B-2016-1321CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS;
11057 FLOWERING PEAR DR CUPERTINO, CA 95014-0492 (323 45 039)
CONTRACTOR:
(SUNRUN
PERMIT NO; B-2016-1321
INSTALLATION
SERVICES INC)
SAN LUIS OBISPO, CA
93401
OWNER'S NAME; OLSSON FREDRIK K AND JEANETTB
DATE ISSUED: 02/08/2016
OWNER'S PHONE: 408-799-5976
PHONE NO. 669-253-0011
LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO:
License Class C-46 Lic. #750184
Contractor (SUNRUN INSTALLATION SERVICES INC) Date 0210812016X
BLDG X ELECT _PLUMB
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
M(ECI-1 X RESIDENTIAL _ COMMERCIAL
with Section 7000) of Division 3 of the Business & Professions Code and that my
license Is In full force and effect.
JOB DESCRIPTION.
I hereby affirm under penalty of perjury one of the following two declarations;
INSTALL 15 ROOF TOP, PLUSH MOUNTED PV MODULES (4.1KW) &
1, I have and will maintain a certificate of consent to self-insure for Worker's
INSTALL (N) 100 AMP SUB PANEL
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. A� 1 have and will maintain Worker's Compensation Insurance, as provided for
--r^y `fay Section 3700 of the Labor Code, for the performance of tbo work for which
this permit is issued.
Sq. Ft Floor Area:
Valuation: $10000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
APN Number:
Oceupaney Type:
information is correct. I agree to comply with all city and county
ordinances and state laws relating to building construction, and hereby
323 45 039
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
PERMIT EXPIRES IF WORK IS NOT STARTED
expenses which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant understands and will
WITHIN 1.80 DAYS OF PERMIT ISSUANCE OR
comply with all non-point source regulations per the Cupertino Municipal
1.80 DAYS FROM LAST CAL4ED INSPECTION.
Code, Section .18.
Signaturenofia- Date 42108/2016
Issued by: MELISSA
hate: 02/08/20I6
OWNER-BUILDER DECLARATION
RWROOFS:
I hereby affirm that I am exempt from Ilia Contractor's License Law for one of the
All roofs shalt be inspected prior to any roofmg material boing installed. If a roof is
following two reasons:
installed without first obtaining an inspection, I agree to remove all new materials for
r. 1, as owner of the property, or my employees with wages as their sole
inspection.
compensation, will do the work, and the structure is not intended or offered
for sale (Seo.7044, Business & Profession Code)
Signature of Applicant:
2. I, as owner of the property, am exclusively contracting with licensed
Date: 02/08/2016
contractors to construct the project (Sec.7044, Business & Professions Code).
I hereby affirm under penalty of perjury one of the following three declarations;
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
a. 1 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
HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
2. I have and will maintain Worker's Compensation Insurance, as provided for
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
by Section 3700 of the Labor Code, for the performance of the work for which
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
this permit is issued,
Health & Safe Code, Section 25532 a should I store or handle hazardous
Safety ( )
a. I certify that in the performance of the work for which this permit is issued, I
material. Additionally, should I use equipment or devices which emit hazardous
shall not employ any person in any manner so as to become subject to the
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If, after making this certificate of
will maintain compliance with the Cuperthio Municipal Code, Chapter 9.12 and
exemption, I become subject to the Worker's Compensation provisions of the
the Health & Safety Code, Sections5 534.
Labor Code, I must forthwith comply with such provisions or this permit shaII
M25533,
Owner or authorized agent: '
be doomed revolted,
Date; 02108/2016
APP7,ICA_NT CE11TIFICATION
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information Is
I hereby affirm.that there is a construction lending agency for the performance
correct. I agree to comply with all city and county ordinances and state laws
of work's for which this permit is issued (Sec. 3097, Civ C.)
relating to building construction, and hereby authorize representatives of this city
Lender's Name
to enter upon the above mentioned property for inspection purposes. (We) agree
to save Indemnify and keep harmless the City of Cupertino against liabilities,
Lender's Address
Judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Addificnaily, the applicant
ARCHITECTS DECLARATION
understands and will comply with all non-point source regulations per the
I understand my plans shall be used as public records.
Cupertino Municipal Code, Section 9.18.
Licensed
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT , BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 85014-3255
(408) 777-3228 • FAX (408) 777-3333 - building(cDcupertino.arq
PV4pp_201- Ldoe revised 03116/11
PROJECT ADDRESS 1 1 4 iJ tai r t� t 9�
OWNER•NAI'le f
{ Loe—'
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i PHONE f t � f
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E-MAIL
STREET ADDRESS
CrrY, STATE, 21? FAX
CONTACT A'AA4E' y/�j y PHO E-MAIL
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STREET ADDRESS CITY, STATE. Z�I1P�
FAX
❑ OtS't,ER ® OWNER -BUILDER ❑ 01iWERAGENT krOkIACTOR ❑CUN' RACTORAGENT ® ARCkO"ItCY ❑ EPGINEER ❑ 1)E1ELOPER ❑ TENANT
CONTRACTORNAME I /' LICENSE N`90ER ` LICENSE TYPE
J
BUS. LIC a yy 'fir ry
G• 'j C
COMPANY NAME �`6•t
E-MAIL_
FAX
STREET
z ,coo SQ'I i:,
ZIP
I C � �05-e_ cta- 9 s
PH
- 2_q1 0151(
ARCOTECTIENGINEER NAME LICENSE. NUMBER
BUS. LIC m
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, 217
HDNB
USE OF ❑ ISM or Duplex ❑ IF4I]Iti-Fatriily
PROJECT IN WILDLAND
PROJECT IN
STRUCTURE: ❑ COtIlM=ial
URBAN INTERFACE AREA ❑ Yes ❑ No
FLOOD ZONE ❑ Yes ❑ No
®DLAR PANELS
ELECTRIC VEHICLE CHARGING STATION
❑ SOLAR 1VATER HATING
❑ OTHER:
FOR SOL4R PANELS: NUJh1RER OF PAIWSNNITS: j IULOWATTS tCOha4ERCIAL 01\11A�;
TOTAL VALUATION: /+1'
DESCRIPTION OF WORK p 1• V� en
Mj-
TV
AM
By my signature below, I certify to each .Of the f011ou+ing; 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 local
ordinances and state favus relating co tru a hori a resentatives of Cupertino to enter the ve-i entified property for inspection pu€poses.
S igmture of Applicantl_�e i ' 10
Date: _
SUPPLEMENTAL INFORMATIONREQUIRED
_
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PV4pp_201- Ldoe revised 03116/11
CITY OF CUPERTINO
FEW Ti'ii`,F' FNTIMATO-P _. RTTTT.T)TNP "TI714ZTn1V
ImiADDRESS:
11057 FLOWERING PEAR DR
DATE: 02108/2016
REVIEWED BY: MELISSA
APN: 323 45 039
BP#1:
*VALUATION: 1$10,000
*PERMIT TYPE: Building Permit
PLAN CHECK TYPE: Alteration i Repair
PRIMARY SFC] or Duplex
USE:
O,O
PENTAMATION
PERMIT TYPE: SOLAR -RES
WORK INSTALL 15 ROOFTOP, FLUSH MOUNTED PV MODULES 4.1K & INSTALL N 100 AMP SUB
SCOPE I PANEL
evvtr,: x fats esunrate noes not tnctuaefees (lue to otlaer Departments (i.e. Planning, Public Works, Fire, Sanitary Seaver- District, School
Wwrhv— Pfr. y_ Thp.ro foo.r nro A—J." tbo ae ofin..wnrn::.. Fn........er.,:.......: r..T, P., ..—A—....., A... /r., 4.,, ti....s r . .11.1..1) .—e
FEE ITEMS LT'ee Resolution11.0531 . 711113)
FEE
QTY/FEE
MISC ITEMS
Plan Check Fee:
$0.00
I 4
$236.00
Alternative Energy System
1PII07'OVRES Photovoltaic System
Suppl. PC Fee: Q Reg. 0 OT
O,O
hrs
$0.00
PME Plan Check:
$0.00
= amps
$48.00
Electrical
IBELEC200 Services
Permit Fee:
$0.00
SuppI. Insp. Feer Reg. 0 OT
FO.
hrs
$0.00
PME Unit Fee:
$0.00
PME Permit Fee:
$48.00
t. onsir acdon 7'Av:
Administrative Fee: 1ADMIN
$45.00
0
0
Work Without Permit? O Yes O No
$0.00
Myunced I'I&Liq:ng Fee:
$0100
uelect allon-.Residential
Building or Structure
0
Travel Documentation Fee: ITRs111DOC
$48,00
S_trona Motion Fee: 1B8EISMICR
$1.30
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
SUBTOTAI 5:..:.
$143.30
$284.00
a . ° _:TQTTa F�=:
$427.30
Revised: 01/01/2016
COMMUNITY MANAGEMENT SERVICES
January 2$, 2016
Fredrik and Jeannette Olsson
11057 Flowering Pear Drive
Cupertino, CA 95014
Re: Cupertino Countrywood Homeowners Association
Dear Mr. & Mrs. Olsson:
The Cupertino Countrywood Board of Directors has approved your architectural request to have
Sunrun Installation Services, Inc. install a solar panel system for electricity on the roof of 11057
Flowering Pear, subject to the terms and conditions in the "Notice of Covenant" and "Solar Installer
Indemnity Agreement", which are attached., and the following conditions:
I. The installation must be performed by a licensed contractor.
2. City of Cupertino permits must be obtained.
3. The solar electric panels must be installed only on the roof of 11057 Flowering Pear.
4. Wires and conduits that run from the solar panels to the electric panel must be run inside the
building.
Thank you for submitting your architectural request to the Board of Directors. It is suggested that
you keep a copy of all the documents for your records and disclosure purposes. If you have any
questions, please feel free to contact rne.
Sincerely,
Community Management Services, Inc.
Bob Soares, Senior Association Manager
Cupertino Countrywood Homeowners Association
cc: Board. of DirecLons
1 X3,35 Clry C=rp(-,k Rf)ad. 8t.litc: 20,1 C,r,,rtpbell, GA 95008-13631 voice (408) 5139-1977 fax(408)5E)9--'1970
&0 larg-lior TV , -Y
CL
In
--
In consideration for the permission of the CI PERTINO COUNTRYWOOD
HOMEOWNERS ASSOCIATION, INC- (Ijereillafter "Association") for installation of solar
panels and related equipment, components and items (hercinafter "Solar Energy SYSMIn"),
SUNRUN. INSTALLATION SERVICES, INC. (hereinafter "Installer"), California c0nttaict0r's
license number 750184, with its principal place of bpsiness located at 775 Fiero Lane, Suite 200,
San Luis Obispo 939401, hereby agrees to hold barmless and indemnify the Association, and
defend the Association and its successors, assigns, directors, officers, and agents against any and
all claims, demands, actions, liabilities, losses, expenses or damages, (including attorney's fees),
that the Association may suffer as aresult of, or related to the installation, maintenance,
temporary removal and reinstallation, permanent removal, use or existence of the solar panel
system. The obligation to indemnify shall be effective --von if active or PW&Dnegligence or
-
misconduct of the Association, its successors, assigns, employees Gr -a901.1ts contribiltes to the.
loss or claim. This indemnity wilt not extend to claims, demands, liability or expense wising out
o.f,t,,jc sole negligence or sole Willful misconduct of the Association.
Installer warrants and agrees that installation shall be in conformity with the cur -rent
edition of all adopted building codes.
Installer warrants and agrees that a registered engineer in the State of California has
ovalualed the structure, and the structure will withstand the additional dead weight, wind loads,
and seismic impacts from. the proposed solar SyStOrn.
Installer warrants and agrees the proposed solar sYstem will not reduce the fire -resistance
rating of the roofing system.
Installer warrants and agrees that all -roof penetrations will be, app,Dpriately flashed in
accordance with good practices and the roof manufacturer's recommendations. To the extent
available., design and installation of the Proposed Solar system Shall confol-M 10 the roof
manufacturer reconu-nendatious,
Thetuidersigned has carefully read the foregoing Solar Energy System Installer
Indemnity Agreement and fully -understands and agrees to each and every provision contained
herein. The under -signed warrants he/she is authorized to enter into this Solar Energy System
ellt") on I)ohalfcart1le libove The
Installer Weranity AgrOOMOM CAXTUM'
Installer V-6tuatarily exerg.jtjjpt t1lis Agreetneiv: on tho a Y of 2016.
S'-UrjqkUN INSTALLATION
SF
�W103,S,"l
Y, Print Narne
RECORDING REQUESTED BY
CUPERTINO COUNTRYWOOD HOMEOWNE
ASSOCIATION, INC.
AND WHEN RECORDED MAIL_ DOCUMENT I
CUPERTINO COUNTRYWOOD HOMEOWNE
ASSOCIATION, INC.
c/o Community Management Services, Inc.
1935 Dry Creek Road, Snits 203
Campbell, CA 96008
APN 323-45-039
SPACE ABOVE THIS LINE FOR RECORREK'S uae VrvLa
property Owner: Fredrik K. and Jeannette Olsson
Residence Lot Address, 11057 Flowering pear.Driye
ar �rl'i i, ;ttlil" rriia:0 14
In consideration for the permission of the CUpERTINO COUNTRYWOOD
HOMEOWNERS ASSOCIATION (hereinafter "Association") to permit installation of solar
panels and related equipment, components and items (hereinafter "Solar Equipment") over the
roofing system of the Property Owner's dwell ing structure on the abode -referenced Residence
Lot, the Owner of the improvements constructed at the Residence Lot Address, (hereinafter
"Property"), on his or her own behalf and on behalf of all subsequent owners of the Property,
hereby covenants and agrees as follows:
I . All applicable architectural and structural standards for the installation of the Solar
Equipment shall be satisfied as provided for in Articles VIII of the First Restated Declaration of
Covenants, Conditions, and Restrictions of Cupertino Countrywood Homeowners Association,
recorded on or about May 18, 1988, as Document No. 9696356, in the Official Records of Santa
Clara County, California ("Declaration").
2. A California licensed contractor shall be engaged to install and perforin all necessary
maintenance or repairs on the Solar Equipment installed on the property. The installer and any
entity providing rnaintenatrce to the Solar Equipment shall follow all applicable building codes.
3. Prior to initial installation Of U10 Solar Equipment, Owner will obtain a signed indemnity
agrCument born the Solar Equipment installer requiring thorn to iad€3ninily or rcirnburse the
Association or its rnernbers for loss or damage caused by the inslal lation, maintenance, or use Of
the Solar Equipment.
4. Prior to initial installation of the Sola.r Equipment, owner will obtain (and provide a copy
to the Association) till applicable permits_
5. Prior to initial installation of the Solar Equipment, Owner will lrave the structurc:
evaluated by a registered enginecr to verily thirt the strtr4.trrre will withstand the additional dead
weight, wind loads, and sc;isrrric impacts frorn the proposed Solar Equipment.
falerof4
6. Owner warrants that the Solar Equipment will not negatively influence the fire -resistance
rating of the roofing system.
7. Owner understands that the manufacturer and/or installer of the roof and /or roofing
materials may not warranty roofs with Solar Equipment installed and may discourage installation
of Solar Equipment on roofs. To the extent any warranty otherwise applicable to the roofs is
waived or voided by installation of the Solar Equipment, Owner and all subsequent owners,
agree to pay for any repair and/or replacement, which would have been covered by the warranty.
8. Owner and all subsequent owners, agree to accept full responsibility for any and all
financial issues and liability risks including personal injuries and/or damage to any part of the
Properties, Common Area, and dwellings on Residence /.rots, as those terms are defined by the
Association's governing documents, and include but are not limited to, the roof, roof substrate,
roofing felt and flashings, shingles, and all related roofing components that result from, occur
during, or related to the installation, maintenance, temporary removal, reinstallation, permanent
removal, -use, or existence of the Solar Equipment. This provision shall supersede that of Article
VI of the above -referenced Declaration as it pertains to the Solar Equipment and related roofing
components affected thereby.
9. Owner, and all subsequent owners, will arrange for all work and accepts full
responsibility for the cost of temporary relocation and reinstallation of the Solar Equipment
when roof replacement, repairs, or maintenance is required. Owner, and all subsequent owners,
will pay any fees or costs incurred by Association as a result of, or related to, any delay or failure
to temporarily remove or relocate the Solar Equipment when roof replacement, repairs, or
maintenance is required and/or any increase in the cost of the Association's work attributable to
the Solar Equipment.
10. Owner, and all subsequent owners, accept responsibility for all maintenance, repair, and
replacement of roof or other building col-nponents that may be caused, necessitated by, or
damaged as a result of the installation, maintenance, temporary relocation and reinstallation,
permanent removal, existence, or use of the Solar Equipment.
t l . In the event Owner sells the Property, Owner and all subsequent owners, will disclose to
future owners of the I7roperty that as a condition of ownership, they assume and are bound by the
obligations and responsibilities set forth herein. Owner, and all subsequent owners, will pay all,
costs, including but not limited to attorneys' fees, necessary for the preparation, recordation and
execution of this document. Owner and all subsequent owners, understand they have the option
of completely removing the Solar l quipment prior to selling the !'i°ciperty.
12. if Association is required to engage in any litigation to enforce any rights ender this
Agreement, Association shall be entitled to recover from Owner, and any subsequent owner, in
addition to any other sums due, reasonable: attorney fees, casts and necessary disbursements
involved in said proceedings.
13. Owner, and all subsocluent owners, shall hold harmless, defend, and indemnify
Association, its successors, assigns, directors, officers, and agents against any and all claims,
Page 2 oro
demands, actions, liabilities, losses, expenses or damages, (including attorney's Fees), that
Association may suffer as a result of, or related to the installation, maintenance, temporary
removal and reinstallation, permanent removal, use or existence of the Solar Equipment. The
obligation to indeninify shall be, effective even if active, or passive negligence or misconduct of
the Association, its successors, assigns, employees or agents contributes to the loss or claim.
This indemnity will not extend to claims, demands, liability or expense arising out of the S610
negligence or sole wilifLil misconduct of the Association.
14. The approval granted by the Association for installation of the Solar Equipment is limited
only to the exact proportions and locations as specified in the approval obtained from the
Association.
15. This instrument is to be recorded, and creates a covenant that -,hall run with the land, and
be binding on Owner of the Property, his or her successors and assigns, and all parties having or
acquiring any right, title, or interest in or to any part of the Property.
16. This covenant is created for the benefit of all that certain improved real property located
in the City of Cupertino, County of Santa Clara, State of California, more particularly described
in Exhibit A.
17. The permission granted by the Association may be revoked, by the Association -for breach
of this Covenant, or upon the order of the City or the County Of Santa Clara.
18. All costs and/or attorney's -fees incurred in the enforcement of any of the provisions Of
this covenant shall be recovered by the -OTevalling party.
19. Owner agrees that he or she will deliver a copy of this covenant to any Prospective
purchaser of the Property prior to the execution of any contract for sale of the Property.
The undersigned has carefully read the foregoing Notice of Covenant and fully
understands each and every pK-W
' ion contained her0ii, to which he/she agrom.. ,,r,hu--.tjjl(.jersigned
S
Owner has voluntatily.='cuted tftis Notice of COW11-8.11t on the ZY day
2016.
To be signed in the presence, of a Notary.
P,161t.-3 of'lf
OWNER
EXHIBIT "A"
THE LAND REFERRED TO HEREIN BELOW IS SITUATED IN THE CITY OF
CUPERTINO, COUNTY OF SANTA CLARA, STATE OF CALIFORNIA AND IS
DESCRIBED AS FOLLOWS:
Parcel One:
Lot 87, as shown on that certain Map entitle Tract No. 6059, Cupertino Gardens Unit
No. 2, which map was filed for record in the Office of the Recorder of the County of
Santa Clara, State of California, on September 29, 1977 in Book 405 Of Maps at page(s)
7.
Excepting therefrom the underground water or rights thereto with no rights of surface
entry, as granted to California Water Service Company, a California Corporation,
recorded March 8, 1978 in book D512 of official Records, page 487.
Parcel Two:
Easement for use and enjoyment in and to (common area) as set forth in Declaration of
Covenants, Conditions and Restrictions, recorded May 12, 11977 in book C817 of Official
Records, page 740.
APN: 323-45-039
Pap- 4 of4
ACKNOWLEDGMENT
A notarypublic or other officer completing Phis
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validi!.y of that document.
State of Calif a � C )
County of , J� %�0\jo-Mf�
N D before me, 9 _' �`e• J .dl 1' V aS a t
On _L — I- (insert name and title of the .officer)
personally appeared 62.d_7kYr_ .1 7 - � .� ....�
who proved to me on the basis of satisfactory evidence to be the pOT,60t�(s) whose names) is/are
subscribed to the within instrument and acknowledged to me that he/shelthey executed the same in
his/her/their authorized capacity(ies), and that by hislher/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
R. KAU
COMM, # 2040192
WITNESS my hand and official seat. .,T NOTARY PUBLIC -.CALIFORNIA
SANTA CLARA COUNTY
rdy Comm, EXp, September 26, 2011,1
U
Signature
(Seal)
rya
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO
(408) 777-3228 •FAX (408) 777-3333 • building(olcupertino.org
PURPOSE
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2016 CRC Section R314; R315, 2016 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, R315, 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 ALAR_ M
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s) - (Smoke alarms shall not be located within 3 feet of bathroom door)
On every level of a dwelling unit including basements and habitable attics 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 o A i -Ler 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 specified below have been tested and are operational, as of the
date signed bel/ow.
Address: / 6l �L� 'j''> Permit No.�2�i� " dS-
Specify Number of Alarms: _ r Smoke Alarms: ,fes I + Carbon Monoxide Detectors: r�
i have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name: A
Signature.... .................:....................................................... Date:a?
�4ontractor Name:
Signature...................................................................... Lica.......... ............ .................. Date:...................
Smoke and CO form.doc revised 01/10%017
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
Iw�# I 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
€7
CUPERTIN
08) 777-3228 • FAX (408) 777-3333 • buildingO)cupertino.org f
Owner Name Permit No.
Address 110S-7 F/
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1.101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
ANo 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 properly 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-coinpliant plumbing fixtures shall be replaced with water -
conserving plumbing fixtures throughout the building (regardless of whether property undergoes alter a ions or
improvements).
❑ My property is a connnercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improvements shall require non- compli�nt
plumbing fixtures to be replaced with water -conserving plumbing fixtures. I
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 page.._.
Owner or Owner Agent's Signature Date LY�-
_ ,,,,ilei to tinct vnnr hntltl7nQ Tle1lY11i.
Upon completing ana signing rms k-ICIU11UMc, 11 uaac i
SB407 2015.doc revised 01/05117
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Owner
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BU LOING DIVISION
10300 TORRE AVENUE CUPERTINO, CA 9f-0143255
(408) 777-3333 - buildiixaCo unertino.oru
Address A I I( r N G. -
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
1A No Go to Question 2.
Skip the rest of the form and sign bottom of form.
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 fora and sign bottom of form.
I No Go to Question 3.
3. Is water service permanently disconnected for your building?
No Go to Question g FF m.
El Yes Civil Code Sections 1101. i throw h 1101.8 do notay. Skip the rest of the form and sign bottom of for
1
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.
C 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:
f MY property is asingle-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, 20.19, 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-com pliant 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 C aliforn i a 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 followine Daae.
Owner or Owner Agenfs,
Upon completing and signing this Ceitrficate, please return it to the Building Division in order to final vour building nermi t_ '
SB407 2015.doc revised 08/26/15