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15090189CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10285 SCENIC BLVD I CONTRACTOR: THE D & M GROUP PERMIT NO: 15090189 OWNER'S NAME: SHOENHAIR RICHARD T AND MARGAR OWNER'S PHONE: 4086740791 ISL LICENSED CONTRACTOR'S DECLARATION License Class 4P-1 Lic.# t: d S3 yj Contractor-rtkt 1) tLibt G" R ©e• ra Date 'I - ? I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: t. 1 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 performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by 7.Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION 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, 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 regulations per the Cupertino Municipal Code, Section 9.18. SignatuT Date zY— /6- 0 OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: t. 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) 2 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: i 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 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. I 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 1 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, 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 regulations per the Cupertino Municipal Code, Section 9.18. tiignature Date 18361 SWARTHMORE DR I DATE ISSUED: 09/29/2015 SARATOGA, CA 95070 1 PHONE NO: (408) 313-0761 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ KITCHEN REMODEL (240 SF); INSTALL (N) 200 AMP PANEL "q. Il I1"m k rea: I Valuation: $41000 Ts, \umher: 35702005.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTIO(N��. Issued by.. � Date: J RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(x) should I store or handle hazardous material. Additionally, should 1 use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533. and 25534. O or authorized agent: C rDale: rf -.Z4—/5 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. licensed GENERAL PERMIT APPLICATION MEP I COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255/ (408) 777-3228 - FAX (408) 777-3333 - buildino(olcuoertino.oro t 9 CUPERTINO I S 0q0 I -� ❑ PLUNIDING ❑ MECHANICAL E ELECTRICAL ❑ MISCELLA.'\"EOUS PROJECT ADDRESS 10 2 C C C 3 1 pe{ ✓ APN k -, l 2-, O o co OWNERNAME PHO r•1✓=.Z 'Z" STREET?DDRE(10 2,95- 5-C C 3 LP� CITY, S�'k,ZI-0't- C� 9,5-0 /Y F._a gm t7 CONTACT NAME �'Hqog3130;>6/ �j0 E-14ML U 1 D 14 ?,two STREET.�,D RESS (�,36 CITY STATE, ZIP S FAX ❑ OWER ❑ 071.7ER-BUILDER ❑ OV. ERAGE.^.' 1K7:)NIRACTOR ❑ CONTRACTORAGENT ❑ ARCFSBCT ❑ ENGL\'EcR ❑ DEVELOPER ❑ TENA];- Co"'-QVOG I6COSr3 ER LIC>aET1?E BUS. LIC r COMPANY NAJM . I E-MAIL FAX STREET AI�F 3 6 r Sc�, 27Hr>7 c �Z CITY, S�T Z2 e �� 'C7 �� �� PHO; 0 U � 13C7 "?K/ r 4 B rL1C V ARCHITECT/ENGIN'EERNAAQE LICENSE Nrn4BER BUS. COMPANY NAME _ —. E-MAIL FAY - — - STREET ADDRESS C'I Y, STATE, ZIP PHONE USE OF ❑ SI—D., DLPLEX ❑ PROTECT IN WIlDLAND ❑ YES PROJECT IN ❑ YES IS THE BLDG AN ❑ Y Is B=IIdG: ❑COW4ERCIAL URBAN INrUFACE AREA ❑ NO FLOOD ZONE ❑ NO EICHI.ER HOME? ❑ NO DESCRIPTION OF WORK/ mVol W" 4043 00 /! M4 P4'A e l TOTAL VA-LUATION: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on pro erty 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, o comply with all applicable local ordinances and state laws relatin ing construction. I authorize representatives of Cupertino to enter theabov2 enti5ed� ro erty for inspection purposes. Signature ofApplicant/Agent: �� Date: f SUPPLEMENTAI. INTFORMATION REQUIRED OFFICE 1"SE ONLY ❑ 0�'EP-Ii?E-CDG�TLI2 _ ST N-DAFD i z L, 7_ARG£ 0P - MEPAIisCApp_2011.doc revised 06/21/11 CITY OF CUPERTINO F&T�1 FEE ESTIMATOR — BUILDING DIVISION 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 preliminart in ormation available and are onl j, an estimate. Contact the Dept for addn 7 info, FEE ITEMS (Fee Resolution / 1-053 E�(f. 7/1/13) ADDRESS: 10285 SCENIC BLVD DATE: 09/29/2015 REVIEWED BY: PHUONG APN: 357-02-005 BP#: *VALUATION: 1$41,000 PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: 0.0 1 PENTAMATION 1 R3SFDREM PERMIT TYPE: WORK KITCHEN REMODEL 240 SF); INSTALL N 200 AMP PANEL SCOPE F200 amps $48.00 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 preliminart in ormation available and are onl j, an estimate. Contact the Dept for addn 7 info, FEE ITEMS (Fee Resolution / 1-053 E�(f. 7/1/13) 1lec:h. Plan ('h(,,,k F_ Other .4dech. InN1F-1 I QTY/FEE Elec. Plan Check 0.0 hrs $0.00 Elec. Permit Fee: IEPERMIT Other Elea Insp. 0.0 hrs $48.00 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 preliminart in ormation available and are onl j, an estimate. Contact the Dept for addn 7 info, FEE ITEMS (Fee Resolution / 1-053 E�(f. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 D4Es.f. $645.00 Remodel, Kitchen (<=300 sf) /REMRESKIT Suppl. PC Fee: (j) Reg. O OT 0.0 1 hrs $0.00 PME Plan Check: $0.00 F200 amps $48.00 Electrical IBELEC200 Services Permit Fee: $0.00 Supp/. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $48.00 (111slrucliulr 141_" Administrative Fee: IADAIIN $45.00 O E) Work Without Permit? O Yes (F) No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential Building or Structure E) i Travel Documentation Fee: ITRA!'DOC $48.00 Strong Motion Fee: IBSEISMICR $5.33 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $2.00 SUBTOTALS: $148.33 $693.00 TOTAL FEE: $841.33 Revised: 07/02/2015 CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: < b Z SS Scc PERMIT # SO R 0 (Y 01 OWNER'S NAME: & c y za [ 1 PHONE # -108 3 t 3 -n2-1 l GENERAL CONTRACTOR: T/.j,� (5 c v 10 BUSINESS LICENSE # ADDRESS:/936 *e7jya4aAx Scr 70 (Zl- CITY/ZIPCODE: QSo7 P *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:' Signature Please check applicable subcontractors and complete the following information: 47 —z g -- 15;- Date S Date Owner / Contractor Signature Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing 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 Owner / Contractor Signature Date E. GA5 HOOD VENT THROUGH ROOF >11111110 am 0 (a) COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION - CUPERTINO APPROVED This set of plans and specifications MUST be kept at the Icb site during construction. It is unlawful to make an Ff!� 3068 , therefrom, withcut approval from the Building Official. The Stamping of this pan and specifications SHA L NOT 00 be held to permit cr to be an approval of the v olation N of any provisions of any City Or finance or State Law. uj LED BY E. TILE FLOOR TO 0 Vyx- DATEREMAIN 2 rn PERMIT # RECEIVED 2 , 2Ui5 LED U -- — I IWP I � P I c, FIT -I Ll _____L_ J LED E. SKYLIGHT TO LED REM I G L 1 �v I � LED LED LED LED r---- -- - D.W. 0 0 GFIG I FIG LED UQR GABINET LIGHTING 10 E. BAY WINDOW TO REMAIN 4030 NEW KITCHEN . Awt Cen�R�c7Ton s�`�'��/.co�Fo/tin ro Zia i3 c({c, CCG, fft, c oceVP4•7cy yRoaP OR -3 . CehSf4�ctton Tr/° : VQ E. SINK & PLU_BM_ IN_ O LOCATION T IN CUPER T INO �► Building Deoertmern SEP 252015 OFFICE COPY NOT TO 50ALE REVIElil t-011 UWE GU1vINLIAWGf: Revlewl By Scope of work: Kitchen remodel, New cabinets, new appliances WP New 200 AMP service panel o-*' R tyL P New high efficiency lighting KITCHEN; • AT LEAST 50% OF TOTAL WATTAGE OF KITCHEN LIGHTING TO BENIGN EFFICACY. • ALL HIGHEFFICACY KITCHEN LIGHTING TO BE SWITCHED 00 SEPERATLY FROM LOW EFFICACY LIGHTING. (D • PROVIDE AT LEAST 2-20 AMP DEDICATED SMALL APPLIANCE o(1) CIRCUITS AT KITCHEN COUNTER TOPS. w • PROVIDE DEDICATED CIRCUITS FOR: DISHWASHER, GARBAGE DISPOSAL,TRASH COMPACTOR, MICROWAVE. • PROVIDE COUNTER TOP OUTLETS 48" MAX. • PROVIDE ONE COUNTER TOP OUTLET FOR COUNTER 12" OR WIDER. • PROVIDE AT LEAST ONE COUNTER TOP OUTLET FOR ISLAND OR PENNISULA WIDER THAN 24". • ALL OUTLET TO BE GFI 6 TAMPER RESISTANT PROTECTED. • D.W. SHALL BE FITTED WITH APPROVED AIR GAP FITTING. • PROVIDE GAS SHUT-OFF IN AN ACCESSABLE LOCATION. • PROVIDE SMOKE DETECTORS IN EACH SLEEPING ROOM d HALL. • PROVIDE CARBON MONOXIDE DETECTOR CENTRALY LOCATED OUTSIDE EACH BEDROOMS. Property /owner address: Contractor: Richard 6 Margret Mykland The D&M Group 10285 Scenic Blvd. 18361 Swarthmore Dr Cupertino, Ca. 95014 Saratoga, Co. 95070 408-674-0791 408-313-0761 Ca. Licence #605343 . Awt Cen�R�c7Ton s�`�'��/.co�Fo/tin ro Zia i3 c({c, CCG, fft, c oceVP4•7cy yRoaP OR -3 . CehSf4�ctton Tr/° : VQ E. SINK & PLU_BM_ IN_ O LOCATION T IN CUPER T INO �► Building Deoertmern SEP 252015 OFFICE COPY NOT TO 50ALE REVIElil t-011 UWE GU1vINLIAWGf: Revlewl By E. GAS FLOOR TO m REMAIN 0 co uj I I I——T----T— -—1 I I I I I L -L— — — — -L— — —J I ------------� I J------------= CuPER T INO 3uildinq Deocrtrrtent E. SINK LOCATION E. BAY WINDOW TO TO REMAIN J) `� .- X013 REMAIN 4030 'REVIEVvEV r(jk LuL)E `umPLIANCE Kevieweo a., y EXISTING KITCHEN NOT TO5GALE CUPERTINO Owner Name Address rV .Z 3 S 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 • building(d.cupertino.org 'Mvfilah c( Permit No.1-57, 1 W 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 fonn. F91 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 forin and sign bottom of form. No Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Q 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 1.101.8 do not apply. Skip the rest of the form and sign bottom of form. ® 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.. Please check ONE of the following: 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 irnprovernents). 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 thatit1he water -conserving pjurfibing fixtures om ; ly with the requirements as indicated in the table on the following page. I Owner or Owner Agent's Signaturel {/ Lbl-/ i� �-Ll ,l CX Date:/,moi d'ZcgV1 Upon completing and signing this Certifrca&,Jplease return it to e Building )division in order to final your building permit. SB4072015.doe revised 08/26/15 BUILDING PERMIT CANNOT BE EINALED AND COMPLETED UNTIL, THIS CERTIFICATE. -HAS BEEN SIGNED 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. SB407 2015.doc revised 08/26/15 Non -Compliant Water -Conserving Plumbing Fixture PlumbingFixture (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. SB407 2015.doc revised 08/26/15 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 a FAX (408) 777-3333 o building(a.cupertino.org 'a,1 Aress L® .Z VS SCe i)ic,woo-op a �S:�u oke:57-5boi1 r lim-i- 21 t PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN , (:NF,D AND RETURNED TO THE BUILDING DIVISION 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: h -i 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 �QWner��o.�®U�iner Agent s) -Name, � ��v I �% i � -S afar-e......�_.�:'.:�.........................................�:: �. .t.�_: -�.:�..... __............,'D'a a: 1z-2`/ C:otractor. Name:---- �4v lZ t -e- 4��--6 (753 Y3 5"Dat ,� •H,ti1 G=Rc�� 1� Smoke and CO fonn.doc revised 03/18/14