B-2016-1299 SMOKE/WATER OWNER CERTIFICATE OFCOMPLIANCE FILE
COMMUNITY DEVELOPMENT DEPARTMENT►BUILDING DIVISION
CUPERTIINO 10300 TORRE AVENUE►CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•building(eD-cupertho.or4
PF""T CAt"OT RF VINIkLED AND CO PLE,TED UNTIL THIS CERTIFICATE Y 4
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.
GIEN,ERAL 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 ALARMCO AL AR,
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 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.Tin dwelling units witl no commercial power supply, alarm(s)maybe solely battery operated.
In existing dwellu g.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 ba,CRC Section R314 and CBC Sections 907.2.11.4 and 420..6.2.An electrical permit is required for
alanns which must be connected to the buildirig 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,man ufact,,l rer:'s instrumetioms and in,compliance with the California Building,
anid Calif o,nua:Resideritial Codes.The alarms have,been testedt;d are operational, as,of the date signed
below..
U,haFva rea�f_a:nd a rhe:t ?cam' w�fil it the;Yer, and cont of,this statement;
x.
.._.....,
ConiacEn Name::
! n
Signatue._ .............................. Dale'
Smoke an&CO forn.6c r=evised...03'1T8%Z4)
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE FILE
COMMUNITY DEVELOPMENT UE PARTMENT-8U10.ING DIVISION
'10300 TORRE AVENUE C PERTINO,CA95044-3255CUPERTINO
�l
"I (408)777-3228-FAX(408)777-3333 bui[diR a. laerrino;orr�
Owner Nam C '1 uc�l a P--; :5. KA"y Permit N o
Address
1. Is your real property a registered historical site? 3
❑ Yes Civil Code Sections 1100111..1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
❑ No Go to Question 2. G /V
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.
E The licensed plumber's certification has been,provided to the Building Division.
Skip the rest of the form nd sign bottom .
❑ 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.
z�'' No Go to Question 4. �'�////�
b L /
4. Is your real property built and available for use or occupancy on or before January 1, 1990 21
❑ 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 futures (regardless of whether
property undergoes alterations or improvements).
❑ My property is a-multifamilyresidential 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 wafer-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 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•ff ' Dat6g, 4
Upon cornpleting and signing this Certificate,please return it to the Building Division in order to final your building per.mit. '
SB40:7 2015.doc revised 08126115