B-2016-1280 SMOKE/WATER 'XIDE
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' OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION r n S r
C UPERTIMP 10300 TORRE AVENUE•CUPERTINO,CA 950143255 U
(408)777-32.25•FAX(403)777-3333• bui1clinqftcupeitir7q M
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PURPOSE
This affidavit is a self-certification for the installation of all required Smoke.and Carbon Monoxide Alarms foy
compliance with 2013 CRC Section R314, 2013 CBC Sections 420.6 and 907,2;11.2 where ilo 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.x.11.5 and 420.6 re- ire-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 X X
bedrooms)
On every level of a dwelling unit including basements X X.
Within each sle_T'n room
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 4.20.6 and shall be approved by the Office of the State Fire Marshal.
'ower Supply:In dwelling units with no coxntmercial power supply, alarm(s)may be solely battery operated.
In existing'dwelliulg units, alarms are permitted to be solely battery operated where repairs or alteration s-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 buildiuig wiring.
As owner of the above-referenced property,I hereby cerWy.that the alarm(s)referenced-above has/have been
installed in accordance with the manufacturer's instructions' and in compliance with,the California Building
axed,Califonaia-Residential Codes.The alarms have been tested and are operational; as.of the date signed
below.
I have read and a L ree-to cernply with:the,termsi and,conditions of this statement
odr for C3vunaFp� ant's) Fa�� :
000usignedby: 2/25/2016 1 1:21 PM F
Eonit'eclor ame: Dnt
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Si,rtialure: �' ..:.. .... .1...........Qle_
Smoke curd:COA m.dbc rev sed:03/1"8/1:4'
DocuSign Envelope ID:90989FF9-2F84-4D2A-Al l4-C1 D5FFl BBAFE
PLUMBING FIXTi URF-10 �� t
OWNEk CERT' IFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE-CUPERTINO.CA 95014-3255
(408)777.3228-FAX(408)777.3333 buildina@_cu2errtino.ory
Owner NameF:i yy YermitNoP`i .1'
S
Address
CA
1. Is your real property.a registered historical site?
❑ Yes Civil Code Sections 1101.].through 1101.8 do not apply. Skip-the rest of the foim and sign bottom,of forth.
rv$ No -00 to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or confipration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
® Yes Civil Code Sections 1101.1 throiugh 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.
10 Go to Question 3.
3. Is water servicepermanently 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.
t;KLNo 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.
,I5-Yes My real property is built and available for use or occupancy on or before January 1,1994.
Civil Cade 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-
"
Mypropertyis asingle family residerncial realproperty- See Civil Code Sectio
n.
On and after January 1, 2014,building alterations or improvements shall require all non-compliantplumbing 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 mcthffamily residential real properly. 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-replaccd with water-conserving plumbing fixtures.
On or before January.l,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving
aterconserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
ED My property is a commercial real property. Sec 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 fiictures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Seetions'l 101.1
through l 101.8,the current California Plumbing Code and California Careen Building Standards Code,and manufacturer's
installation requirements, and that the water-conserving plumbing fixtures eomplq with flee requirements as indicated in the
table on the fall owin age. DocuSigned by:
Owner or Owner Agent's Signature: pace...2 25 Z PM PT
Upon completing and signing thisNMV,,$%49a,return it to,the Building Division in order-to final.your building permit.
3,0407 2011 doc.revised 08/26/13