15100195CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10199 E ESTATES DR CONTRACTOR: WILLOW GLEN PERMIT NO: 15100195
ELECTRIC INC
OWNER'S NAME: NAPPOLY CLEMENT AND APARNA
OWNER'S PHONE: 4083074183
❑ LICENSED CONTRACTOR'S DECLARATION
License Class C Lic. # AN
Contractor l �� 1 �'1�,(,'1L�
ndDate U
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:
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
rformance of the work for which this permit is issued.
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
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 WIX Date f�
❑ OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of
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
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.
Z 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 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
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
1085 WARREN AVE I DATE ISSUED: 10/23/2015
SAN JOSE, CA 95125 j PHONE NO: (408)289-9725
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
INSTALLATION OF EV CHARGIN CIRCUIT WITH (1) 50 AMP
DEDICATED CIRCUIT W/NEMA RECEPTACLE INSIDE GARAGE;
UPGRADE MAIN ELECTRICAL PANEL (200 AMP).
Sq. Ft Floor Area: I Valuation: $3940
APN Number: 36908006.00 1 Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by: Z -Al �Date: /� 3 '15 -
RE -ROOFS: f
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:
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.
Owner or authorized agent:lAwhr—
Date:
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
l ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408) 777-3228 - FAX (408) 777-3333 • building aAcupertino.orA
AE
PROJECT ADDRESS / O / � C% �t
MIN x
OWNER NAME � A
PHONEe, 4g) / O /�/
E'�iA'k—A
STREETADDRESS ^� C+� �S /�
�1
CITY -,A W. , ZIP
CONTACT NAME
PH NG L' -MAIL
Matt Lon re
- w
STREET ADDRESS P.O. Box 8430
CITY, STATE. ZIP San Jose CA 9 515 5 FAX (408)289-9725
❑ 01%'NER ❑ OWNER -BUILDER ❑ OWNER AGEN I ® CONI R ACI OR ❑ C0N IRACFOR AGEN r ❑ ARCM) EC 1 ❑ ENG1NEE.R ❑ DE.VE.t.OPLR 11 UNAN i
COtiTRACTOR NANi � 77LICENSE
Londre
NUMBER
591918
LICENSE "TYPE
C10
BUS. LIC 4lark
15897
COMPANY NAME willow Glen Electric
F -MAIL mark@willowglenelectr
& com
STREET ADDRL'S
SP.O. Box 8430
Ci1Y_ STATE, "LIP
San Jose, CA 95155
PRONG
(408)289-972
ARCHITECTIENGINEER NAME
LICENSE NUMBER
BUS. LIC q
COMPANY NAME � 7/� �
\
F:-MA1I.
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE of ■ SFD or Duplex [j Multi -Family
PROJECT IN WILDLAND
PROJECT IN
Commercial
URBAN INTERFACE AREA ❑ Yes it No
FLOOD ZONE ❑ Yes ❑ No
STRUCTURE: ❑
El SOLAR PANELS
ELECTRIC VEHIC[.E CNARGING STATION
❑ SOLAR WATER HEATING
El OTHER:
FORSOLAR PANELS.• NUMBER OF PANELSJUNITS:
KILOWATTS (COMMERCIAL ONLY).
TOTAL VALUA"IION: 47Z/4L ' 1 '—
DESCRIPTION OF WORK
20064C ` 40
G�W ILA
[RECEIVED AY:
By my signature below, I certify to each of the o wi
th roperty owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information I have provi s o I h ve the Description of Work and verify it is accurate. I agree to comply with all applicable la al
ordinances and state laws relating to build i t n.
uth r resentatives of Cupertino to enter the above -identified property for inspection purposes.
Signature of Applicant/Agent:Date:
SUPPLEMEWAL INFORMATION
REQUIRED
OFFICE USE O!NI.v
E'ER -TRE -COUNTER
❑ EXPRESS
a
w
❑ STANDARD
J
Z
n
❑ URGE
❑ ..LUOR ommi
CL.
P I App_2011, doc revised 03/16/11
.CC
Ml
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: 10199 E Estates Dr DATE: 10/23/2015 REVIEWED BY: Sean
IPN: BP#: `VALUATION: J$3,940
*PERMIT TYPE: Building Permit PLAN CHECK TYPE: Addition
PRIMARY SFD or Duplex PENTAMATION SOLAR -RES
USE: pPERMIT TYPE:
WORK Installation of EV char in circuit with 1 50 amp dedicated circuit w/NEMA receptacle inside garage;
SCOPE upgrade main electrical panel (200 amp).
NOTE: This estimate does not include fees due to other Departments (i.e. r)tanncng, ruacic worKs, rare, Sanitary newer "tstrict, acnuut
..s„ 1 Tl --- --- %. .. i sl...,- .1:... :.r. aeinrw�irf nta /�11lI1t!/�tA nr�r] nro ns�%�f n» nctiynnt0 rmitivrt th0 [)ant fnr ,7d d"'l INfn_
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13
.1:Iech. Plan Check
1'111111%3.
Elec. Plan Check 0.0 hrs $0.00
Mech. Permit Fec:
Plumb. Peiw,,--E,
Elec. Permit Fee: IEPERMIT
Otiler .,i4ecli. Insp.
Other Plumb Insp.
Other Elec. Insp. 0.0 hrs $48.00
:fech. hap. Fee:
Plumb. Insp. Fee:
hrs
NOTE: This estimate does not include fees due to other Departments (i.e. r)tanncng, ruacic worKs, rare, Sanitary newer "tstrict, acnuut
..s„ 1 Tl --- --- %. .. i sl...,- .1:... :.r. aeinrw�irf nta /�11lI1t!/�tA nr�r] nro ns�%�f n» nctiynnt0 rmitivrt th0 [)ant fnr ,7d d"'l INfn_
FEE ITEMS (Fee Resolution 11-053 Eff 7/1/13
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.001=
#
$109.00
Alternative Energy System
1 CHRGSTA EV Charging Station
Suppl. PC Fee: Reg. () OT
r0_,_0
hrs
$0.00
PME Plan Check:
$0.00
=amps
$48.00
Electrical
IBELEC200 Services
Permit Fee:
$0.00
Suppl. Insp. Feer Reg. O OT
[_0_-0_1
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
C'ons,t/ uefion Kix:
Administrative Fee: ]ADMIN
$45.00
O
E)
Work Without Permit? O Yes No
$0.00
Advanced Planning Fee:
$0.00
Select a Non -Residential
Building or Structure
O
0
Travel Documentation Fee: ITRA VDOC
$48.00
Strong Motion Fee: 1BSEISMICR
$0.51
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTALS:
$142.51
$157.00
TOTAL FEE:
$299.51
Revised: 10/01/2015
Replace the existing 100A main electrical panel in the
backyard with a new 200A main electrical panel.
Install one dedicated 240V 50A circuit with a NEMA 1 50
receptacle installed on the interior left side of the 2 -
garage for EV charging. The circuit will be/ren o gh the
attic in 6/3 Romex. , /
PLOT PLANS JT,f� Mf'
DATE / O
PLANNING DEP
CUPERTINO
Clement Nappoly
10199 E Estates Drive.
Cupertino, CA 95014
(408) 307-4183
RECEIVED
COMMUNITY
BUILDIN
DIVISION - CUPERTINO
PPROVED
This set of plans an
specifications MUST be kept at the
job site during con
ruction. It is unlawful to make any
changes or alt
ations on same, or to deviate
therefrom, without
pproval from the Building Official.
The stamping of this
Ian and specifications SHALL NOT
be held to permit
to be an approval of the violation
of any provisions
any City Or 'n& HOMttate Law.
BY
.1:5
DATE .
.-
PERMIT NO.
/ f f .
Garage
18'
—25'
Residential Electrical Load Calculation
Site Location:
Prepared by
Clement Nappoly
Willow Glen Electric, Inc.
10199 E Estates Drive.
PO Box 8430
Cupertino, CA 95014
San Jose, CA 95155
(408) 307-4183
(408) 289-9725 - office
ILLOW
LEN
LECTRIC
General Lighting and Receptacle Loads [220.12]
3 watts per ftZ x
1,500 =
4,500
Small -Appliance Branch Circuits [220.52(A), 210.1(C)(1)]
1,500 watts x
2 =
3,000
Laundry Branch Circuit(s) [220.52(B), [210.11(C)(2)]
1,500 watts x
1 =
1,500
9,000
Fastened -In -Place
Appliances (220.53] Kitchen
Bath(s)
Outisde/Miscellaneous
Refrigerator(s) = 960 Instant Hot H20(s) =
Exhaust Fan(s) =
Hot Tub =
Dishwasher(s) = 960
Hood Exhaust(s) =
Jacuzzi Tub(s) =
Pool Equipment =
Garbage Disposal(s) = 720
Gas Range(s) =
Ri,—ant Heating =
H2O Pump =
Microwave(s) = 1,200
Gas Oven(s) =
Steam Shower =
H2O Pump =
Trash Compactor =
Wine Fridge(s) =
=
BBQArea =
_
_
=
60A Circuit =
Total Fastened -in-place Appliance Load
3,840
Clothes Dryer(s) [220.54]
80% x
240 x
Derating
Volts
Amps
780
OR
Name Plate Rating of Clothes Dryer =
780
Ranges, Ovens, Cooktops, and Other Household
Cooking Appliances [220.55)
80% x
24 x
30 =
6,960
Derating
Volts
Amps
AND/OR
Name Plate Rating of Cooking Appliances =
1,200
Heating or Air -Conditioning System (Compare the
heat and A/C, and omit the smaller.) [220.60]
Air Handler/Furnace
115 x
6.0 -
Volts
Amps
Air Conditioning Unit
690
55% x
240 x
=
Derating
Volts
Amps
AND/OR
Name Plate Rating of Air Handler & AC Units =
Total Volt -Ampere Demand Load [220.83]
Greater of.•
Air-conditioning Equipment
690 x
100% =
690
Electric Space Heating
- x
100% =
First 8kVA of all other loads
8,000 x
100% =
8,000
Remainder of all other loads
12,580 x
40% =
5,032
13,722
Total
Current Minimum Amperes
13,722 _
240 = 57,2
Current Minimum
200 Amps
(voltage) (minimum amperes)
17 Size Service or
Feeder [240.6(A)]
currently
Electric Vehicle [625.14)
125% x
240 x
40 =
12,000
Continuous Load
Volts
Amps
Minimum Amperes with Added Load
Minimum Size
Divide the total 25,722 _
240 = 107.2
20
Service or Feeder
200 Amps
volt-amperes by
(voltage) (minimum amperes)
w/ Added Load
with added load
the voltage.
[240.6(A)]
NOTES
All References are to 2014 National Electrical Code.
Questions? Contact the Tesla Technical Support Team:
ChargingInstallation@teslamotors.com 1650.681.6133 (Monday - Friday) 1877.798.3752 (24/7)
INSTALLING YOUR 240 VOLT OUTLET
The recommended home charging installation option for Tesla vehicles is a 240 volt
NEMA 14-50 outlet. This outlet is commonly used for electric range stoves, large RVs
and electric vehicles. Installed with a 50 amp circuit breaker, this outlet enables a
recharge rate of about 25 miles per hour.
Consult a licensed electrician to review the electrical load of your home prior to
installation. Once the installation has been planned, the electrician can source a permit
from your local building department to begin work. After installation, the electrician will
schedule an inspection to approve the new electrical circuit.
This guide provides reference for specifications to install this outlet. Since each
installation is custom to the home, all hardware for the NEMA 14-50 outlet will be
provided by your electrician.
GROUND TO TOP
NEMA 14 -SO DETAILS
• Voltage: Single phase, 208-250 Volt AC supply, 60 Hertz
• Circuit Breaker: 50 Amp (125% overcurrent protection)
• Operating Current: 40 Amp (maximum continuous current)
• Conductors: 6 AWG, Copper Wire Only. Upsize wiring for installations over 150 feet
• Ground Fault Circuit Interrupter: Not required
• Service Disconnect: Not required
• Receptacle Recommendation: High quality, industrial grade receptacle
• Ventilation: Not required
• Outdoors: Install with NEMA 3R rainproof enclosure
• Electric Panel: Install circuit breaker as close to the utility feeder as possible to
minimize voltage drop from other large circuits
RECOMMENDED OUTLET LOCATIONS
CHARGE PORT
OUTLETS
Install near vehicle charge port, maximum 15' away, minimum 18" above ground
T=SLR
FOR YOUR RECORDS
ELECTRICAL COMPANY
PHONE NUMBER
EMAIL ADDRESS
PERMIT NUMBER
INSTALLATION DATE
3500 Deer Creek, Palo Alto, CA 94304 1 July, 2015 1 Version 1.6
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE i L
Im COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
3228 z7,7-3333 • building(a�cupertino.org I I�
Owner Name el r IV�9" (�(✓`�/ ��y;� Permit No. lgv�lD�
Address r o lqq l� U9 IMSS IDF, I CVT PEPO 1 K-0 I CA
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..
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 110 1. 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 110 1. 1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. _P;ease 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 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-conservm plumb' fixtures comply with the requirements as indicated in the
table on the following page. /' A&,.A 1 /
Owner or Owner Agent's Signature:
Date:
Upon completing and signing this Certificate, pleasVr urn't,,A4e Building Division in order to final your building permit.
SB407 2015.doc revised 08126115
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. doe revised 08/26/15
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.
SB407 2015. doe revised 08/26/15
Address
�347yss
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 - building aacupertino.org
MJFILE
ullih,5 0_5�
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the
bedroom(s)
X
X
On every level of a dwelling unit including basements
X
X
Within each sleeping room
X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply: In dwelling units with no commercial power supply, alarm(s) may be solely battery operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access by means of attic, basement or crawl
space. Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for
alarms which must be connected to the building wiring.
As owner of the above -referenced property, I hereby certify that the alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to comply withAe terma/d conditions of this statement
Owner (or Ow``--Vneer Agent's) Name: e-�
sv1/
l
Signature ................................................................................ Date: .. ..... ...`�.
Contractor Name:
Signature................................................................... Lic.#...................................... Date: ...................
Smoke and CO form.doc revised 03/18/14