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15100124CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10092 FIRWOOD DR I CONTRACTOR: ANTHONY LEWIS PERMIT NO: 15100124 OWNER'S NAME: DIKSHIT ASHUTOSH S AND VANASHREE OWNER'S PHONE: 4086563149 PC LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor e.. ' I hereby affirm that I a 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: 1. 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 ilation erformance of the work for which this permit is issued. ve and will maintain Worker's Compensation Insurance, as provided for by 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-pNjin1 sourye-Ngulations per the Cupertino Municipal Code, Section 9.18. 15 -C7f" OWNER -BUILDER DECLARATION I 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. I, 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: 1. 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. 3. I certify that in the performance of the work for which this permit is iss ed not employ any person in any manner so as to become subject to the Work7s!h er 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 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. Signature Date 1070 BIRD AVE I DATE ISSUED: 10/15/2015 SAN JOSE, CA 95125 1 PHONE NO: (408) 217-8621 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL (N) 50 AMP ELECTRICAL CIRCUIT FOR NEMA 14-50 OUTLET WITH DISCONNECT FOR TESLA EV IN GARAGE Sq. Ft Floor Area: I Valuation: $1725 APN Number: 34233037.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPEC ION. 1 ✓ Issued by:$W_,_0!5UL" " "' Date: �O ' 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. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. agent: �I-, uL, Date: ) Czi---1 S- S CONSTRUCTION LENDING AGENCY I 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 Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO 150010A9 ALTERNATIVE ENERGY PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)-cupertino.org PROJECT ADDRESS U F" APN # /<2Q O e OWNER NAMAS 14 V (L? v � ( PHONE � � Jy _ (n � q � E -MAS STREET ADD7ESS I C�Ur�'E, Z C �1 (1Soj 4 1 7 "� FAX CONTACT NAME - HON�rEf�` s - E-MAIL, P -Q U-0/1-(30 A n—rLvy�-' I o',i-s - �-�ts �w��• ��. �� STREET ADDRESS * Y 1)n_7 A ✓�, CITY, STATE, ZIP_—,� �h% �� CSA FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT �CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAM-� 1 LICEN E NUMBER LICENSE TYPE C, BUS. LIC # Nh v COMPANY NAME �, E-MAIL FAX STREET ADDRESS CITY, ST Z 6 �J ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF --Q�SFD Or Duplex ❑ Multi -Family PROJECT IN WILDLAND PROJECT IN STRUCTURE: ❑ Commercial URBAN INTERFACE AREA ❑ Yes ❑ NO FLOOD ZONE ❑ Yes O ❑ SOLAR PANELS LECTRIC VEHICLE CHARGING STATION TO SOLAR WATER HEATING ❑ OTHER: FOR SOLAR PANELS. NUMBER OF PANELS/UNITS: KILOWATTS (COMMERCIAL ONLY): TOTAL VALUATIO DESCRIPTION OF WORK• /2_1 c I H _.5 , l�r f �` '� ��S - t—) C=1LA G C RECEIVED BY: )*LOOLW By my signature below, I certify to each of the 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. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws rel�n�tobu'ldi struction. I auth ize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/ �_ L 1 Date: f SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY W OVER-THE-COUNTER a F EXPRESS ❑ STANDARD U W U ❑ LARGE < a ❑ MAJOR P VApp_201 1. doc revised 03/16/11 CITY OF CUPERTINO IS1000� FEE ESTIMATOR —BUILDING DIVISION ikADDRESS: 10092 Fir Wood Ct. DATE: 10/15/2015 REVIEWED BY: PAUL -.14 APN: 342 33 037 BP#: *VALUATION: 1$1,725 "PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition PRIMARY SFD or Duplex USE: 'ajf;tl�. Ir�sp. T �yc PENTAMATION SOLAR -RE PERMIT TYPE: WORK Install N 50 Amp Electrical Circuit for Nema 14-50 outlet with disconnect for TESLA EV in Garage SCOPE Suppl. Insp. Fee: Reg. Q OT NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrlrt_ oto-)- Thovo fooc aro havod nn tho nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E ..' 711113) r lif ( r„F� fl(t) E'lec. Plan Che< : fech. l'ermil Fee' [Plumb. Permit tree: Elec. Permit 1,ee' Other Hech. Insp. !'Nher Plumb Insp. Other glee. Insp. 1l r.'/t. Cra.st?. Fee: 'ajf;tl�. Ir�sp. T �yc I Ic c. Inst?, Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School Dictrlrt_ oto-)- Thovo fooc aro havod nn tho nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 E ..' 711113) FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.001= # Alternative Energy System $109.00 1 CHRGSTA EV Charging Station Suppl. PC Fee: Reg. 0 OT Fo. 0 hrs $0.00 PME Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee: Reg. Q OT 0.0 1 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 °,•Iraciion .I cox: Administrative 1 E) Work Without Permit? 0 Yes No $0.00 Advanced Planning Fee: $0.00 Select a Non -Residential E) Building or Structure i 1 'rc vel1?roc rl�n �nt�lti rrt 'e7c's. Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg, Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $109.00 TOTAL FEE,,T $110.50 Revised: 10/01/2015 /lC .PC Lo COPY Q5 /Ail - -.� ^T t-1 1 � (I E(� f .iJ r COMMUNITY DEV PMENT DEPARTMENT BUILDING DIVI ION - CUPERTINO APPROVED This set of plans and specifications FAUST be kept at the job site during constructsn. It is unlawful to make any changes or alteratio s on same, or to deviate therefrom, without appro al from the Building Official. The Stamping of this plan and specifications SHALL NOT be held to permit or to be an approval of the violation of anyoovisions of any ity Ordinance or State Law. By 1..�•l DAT PERMIT # I Building Department � OCT — r OCA CODE COMPLIANCE IAC`. Reviewea By PLOT PLAN KEB`i,`' DATE o .i _ PLANNING DEFT ' CUPERTINO /UJCIUC� ��<C(f. RECEIVED OCT 15 2015 8Y Cj!"cFj'NO nent i.vi4dinq 0�,Pat OCT 15ICA6 REV D;: G D . � ;mPLIANCE $ CR Reviewed Bye ti I C' e C�v p d, vv r w \-, % \ J ar a ( %ol f4 - AnthonyLewis Inc. ) Building and F.Icctrical RESIDENTIAL ELECTRICAL LOAD CALCULATION SHEET Load Calculation for Existing Dwelling Unit 220.83 1. GF NERAL LIGHTING: Table 220.12 lSq. ft. x 3 VA =------------- VA Small Appliances: 210.11 (C) (1) and (C) (2) VA x 2— circuits=--- 3 bOD VA Laundry: 220.52 (B) I— VA x 1 circuit = 0 U VA Total: 5q -VA 2. FIXED APPLIANCES: 220.83 The name plate rating of the following: A. All appliances that are fastened in place, permanently connected, or located to be on a specific circuit. Dishwasher = Z S Q (1500) VA Disposer = 7�O O (800) VA Compactor = (99) VA Microwave = (1300) VA Spa/Pool Motor = (12,000) VA Attic Fan = (1600) VA Total?-0�() VA B. COOKING EQUIPMENT: Table 220.55, Notes CUF'ERTINO Building Department Lo OCT 15 2015 REVIEWED FOR CODE COMPLIANCE Reviewed By: Col A VA x °i► = VA Col B 00(D VA x % lav VA Col C VA x % VA Total ------------------------- R-00 VA C. DRYER: 220.54; Table 220.54 VA x % _ VA D. WATER HEATER: VA Total VA 1 Anthony Lewis Inc. Building and Electrical 3. APPLYING DEMAND FACTORS: Table 220.83 (A) or (B) 1" 8000 VA x 100% = VA Rcmaining�� VA x 40%_� VA "Total ------------- �� l VA A/C UNIT 1 = - `�3_VA x 100% =_ _4 ZZ0 VA A/C UNIT 2 = VA x 100% = VA E V S E _ 6rjLC) VA x 100% =0k6VA Total VA Total of A/C Loads and All Other Loads: y VA 4. ELECTRICAL SERVICE: G�L k— Total VA O VA VA/240 volts = �, l-7 Arrips . � Minimum Conductor size , copper GEC. copper CUPERTINO Building Department OCT i �-=- 5 2015 REVIEWED FOR CODE COMPLIANCE RevieWed By. G. 2 LIP GJJP(ER rW&Iified electrician, or have questions about home charging installation? 80ding Depar fq Tesla at: ChargingInstallation@teslamotors.com or 1-877-798-3752 5 - REVIEWED ` OCT i 2015 FOR CODE COMPLIANCE Reviewed By: INSTALLING YOUR 240 VOLT OUTLE Every Model S includes the Mobile Connector, which is a 20 -foot long cable with a set of adapters for standard electrical outlets. The NEMA 14-50 adapter ensures the best charging experience with the Mobile Connector. Tesla recommends installing a 240 Volt outlet with a NEMA 14-50 receptacle where you plan to park your vehicle. This is a cornmon outlet, often used for home appliances, and the electrician you hire for the installation will provide all necessary materials. You can charge your Model S from this outlet at a rate of 29 miles per hour. Below you will find all relevant information required for an electrician to complete the installation. Note: municipal building departments frequently require a permit and inspection for any electrical modifications in your home. Any licensed electrician will be able to take care of this paperwork and provide a copy for your records. uj S_ Q 0 �n N N 0- 0 0 1 0 0 Z D O a 0 0 �n v a w z DETAILS Voltage: Single phase, 208-250 Volt AC supply, 60 Hertz Current: 50 Amp circuit breaker / 40 Amp continuous current • Wiring Recommendation: 6 American Wire Gauge, copper conductors only • Ground Fault Circuit Interrupter: Not required • Service Disconnect: Not required • Receptacle Recommendation: High quality, industrial grade receptacle • Location: Install near vehicle charge port, maximum 15 feet away. Minimum 18 inches above ground. • Electric Code Compliance: Installing electrician will source permit and inspection as required by local municipal building department RECOMMENDED OUTLET LOCATIONS ONF OR TWO VEHICLE GARAGE CHARGE PORT ........................ . OUTLETS -7 C_ .........I ................. . FOR YOUR RECORDS ELECTRICAL COMPANY PHONE NUMBER EMAIL ADDRESS PERMIT NUMBER INSTALLATION DATE T = 5 L Fi 3500 Deer Creek, Palo Alto, CA 94304 1 Nov. 2014 1 Version 1.0 CUPERTINO OwnerName i WATER=CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 ^ FAX (408) 777-3333 e building(a)cupertino.org -1 17dk5 1,` t Permit No. Address L-)� , fiin 'W`c'-n IDP--. NPEOINICi CA ISO F I L E' 1 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. JIRKNo 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. ,'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. 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. ; 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. Check one of the three following statements and sign bottom of form.. 5. Please check ONE of the following: fu 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 110 1.8, 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 followine baize. fir,.._ /% / Owner or Owner Agent's Signatur y, /�(' / /�,' _ Dates iID/22/ / 1� upon completing and signing tats Uerttttcate, please return it to the .Building Division in order to final your building permit. SB407 2015.doc revised 08/26/15 BUILDING PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS � �ERTIFICATI•; HAS BEEN ST THE _AND RETTTRNED 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 Fixture/ (Fixture Complying with Current Code Applicable to New Construction) —Plumbing Maximum Water Usage/Flow Rate = = Fixture Type 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 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 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 e CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 • building(d_)cupertino.org 1 C7c/ ;cFr�s I �-' cl.i L >�� L # ca rttas xS ce: 3 �Garlcnr�Mranoi de: 2 - PERMIT PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN,5TQ_NE12 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 $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be connected to the building wiring. As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been installed in accordance with the manufacturer's instructions and in compliance with the California Building and California Residential Codes. The alarms have been tested and are operational, as of the date signed below. 1 have read and agree to comply with the terms and conditions of this statement Quin , ments).-Name: 1vi IO�ZZ) 15 �$inaure... ...................- .... ........................................... Cont�acxorNbme: LE LJ l� .��C , 112'q� Q� {� ,_Az. `�?'L .t17. Vlc>... fL,-_i t-'.�.�L�t•�................ Da#eZ N s C Smoke and CO form.doc remised 03/18/14