15090167 SMOKE/WATER SMOKE CARBON MONOXIDE ALARMS
'OWNER CERTIFICATE OF COMPLIANCE FILE
COMMUNITY DEVELOPMENT DEPARTMENT s BUILDING DIVISION
UP Ti O : I0300,TORRE AVENUE a CUPERTINO,CA 95014-3255
(408)777-3228-FAX(408)777-3333•_bullding(o-cupertmo.org
Address
N rcx4e #olluarnls. CAT-bon Monoxide.
PERMIT CANNOT BE FIN ALED AND COMPLETED UNTIL TMS CERTIFICATE
S BEEN TF; AND HEMI—MD 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 2013 CRC Section 8314,2013 CBC Sections 420.6 and.907.2.11.2 where no interior access for
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 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 X X
bedrooIIi(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burriing 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 commereial-Power supply,alarms may_o_e solely battery operated._
_ .
exisd-c dvverlu b u ns alarms=are perrru-tted-ro.oz ssely-battery-ogeratea-where-ree=rs-r-aons. o _
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 alarms) 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 have been tested and are operational, as of the date signed
below.
have read and agree to comply with the terms and conditions of this statement .
a,%ner(or ocmer Age ffi;)Name;
Si nature:.. ....... ... .......... . ... .... ......................Da erQ'n.9.0...-. �1
t£aotd Name;
nature......,.o .. .... .......Lid.#.................... Dat
Smoke and CO.form.doc remised 031J8114
-WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPEI2TI iQ 10300 TORRE AVENUE•CUPERTNO, CA 95014-3255
(4Q8)777=3228 FAX{408j 777-3333• buildin4(a-cuoertino.orc
Owner Name �IC11�S Q Permit Na
Address \
1. Is your real property a registered historical site?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sib bottom of form.
k No Go to Question 2.
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures isnot technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
Q The licensed plunber's certification has been provided to the Building,Division.
- � ' ` - Skip the rest of the,form and.sign bottom of form.
1 No Go to Question 3.
3. Is water service permanently disconnected for your building?
11 Yes Civil.Code Sections 110 1.1 through 110 1.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 4.
4. Is your.real property built and available for use or occupancy on or before January 1, 1994?
El No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
91 Yes My real property is built and available for use or occupancy on or before January, 1,,1994. .
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the t1uee.following statements drid'sign
bottom of form_.
5. Please check ONE of the following:
Q My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
9 My property is a inultifaniily residential real property. Sze Civil Code Section 1141.5. -
T=.s__On and after Januai<rJ__24d4 spec�ed_biz1d n t ?ons or- rtvuenner-_tom shall r-equine non- aompliaat -
Min
On or before January 1, 2019,all non-compliant plumbing fixtures shall be replaced with water
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
❑ My property is a commercial real property. See Civil Code Section 1141.5.
On and after January 1, 2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.I
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements, and that the water-conserving plumbing-fixtures comply with the requirements as indicated in the
table on the following page.
I—Date,-
d'o-16 of Owner Agent's Signature:
Upon completing and signing this Certificate, e rete ' to the Bu ing Division in order to'final your building permit.
SB407 2015.doc revised 08126115