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15080091
I CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10745 N DE ANZA BLVD UNIT 101 I CONTRACTOR: GB GROUPPERMIT NO: 15080091 LOWNER'S NAME: JUN QI & XUBO GENG 8921 MURRAY AVE DATE ISSUED: I0/13/2015 OWNER'S PRONE: 4082263300 1 GILROY, CA 95020 PHONE NO: (800)653-7172 V LIC(E�N.SED CONTRACTOR'S DECLARATION License Class Lic.# Contractor Date 4 I hereby affirm that I am licensed under the provisions of Ch pter (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: 1. 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. . 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 permit is issued. APPLICANT CERTIFICATION - I certify that I have read this application and state that the above information is i 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, applicant understands and will comply with all non -point source lation _ the 'lupertino Municipal Code, Section 9.18. Signature Date 1 0 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. I, as 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) 2. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: 1. 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. 2. 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 permit is issued. 3. 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 become subject to the Worker's Compensation provisions ofthe Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION 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, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Date JOB DESCRIPTION: RESIDENTIAL ' [] COMMERCIAL EXTERIOR LOCALIZED LIKE FOR LIKE REPAIRS TO COMMON AREAS OF COMPLEX (UNIT 101 FOR PERMITING PURPOSES ONLY) Sq. Ft Floor Area ! Valuation: $250000 APN Number: 32626031.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPIJCTIONo Issued by:� Date: 1 O '6 RE -ROOFS: 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. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & fety Code, Sections 25505, 25533, and 25534. Owne o tlorizeaagen(, i date: i(; j -' 15 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT' BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 • building(ftupertino.org ' ❑ ADDITION ❑ ALTERATION / Ti, ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS Q A L g APN # P /) OWNER NAME (' !/ _� PHONE 0 Z ' E-MAIL rrPrTi C � IO iJb STREET ADDRESS �® \ • � /1 o j ATE, ZIP �fo Tt , `o FAX CONTACT NAME N / STREET ADDRESS Q�j;(,��p ((��� \ p �U IL ci6dl'�J sr - to 3' PHONE �� ) `f CITY, STATE, ZIP E-MAIL FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT A ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTORNAME _ t I 1J LICENSEBER LIC NSE TYPE 3 - BUS. Lie COMPANY NAME # STORIES E-MAIL TYPE OCC. FAX STREET ADDRESS tA U gkkl� CITY, STATE, ZIP NEW FLOOR. AREA DEMO AREA PHONE ARCHITECT/BNGINEERNAM•E LICENSENUMBER BUS. LIC# COMP NAME - E-MAIL �'S y Fnu6 FAX STREET AD RESS tn�U1 t<<,A 1 cf1Z0(-t_&_ 16 CITY, S A ZIP RWI A1n A// rA �f 4( -7 PHONE 1 r DESCRIPTION OF WORK EXISTING USE - PROPOSED USE - CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG AREA NEW FLOOR. AREA DEMO AREA TOTAL NET AREA _ ' BATHROOM REMODEL AREA - KITCHEN - - REMODEL AREA OTHER .. REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA []DETACH - ❑ ATTACH - - - - i wna.a.u�v UtVll J:. 11, AlIM'Ul411 UI1111 LJYrb brLUAL)b1UKY LJYth BEING ADDED? []NO ADDITION? [JNO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YESRECE eco D $Y _ ALUATION: PLANNING APPL # NO PLANNING APPROVAL LETTER EICHLER HOME? E] NO _ By my signature below, I certify totof ollowing: I am th propertyowneror authorized agent to act on the property owner's behalf. I have read this application and the information I his c ect. I have rad theDescription of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relatingtruction. I autho ize p sentatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: A - t ( i _ New SFD or Multifamily dwellings: Apply for demolition permit for existing building(s). Demolition permit is required prior to issuance of building permit for new building. _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. _ Copy of Planning Approval Letter or Meeting with PIanning prior to submittal of Building Permit application. B1dgApp_2011.doc revised 06121111 CITY OF CUPERTINO FVV FNTIMATnD — R1T11.7n11VC_'nYXT1rQ1rd-1XT ADDRESS: 10745 N DE ANZA BLVD DATE: 08/1112015 REVIEWED BY: SEAN APN: 1 4- 1 &2! *VALUATION: 1$250,000 *PERMIT TYPE: Building Permit PLAN CHECK TYPE: Alteration / Repair . PRIMamwe ARY Multi -Family Dwelling USE: Buildina is PENTAMATION PERMIT M >3 Stories E) Yes 0 No� TYPE: 1GENRES WORK EXTERIOR LOCALIZED LIKE FOR LIKE REPAIRS TO COMMON AREAS OF COMPLEX (UNIT 101 SCOPE FOR PERMITING PURPOSES ONLY) I 01111er A'fech. [nsy)'� IAlech. hup, Fee: 0iher.P1,,,wib his.n I'Itin7b. hisp, Fee: Other hh,C. 111SJI. E -lee. Imp. Fee: NUIE.-This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. efr.)_ Thorn fp.-v aro havod n" fho prolimi"ary i"fnrmi7fin" lyw7ffiAlo ty"d arp nyihy im aviimah, I-ymfart tho Dont fnr add"11 infn_ FEE ITEMS (Fee Resolution 11-053 Eff. 7IL13 FEE QTY/FEE Alecl Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 1'hopib. Plan (711 C C k A Suppl. PC Fee: (j) Reg. 0 OT M E""ec. Nan $0.001 .We'J1. Pejwzil Fee: $0.00 1 [Phimb. Per Ji Fee:el-11-Ift Permit Fee: Hourly Only? 0 Yes (F) No $0.00 Tee: I 01111er A'fech. [nsy)'� IAlech. hup, Fee: 0iher.P1,,,wib his.n I'Itin7b. hisp, Fee: Other hh,C. 111SJI. E -lee. Imp. Fee: NUIE.-This estimate does not include fees due to other Departments (Le. Planning, Public Works, Fire, Sanitary Sewer District, School District. efr.)_ Thorn fp.-v aro havod n" fho prolimi"ary i"fnrmi7fin" lyw7ffiAlo ty"d arp nyihy im aviimah, I-ymfart tho Dont fnr add"11 infn_ FEE ITEMS (Fee Resolution 11-053 Eff. 7IL13 FEE QTY/FEE MISC ITEMS Plan Check Fee: Hourly Only? 0 Yes 0 No $0.00 2 hours Plan Check, Hourly $286.001 ISTPLVCK A Suppl. PC Fee: (j) Reg. 0 OT M hrs $0.001 PME Plan Check: $0.00 1 Permit Fee: Hourly Only? 0 Yes (F) No $0.00 Suppl. Insp. Fee -E) Reg. 0 OT Q 0 hrs $0.00 1 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Cl)nsiruciion Tcllx: Fee: 0 (a Work Without Permit? 0 Yes Q) No $0.00 Adyanced.Plqj2nin Fee:$0.00 hours Inspections ]0 $1,144.001 ISTINSP Inspection, Hourly E) 1'rav�!1,Doc*.,zji,ne!ntoiie)i7, fi'ees: Strong Motion Fee: !BSEISMICO $70.00 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $10.00 ' ST $80.001$1,430.00 $1,510.00 Revised: 07/02/2015 SMOKE ! CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION CU PERTI N O 10300 TORRE AVENUE - CUPERTINO, CA 850143255 (408) 777-3226 - FAX (408) 777-3333 - twiid1nod1b2Lg rNno ora PEPMT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED, ],AND W TO THE BUH DWUpMSION PURPOSE This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R3146 R315,2016 CBC Sections 420.6 and 9072.113 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 ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom s — Smoke alarms shall not be located within 3 feet of bathroom door X X 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 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 California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. Address: I07+s' N PS $►Lv� �j- lob 6'Vfflf10V# ""PermltNo. Mala) Specilj Number of Alarms: # Smoke Alarms: # Carbon Monoxide Detectors: to Compdv with the terms and cmdIbns of this & (Of twv Smote and CO form.doc m*ed 01/1012017 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION C U P E RT I N O I 10300 TO RRE AVENUE • CUPERTI NO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - building0cupertino.ora PERMIT CANNOT BE FI(NALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED. SIGNED, AND RETURNED TO THE BUILDING DIVISION , 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 ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) — Smoke alarms shall not be located within 3 feet of bathroom door X X On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room I 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 California Residential Codes. The alarms specified below have been tested and are operational, as of the date signed below. Address: 10745 N De Anza Blvd Unitl 11, Cupertino CA 95014 Permit No. Specify Number of Alarms: # Smoke Alarms: l 4 I # Carbon Monoxide Detectors: r� I have read and aaree to comoly with the terms and conditions of this statement Owner (or Owner Agent's) Name: Vi'a a Lakshmi Pamidi Signature ................ ....................................... ....... ............ ............................. Date:Q51.1.9J2Q Naam�e: ) 4101-1111 Co tra ( � [Jctor f fiiC• Si natur ic.# ..10A7.......t8............. Date:I ..... 7 Smoke azul COjorm.doc revised 01/10,2017 CUPERTINO SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 (408) 777-3228 - FAX (408) 777-3333 - guilding6cuoertino.ora PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED, STQNED, AND UJ 1. L RNED TO THE BUILDING DIVISION 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 8314, 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 ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) — Smoke alarms shall not be located within 3 feet of bathroom door X X On every level of a dwelling unit including basements and habitable attics X X Within each sleeping room I 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, alann(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 instntetions 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 below.�/�C, LX 403 ( Chi C��p/ 1 Address: 1v f t V �� Dv Permit No t50�B Specify Number of Alarms: # Smoke Alarms: 1 1 # Carbon Monoxide Detectors:. 1 have read and actree to coMply wkkthe terms and conddions Owner tor Owner � e 0 G tr'I ��i oG�._ ���z�/� % Sfanature.............................................................................................. Date:................... Name: a Smoke mxt COfam.doc revised 01!102017 Oak Park Terrace Homeowners Association August 13, 2015 Dear Ms. Names, As the Agent for the Oak Park Terrace Homeowners Association, the Board is fully aware of, and authorizes the proposed voluntary exterior common area repairs at the project, Oak Park Terrace. Furthermore, the Oak Park Terrace Homeowners association is aware of, and authorizes the use of Unit 101 for purposes of obtaining 1 permit for these exterior common area repairs. If you have any questions, please contact me directly at (408) 226-3300. Sincerely, On Behalf of the Board of Directors Cr ig Cordi, CCAM Community Manager Compass Management Group, Inc. 77 Las Colinas Lane San Jose, CA 95119 (408) 226-3300 (Office) (408) 226-3406 (Fax) CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: 10745 N. De Anza Blvd. PERMIT #15080091 OWNER'S NAME: Jun Qi & Xubo Geng PHONE # 408-848-8118 ext. 127 GENERAL CONTRACTOR: The G.B. Group, Inc. BUSINESS LICENSE # 022367 ADDRESS: 8921 Murray Ave. CITY/ZIPCODE: Gilroy, CA 95020 *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTIONS) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring / Carpeting Linoleum / Wood X Glass / Glazing Central Glass Industries '�Ll Heating Insulation Landscaping Lathing Masonry Painting / Wallpaper Paving X Plastering A&S Painting and Plastering, Inc. Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile G( m n . 17 Owner / Contractor Signature D e CONTRACTORS CONSULTANTS CA 6809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. J _ 1� Property address: �� I I A!\ Building Permit #: �;nRn9� I am the O Contractor, • Owner, or O Authorized Agent. h p -t I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 1 O Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. !7 a 0 Carbon monoxide d Print Name have been installed as required by the CRC and the manufacturer's recommendations. 1 / v)- 7 Date I),' V(,✓e, Mailing Address City, State, & Zlp Code 0 og Phone Number Smoke detector and CO detector were installed by: (I L--�V (aq 2 l kvrrPSA< jc_° , C&AN CA , 5071) � � �e efig Street address, City, & Zip Code ne Number CONTRACTORS CONSULTANTS CA 680918B C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Old, Property address: /074% — N. De Aw Olvd. 4103 Building Permit #: C Ei D _ Q0 f ( I am the O Contractor, • Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 0 Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. 0 Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Z Signature Date Print Name Phone Number lops' AL 92-A419, g/id 9103 Mailing Address Ccge(—Ino CA qS 6/v, City, State, & Zip Code inS W—L��' Smoke detector and CO detector were installed by: 3ec (co) & h � pudl,.�S J V fn-zls' iy. De Ama. 131 d. #l03 6Y>6 • SY1 -M11- Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6B0918B E33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM <� kap California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: N1 12 (05 Building Permit #: LC,4 tY, I am the O Contractor, O Owner, or O Authorized Agent. VWreby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. 611' lw Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. l 0 -Tc, --n 2,, t Si Date b�u&n,i& RA -1 L� — Print Name Phone N tuber Mailing Address �qx> r,o City, State, i Zip Code Q� Smoke detector and CO detector were installed by: C) LT, Cc)n1 i CAo�rJYno1Cp— CAC>CAOV - \/ Street address, City, & Zip Code Phone Number 4 CONTRACTORS CONSULTANTS CA 6809188 E33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: l 17 '4- q 5 N • D 15 A Nxa P) INI � • Ok& Building Permit #: E -a' C,0T UFT 1 N 0 C -h °(5 0 t I am the O Contractor, Vowner, or O Authorized Agent. I S �C)oo / I�herreby declare and certify, under penalty of perjury under the laws of the State of California, that: 6Y Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. r-� a O Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. — 10 b 0- t td t11td k� tzf��) 116 Signature Date g15Rhs J) A- UA -L '+aS•69 864 Print Name Phone Number IVTL�5 N•W AN7-h- Blvd. Mailing Address GOPEPTINO cA g501(c City, State, & Zip Code Smoke detector and CO detector were installed by:,7,5roo V -P- �`� �`� IKR TAW bc:0ld Street address, City, & Zip Code Phone Number CITY OP ^ FORM #34611/21116 SUBJECT TO CHANGE s JOSE Smoke Alarm and Carbon Monoxide CAPITAL OF SILICON VAIJA.'y )/�� r+�9 ' planning, %iifilding and Alarm (,.,� ff i d �. ]Vit Codc 0dorccufcnl f ♦ CA I This signed verification must be completed prior to the final inspection by the City of San Jose California Residential code (CRC) sections 8314 and R315 requires smoke and carbon monoxide alarms to be installed in all residential buildings. Smoke and carbon monoxide alarms are permitted to be battery operated in buildings where no alterations are performed on the interior. Smoke, carbon monoxide or multiple -purpose alarms (carbon monoxide and smoke alarms) must be approved and listed by the State Fire Marshal. For an approved list of alarms, go to littp:llosfm.fire,ca.gov. The devices must be installed per the manufacturer's Instructions. Please Print: PERMIT NUMBER. i Humber. `o - i Street: 10 +f.� i.� S L— �N ?i'6� City: Zip:: PROJECTADDRESS. VV San JOS. ___ L.UL 1� _�U-t� l✓cl._ tit o. _ C-4 PROPERTY OWNER:I S A \A'R'R l {Z,4}. p G, D T 'K T -- ALARM LOCATION REQUIREMENTS Smoke alarms are installed and functioning: 1. In each sleeping room. 2. Outside each separate sleeping area in the immediate vicinity of the bedrooms. 3. On each additional story of the dwelling, including basements and habitable attics but not including crawl spaces and uninhabitable attics. In dwellings or dwelling units with split levels and without an Intervening door between the adjacent levels, a smoke alarm installed on the upper level shall suffice for the adjacent lower level provided that the lower level is less than one full story below the upper level. Carbon Monoxide alarms are installed and functioning: 1. Outside of each separate dwelling unit sleeping area in the immediate vicinity of the bedroom(s). 2. On every level of a dwelling unit including basements. I hereby verify that smoke alarms and carbon monoxide alarms have been installed in compliance with current California codes and all alarms have been tested and are functional for the above permit. I am the (check one): O licensed Contractor Wroperty Owner =sem' Yv- -- - C C) D SIGNATURE PRINT Name DATE llPbce-bpi!;Ii+g2i,6u��9: ;O:r:;i•mCr-!Irurel�BGlIE'OtFS rot C^ tct I)I- , is ?r,..vvLs.IAr!uw SAIL 't:.n i Ity Hall, iC.i} . Saui.1 Claw SC- SX1 CONTRACTORS CONSULTANTS CA 5809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line -eplacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: > _ Building Permit #: CVS 2TcN 6 CA, I am the O Contractor, O Owner, or O Authorized Agent.® Zw Le r II hereby declare and certify, under penalty of perjury under the laws of the State of California, that: G -"*` Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. OY Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. 011.�3i� Signature Date Uma Wrejesool Print Name Io7�5 IJ De Anza. &4d tII0 Mailing Address n r[,r no City, S ate, & Zip Code - 950( Re n te'r Phone Number Smoke detector and CO detector were installed by: E291tTML Af>A)f=Imp(�`in Q-C�O� C, Street address, City, & Zip Code Phone Number 1 CONTRACTORS CONSULTANTS CA 6809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: 10-7 Q �-N 8, AJtl;;Li4 ,SL>/� 1 Building Permit #: 150R oc)q Lgf6RT)A)0 11 S-0 y I am the O Contractor, • Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: O Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. 0 Carbon monoxide dettor e been installed as required by the CRC and the manufacturer's recommendations. 0 2— Signature Date /Ul VRf}L I d /-%.A z PR6X'S,Scs Print Name f O7u c DX 4IVV2-,t '!�Lt/i) )1 Z Mailing Address C l� �� i /W a C'F7- Phone Number City, State, & Zip Code S O KLtt. 1 E C D lit ��' 1 `- Smoke detector and CO detector were installed by: C D d tt 2 cf-d✓ ' -- '1,,k ( b 7 G g N D of Ag -)A $ Lw #F I f Z-- cvpaTyr nq D $ -7 ZS- O ti 2 -8 - Street address, City, & Zip Code 4l "!y Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: I04s, N �.) 1;� �,��1 . U Iti L 113, Building Permit #: /508W2.1 I am the O Contractor, O Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 0 Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. © Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. i Signature Date 9 z &sec: Print Name Phone Number 107,6!9 N Dt Arr,c, blvd (l �, 1 15 Mailing Address � ,e nft City, Sta e, & Zip Code Smoke detector an CO detector were installed b Ayre PC m r, b-ro4r &J,, &, kd g /0 : l .-t. ,L( Iw Cc 0 h- . PIU 4 Ca, bon MonvxicjL c&L-Ywm t L`,1SWpd q�7z C P i'rsl .Ater( bra"d ) . Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: l L 7 ' N as A Ni -A ��— Building Permit #: C L)PECI 1 Nd (A 0/ S-0) � 15�goo�l I am the O Contractor, *Owner, or O Authorized Agent. 1 hereby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detect rs have been installed as required by the CRC and the manufacturer's recommendations. 12- (23 Signature Date Print Name Mailing Address C i fC R T f /\l b i L,4 01 1,7o J C� City, State, & Zip Code i L o � Phone Number Smoke detector and CO detector were installed by: AI ,, rI & Street address, City, & Zip Code Phone Number 'Smoke Alarm and Carbon Monoxide Planning, Building wird Alarm Affidavit Code Enforcement California Residential code (C RC) sections R314 and 8315 requires smoke and carbon monoxide alarms to be installed in all residential buildings. Smoke and carbon monoxide alarms are permitted to be battery operated in buildings where no alterations are performed on the interior. Smoke, carbon monoxide or multiple -purpose alarms (carbon monoxide and smoke alarms) must be approved arid listed by the State Fire Marshal. For an approved list of alarms, go to http://osfm.fire.ca.gov. The devices must be installeo per the manufacturer's instructions. Please Print: ALARM LOCATION RE( Smoke alarms are installed 1. In each sleeping room. 2. Outside each separate 3. On each additional sto and uninhabitable attic adjacent levels, a smol lower level is less than street: REMENTS I functioning: City: Zip: eeping area in the Immediate vicinity of the bedrooms. of the dwelling, including basements and habitable attics but not including crawl spaces In dwellings or dwelling units with split levels and without an intervening door between the alarm installed on the upper level shall suffice for the adjacent lower level provided that the ie full story below the upper level. Carbon Monoxide alarms ate installed and functioning: 1. Outside of each separite dwelling unit sleeping area in the immediate vicinity of the bedroom(s). 2. On every level of a dw Iling unit including basements. I hereby verify that smoke Olarms and carbon monoxide alarms have been installed in compliance with current California codes and all alarms have Oeen tested and are functional for the above permit. I am the (check one): ❑ tl: Contractoiroperty Owner '11 PRIN! Name W CONTRACTORS CONSULTANTS CA 5809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. I /� [[1J �" Property address: Io �5 /. AP rl za W� X 11 Building Permit #: 15 a ,2() 09T_ I am the O Contractor,wner, or O Authorized Agent.ec+>7J r I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 10 Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detectors h been installed as required by the CRC and the manufacturer's recommendations. 2e-,�', i 1-;�, Signature Date e i SGS - z 9 C� 5 - Print Print Name Phone Number Mailing Address City, State, & Zip Code Smoke detector and CO detector were installed by: -pF IJAJ 9 tZM(14 S . C (9., Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. �!1 Property address: ' �� S W 01E A-V 2-A 131,09 UN 1 T 12.( Building Permit #: r U [� 9l I am the O Contractor, O Owner, or O Authorized Agent. f�Fkw; I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: ® Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. 0 Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signatu - Date Print Name 1014s N X A±!2 -A fl,D Wj 1,r 1 u Mailing Address City, State, & Zip Code Phone Number Smoke detector and CO detector were installed by: PE A.Jia l i2 07 -1 -(c -/Z �, _ r0 Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 5809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: h% Atv2.l-)- ALVD 4 0- 3 Building Permit #: 1508002/ ,u peen i t -o Yt 17 I am the O Contractor, 0 Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. �. Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signature Date Print Name Phone Number A�Q/-) 13L -VD 2, Mailing Address L G(PC-)2T[AJQ City, State, & Zip Code Smoke detector and CO detector were installed by: L L�' /����E--;24oCZM66!:3CC'C;P—. z3 12 -TIN 0 , CA qSD I� Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 68O918B C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line -eplacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. n' �l Property address: U nE ���/ SL �7 (� � Building Permit #: 1 5[) R QQQ 1 I am the O Contractor, O Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. ® Carbon o oxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signature Date Print Name Phone Number Mailing Address CpA- o City, Stat , &Zip Code Smoke detector and CO detector were installed by: Street address, City, & Zip Code v Phone Number CONTRACTORS CONSULTANTS CA 5809186 E33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit re�fecr;e ed below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. l v Property address: 0 Building Permit #: I am the O Contractor,-ofOwner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: ' Smoke detectors have een installed as required by the CRC and the manufacturer's recommV tion ns. �Q O Carbon m oxide Bete tors have been installed as required by the CRC and the manufacturers recommendations. 01-'r 2z/ 6 Signa ure Date �; I "r— I LA 10 ) -1-5- IL (� -76 71� Print Name Phone Number Mailing Address C,&A- �� ' 7 ( City, State, & Zip Code I \ Smoke detector were installed by: Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: to IV (1(�� (�2 �2�1 rJ�y Building Permit #: 15 o 8 a( l I am the O Contractor, ® Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: ® Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. ® Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signature Date Print Name Phone Number Mailing Address City, State, & Zip Code Smoke detector and CO detector were installed by: &AL4 Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 680918B C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line -eplacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: 16 -4 4 S A)c^r it, ik Arl2g 6tj4 j aA j'l Building Permit #: 0 i (1,( q A QTl� Zk 'Z -- I am the O Contractor, 9'Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: ®' Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detector have been installed as required by the CRC and the manufacturer's recommendations. Sign atur `/ Date 1ZZ 6 � h� i r //'o/1 sem/ i> Print Name Phone Number i (ti.-{ Flaw or- A)zh. 91 \l�_- `112 Mailing Address �A tNn C'P ' City, State, & Zip Code / / Smoke detector and CO detector were installed by: h I l ��/� i l i�,� �E f� �('7 r • 6- P C v/U57 VC,1(0i Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 680918B C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: tl (U 7 H S N J)E P A a Quid - uN►r Building Permit #: ZI I am the O Contractor,911owner, or O Authorized Agent. curce r(No - ck - 9 SJ 1 i I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: eSmoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. TAr-Zo17 Signature~ Date CIaUr-RV nf'IJ.t L}Ot '1ZS"3OIO Print Name Phone Number 107AIS C At f-4 v- VN1-1 ZII Mailing Address Lv'�rei,N�' City, State, & Zip Code Smoke detector and CO detector were installed by: Smoke 7)e L+WCc}or 64 13 u " I d e✓ ca De4etfo✓ bw So O , Street address, City, & Zip Code f Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 31S requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: 11)44k /U, D. An�-4 81VA t 7 Building Permit #: i 5X� A. 004' � I am the O ContractorAawner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: " Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detectors ha been installed as required by the CRC and the manufacturer's recommendations. Signature Date hG Print Name Phone Number Mailing Address City, State, & Zip Code Smoke detector and CO detector were installed by: nt 3 ;)14 E'V OBJ 12142 9J r Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 5809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address.- � 7 S� Gtr Building Permit #: ( 4 6---0 ✓ I am the O Contractor, QiOwner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 0 Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon mono i e detectors ha a been installed as required by the CRC and the manufacturer's recommendations. Signa Date VD S�_ 3 Print Name Phone Number Mailing Address ,ISS r4 - City, State, & Zip Code Smoke detector and CO detector were installed by: k-- .l�►+c �1 t,.LP,c.[ �J� Street address, City, & Zip Code Phone Number 'Smoke Alarm and Carbon Monoxide Planning, Buildingatd Alarm Affidavit Code Enforcement California Residential code ( RC) sections 8314 and R315 requires smoke and carbon monoxide alarms to be installed in all residential buildings. Smoke and carbon monoxide alarms are permitted to be battery operated in buildings where no alterations are performed or, the interior. Smoke, carbon monoxide or multiple -purpose alarms (carbon monoxide and smoke alarms) must be approved arid listed by the State Fire Marshal. For an approved list of alarms, go to http://OsfmJire.ca.gov. The devices must be installed per the manufacturer's instructions. Please Print: ' r Number:l Street: City.tCity.n, Zip: }pIrSS PROJE�CTAt; ii - - .C._..._ A I_..�r1�-.._.._.�.��..._ ALARM LOCATION! REOUIREMENTS Smoke alarms are installed hand functioning: 1. In each sleeping room. 2. Outside each separate sleeping area in the Immediate vicinity of the bedrooms. 3. On each additional story of the dwelling, Including basements and habitable attics but not including crawl spaces and uninhabitable attlirs. In dwellings or dwelling units with split levels and without an intervening door between the adjacent levels, a smo a alarm installed on the upper level shall suffice for the adjacent lower level provided that the lower level is less than one full story below the upper level. Carbon Monoxide alarms ake installed and functioning: 1. Outside of each separ to dwelling unit sleeping area in the immediate vicinity of the bedroom(s). 2. On every level of a d fling unit including basements. I hereby verify that smoke codes and all alarms have I am the (check one): ❑ , 51 NATURE ns and carbon monoxide alarms have been installed in compliance with current California tested and are functional for the above permit. Contractor i &roperty Owner i Name ACT— PRINT AATs CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line -eplacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: 1`4- tk, 41-Y7-1 '3�-21S Building Permit #: 15 I am the O Contractor, O Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: ® Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carb onoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signa Date S5 Q Print Name Phone Number 1,0'1 1-�s n IrA-, 2, L - Mailing Address p� City, State, & Zip Code Smoke detector and CO detector were installed by: O fel U 4 o a � �, �, Z Street address, City, & Zip Code Phone Number CITY of �" s JOSE CAPITAL OF SILICON VALLEY FORM #346 11/21/16 SUBIECTTOCHANGE Smoke Alarm and Carb®n Monoxide Planning, Building and Alarm Affidavit Code Enforcement This signed verification must be completed prior to the final inspection by the City of San Josh California Residential code (CRC) sections R314 and R315 requires smoke and carbon monoxide alarms to be installed in all residential buildings. Smoke and carbon monoxide alarms are permitted to be battery operated in buildings where no alterations are performed on the interior. Smoke, carbon monoxide or multiple -purpose alarms (carbon monoxide and smoke alarms) must be approved and listed by the State Fire Marshal. For an approved list of alarms, go to http://osfm.fire.ca.gov. The devices must be installed per the manufacturer's instructions. Please Print: PERMIT NUMBER: PROJECT ADDRESS: Number: Street: City: Zip: it r j�� 1 I ( (`� q I tl li �� -�� lV Vii- ��-� l j �` maL � t S� PROPERTY OWNER: LICENSED CONTRACTOR: ( ? C� ALARM LOCATION REQUIREMENTS Smoke alarms are installed and functioning: 1. In each sleeping room. 2. Outside each separate sleeping area in the Immediate vicinity of the bedrooms. 3. On each additional story of the dwelling, including basements and habitable attics but not including crawl spaces and uninhabitable attics. In dwellings or dwelling units with split levels and without an intervening door between the adjacent levels, a smoke alarm installed on the upper level shall suffice for the adjacent lower level provided that the lower level is less than one full story below the upper level. Carbon Monoxide alarms are Installed and functioning: 1. Outside of each separate dwelling unit sleeping area In the immediate vicinity of the bedroom(s). 2. On every level of a dwelling unit including basements. I hereby verify that smoke alarms and carbon monoxide alarms have been installed in compliance with current California codes and all alarms have been tested and are functional for the above permit. I am the (check one): ❑ Licensed Contractor Si Iroperty Owner Gary Lin / Property Manager PRINT Name DATE 3121/17 \\Prce-buMing2\8u11diog Dhisfon CollaleraPiBULLEi1NS San Jose Permit Center 408-535-3555 lvwnv.sanjoseca.gov/building San lose City hall, 200 E. Santa Clara St., San Jose, CA 95113 CONTRACTORS CONSULTANTS CA 5809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: ID -7 4 S Iv . �)?, 011&k F,(Vd Building Permit #: C n8009/ I am the O Contractor, O Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: ® Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. ® Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. DW66��- 121&1� Signature v Date � IC '16k,415 -2(g Print Name Phone Number LD74S; ►�. �E ALiza SIvd_ t # gl� Mailing Address C',u 0a, CH 5dlI�- City, State, & Zip Code ' Smoke detector and CO detector were installed by: 'BL6 ae- Y Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: �C I �f�� N DLA QLuiU . t� 2.21 Building Permit #: fl v � v I am the O Contractor, .Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 0 Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. ® Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. L;l 0112—C) Signature Date 3N1ti Print Name Phone Number (�. Pt 6L -o. `{ zzi Mailing Address City, State, & Zip Code t Smoke detector and CO detector were installed by: 0 12 I . CM �'��2(1 I S()(�I If ok ST L LZZ3 Street address, City, & Zip Code Phone Number b flcolr) CONTRACTORS CONSULTANTS CA 680918B C33 NV 48930A - C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: ICIL5Building Permit #: l I am the O Contractor, O Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: `Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. O Carbon mo oxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signature Date Print Name Phone Number Mailing Address o'.- JVN \" C ,N ck5o l C_ City, St te, & Zip Code Smoke detector and CO detector were installed by: w..� ��, ;. �c� S, Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. tt nn_J1 Property address: )04511 19,° Q>4 WiX i'- 4gc4� Building Permit #: ow 4 4 1 am the O Contractor Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon mqnoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Si dn dtur Date Print Name Phone Number ; 'Mailing Address City, St$te, & Zip Code Smoke detector and CO detector were installed by: W7", 4e� 1oYi!'O�fS Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: %a "7 4 S N OZ P&T4 G "0 *-30} Building Permit #: I am the O Contractor, O Owner, or ®'Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. 0 Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. JKI� l,:- , ZO f Signa ure Date 546-a6ag{ Print Name Phone Number a7y-�5 l ailing Address , ner.- , CA 9 5Cf 7 City, State, & Zip Code a4 Smoke detector and CO detector were installed by: 7k—. - l-&2 AR nT ie-� - Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line -eplacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. �/ i� Property address: l � �/ Y,5 �bAu iJ I /� n�9ti �Iyd Building Permit #:1"4- I am the O Contractor, O)Owner,orized Agent.y lGo'* I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. C� Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Sign ture Date 14,75C n - Print Name Phone Number Mailing Address r l 0— 0 0'e, V --C i V) City,, & Zip Code Smoke detector and CO detector were installed by: Y Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 680918B C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 31S requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: S2, Building Permit #: J C---%t1%C1C\!R t I am the O Contractor, 6 Owner, or O Authorized Agent. I her by declare and certify, under penalty of perjury under the laws of the State of California, that: 7Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. A' Carbon monoxide detector een installed as required by the CRC and the manufacturer's recommendations. Sig Date Print Name Phone Number All v Siling Ad&ess City, State, & Zip bode Smoke detector and CO detector were installed by: 0'64A�IQ �C� r OQ? 32�Q� c(r) Z�2 TOc k,'( Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: r..Olt-t5 N - PfA`lA'bu\ (3 V t� Building Permit #: -G,,° K I am the O Contractor, G'Owner, or O Authorized Agent. 150 gOOC?/ I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 0 Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. C Carbon monoxide detectors have LL,een installed as required by the CRC and the manufacturer's recommendations. Signatu a Date Print Name Phone Number io74r N. - Mailing Address t:n/14 City, StAte, & Zip Code Smoke detector and CO detector were installed by: '2.C-A,)A; !, �� �j/F 25 C Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address:�0� e "'�� V l�{� 1� 7V I Building Permit #: i C:� � A® b I am the O Contractor, Owner, or O Authorized Agent. G�`� v �� � I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. � J &!� 0 Signature II Date Print Name Phone Number (o�4S �J Pe Arm R14 UntTT vl Mailing Address RN -j -r 0 (-(+ Y gym( City, Statb, & Zip Code Smoke detector nd CO detector were installed by: Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 8809188 E33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. ra Property address: ID 7 i A) • li Building Permit #: no91 Lf I am the O Contractor, ewner, or O Authorized Agent. 6A" I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: �Q Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signature V, ) Print Name Mailing Address City, Stote, & Zip i % /7 Date Ph ne.Nu er / Smoke detector and CO detector were installed by: -A� S Street address, City, & Zip Code Phone f4bmber 1 CONTRACTORS CONSULTANTS CA 5809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: 1 p 'ltt-S NiJe-A- 2--;;z- R CQ4 Building Permit #: 15060091 I am the O Contractor, Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. 1.a12-�1� Signature Date r�Wru h��ah c7�wlan/ciV0,,h tP o$ '?`iG ►'G2_.2' Print Name Phone Number 11311 "- 4 fl 0 - Mailing Mailing Address UTCAk'A' 011 City, State, & Zip Code Smoke detector and CO detector were installed by: Lee—AuN Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 580918B C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: �� 7 4 ��� �� , n,Fa, I�w c�41�t�,V;D ( Building Permit #: Q I am the O Contractor, 0Owner, or O Authorized Agent. 150800q/ I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: ® Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. 10 Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. t, . Signature Date Print Name Phone Number /c27z� Mailing Address C apiq-4-1�0 City, State, & Zip Code Smoke detector and CO detector were installed by: Street address, City, & Zip Code ,- P, - CA 24 17 -33 Phone Number CONTRACTORS CONSULTANTS CA 6809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line -eplacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. /n Property address: 1��1�9 5 A) SN% AA G Z?(-� Building Permit #: I am the O Contractor, O Owner, or O Authorized Agent. 71 h by declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. ereCarbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signature Date /K /1. CSI e -e k Print Name �o z�( A/r Pe 4n 7N Pipl, Mailing Address State, & Zip Code W 977- Phone Number Smoke detector and CO detector were installed by:�����Ci� Street address, City, & Zip Code Phone Number • * ind.••molngvlrs%ftl'— ' idiom 6�ifii 0"imfloclW16 Utemir4W NA ROKAlitttls0 dvw.am.COW Ob..: 'AdiN"W ftvMMwsft,r lrt,460b: pig d ... Q.wl .0k, .00t.:.. 16 o' 4m t ma." OV: wi IM. Ok P.M. WON—* .. ...... ce .. . . . . . . . . . 'A '34. ce 'A '34. A, CONTRACTORS CONSULTANTS CA 580918B C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: to14-S tA- De t►nZa Vyck V6,13ls Building Permit#: 15o60L1)911 Gu F"no ch-o!;SoIq I am the O Contractor, downer, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 0' Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. TI I I Signatu Date Sai VaAeep VaAKA Print Name 1014.5 N. Dt AV17A Alva Uf1it 315 Mailing Address U/,Pty-tivio , CA — 5501 ,c� City, State, & Zip Code ItOg- 6SS-64-+,q Phone Number Smoke detector and CO detector were installed by: �r�Q aV►Ow �d.PXS r� Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 6809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. nn Property address: O sl✓ P12A . ,(�u` 3]I ^ uilding Permit #: �—E. �« �— I am the O Contractor, Owner, or O Authorized Agent. 1y Smoke declare and certify, under penalty of perjury under the laws of the State of California, that: 4y Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. Carbon monoxide detectors ave been installed as required by the CRC and the manufacturer's recommendations. Q�l li 6/)v1] Signature Date XII o�lo�l C,7 C�-�g) 6 6 -317 Print Name Phone Number 10 ►4, IV Mailing Address I4 - City, State, & Zip Code Smoke detector and CO detector were installed by Street address, City, & Zip Code Phone Number CONTRACTORS CONSULTANTS CA 5809188 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. C� Property address: 16714< u �,� ,4� 8I VD LIMIT 32-1 Building Permit #: � rj Bon / (-Uei AT S+40 CA °ISD 11 I am the O Contractor,)W( 6wner, or O Authorized Agent. IIheereby declare and certify, under penalty of perjury under the laws of the State of California, that: V Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. G- Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signature Date -�2A,,A Liu L 4i` Z 70ti 43690 Print Name Phone Number 1674S- Mailing Address 01 City, St e, & Zip Code Smoke detector and CO detector were installed by: wr.,-f- i aAwlt-- l hn 4, ov✓� T. Street address, City, & Zip Code J Phone Number CONTRACTORS CONSULTANTS CA 68091813 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: 10iLtS o1r+6 Q'AL Amax Blvd.• # SU _ Building Permit #: 15 [),e 0(-)g I/ I am the O Contractor, • Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 0 Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. 0 Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. A� 4,A,- % �& 114114 Signature Date '%$t Print Name Phone Number IMS O S23 Mailing Address C11MY6%0 ,CA "15004 City- , & Zip Code "_ Smoke detector and CO detector were installed by: Vl3ffit0W V%Vr tot 4S N. rit Wbk &A . 14 32 3 (!t 01f ) Y kt , 2.4 �t 3 Street address, City, & Zip Code CV f CA IMOVA Phone Number CONTRACTORS CONSULTANTS CA 6809186 C33 NV 48930A • C-4 78833 SMOKE DETECTOR AND CARBON MONOXIDE INSTALLATION SELF CERTIFICATION FORM California Residential Code (CRC) Section 314 requires that smoke alarms are installed in existing dwellings anytime building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. California Residential Code (CRC) Section 315 requires that smoke Carbon Monoxide (CO) alarms are installed in existing dwellings that have attached garages or fuel burning appliances anytime a building permit with a job valuation of more than $1,000.00 is issued for an addition, repair or alteration. Furthermore, Health and Safety Code Section 17926 states that all single family dwellings that have attached garages or fuel burning appliances must have a CO alarm installed prior to July 1, 2011 and that all other dwelling units that have attached garages or fuel burning appliances must have a CO detector installed prior to January 1, 2013. Smoke and carbon monoxide alarms shall be located outside each sleeping area, in the immediate vicinity of bedrooms and on every story of the dwelling; including basements and habitable attics (split levels are considered one story). Additional smoke alarms are required in each sleeping room and any room with a closet. Work subject to a building permit includes but is not limited to; furnaces, water heaters, sewer or water line replacement, reroofs, etc. This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. , Property address: �d� %� �'C �zk D/� - 3"� , C NAC)Building Permit #: I am the O Contractor, (7Aowner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. i Carbon monoxide detectors have been installed as required by the CRC and the manufacturer's recommendations. Signature Date CH t11 -LIQ l4& I Print Name Phone Number 1 o1 4t r/ Mailing Address Comj?- et% , �I �So1� City, tate, & Zip Code Smoke detector and CO detector were installed by: 5-m lu -e L c (J[;uY ht. i (Xe4r Co OG�; 5el f Street address, City, & Zip Code Phone Number This self certification form may be used if the interior of the dwelling will not be accessible to inspect the placement of smoke and CO alarms at the time of final inspection. The permit referenced below cannot be finalized until this form is completed, signed, and reviewed by a city inspector. Property address: 10 145 RNflf�k a5�21�,Building Permit #: I am the O Contractor, 6 Owner, or O Authorized Agent. I hereby declare and certify, under penalty of perjury under the laws of the State of California, that: 0 Smoke detectors have been installed as required by the CRC and the manufacturer's recommendations. ® Carbon monoxide detectors have been ins alled as required by the CRC and the manufacturer's recommendations. « -:36 - 16 Signature Date r NJ t-tu`y 4�� 7g5 S Print Name Phone Number Mailing Address C OF, aTI NU • City, State, & Zip Code j - Smoke detector and CO detector were installed by: Street address, City, & Zip Code } Phone Number