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15110168CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10851 WUNDERLICH DR CONTRACTOR: LIU MINGSHIAN PERMIT NO: 15110168 OWNER'S NAME: LIU MINGSHIAN 10851 WUNDERLICH DR DATE ISSUED: 11/24/2015 OWNER'S PHONE: 4087685848 CUPERTINO, CA 95014 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL Ej COMMERCIAL DEMO UNPERMITTED PATIO COVER IN REAR YARD License Class Lic.# AREA Contractor Date 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: 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: $1000 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 APN Number: 37529023.00 Occupancy Type: permit is issued. 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 tosave 180 DAYS - ALLED 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 granting of this permit. Additionally, the applicant understands and will co ed by: ate: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature 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 e following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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) 1, 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 f1 ave and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous ompensation, 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, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for the performance of the work for which this Owner Date: permit is issued. or authorized ager "f 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 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. Signat i Date1l A:4(l rc,; a um� ishail CUPERTINO, ❑ NEW CONSTRUCTION CONSTRUCTION PERMIT APPLICATION COMMiiUNITY DEVELOPMiiEN T DEP 'RTIJiEN T • BUILDING DIVISIONt3 10300TORRE AVENUE • CUPERTINO, CA 55014-3255 / (408) 777-3228 • FAX (408) 777-3333 - bulldino5cuDeriino.ora LJ ADDITION . ❑ .4J -i RATION / TI ❑ REVISION / DEFERRED ORIGIN d.L PER1,9-1 PROtCf ADDRESSd A?N R i ,�'C I (A � u ln/Y'�-err ( ► 4 -, Vv- 3 �S- � } - O Z3 Oli?�cR NAl �i Int Bldg*p_2011.doc revised 06121/11 Oil � �Gtlti I P 0� � � 3Q s6c �S �2 ��, A STREFI ADDRESSr- • , Q C1 I � �j�" Cil Y, STATE, ZIP� FAX U,'j u j. v � (��- w CONTACT N'.L✓E PnOh -40 STREET/•DDR=SS i,�G�- '//1 P22V JA) 13 V�dvjr CiiY, ST.4i: Z3 �\� r(> � .S�I I FAX W1cR p P.-3UIIDER ❑ OCM^ `RAG-�'C ❑ COLT R4CTOR ❑ COJFr 4CTORAGT"f/v ❑ ARC_- -CT Cl ENGLti~✓R ❑ D---v-LOPBR ❑ -1;Ahr CONTRACT OR N-AbrME I LIC=1.— SE'Nu"MzR I LiCEN S° -1 yr- I BUS. LIC R CO]✓3A9Y1�Ah4'-- I >-N4IL I F.4X STREET ADDRESS I CrTY, STATE, ZIP PHOh ARC:T ECT/ENGD�EF-R Nt �fE I LICENSE NU1.rER BL'S. LIC R CON,PAIN NAI✓.B BNLUL I FAX STREET ADDRESS I C-11-Y,STAT n, ?IP I P i01^ DESCRIPTION OF WORK ` 1 E?OS.D,G USE PROPOSED USE CONSTR. T1,?E € STORrS i USE I TYPE OCC. SQ.FT. VALUATION (S) 2:zz G NEW FLOOR DEA4O TOTAL AREA AREA AREA I N—iIAREA BATIR0O.M OT_R RFdODEL AREA RD.40DEL AREA REM, ODEL.tREA PORCHAIREA D=CK.A.R=A TOTALDECKIPORCHA,BA G.=RAGE PR .4: D�iAC3 ❑ A T TACH ;VDHLLLD,GUNirS: IS A SECOND UNIT Ll YES SECOND STORY [ YES BEING ADD€D? ❑NO I ADDITIO!\? []NO PRE-nPLICATION YEE % Y= S S, PROVIDE COPY OF IS THE BLDG las -= ZRL:' . <. -== _ _=_ _= L� �� I T OT. L \%=LU -t j 41.ON: PL/U G 2PL R ❑ NO PLANK T1�G f3PROVAL LEITER rER I TN EICHLER HOME? ❑ NO + /UGO By my si_neture below, I certify to each of the followin_: I am fne property ox�mer or auth . =�^nt to a e ov„Ier's behalf. I have read this application and tie information I -have -provided -is corect: -I have -read -the Despription ofA\ fork -and ve _ tt-Is ---'zaree to comply with all' at) I- '-ble ]ocl- v- ordinances and state laws relating to building construction, I authorize representatives 'of Caper ino to en P . e above-ige ltir?e or inspection purposes. Si -mature of ADDlicentlr.�ent:. ! i SUPPLE?`r�?^ j�T�L _ OIZMATION REQUIRED 2 ; =�--t' .,.; . vi._Piu-'� CEEC��r -.�_ � _,_� OL�G �)✓IE.«=:b,�:.:_r'r - _ New SFD or Mulhifzinily d, ellinn: Apply for demolition perrnit existing building(s). Demolition permit is required prior to issuance of buildingis e� -O«RTF COL�iIER BL�DL'�G'PL 3>\Rr.«ttP� permit for new buildin;. ardous Materials Disciore Congineerclal Bldgs: Provide a completed Hazsi 4 _ for.n i-fz I Hazardous >\fateriai_s are being used as part of this project. - ? Copy of Plarmimg Approval Letter or Meeting wiul Plannipprior to r -f•+ submittal of BulldmQ PeriIllt c Dlicatiori. Bldg*p_2011.doc revised 06121/11 CITY OF CUPERTINO FEE ESTIMATOR - PUILDING DIVISION 1A, ADDRESS: 10851 WUNDERLICH DR DATE: 11/24/2015 MELISSA MISC ITEMS APN: 375 29 023 JREVIEWEDBY: BP#: 'EVALUATION: j$1,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair PRIMARY SFD or Duplex USE: $0.00 PENTAMATION 1GENRES PERMIT TYPE: WORK DEMO UNPERMITTED PATIO COVER IN REAR YARD AREA SCOPE Permit Fee: Hourly Only? 0 Yes (D No $0.00 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 hated on the nreliminary information available and are only an estimate. Contact the Dent for addn'1 info. FEE ITEMS (Fee Resolution 11-053 Eff. 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? (:) Yes (F) No $0.00 = hours Plan Check, Hourly $143.00 ISTPLNCK Suppl. PC Fee: (E) Reg. 0 OT FO.0 Fhrs $0.00 PME Plan Check: $0.00 Permit Fee: Hourly Only? 0 Yes (D No $0.00 Supp/. Insp. Feer Reg. Q OTQ,0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 (.0775iruction 7LTX.- F71 .fl(lininis,li-alive Fee.- 0 Work Without Permit? 0 Yes D No $0.00 Advanced Planning Fee: $0.00 hours Inspections $286.001STINSP I Inspection, Hourly 0 /t°ray ��l I: rx;rr rtattrrtrr�a Fees: Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.50 $429.001.."TOTAL FEE: ' $430.50 Revised: 10/01/2015 OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 CUPERT[NO (408) 777-3228 • FAX (408) 777-3333 • building a5cuDertino.org — 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 DRESS._ :......APN. BPS bL 75 41f \J, PlIr OWNER NAME_ .. OWNER ADDRESS- ` ..� .......: -/ � (/ -. DESCRIPTION OF WOft� rOWVe \ CJ�Yihtf We are providing you with an Ownet-Builder Acknowledgment 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 information.) X11 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner- Builde,l building permit that erroneously implies that the property owner is providing his or her own labor and material perso4ally. 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 provid�,,covemge for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insuran� �e 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. �J I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may proteot myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her namelinstead 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. b. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total�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. 6. 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 uneml��ployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. e"�-,A. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residJntial 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 performed under contract with a licensed general building Contractor. X81. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any fl�ancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 11 0wnerBui1derF6rm 2010.doc revised 04/14/10 I understand I may obtain more information regarding my obligations as an "employer" from the Internal ue Service, the United States Small Business Administration, the California Department of Benefit Payments, e California Division of Industrial Accidents. I also understand I may contact the California Contractors' State ,e Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I party legally and financially responsible for proposed construction activity at the site address listed above. . I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide Dplicable laws and requirements that govern Owner -Builders as well as employers. '►� 2. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the inform'`Ttion-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' be held liable for damages. If - you -obtain a perr-bit. as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or note those 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 owner's si nature. Property Owner's Signatu�r �. Date; C1 (NOTE: The following Authorization Form is required to -b -e c -o- m-- p--l-e-t-e- Y 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: CtvnerBuilderFOYm 2010.doc revised 04/14110 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE FILE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION ;:;� CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 o buildingOo cupertino.org / Owner Name �-q_ k ; a� �,`� Permit No. % ��/ L9 /U Address )/ d, _nt 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 4 NJ 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. El 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. >3 Er No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, 1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. Yes My real property is built and available for use or occupancy on or before January 1, 1994. Civil Code Sections 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: 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 11.01.8, 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 nage. i 'I-, . _ Owner or Owner Agent's Signatur�'u.' Date / 5— Upon completing and signing this Certif a e, please return it to the Building Division in order to final your building permit. SB407 2015.doc revised 08/26/15 B1L1ILD]L'NG PEM -_IIT Ct-ININ COT 13E FUii. �_ A < F , CERTIFICATE, . �iE�'!1 � ,�. , t��3 � ��ivr1a � 1. If the existing plumbing ix ure water SB407 2015.doc revised 08126/15 Non -Compliant Water -Conserving Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) -Plumbing Fixture Maximum Water Usa a/Flow Rate Fixture Type 2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage 2013 CALGreen Div. 4.32013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 /Flow Rate Single -Family Multi -Family Commercial Residential Residential Exceed 1.6 Gallons/flush Single flush toilets: 1.28 gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, Water Closets (Toilets) average flush volume of two reduced flushes and one full flush Exceed 1.0 0.5 gallons/flush Urinals Showerheads Gallons/flush 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. Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Faucets — 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 Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons .per minute 1.8 gallons per minute @ 60 Faucets— Kitchen per minute 60 psi May temporarily increase @ 60 psi May temporarily psi Faucets 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. n_ __ .L_ r. _.._ t,,... ;+ ;, n,f Pnii;rPri to hp iinararierl 1. If the existing plumbing ix ure water SB407 2015.doc revised 08126/15 SMOKE 6 CARBON MONOXIDE ALARM OWUER CERTIFICATE OF COMPUANCE IF `. COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION r._RT0M0 10300 TORRE AVENUE e CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - bull ding (a.cupertino.org PURPOSE 41litgn9�lde / PERMIT CANNOT BE FINALED AND COMPLETED UNTIL T11IS CERTIFICATE, HAS BEEN IXC , � F .A. AN,1) . 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 Califonlia 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 - C7�tr��or-QWRerAgenCs) [�arrte: Nil- 5i=naftr'e....................................................................................... ......................... D2e:..............�s.. Contf6b drName. Si''-•-� r--' ti .. - naftre...................................................................... Ltc;`:.................................... Da.trr'.` ................... „ Smoke and CO forni.dbc remised 03%1'8/1.¢