The URL can be used to link to this page

15100157CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21441 ELM CT CONTRACTOR: DELUXE AIR PERMIT NO: 15100157 OWNER'S NAME: YAO SHING SHWANG AND LILI TRUSTEE 10 N EAST ST STE 210 DATE ISSUED: 10/20/2015 OWNER'S PHONE: 4083431288 WOODLAND, CA 95776 PHONE NO: (530) 662-5008 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REPLACE (E) FURNACE & (E) A/C UNIT, SAME LOCATIONS (� ? Q� License Class L " Lic. # q —1 L� �i� — I ContDate e yractor 1 hera firm I am licensed under the provisions of Chapter 9 (commencin ith Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. Sq. Ft Floor Area: Valuation: $18330 I hereby affirm under penalty of perjury one of the following two declarations: APN Number: 36201018.00 Occupancy Type: 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 EXPIRES IF WORK IS NOT STARTED permit is issued. WITHIN 180 DAYS OF P IT ISSUANCE OR APPLICANT CERTIFICATION IKDAVS FiR PECTION. 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 re / to building construction, and hereby authorize representatives of this ci Issued b Date: 0 upon the above mentioned property for inspection purposes. (We) o 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 ROOFS: all non-point source re � s per the Cupertino Municipal Code, Section 9.18. All roofs shall be inspected prior to anyy roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for Signature Date %d r?a lIs— inspection. Signature of Applicant: Date: ❑ OWNER-BUILDER DECLARATION ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE compensation, will do the work, and the structure is not intended or offered for I have read the hazardous materials requirements under Chapter 6.95 of the sale (Sec.7044, Business & Professions Code) California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain 2. I, as owner of the property, am exclusively contracting with licensed contractors to compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & construct the project (Sec.7044, Business & Professions Code). Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air I hereby affirm under penalty of perjury one of the following three declarations: contaminants as defined by the Bay Area Air Quality Management District I will 1. I have and will maintain a Certificate of Consent to self-insure for Worker's maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Compensation, as provided for by Section 3700 of the Labor Code, for the Health & Safety Code, Sections 25505, 25533, and 25534. performance of the work for which this permit is issued. 2. I have and will maintain Worker's Compensation Insurance, as provided for by Owner or rized agent: Date, )0 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 CONSTRUCTION LENDING AGENCY not employ any person in any manner so as to become subject to the Worker's I hereby affirm that there is a construction lending agency for the performance of work's Compensation laws of California. If, after making this certificate of exemption, I for which this permit is issued (Sec. 3097, Civ C.) become subject to the Worker's Compensation provisions of the Labor Code, I Lender's Name must forthwith comply with such provisions or this permit shall be deemed Lender's Address revoked. ARCHITECT'S DECLARATION APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I understand my plans shall be used as public records. correct. I agree to comply with all city and county ordinances and state laws relating Licensed Professional 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 GENERAL PERMIT APPLICATION MEP 10 ''k COMMUNI TY DEVELOPYi�ENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 9501? -3255 SUP: RT[hlO (408) 777-3228 • FAX (408) 777-3333 - buildinc(a-cuDer tino.org m 1 5 (106,0215 ELECTRICAL ❑ IvIISCELLAYEEOUS PROJECT ADDRESS Lj L� ^ j I 4'.pN1 3 � C_. -S OWTiR NANEu t _ ', f \1140 Q I PHONEI-J l0(9)3 1 3- 96 I t l✓mob IL STREET ADDRESS L�� l ' W / i ,V FAX 1 � � � C -r CITY, STATE ZIP 0, L) >127, c� ��=�R COI:TACT 1.4 -ME C L U R t IZ PHONE &10 E44kiI. STREET ADDRESS C ,.ATE ZIP FAX ❑ O'VkN t ❑ 0Vq,---BUILDER ❑ OtiIN-irMAGENT ❑ CONTRACTOR ❑CO-N-7UCTORAGIENT ❑ ARC'_:T`tCT ❑ ENC3L\ ZR ❑ D=vELO?� 7 -j --g'. K. 1 CON, TRACT0R NA.A�E D 'LQ2ff At 12 I LICENSE "'ML SER n � L� �n I LICENSE TSG- � I BUS. LIC cz COMPAI\'•Y NAJa 1 r` c /t ` `Z I E-MAIL I FA. STREET ADDRESS / V V. C 4S T S� p� I O CIT , ST O,IIc N % �� 1J 7 7 b NO � " 7 Q A CHITECT/a,,GLNEER NAME I LICENSE NgWBER , I BUS. LIC R COI✓1.PA NrY' NAN,E I E-1✓,AIL I FAX STREET ADDRESS I CITY, STATE, ZIP I PHONE USE or SF0 or DUPLEX ❑ 12tJLTI-r'A 1,�.Y B'UIITiNIG: fes] C01'D'=CIhL I PROTECT N WILDLA1iM ❑ m Ij URB N'' R\'TERFACE ),Pak ❑ 1:0 ! PROJECT IN ❑ YEs I FLOOD ZOl,�- ❑ ?;-0 IS TIM BLDr AN ❑ _�, I E1Clin-Ek HOME? ❑ NO DESCPIPTION OF WORK P(E A./'I 12 Iq tea/ 0 1< �✓ �- 5 v s r r -M_ , u TOTAL VALUATIU'\: �� J D By my signature below, I certifyto aach of the following: lam the property owner or authorized agent to act roperiy owner' a r. 4 this application and the information I have provided ' correct. I have read the Description of Work and veri� it is accurate. I agr com all applicable loc?T ordinances and state laws relating to building traction. I authorize representatives of Cupertino to enter theL, r perTy for inspection purposes, Signature of Applicant/Agent: Date: TAI, I-T'ORvIATION REQULR.ED r=ca:n�*r .. Ai1'EPM'7scApp_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 21441 ELM CT I DATE: 10/20/2015 1 REVIEWED BY: MELISSA APN: 362 01 018 BP#: I *VALUATION: 1$18,330 'PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/A USE: PERMIT TYPE: WORK REPLACE E FURNACE & E A/C UNIT SAME LOCATIONS SCOPE APPLIANCE / EQUIP TYPE FEE ID flan (Aleck QTY UNITS BP FEES Elec. Permit A/C Units (<=10K cfm) 1 BREMAIR Other Eke. lase. 1 # $72 Furnace, Forced -Air 1 MF=R=<100 AS"uppl. Insp Fee 1 # $143 PME Unit Fee: $215.00 PME Permit Fee: $48.00 (:'On,struction Taxa Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC $215.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, Janitary Newer Uisirici, 3cnooi n i,41.:_4 iffy. TL.- f'n- - h"-1 A" fife nrnif Lff/Nnrff ;sifnrs'N/If;n" nif/IIInhIO ""d fir0 nnIu i" OCtimirto t"n»tn!'t tho Aunt fnr nd/dn'1 info_ FEE ITEMS (Fee Resolution 11-053 Ek -'711/13) Mech. Plan Check 1 0.0hrs $0.00 flan (Aleck 1'Jec. I'laii (_`heck Mech. Permit Fee: IMPERMIT [Plumb, Permit fee Elec. Permit Other Mech. Insp. 0.0 hrs $48.00 Other Eke. lase. Afech. Insp. Tee: "l imb. Insp. Tee: 1,.Jec. Insp. Fee. NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, tire, Janitary Newer Uisirici, 3cnooi n i,41.:_4 iffy. TL.- f'n- - h"-1 A" fife nrnif Lff/Nnrff ;sifnrs'N/If;n" nif/IIInhIO ""d fir0 nnIu i" OCtimirto t"n»tn!'t tho Aunt fnr nd/dn'1 info_ FEE ITEMS (Fee Resolution 11-053 Ek -'711/13) FEE QTY/FEE MISC ITEMS Playa Check .Fee: Suppt PC Fee PME Plan Check: $0.00 Permit Fee: AS"uppl. Insp Fee PME Unit Fee: $215.00 PME Permit Fee: $48.00 (:'On,struction Taxa Administrative Fee: IADMIN $45.00 Work Without Permit? 0 Yes (E) No $0.00 (lvrrneed .Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $2.38 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $359.38 $0.00 TOTAL FEE: $359.38 Revised: 10/01/2015 J 1 h i C yr t-MLIrvr%N0, ALTERATIONS - HVAC `1. CEC-CFIR-ALT-03-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-03-E Alterations - HVAC CZ 1, 3 to 7 and 16 (formerly CF -IR -ALT -HVAC) (Page 1 of 1) Site Address: Enforcement Agency: Date Prepared: Permit#: ILI LI IL M C', -T- Equipment Type Equipment Efficiency _ New: Ducting, Plenums, Lineset Conditioned Thermostat Required R -value Floor Area (sq ft) ❑ Packaged System ❑ Evaporator Coil 9(0 AFUE COP DR -6 (CZ 1,3-7) Ducts Served by system CTsetback C�Split System ❑ Condensing Unit -7 SEER ❑ R-8' (CZ 16) Ducts0 sq ft (If not already HSPF E3R-6 (all CZ's) Plenums present, must ❑ Furnace ❑ Lineset 0 EER ❑ R-5 or R7.5 Lineset' I be installed HERS VERIFICATION SUMMARY Installer determines work to be completed and matches to one of the options below. At permit application this form is allowed to be filled out by hand. For final inspection all forms are to be registered (no hand filled forms allowed) and a copy left on site. Q 1. HVAC Changeout/Repair Required Compliance Documents to be left on site for Final: Can include new ducting All Equipment, CF1R-ALT-02-E Condenser Unit, Evaporator Coil, CF2R: MECH-01, MECH-20-HERS Air Handler/Furnace CF3R: MECH-20-HERS Installer Requirement: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks) Exempted from duct leakage testing if: ❑ 1. Duct system registered with HERS provider as previously sealed, or ❑ 2. There is less than 40 linear feet of duct in unconditioned space, or ❑ 3. Existing duct systems are constructed, insulated or sealed with asbestos (list manufacture date of building ....... ❑ 2. New HVAC System Required Compliance Documents to be left on site for Final: All new equipment and All New Ducts' CFIR-ALT-02-E CF2R-MECH-01, MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS CF3R-MECH-20-HERS, MECH-22-HERS, MECH-(23 or 24) -HERS' Installer Requirement: Duct leakage < 6%, Fan Efficacy (.58W/CFM), Air Flow >_ 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ 3. All New Ducts with Replacement Required Compliance Documents to be left on site for Final: Includes replacing or installing All New CF1R-ALT-02-E Ducts' and one or more of the following: CF2R-MECH-01, MECH-20-HERS, MECH-(23 or 24) -HERS Condenser Unit, Evaporator Coil, Furnace CF3R-MECH-20-HERS, MECH-(23 or 24) -HERS Installer Requirement: Duct leakage < 6%, Air Flow >: 350 CFM/ton (or Standards Table 150.0-C / D alternative) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ❑ 4. New Ducting over 40 feet Required Compliance Documents to be left on site for Final: Adding or replacing ducts in unconditioned CF1R-ALT-02-E space but less than All New Ducts' CF2R: MECH-20-HERS CF3R: MECH-20-HERS Installer Required to: Duct leakage (< 15% or, < 10% to outside, or seal all accessible leaks) ❑ Exempted from duct leakage testing I existing duct systems are constructed, insulated or sealed with asbestos. ' All new ducting R-8 required when more than 40 ft installed and R-6 when less than 40 ft installed. This includes in walls, between floors etc. ' A New Duct system is when the duct system is constructed of at least 75 percent new duct material, and up to 25 percent may consist of reused parts from the dwelling unit's existing duct system (e.g., registers, grilles, boots, air handler, plenums, duct material. 3 R-5 (1" thick insulation) for linesets 1" and less. R-7.5 (1.5" thick insulation) for linesets over 1 inch. Most mfg will require Suction line Diameter with insulation as the following 1.5-2T-25/", 2.5-3T-2%", 3.5 to 4T-2%8', 5T-4 ,' Contractor (Documentation Author's /Responsible Designer's Declaration Statement) I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the information on this document. 3. That the energy features and performance specifications for the design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts 1 and 6 of the California Code of Regulations (CCR). 4. That the energy features and performance specifications, materials, components, and manufactured devices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the CCR. S. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. Responsible Designer Name: Responsible D Sign re: Date Signed: License: ()1 12c, ID C2,el5— QQ "�S3 Add,/r/�es�s: City/State/Zip: Phone: c %/)��.- LI)Company: /1 7 C V 7- A `. r �S I J r I to `> �1 �J O ///�� //yam/ C) (//j (5-30)66 "- V 0 ♦� For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300 CUPERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES ? OWNER CERTIFICATE OF COMPLIANCE f� b�4;� COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 1 '1" ` (408) 777-3228 • FAX (408) 777-3333 - building(a)-cuper ino.org ,a — S h yM n G Ya- D Perm Address Vn1 r'vu V1 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. V4o 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. VNo 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. 4'' 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. LSI' 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: Er 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 -conserving plumbing fixtures comply with the requirements as indicated in the table on the following t)ase. , Owner or Owner Agent's Signature: i C4 -U Date: 12-1(1-1 Upon completing and signing this Certificate, plWse return it to the Building Division in order to final your building permit. SB407 2015. doe revised 08126115 BUILDING PERMIT CANNOT BE FINALED. AND COMPLETED UNTIL. TRIS CERTIFICATE HA.S'BEEN I TNED AND RETURNED- TO. TILE BUILDING PIVISION: - - 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB4072015.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. SB4072015.doc revised 08/26/15 PURPOSE SMOKE / CARBON MONOXIDE ALARMS OWNED, CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 o building a-)cupertino.org *312010, Lmv J_ PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN ,, CNE AND R ,TSD TO THE BUILDING DIVISION This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal. Power Supply: 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 with the terms and conditions of this statement er Agent -s) -Name: SI n 5 VIWa yt y�c v ,Si` natdre..... ......... .........-..... .......... Date, `T� ConYiacto�-Name: Si'afure........ ........................................................... 'Lic1'................. Date: Smoke and CO form.doc remised 03/18/14