B-2016-1398 SMOKE/WATER ►�
OWNERGERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION
(Cll�P �►�Cly 10300 TORRE AVENUE e CUPERTINO, CA 95014-3255
(408)777-3228 o FAX(408)777-3333 o building aC.cupertino.org
"e
PERMIT C .N'NOT BE VIIy�r/�A��j]��'�JD ANIS COMPLETED��•.yp �j�7QirTIL' 'JHS C'[ERT I(�I CATS
1'14\.11.1. 0 y r -L7 aJ JD 'V�I
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.
GIENERAIL IN, FORMATION
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 AEARN/l CO AILARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basements X
Within each sleeping room T 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,dwellung.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 R-314 and CBC Sections 907.2.11.4 and 420°.6.2.An electrical permit is required for
alarinns which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that tlte alarm(s)referenced above has/have been
installed in accordance wit h.,the rnanufact,urer:'s i7nstrudions and in, cornpl'iance with the California Buiildlinng
and Calz�onni�a Resident a-1 Codes.The alarms have been tested ndl are operafiiomal; as.of the date sigpjedl
b elow
_ I!ha,ve1 read andf a,ree to,co,,;1;with tl�e;t0rms,andd!condizidn!s.of this•sfatemen
.. ............................... ....................................... ..Dafen...... �
Cbntracfer Name::
Sigature........_..........................................................L�c# :.......................... Date
Smoke and CO'fz?rni,dbe revised:03/1,8/1:4`
OWNER CERTIOICATE OF COMPLtANCE
C4MMUNiT'Y DEVELORAE-ENT DEPARTMENT o BUILDING DIVISION
P T6 10300 TORR,E AVENUE®CUPERTINO,CA.95014-3255
CUER (408: 777-3228-.FAX(408)777-3333 c budding(dcuoerUn�o.ora
Owner Nameo�*<—Dy Permit Nod
Address li(f e) ( cAluyp/u
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.
XNo 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.
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?
XNo 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).
❑ Mypropertyis a.multifamily residential realpropeity. See Civil Code Section 1101.5.
On and after January 1,20'14, 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-corn.pliant. 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 S ections 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 foll-owing.page.
Owner or Owner Agent's.Signature
Upon cornpfefthg:and signing this Ceiaificate,please ret n,it to the Building Division in order to final:your building perrni.t. '
SB-407 2015.doc revised'08/26/15