate, please 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 rigure snown, it is not requireu Lo or, upgiaueu. SB40720.15.doc revised 02/04/15 Rion -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usage/Flow Rate 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Fixture Type Water Usage 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 /Flow Rate Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallon lush (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 rigure snown, it is not requireu Lo or, upgiaueu. SB40720.15.doc revised 02/04/15 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 • buildino(5)cupertino.orQ in F I L": R�5 lox . 1._. t 10� Address 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 $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement Owner$(or Owne Agen 5aI „+�,,-` �� : �, j Qi ei nature. ......... . .......... ; -� �- .. .. _.,, .:................ imam Date...... ......... Contractor Name: V Signature................................................................... Lic.#...................................... Date:................... Smoke and CO form.doc revised 03118/14