15110068to
2+1
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 6359 CANDLEWOOD CT
CONTRACTOR: SATYANARAYANA
PERMIT NO: 15110068
PODURY AND PODURY SHA
OWNER'S NAME: SATYANARAYANA PODURY AND PODURY SHA
6359 CANDLEWOOD CT
DATE ISSUED: 11/12/2015
OWNER'S PHONE: 4088860240
CUPERTINO, CA 95014-4610
PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL E]COMMERCIAL ❑
REPIPE INTERIOR WATER PIPING WITH COPPER;
License Class - Lic.#
REPLACE
WATER HEATER AT SAME LOCATION; REPLACE
Contractor. Date
LAUNDRY
I hereby affirm that I am licensed under the provisions of Chapter 9
SINK.
(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:
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.
Sq. Ft Floor Area:
Valuation: $4000
I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700o ; f the Labor Code, for the performance of the work for which this
APN Number: 36918030.00
Occupancy Type:
permit is issue.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS FROM LAST CALLED INSPECTION.
indemnify'and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Issued by: Date: 11 Z
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.' j ..
RE -ROOFS -
Signature 1 Date
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:
I hereby affirm that I am exempt from the Contractor's License Law for one of
t following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
as owner of the property; or my employees with wages as their sole compensation,
will do the work, and the structure isnot intended or offered for sale (Sec.7044,
Business & Professions C
iode)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations: :, ' . -
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance, as provided for by
the Health & Safety Code, S ns 25505, 25533, and 25534.
.40
Section 3700 of the Labor Code„for the performance of the work for which this
�
Owner or authorized agent: " Date: 1
permit is issued... - ....
I certify that in the performance of the work for which this permit is issued, I shall
of 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
CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code, I must
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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,
ARCHITECT'S DECLARATION
costs, and expenses .which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
9.18.. a'
Signature
Vi-
- fir.
. - &K4
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT t BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 9501A 3255
(408) 777-3228 t FAX (408) 777-3333 t buildina(d)Cuoerino.org
In PLU\/MINCT ❑VIE-Clik ICAL []ELECTRICAL ❑AiISCELLA-NEOUS
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PROJECT ADDRESS 6• j 1 1 W DOD C i I APN
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CITY, STATE, ZiP C L t P t2 t i� Q I F a X
CONTACT N."2V'E 3AMC- A5 j�-��v� PiiO��
I E-MAIL
STREET ADDRESS
CITY, STATE, Zip
I FAX
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BUS, LIC
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CITY, STATE, ZIP
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A RCHITECTIENG?\`EERN.A. �E I LICENSE iNMU BER
BUS. LIC
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STREETADDRESS
I CITY, STATE, ZIP
I PHONE
L'SE OF SFD- aDIIPLE: ❑ 1✓rULTI-rAbGLY PROI-tCTINwILDLA-\TD ❑ Yz-s PROi-CTLN ❑ YES
IS TrEBLDG.4N ❑ 1,:s
B iTTDL�G: ❑ COhn'll-- ,CI4L UP3.�?' L�TIEFt ACn 4REA ❑ No FLOOD ZONE ❑ I O
EICY3 ERIiO]✓.E7 ❑ No
DESCRIPTION OF 1;'ORK a—
TOTAL V JXATION: �l b 1% V a
RECtIr D nY r r ` rrf + n , s, i
,
By my signatu-e below, I certify to each of the following: I un the proper -Ly owner or authorized agent to act on the property owner's be 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 am-ee to comply with all applicable local
crd-i=ces and state laws relatir-!g con - fiction. I authorize representatives of Cupertino to enter the above -identified propei;y for inspectionpu-poses.
7uildiLmi
SiQnatLre of Applicant/Ageut:pate: t I 1 1 2 15
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CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
APPLIANCE EQUIP TYPE
ADDRESS: 6359 Candlewood Ct
DATE: 11/12/2015
REVIEWED BY: Phuong
QTY
-APN::'.; 369-18-030
BP#:
*VALUATION: 1$4,000
'PERMIT TYPE Plumbing Permit
TPLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY''PENTAMATION
USE:-:.' SFD or Duplex
PME Plan Check: '
1 RPRP
PERMIT TYPE:
;'
RepipoAnterior water piping with copper; replace water heater at same location; replace laundry sink.
ERK
PE
Water Heater
APPLIANCE EQUIP TYPE
FEE ID
QTY/FEE
wea,.;, ff"ec'.
QTY
UNITS
BP FEES
h
Other Plumb Insp. 0 rs $48.00
Re -Pipe Interior"
1PRREPIPE
-'h ib. I
PME Plan Check: '
1
#
$14
Water Heater
1 PRWHEATR
1
#
$29
PME Permit Fe&:
Fixture or,Trap-
1BPFIXTURE
1
#
$10
$45.00
Work Without Pefthit? C) Yes (F) No
$0.00
Travel Documentation Fee, I TR,4 VDOC
$48.00
Stron��,Motion Fee:, IBSEISMICR
$0.52
Select an Administrative Item
B1dg`Stds Commission Fee: 1BCBSC
$1.00
TOTALS:
$53.00
COTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, lire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate, contact the Dept lor aildn't info.
FEE ITEMS (Fee Resolution .1.1-053 ELJL71'11.13)
Plumb. Plan Check 10.0 1 hrs $0.00
QTY/FEE
wea,.;, ff"ec'.
Plumb. Permit Fee: IPPERMIT
-'Perg1h Fee:
olher!Vfech. A�sp.�
h
Other Plumb Insp. 0 rs $48.00
-kf(xh. Insp,
-'h ib. I
PME Plan Check: '
COTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, lire, Sanitary Sewer District, School
District, etc.). These fees are based on the preliminary information available and are only an estimate, contact the Dept lor aildn't info.
FEE ITEMS (Fee Resolution .1.1-053 ELJL71'11.13)
FEE
QTY/FEE
MISC ITEMS
PME Plan Check: '
$0._00
PNM Unit Fee:
$53.00
PME Permit Fe&:
$48.00
Administrative Fee: JADMIN
$45.00
Work Without Pefthit? C) Yes (F) No
$0.00
Travel Documentation Fee, I TR,4 VDOC
$48.00
Stron��,Motion Fee:, IBSEISMICR
$0.52
Select an Administrative Item
B1dg`Stds Commission Fee: 1BCBSC
$1.00
$195.52
BT -1-01 FEE
$195.52 AL,
Revised: 10/01/2015
i
CUPERTINO
OWNER -BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 - FAX (408) 777-3333 • build! noaQCUDertino.orq —
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS �. j `t Cr4 P73
C Lt
- VQo '-i .
..API
BPlrm
OWNER NAME j5c��t(rz.Y..5A
OWNER ADDRESS: � � �7 1 L�'N �'�� � 0'� C �
..:, S
Cur- ��,G r2T / D ; ' �t % 57D I
DESCRIPTION OF WORK:
We are providing you with an Ownet-Builder Ackhowledgment and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We
will not issue a building permit until you have read, initialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
(DIRECTIONS: Please read and initial each statement below to signify you understand or verify this infonnation.)
1,, 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material
personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my
insurance coverage for injuries to workers on my property.
2. 1 understand. building permits are not required to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
-�' 3. 1 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her
name instead of my own.
�,�4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
0 5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
tdtal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
P6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless,all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is pperformed under contract with a licensed general building Contractor.
1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04/14/10
_q . I understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed
contractors.
�- \ 10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I
am the party legally and financially responsible for proposed construction activity at the site address listed above.
,�11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide
by all applicable laws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information 1 -have -provided on this form. Licensed contractors are regulated bylaws designed to protect.the.public. If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a. result of a complaint -Your only remedy against unlicensed
Contractors maybe in civil court. Itis also important for you -to understand that if an unlicensed Contractor or
employee of that individual or firm is injured .while working on your property, you may held liable for damages. If
you obtain a perrhit-as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not--
those
otethose Contractors are properly licensed and the status of their workers' compensation insurance coverage.
CONSTRUCTION LENDING AGENCY
(DIRECTIONS: Please complete the following construction lending agency information.)
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
(Sec 3097 Civ.)
Lender Name: Lender Address:
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license,
form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued
to verify the property owners sin tore. _
Property Owner's Signature: `'''l- - Date: 11 I is
---------------------------------------------------------------------------------------------------------------------------------------------
(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an
agent of the property owner to apply for a construction permit for the Owner -Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other
verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's
signature.
Property Owner's Signature: Date:
OumerBuilderFOrm 2010.doc revised 041/14110
CUPER INN
Owner Name
@ ATER-CONSERVONG PLUMBING FIXTURES
OWNER CERTIFICATE OF C®MRLBANCE
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(40 8) 777-3228 a FAX(408) 777-3333
��-yam.,
Address. �n �� �-� �"- j.z�.vw CA -
1.
A-
F E an Erm
IFT7 M O -A
11 oa6,g
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 fon-n.
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 110 1. 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.
E9 % 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.
'l 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 110 1. 8 apply. Check one of the three following statements and sign
bottom of form...
5. Please check ONE of the following:
L�4 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 improvernents).
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 Signatu
Upon completing and signing this Certificate,
Date -.,_] 1I I ( -9
it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15
IF1D—IIID NG 11D.11;RNET CE�� GT BE -rR' I -4�� COr� LE' TEI �'f��.i9�.
CE32'T F C_� 1AS I3 Vii'; �I_ ,i� , AIN, D RE,1 J_i�
1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown, it is not require to e upgra e .
SB407 2015. doc revised 08/26/15
Non -Compliant
Water -Conserving Plumbing Fixture
(Fixture Complying with Current Code Applicable to New Construction)
Plumbing Fixture
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 @ 50 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 require to e upgra e .
SB407 2015. doc revised 08/26/15
CUPERTBNO
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
10300 TORRE AVENUE ^ CUPERTINO, CA 95014-3255
(408) 777-3228 o FAX (408) 777-3333 o building(a.cupertino.org
9"Miclttl��S � till• Ise: L �ti r
�L,
P1ERNUT CANNOT DF FINALED AND COIMPLETED UNTIL THIS CERTIFICATE
HISEEE ANDunr-k�N DD '�� �I1E D ,DrNG DI S�gSICJ.N
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 acgree to comply with the terms and conditions of this statPment
=• Ow��f,_.or Owner Agentsl lVa� e:
Si
Smoke and CO forni.doc remised 03118/14
I q
.
.
........... ......... .... ... .................................................................... 0
.................
Con�Fadf&Name:
.
Sin...................................................................... .................................... Dat!:...................
Smoke and CO forni.doc remised 03118/14