15090167 SMOKE/WATER SMOKE I CARBON MONOXIDE ALARM
.w V . OWNER CERTFI TF COMPLIANCE. FILE
COMMUNITY DEVELOPMENT DEPARTMENT.BUILDING DIVISION �(.�—i -
UPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 90014-3255
(408)777-32,28
o FAX 408)77 -333-building o)
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PERMIT CA TOT BE FIINALED AND COMPLETED UNTIL TI RS CERTIFICATE TOTAL)
HAS BEENI��T, i AND RETLRi D TO THE BUI LDLNG 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 R314, 2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
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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
bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-bunging appliances and that
do not have an attached garage. Carbon Mzonoxide 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:hi dwelling units with no commercial power supply, alarm(s)may be solely battery operated.
--in existing-dwellhwaits;a arms-are-perniitte—d-to-lie sd el atfer` opera e-d--v efe repairs or-a era ons 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 alarm(s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
arld California Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
I have read and aree to compl with the terms and conditions of this statement
El v mer(or
Ow.ner Ag rt"sy Name
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dr frac or Name:
Signature........................:..........................................Uc.#......................................Date: ...................
Smoke mud CO.form.doc revised 03118114
i WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE t)F COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CUPERT 10300 TORRE AVENUE•CUPERTINO,CA 95014-3265
INO
(408)777-32 F (408)777-3333 builbin cuoertino.or 1
Owner Name i I Mi:." Permit N o. (�_p-71
Address &C V
1. , Is-your real-property a registered historical site?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
JK 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 Mures is not:technically feasible?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
0 The licensed plumber's certif cation has been provided to the BuiFdin Division. _ _. _ __. ___
Skip the rest of the form and sign bottom of form.
l No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
J4 No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
0 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.
V Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONTE- of the following:
El 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 futures throughout the building.On or before January 1,2017,all non-
compliant plumbing futures shall be replaced with water-conserving plumbing fixtures (regardless of whether.
property undergoes alterations or improvements).
K Mypropertyis a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014,specified building alterations or improvements shall require non-compliant
�� inb u es to e rep ace1 ua er-consen ing p um ing rxlUres.
On orbefore January 1, 2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing Mures throughout the building(regardless of whether property undergoes alterations or
improvements).
Q My property is a commercial real property. See Civil Code Section 1141.5.
On and after January 1, 2014,specified building alterations or improvernents 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).
1,as the owner or owner's agent of this property,certify under penalty ofperjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8,the current California Fluinbing 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 thefollowing page.
e.
Owner or Owner Agent's Signature: [3ate: 'll)O�i 20[5
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doe rei4sed 08126/15