15100018 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 8147 PARK VILLA CIR CONTRACTOR:FOUR SEASONS ROOFING PERMIT NO: 15100018
OWNER'S NAME: KODUR NARASIMHAPRASAD G TRUSTEE&E PO BOX 1668 DATE ISSUED: 10/02/2015
OWNER'S PHONE: 4085591970 SAN JOSE,CA 95109 PHONE NO:(408)278-0330
❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
BLDG#8147,#8149,#8151-REMOVE(E)ROOF TILE AND
License Class C-3 9 Lic.# UNDERLAYMENT AND INSTALL 2(N)LAYERS OF NEW ROOF
C FELT AND(N)BORAL OS CLAY"S"TILE(16 SQUARES)
Contractor/51/X1 �x loris�-1--6 /,...Date /o/-,-
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.
1 hereby affirm under penalty of perjury one of the following two declarations: Sq.Ft Floor Area: alu;ui ui: �nai
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. APN Number:35610045.00 t/ccup:uu I pe:
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.
APPLICANT CERTIFICATION
PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR
correct.I agree to comply with all city and county ordinances and state laws relating 180 DAYS FROM LAST CALLED INSP CT ON.
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to saver/�
indemnify and keep harmless the City of Cupertino against liabilities,judgments, Issued by: Date: 1 V (J�/v
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 pmare regulations per the Cupertino Municipal Code,Section 9.18.
RE-ROOFS:
Signature Date /o/4-4-0/5 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: /o a- moo/
I hereby affirm that I am exempt from the Contractor's License Law for one of 61/
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
t. 1,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)
2. I,as owner of the property,am exclusively contracting with licensed contractors to I have read the hazardous materials requirements under Chapter 6.95 of the
construct the project(Sec.7044,Business&Professions Code). California health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
1 hereby affirm under penalty of perjury one of the following three declarations: Safety Code,Section 25532(x)should I store or handle hazardous material.
t 1 have and will maintain a Certificate of Consent to self-insure for Worker's Additionally,should 1 use equipment or devices which emit hazardous air
Compensation,as provided for by Section 3700 of the Labor Code,for the 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
performance of the work for which this permit is issued. Health&Safety Code,Sections 25505,25533,and 25534.
2. 1 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 thisOw ora ized agent:
permit is issued. Date: /° "/S
3. I certify that in the performance of the work for which this permit is issued,I shall
L11-
not employ any person in any manner so as to become subject to the Worker's CONSTRUCTION LENDING AGENCY
Compensation laws of California. If,after making this certificate of exemption,I I hereby affirm that there is a construction lending agency for the performance of work's
become subject to the Worker's Compensation provisions of the Labor Code,I for which this permit is issued(Sec.3097,Civ C.)
must forthwith comply with such provisions or this permit shall be deemed Lender's Name
revoked.
Lender's Address
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is ARCHITECT'S DECLARATION
correct.1 agree to comply with all city and county ordinances and state laws relating I understand my plans shall be used as public records.
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to save Licensed Professional
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.
Signature Date
�r
-- REROOF PERMIT APPLICATION
COMMUNI 1 Y DEVELOPMENT DEPARTMENT • BUILDING DIVISION
i 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255
CUP! R"T I N O j (408) 777-3228•FAX (408)777-3333•building(aDcu�ertino,ory
PRO1EiCi ADDRESS / J A✓�` GSC APN n 356 I O O •
L-MAIL
tv
S'Ipr:rr u�noc:. t C.— :rn ry nu j FAX
cueuw�to_ 64
CON FAC lNe IMU PHONE ^ a L'-\LUL
SIRLH ADDRL•SS CIIY.SI-Alli. ZIP I•AX
❑OWNER ❑ owNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGFNI ❑ ARCHILC-1' ❑FNGINLLR ❑ DEVELOPER ❑TENANT
CON17RACTOR ,ML LIC'FNSENUMBER LICENSF.'I1'1'i BITS.1. 0
COMPANY NAME E>MAII. FAX(,el )
? -,a r
S7RL•'GI':1� SS C!'lxjS'I)Ylli.Z ' PHONE'<i'.%f:
ARC'Iirrr'TifN0FNFER NAME LICENSE NUA11iliR BUS.LIC k
COMPANY NAMI- F-MAII. FAX
STREET ADDRESS CI IY,STA,n:,ZIP PHONE
USE OF ❑ SFD or Duplex A Multi-Family ROOF AREA VAt. Al ION
�rRl;rruR1: ❑ Commercial i /s b40s _
ExisrING ROOF'I)TF ❑111111:r-UP ROOF ❑ASPI IAI:r SHING(.F.S ❑WOOD SIMES ❑WOOD SHINGLES JKOTIIER(SPEC1FY)7C --
Rt>MOVI lkEPLAC'E �)S IF NO. TIYWO()D 115;' 13 _YE3o%n PITCH :12 ROOF A
It LAYERS TICKNESS
0 No
T PE
1
PRUI'USIiU RUUF'1'Yl'L•"-: ❑BI11C1=UP ROOF ❑ASNHI:
AI'SHIN(iLLS ❑WUUU SIIAKL•S 11WUUD SIIINGLI:S !®U'1'HICC-ES REPORT#LK !�
DESCR1111ON OF WORK
c�iv� / ,c-, �fin •ov/ />/-s ,���--/. �c.2�/��lr{y�:,��.
By my signature below,1 certify toeacTiofthc 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 1 have read the Description of Work and verily 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 pr perty for inspection purposes.
Signature of Applicant/Agent: - Date: 14A /
SUPPLEMEN'I'AL INFORMATION REQUIRED OFb•IC V LSE ONI.V
1 I l'building is associated with a Home Owner's Association,provide letter PLA\CREC'K'('YPC_-_-- - _ I40t.1'INr:SLIP
of approval from IIOA• ov F R-rnl.rOt rt:R I_i Btat.DING PLAN Rl:v IE%%
I
Provide Planning approval to verify ifthere any restrictions. U t�rRr!ts C7 PLANNING PL.vn IUVIE
r
j Provide copy of Manufacturer's Installation Specifications. ❑ 10ANDARD ❑ 1 IRL DEPt
Provide signed copy ofCupertino's Tear-OITPolicy. ❑ o'nuat:
1
Re)-oof4pp_2011.doe i-evrs'ed 03116111
CITY OF CUPERTINO 155 i00q
FEE ESTIMATOR — BUILDING DIVISION
R'PERM
DDRESS: 8147,8149, 8151 Park Villa Circle DATE: 10/02/2015 REVIEWED BY: PAUL
PN: 356 10 045 BP#: `VALUATION: $6,405
PE: Minor Building Permit PLAN CHECK TYPE: Re-roof
Multi-FamilyDwelling Buildina is PENTAMATION 1 R2ROOF
USE: >3 Stories Q Yes Q No PERMiTTVPE.
WORK BLDG #8147,#8149,#8151 - REMOVE E ROOF TILE AND UNDERLAYMENT AND INSTALL 2 N
SCOPE LAYERS OF NEW ROOF FELT AND (N) BORAL OS CLAY "S"TILE (16 SQUARES)
FEE ID ROOF AREA
s.f.
1REROOFMRES 1,600
i.�ch. flan Check
afe
Lj I
NOTE: This estimate does not include fees due to other Departments(i.e. Planning, Puhlic Works, Fire,Sanitary Sewer District,School
District,etc . These ees are based on the reliminarti
information available and are only an estimate Contact the De t or addn7 info.
FEE ITEMS (Fee Resolution ll-053 F.(f 7 1 13) FEE QTY/FEE MISC ITEMS
1pp/. PC/
"11171h. ,i1ech.'Lie(
Permit Fee: $272.00
Siq,p hish i
Plunth. :I fCC11. EICL'
Phinih.:I fech. /-:/arc i',rnur / c,
Construction Tux:
Administrative Fee:
Work Without Permit? O Yes (F) No $0.00
Idnmccd Plunning FC(
I ravel Doculn(va(nion /•*c,r.,
i
Stronp-Motion Fee: IBSEISMICR $0.83 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC 1 $1.00
SUBTOTALS: 1 $273.83 $0.00 TOTAL FEE: $273.83
Revised: 07/02/2015
{ REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E.,C.B.O., BUILDING OFFICIAL
+:U N F2T I N o 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)777-3228•FAX(408)777-3333-building cuuertino.orp
PRO)L'CI'AUDRl:3S C APN 11
- -
S I-REE.-T ADDRES —, ---- CtT .srA7 L"Al FAX'. Y
CONTRACTOR Nn�7�' LICENSE NUMBER LI NSA"1' PE. BUS.Li�.B
�
COMPANY NAME E-MAIL F4X
STREF.'f A�)DRESJ� • . Cr}s1�ti'1'ATB,7ffl-' P[IONE 'Y
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable provisions of the 2013 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please schedule inspections online or call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-
2:30pm (Friday) to schedule inspection. For Tear-Off and Nailing Inspections, you must also call on the
day of the inspection only after that phase of the work is completed, The building inspector will be
available within one hour. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs)
and 7:30-10:30am and 12:30-2:30 (Friday). Final Inspections will be given a two hour window.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the naik/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of/4" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection.
c. Proper spark arrestor installation,vents painted, gutter/downspouts installed, debris removed.
%. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee. The re-inspection fee shall be paid before another inspection can be
scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the
property owner's behalf. L understand and agree to comply with the re-roof policy stated above. I also understand that
smoke.detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and 11315 of
" the 2013 California Residential Code.
Signature ot'A plicant/A nt: Date: /
Reroo/1'o1icy_2014.doc revised 01/15/I4
WESTMONT PARK VILLAS IIOtV1LOWNI?.l:S ASSOCIAllON
`ESTMONT PARK'VILLA`S i.IOA
do COMMUNITY IvIANAGI3lvIT~,N7'Sly;RV1C�;
1935 DRY CREEK ROAD
CAMPBELL, CA M03
(1105) 559- 1917
8/10015
city of Cq?ei lino
Budding;Departnlelli
I'o the City Of('upedhl.r);
"leaso dote,illi; Westmont Park Villas HOA has Wntract(-d and approved 1?01+r Seasons
!3.00filla to pvrtolln 57 re-roofs of our honics,roplacing;lho current Tilc Roofing sJsitm
;viiEr nc:�s
-BOR 1,\11*, U.S. TITA"ONli PIF'CT: ISS'ION "S"CLAY 'f f E,F:SYS'I ENT, We
i.:�: sele:c:tc;<t the colo; 'T)to ill, iso I exist�i g icor.
C
Diana k. Johnsoa
Vice-President
Cot-1lztltutity ivlanage1110'at services
i
WATER-CONSERVING PLIUMBING'FIXTURES
`VVNER CERTIFICATE OF COMPLIANCE
O OfNIMUN]TY DEUELOP10ENT DEPARTMENT}BUILDING DIVISION
10300 TORRE AVENUE•GUPERTENO,GA 95014-325
(408)777-322$m F {408 777-333 a din .0-cucertino.or
Owner Na-rne 'F' V aT me C v.�1'errnit No. 5 oc�o 1�
Address L�� ��� o� ► i ��
1. is your real gropeit-y a registered historical site?
Yes Civil Code Sections 11101.1 through 1101.8 dci no*apply. Skip the rest or the form and,sign bottom of form.
No Go to Question 2.
j. 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 Mures is not technically feasible?
Yes Civil Code Sections 11031.1 through 1101.8 do not apply.
0 The licensed plumber's certification has been provided to tithe Building Division.
-��lrrrh�rest-o�th��onrF�!-d�+_b°rrroottorn-c�oii�L
l�ro Go to Question 3.
3. Is water service permanently disconnected for your building?
Ej Yes Civil Code Sections 1161.1 through 1101.8 do not apply. Skip the rest of the for!n and signbotrom o,f form. `
;iso Go to Question 4.
4, Is your real property built and available for use or occupancy on or before January 1, 1994?
{..( No 1,4y real property is built and available for use or occupancy after January 1, 1994.
l Oode Sections 110`11.1 throug�i 1101.8,do nct apply. Skip the rest of the form and sign botio n of fog.
C iv'
Yes My real property is built and available for use or occupancy on or bef ore January 1, 1994.
Civil Code Sections 110 1.1 througli 110 1.8 apply. Check one of the Lree following statements and sign
bottom of forte..
5. please check-ONE of the following:
11 My property is a Single family?-esidential peal property. See Civil Code Section 1161.4.
On and after January 1, 2014;building alterations or,hrnprovements shall require all non-compliant plumbing fixtures
to be replaced with water-conservin_plumbing fixtures throughout the building.On or before January 1,20}1-1,all non
compliant plumbing fixtures sh aL be replaced with water-conserving plu b ng fiat res` regardless of whether
property undergoess alterations or improlernents)
1 Myproperty is a rn✓iif-7niil} esicer,tial real property. See Civil Code Section 1101,5.
On and after January 1, 2014,specified building alterations or im-provements shall require non-compliant
plu-mbing fixtures to be replaced with water-conservincy p1T rribing fixtures.
_Cin-o�-bye-�n�ary-�L9�`_-1�,�n=cor��l�anl p1„r;b,��ff fix-,�z c.halLhe�pla�e���zt v�izr
conser--vingpluinbing f xtrses fluouQhoutthebuilding`r..'gardless of wheetherproperty:n&rgoess alterations or
imnroveiuen is}.
My properly is a corazit'1ereial real property. See C Fil Code Section 11031.5.
On and after January 1,L�i1 -,Sj'3eC"sited bui1dl21 aiEerat:Glls Gr L2npZGFelnerifS 51:'all regtllie non-compliant . ..
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all nor?-compliant plumbing; fixtures shall be replaced with water-.conserving
r ,_a
p't-alnbing fixtures:throughout the building txegar dless o�wa v her grope ty undergoes alterations or a-aprove-vents).
I.as the owner or owner's agent of t_1is property,certify under penalty of pe:jury that non-comapliant plumbing fixtures will be
replaced prior to date specified above wTith mater-conserving plumbing fixtures in accordance with Civil Code Sections i 101.i
tlrough 1101.8,the current California Fi lmb�:lg Come and California Leen Building Standards Code,and manzufacturer's
installation requirements, and that the water=conserving plu-mbing fzxtu s comply with,-the requ hto
l eats as indicated the
table on Lhe follows-! age.
Owner or Owner Agent's Signature: Date; �!
Upon Completing and Signing CES CeifF Cats;, lease return it to e _-�D. isiori In order to final you.,7-»?lUl permit.
yI SMOKE e CARBON B I E ALARMS
OWNER CERTIFICATE OF COMPLIANCE
t COMIVIUNI TY DEVELOPMENT DEPART iMENT a BUILDING DIVISION
F � 10300 1 ORRE AVENUE=CUPERTINO,CA 95014-3255
(408)777-3228, FAX(408N/777-3333-build!ng(a cuoertino.org j
MR-No.
. dress a ar rs Stroke: Cwbon Mono:�ide: t
PERMIT CANNOT BE FINA ED AND CO�' LETED UNTIL THIS CERTIFIC-ATE
AS BEEN .4-N'DLT NTFD TO THE BUJILDLNG DINgSION
URPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family a_iz id multi-fancy dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwel'ing units exceeds
$1000.00, CRC Section 8314 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 S,�IOIKE ALA 2I � CO AIARTVI
Outside of each separate sleeping area m the immediate vicinity of;he X X I
� F
} bedroom(s)
On ever level of a dwelling unit including basements X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain Reel-burr;ng appliances and that
do not have a-o 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:hi 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 tArhere repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of at ic;basement or crawl
space.Refer to Ci�C Section 8314 and CBC Sections 907.2.11.4 and 4,2.0.6.2.-Ari electrical permit is required for
alarms�Nrhich must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s) referenced above has/hare been
installed in accordance wi-ih the manufacturer's instructions a-,d in compliance with the California Build;—ng
and California"Residential Codes.The alarms have been tested and are operational,as of the date signed
below.
I nave read and agreeto COMP/ with.he terms and conditions of this statement
aw;Seiw,•Q
. :
_
si matt.re... ........
. 2.� �.
�� d ' Si nater D'i
2 NATER;CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
�JFERTti�iO 10300 TORRE AVENUE CUPERTINO,CA 95414-3255
(408)777-3228 FAX(408)777-3333•bui(dinct aDcupertino_org i
Owner=Name- k ,o�oY1U� Permit No. 1 1 �
Address _ � � � �''S� � �C' 4�_
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1141.8 do not apply. Skip the.rest of the form and sign bottom of form.
JK 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.
p e res o e, orrn an sign o om o orm.
$1 No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1141.1 through 1101.8 do not apply. Skip the rest of the form and sib bottom of forma
J� 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.
14 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:
El 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 futures 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).
9 My property is a niultifwnily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non-compliant
On or before January 1,2019,all non-compliant plumbing futures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
❑ My property is a conunercial 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 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 with the requirements as indicated in the
table on the following age. "
owner or Owner Agent's Signature: tate:
Upon completing`and signing-t s „r-tificate,please return it to the Building Division irrord'er to final your building permit.
SB407 2015.doc 7-evised 08126/15-
SMOKE I CARBON MONOXIDE ALARMS
OWNERt.,M_w
CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT a BUILDING DIVISION
�1`i 6 QB { 10300 TORRE AVENUE-CUPERTINO, GA 95014-3255
tt (408)777-3228 a FAX(408)777-3333•building(acupertino.ora
Permit.No. 1 \ t
dress 0 �! \ o rd- #off t' am s Smoke: 3 Carbon Monoxide. . -
PERMIT CANNOT BE FLNALED AND COMPLETED UJNTIL TIRS CERTIFICATE
HAS BF-ENSIGNED AND BEjL1_ZNF,D TO THE BtTII.I)LNG DIVISION
PURPOSE
Tb
is affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314,2013 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 8314 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
bedroom(s)
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:hz dwelling units with no commercial power supply,alarm(s)may be solely battery operated.
l,:E 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 CSC 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
Mim
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Smoke and CO form.doc remised 0311811
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
I LIPERTiNO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(448}777-3228•FAX(408}777-3333• buil5ing{a)cuciertino.ora
Owner Name "' d� a` ,in a. r° o� Permit No. ��J 1 000
Address
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 110 1.1 through 1101.8 do not apply. Skip the rest of the form and sib bottom of form.
9 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.
- p e res o e grin an srbbott6m of form.
K 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 farm and sign bottom of form.
I\zo Go to Question 4.
4. Is your.real property built and available for use or occupancy on or before January 1, 1994?
lL No ML y 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.
W1 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:
El My property,is a single-family residential real property. See Civil Cade 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 Mures 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
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).
El 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-coinpliant 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 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 with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: 5ia�� �� �fi� �. Bate: Oct
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
- SB4072075.doc revised 08126/15
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION
CuPERT'I 0 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
(408)777-3228 o FAX(408)777-3333•buildinaCa.cuperfino.org
Pernift No. V!5 Q OQ
:address \6\ ` �r #of airs Smoke: =g' C1rbaiz Monoxide: 9
]PERMIT C��TOT BE FRq ALED AND COMPLETED UJNTIL TFIIS CERTIFICATE
HAS BEEN S G TE AND RETURNTED 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 8314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATIO
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 AI ARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
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:Tin 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
aiarzas 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 corn2ly with the terms and conditions of this statement
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Signature........ ......... .. ... .s........ .. , ......... .....,........ ......
� �racior Name:
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Smoke cnd CO forn.doc reuised 03118114