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15090160CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10755 ALDERBROOK LN CONTRACTOR: HENNEMAN JEANINE PERMIT NO: 15090160 TRUSTEE OWNER'S NAME: HENNEMAN JEANINE TRUSTEE 10755 ALDERBROOK LN DATE ISSUED: 09/23/2015 OWNER'S PHONE: 4085928484 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE (E) 100 AMP PANEL AND INSTALL (N) 200 AMP SERVICE PANEL. REMOVE (E) INTERIOR SUBPANEL. License Class Lie. # Contractor Date 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. Sq. Ft Floor Area: Valuation: $2800 I hereby affirm under penalty of perjury one of the following two declarations: 1. I have and will maintain a certificate of consent to self -insure for Worker's APN Number: 36921041.00 Occupancy Type: Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 2. 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 permit is issued. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is 180 D YS FROM LAST CALLED INSP CT ON. 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 11 �lc t� ,c upon the above mentioned property for inspection purposes. (We) agree to save Issued by: WL u r� Dater L.J 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 with RE -ROOFS: all non -point source regulations per the Cupertino Municipal Code, Section 9.18. All roofs shall be inspected prior to any roofing material being installed. If a roof is Signature Date installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER the following two reasons: 1. 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 HAZARDOUS MATERIALS DISCLOSURE sale (Sec.7044, Business & Professions Code) I have read the hazardous materials requirements under Chapter 6.95 of the 2. I, as owner of the property, am exclusively contracting with licensed contractors to California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain construct the project (Sec.7044, Business & Professions Code). compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. I hereby affirm under penalty of perjury one of the following three declarations: Additionally, should I use equipment or devices which emit hazardous air 1. I have and will maintain a Certificate of Consent to self -insure for Worker's contaminants as defined by the Bay Area Air Quality Management District I will Compensation, as provided for by Section 3700 of the Labor Code, for the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 255 performance of the work for which this permit is issued. 7" 2. I have and will maintain Worker's Compensation Insurance, as provided for by Ow o thorized agent: /gyp Section 3700 of the Labor Code, for the performance of the work for which this Date: L,J permit is issued. I certify that in the performance of the work for which this permit is issued, I shall CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If, after making this certificate of exemption, I for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name must forthwith comply with such provisions or this permit shall be deemed revoked. Lender's Address APPLICANT CERTIFICATION ARCHITECT'S DECLARATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. 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 Licensed Professional upon the above mentioned property for inspection purposes. (We) agree to save 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 with all non -point source l tions per the Cupertino Municipal Code, ectiol9.18. Signature Date ` [ GENERAL PERMIT APPLICATION 1;5cflo(lho COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildin-ga-cupeitino.org ❑PLUMBING ❑MECHANICAL ®ELECTRICAL ❑MISCELLANEOUS MEP misc PROJECT ADDRESS Panenl Upgrade 10755 Alderbook Ln. APN# c 041 OWNERNAME Nick & Jeanine Henneman PHONE (408) 592-8484 E-MAIL njhenneman@yahoo.com STREET ADDRESS 10755 Alderbrook Ln. CITY, STATE, ZIP Cupertino, CA 95015 FAX CONTACT NAME Nick Henneman PHONE (408) 592-8484 E-MAIL njhenneman@yahoo.com STREET ADDRESS 10755 Alderbrook Ln. CITY, STATE, ZIP Cupertino, CA 95014 FFAX 0 OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME Joe Graham LICENSE NUMBER 864319 LICENSE TYPE B,C-10 BUS. LIC # COMPANY NAME Graham Home Improvements E-MAIL FAX STREET ADDRESS 4357 Hilton Avenue CITY, STATE, ZIP San Jose, CA 95130 PHONE (408) 234-9459 ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF D SFD or DUPLEX ❑ MULTI -FAMILY BUILDING: ❑ COMMERCIAL PROJECT IN WILDLAND ❑ YES URBAN INTERFACE AREA ❑ NO PROJECT IN ❑ YES FLOOD ZONE NO IS THE BLDG AN ❑ YES EICHLER HOME? 0 NO DESCRIPTION OF WORK Remove and replace electrical main exterior electrical panel and remove interior sub -panel TOTAL VALUATION: $2,800.00 RECEIVED BY: O vftj By my signature below, I certify to each of thfollo mg: application and the information I have r i e i ect. ordinances and state laws relating to b o c ion. Signature of Applicant/Agent: I am the property owner or authorized agent to act on the property owner's behalf l have read this I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local I authorize representatives of Cupertino to enter the ab e- dentified p ope for inspection purposes. Date: SUP EME TAL INFORMATION REQUIRED FFICE USE ONLY W OVER-THE-COUNTER PIE w F k EXPRESS U w x ❑ STANDARD U a ❑ LARGE a ❑ MAJOR MEPMiscApp 2011.doc revised 06/21/11 CITY OF CUPERTINO luu, 01 W FEE ESTIMATOR - BUILDING DIVISION 191 ADDRESS: 10755 Alderbrook Ln. DATE: 09/23/2015 REVIEWED BY: PAUL UNITS APN: 369 21 041 BP#: *VALUATION: $2,800 PERMIT TYPE: Electrical Permit PLAN CHECK TYPE: Alteration / Addition / Repair —7PENTAMATION PRIMARY SFD or Du lex pL Amps 1 REAP2 USE: Pel -mit Fec . PERMIT TYPE: i WORK Remove E 100 Amp Panel and Install N 200 Amp Service Panel. Remove E Interior Subpanel. SCOPE PME Unit Fee: APPLIANCE / EQUIP TYPE FEE ID 1'lufrib. Plum Check QTY UNITS BP FEES Elec. Permit Fee: IEPERMIT Services 1 ERT<200 Other Elea Insp.Ehrs $48.00 200 Amps $48 Pel -mit Fec . PME Unit Fee: $48.00 PME Permit Fee: $48.00 Constr°uclion lax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? Yes (D No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $48.00 Stroni), Motion Fee: 1BSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc These ees are based on the reliminar information available and are on1v an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113L A4ech..Plcat Check 1'lufrib. Plum Check Elec. Plan Check 0.0 hrs $0.00 Meeh. Permit Fee: Plumb. Permit Fee: Elec. Permit Fee: IEPERMIT }cher Mech..1ns}�. —L-1 )sdeer f'lun�i> h�. Other Elea Insp.Ehrs $48.00 r�rz7 trc:°> .: _. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District etc These ees are based on the reliminar information available and are on1v an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 Eff. 711113L FEE QTY/FEE MISC ITEMS 'Pian Check .F'ee: 5'ttppL PC Fee PME Plan Check: $0.00 Pel -mit Fec . PME Unit Fee: $48.00 PME Permit Fee: $48.00 Constr°uclion lax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? Yes (D No $0.00 Idvaneed Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Stroni), Motion Fee: 1BSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $190.50 $0.00 TOTAL FEE: $190.50 Revised: 07/02/2015 9-i CUPERTINO OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • buildingna cuoertino.or Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE ADDRESS 1 kLhC12 �6 .- ... APN. 2G��jj I © � BP# QOI OWNER NAME OWNER ADDRESS.�g IoW O 1L �.� V DESCRIF=TION OF WORK: A - 0'Wo i, 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.) J1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- ilder" building permit that erroneously implies that the property owner is providing his or her own labor and material ersonally. 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 injQries to workers on my property. I understand building permits are not required to be signed by property owners unless they are responsible for struction and are not hiring a licensed Contractor to assume this responsibility. 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may ct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her � instead of my own. 4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license bers on permits and contracts. 5 I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tal 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. *fderal I understand if I am considered an "employer' under state and federal law, I must register with the state and 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. 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. 8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for y 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 f9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal venue 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 tr tors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I h parry legally and financially responsible for proposed construction activity at the site address listed above. 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide b I 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 inf rmation l have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint._ Your only remedy against unlicensed Contractors maybe in civil court. Itis 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 verif v the property owner's signatwr� Y _ / Property Owner's Signature: Date: Z1 k� 11 j ---- - - ---- --- - - r------------------------------------------------------------------------------------------------- (NOTE: The following Authors h 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 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) 77-7-3333 m building(cDcupertino.orq Owner Name dr1 tEg1i "-r& W; TP_ P5YWI Permit No. /emo/bo Address iM 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. 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. Skip the rest of the form and sign bottom of form. R9 No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. W No Go to Question 4. 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. Skip the rest of the form and sign bottom of form. X 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. Check one of the three following statements and sign bottom of form.. 5, Please check ONE of the following: �j My 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. 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, as the owner or owner's agent 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 110 1. 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 with the requirements as indicated in the table on the following page. n.0 h.. / % I e IOwner or Owner Agent's Signature: 4 f yg 14 & Date: Upon completing and signing this Cqktffic4e, please return it to the Building Division in order to final your buildin permit. SB407 2015. doc revised 08/26/15 Viz-:,-.. —� ¢��s+ •: '-. _. , ,. y BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS —CE'RTIFYCATE HAS BEEN, I NED AND RETURNED TO THE BUILDING DIVISION 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. SB4072015.doe revised 08126/15 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. SB4072015.doe revised 08126/15 °, dress PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE > CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 • building(a.cupertino.org WEAE-00t, NOt 15 () q 0 1 0 V(0 M,-6 61\14v_ A co of-cadx PERIWI T CANNOT BE FINLED AND COMPLETED UNTIL T111S CERTIFICATE HAS BEEN S1QN'ED AND RF,TIMNED TO THE BUILDING DIVISION 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: Iri 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 _0wri6r:(6r 0.wner-.Agen' s) -Name• �h IJI �sraUre............ I -Contractor Name: �/ % � C S Si''��. e ...... ......... ... ... .............................:Lie:#' ....................................:;_Date: �i� . �.. cJ Smoke and CO form.doe remised 03/18/14