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15100226CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 19011 BARNHART AVE CONTRACTOR: VALLEY HEATING & PERMIT NO: 15100226 COOLING OWNER'S NAME: GUPTA ATUL AND AANCHAL TRUSTEE 11171 N 4TH ST I DATE ISSUED: 10/28/2015 1 OWNER'S PHONE: 4083322670 1 SAN JOSE, CA 95112 1 PHONE NO: (408)2944290 IW LI`CCENNSED CONTRACTOR'S DECLARATION C/1 % License Class C v - Lic. #/ Contractor — Date l 01/2g �f 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 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. 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 sot ce regulations per the Cupertino Municipal Code,, Section 9.18. Signature Date t 00 $ 1r ❑ 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. a. 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. JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ REMOVE AND REPLACE FURNACE IN SAME LOCATION. Sq. Ft Floor Area: I Valuation: $ 4242 APN Number: 37509032.00 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: Date: 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. Owner o uthorizedazent: t 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 CUPEERTINO GENERAL PERMIT APPLICATION CCMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION IN -m -a- 10300 TORRE AVENUE - CUPERTINO. CA 95014-3255 (408) 777-3228 . FAX (408) 777-3333 - buildina(a)CUoertino.org %� J� ?�/ M 1 F- PLUA,BING pal MECHANICAL ❑ ELECTRICAL ❑ MISCELLANEOUS PROJECT ADDRESS � Uc k 4vt- � L �� 3�� ' D � q v i ' �� ✓ ONsTt ERNA'✓a Q � / PHO�NEE 2 ZL 7 — _ I IJi�Z STREET ADDRESSpp �c.r"v1k��r',CITY, STATE, ZIP � I CJ+ llii1+p -IS�� I - FAX CONTACT N.AI✓E / I PHONE E-1vLAIL STREET ADDRESS I CITY, STATE, ZIP i FAX ❑ Oti?.m ❑ o -Awa R-BumD=, R ❑ OWNER AGDr'T gr CONTRACTOR ❑ CONTRACTOR AGINIT ❑ ARMTEC:T ❑ LNGDQ= ❑ DEQ r-LOPEt ❑ TEI h1'Z' CONTRACTORNa.?r'ni %('IkC �� f,k I LICE'l.SENZJTSER !�I (,) I LIMSETYPE c -,J BUS. LIC COMPANY N.AI✓E r� r STREbTADDRESS i I II' G �t h C j I CITY, STATE, ZIP ARCIJTECT/ENGNTER NAME LICENSE NUMBER BUS. LIC — COMPANYN_ANrE _ E-MAIL I FAX -- — —�--- -- -.-- STREET ADDRESS I CITY, STATE, ZIP PHONE USE OF fLSFD or DUPLEX ❑ MI.'LTI-F'.AA�ULY PROJECTV, IN 11-DLANTD ❑ YES PRO?eCT IN L7 YES IS THE BLDG AN ❑ Y=C B=LNG: 13 COMMERCIAL URBAN IINITERFACE AREA �, NO I FLOOD ZONEL� NO I EICFLF-1 1.OY'E7 r DESCRIPTION OF WORK Pylat &V,4 ) nr� Sans (occ,,F:,•• TOTAL VALUATION: a itECF.Ii7ED Bl , 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 lccal ordinances and state laws relating to build in o struction. II onze representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of ApplicanUAgent: '✓ Date: SUPPLEA4ENT,kL II\rFORMATION REQUIRED c c - - o L,' -- MEFMisc,4pp-2011.doc remised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR -BUILDING DIVISION 19 ADDRESS: 19011 Barnhart Ave DATE: 10/28/2015 REVIEWED BY: Sean UNITS APN: BP#: 'VALUATION: 1$4,242 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex USE: I PENTAMATION FURN/AC I PERMIT TYPE: WORK Remove and replace furnace in same location. SCOPE Suppl. Insp Fee- .eePME APPLIANCE / EQUIP TYPE FEE ID ('lamb. Plan CheckI I QTY UNITS BP FEES Elea, Permit Fee: Furnace, Forced -Air 1MFR=<100 other F.lec. Insp. 1 # $143 Permit Fee: Suppl. Insp Fee- .eePME PMEUnit Fee: $143.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? Yes (F) No $0.00 TOTALS: Travel Documentation Fee: ITRA VDOC 1 $143.00 Strong Motion Fee: IBSEISMICR NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 7111113) Mech. Plan Check0.0 hrs $0.00 ('lamb. Plan CheckI I Ptah CheckI I Mech. Permit Fee: I MPERMIT [Phimb. Permit Fee: Elea, Permit Fee: Other Mech. Insp.0.0 hrs $48.00 Other Plumb Insp. other F.lec. Insp. ,Ltech. Insp. Fee: Plumb. Insp. Fee: Elec. hicp. Fee: NOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District. etc.). These fees are based on the nreliminary information available and are only an estimate. Contact the Dept for addn7 info. FEE ITEMS (Fee Resolution 11-053 E . 7111113) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee PME Plan Check: $0.00 Permit Fee: Suppl. Insp Fee- .eePME PMEUnit Fee: $143.00 PME Permit Fee: $48.00 Construction Tax: Administrative Fee: 1ADMIN $45.00 Work Without Permit? Yes (F) No $0.00 AaYanced Planning Fees: Travel Documentation Fee: ITRA VDOC $48.00 Strong Motion Fee: IBSEISMICR $0.55 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $285.55 $0.00 TOTAL FEE: 1 $285.55 Revised: 10/01/2015 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 1 of 3) Project Name: 2015- 0259 Atul and Aanchal Gupta I Date Prepared: 2015-10-06 A. General Information MR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CHR -ALT -02 document for each dwelling unit. O1 Project Name 2015- 0259 Atul and Aanchal Gupta 02 Date Prepared 2015-10-06 03 Project Location 19011 Barnhart Avenue 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 2015- 0259 Atul and Aanchal Gupta 07 Zip Code 95014 08 Dwelling Unit Conditioned 2203 Installing Installing Installing Floor Area (ft2) Location or Area by this SC ducted containing system Number of space conditioning entirely new EO9 Climate Zone 4 10 (SC) systems in this dwelling 1 component? components? feet of ducts? duct system? unit. Alteration Type B. Space Conditioning (SC) System Information 01 02 03 04 05 06 07 08 09 10 Is the SC Installing a SC System SC System CFA served system a refrigerant Installing new SC Installing Installing Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System (ft2) system? component? components? feet of ducts? duct system? SC system? Alteration Type Furnace Whole house 2203 Yes No Yes No No No Altered space replacement I conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)iDiib) This section does not apply to this project. Registration Number: 215-A6348913A-000000000-0000 Registration Date/Time 2015-10-06 11:46:21 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-06 11:43:05 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF111-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 ) D. Altered Space Conditioning System (Sections 150.2(b)lE and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value Furnace Central gas All new Central split No cooling This field or This field or This field or This field or replacement furnace heating AFUE 0.8 AC component section is not section is not Setback section is not section is not components altered applicable applicable applicable applicable Required Documentation: CF2R-MCH-01-E - Space Conditioning Systems Ducts and Fans Duct insulation requirement for new plenums: R6. CF2R-MCH-20-H & CF311-MCH-20-H — Duct Leakage testing required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced. -Leakage rate compliance: <_ 15%, or <_ 10% leakage to outside, or seal all accessible leaks. CF2R-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2RCF3R-MCH-23 & CF3R-MCH-23 Air Flow > 300 CFM/ton required when MCH -25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from MCH -20 Duct Leakage Testing requirements. -Heating-only systems and Air Handler/Furnace changes do not require verification of Air Flow MCH -23, or Refrigerant Charge MECH-25. -Existing duct systems constructed, insulated or sealed with asbestos are exempt from MCH -20 Duct Leakage Testing requirements. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 150.2(b)1Diia and 150.2(b)1E, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. Registration Number: 215-A6348913A-000000000-0000 Registration Date/Time 2015-10-06 11:46:21 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-06 11:43:05 Schema Version: 0.555SDD CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 3 of 3 ) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: GW Faulkner, Cindy l� 6 Company: Signature Date: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2015-10-06 11:46:21 Address: CEA/ HERS Certification Identification (if applicable): 1171 NORTH 4TH STREET City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 Responsible Person'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 Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. 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 California Code of Regulations. 4. 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. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: Responsible Designer Signature: q ; Faulkner, Cindy t Company: Date Signed: ATKINSON CLIMATROLLERS INC dba VALLEY HEATING,COOLING & ELECTRICAL 2015-10-06 11:46:21 Address: License: 1171 NORTH 4TH STREET 258540 City/State/Zip: Phone: SAN JOSE CA 95112 408-294-6290 Digitally signed by Ca10ERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider responsibility for the accuracy of the information. Registration Number: 215-A6348913A-000000000-0000 Registration Date/Time: 2015-10-06 11:46:21 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-06 11:43:05 Schema Version: 0.555SDD CUPERTINO Owner Name Address 6 to U l WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(akupertino.org ,kz— Ci IJIP-rA Permit No. dDZ 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. kNo 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 res f the form and sign bottom of form. 26es My real property is built and available for use or occupancy on 4anuavy 1, 1994. Civil Code Sections 1101.1 through 1101.8 apply. Check one wing sta m is and sign bottom of form.. _ �Of� 5.Oase 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-cornpliant 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 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 followinp- pane. Owner or Owner Agent's Signature: ��, �J- / Date: 11 /(s / 15 1 Upon completing and signing this Certificate, please return it to the Building Division in order to final vour buildine hermit SB407 2015.doc revised 08/26/15 BUILDING PERMIT CANNOT BE FINALED AND CONfPLETED UNTM THIS CERTIFICATE HAS BEEN SIGNED AND RETURNED TO THE BUILDING DIVISION 1. If the existing plumbing fixture water usagelflow rate is equal to or lower man the figure shown, ,l 10 11UL i�%JUII U urb u��u SB407 2015.doc revised 08/26115 Non -Compliant Water -Conserving Plumbing Fixture Plumbing Fixture/ (Fixture Complying with Current Code Applicable to New Construction) 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 si 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 usagelflow rate is equal to or lower man the figure shown, ,l 10 11UL i�%JUII U urb u��u SB407 2015.doc revised 08/26115 CUPERTINO Address I '[ 0 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(ftupertino.ong 0 Permit No. M D -zz S_ PERMIT CANNOT BE FINALED AND COMPLETED UNTIL THIS CERTIFICATE HAS BEEN SIGNED 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 CSC Sections W.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi -family dwellings sl ov with oke Alarms and Carbon Monoxide alarms. When the valuation of additions, terations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2 1.5 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 Owner (or Owner Agent's) Name: 14146HA'li �4UCT .......................................................................................... . Signature .......... t... . Date:.I. Contractor Name: Sinature................................................................... Lica...................................... Date:................... Smoke and CO for n.doc revised 03/18/14