15110016 SMOKE/WATER r .>
OWNER CERTIFICATE CSFPU CE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228 a FAX(408)777-3333•buildinafc-Dcupertino.ora
. - permit NG,Z. ` ' `ir a rue. Smoke: Carhott�I�ilaxide'
PERMIT CANNOT BE FINALED A_N1 D COMPLETED UJNTIL TMS CERTIFICATE
HAS BEE,N lUN ANI3 RET : T-D TO THE BUILDLNG DI ?'CSII}N
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections-are requ red, -_______
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 dwelIing'units exceeds
$1000.00, CRC Section 8314 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)
Oil every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:Til dwelling units with no commercial power supply, alarms)'may be solely battery operated.
_-_vI.,existmg-d vel?l tg-c zits;alarms-a-re-permit-ted-to be-s,oIely hater-operated=Yvhere repairs-or altteratiorts 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 have been tested and are operational] as of the date signed
below.
I have read and agree to comply With the terms and conditions of this statement
C?cpii�F(or, merAgept's)Name:
-
Sinature... ' At................. ...... ....... .. ........ . ...........Date:
C "'a"t Name:
Si fueic#.. W- TAO .,..Rafe. : .
GIX 12 We< Smoke a=id CO forn.doc revised 03118114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
CUPEFtT[MO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-32 8�F (40 )777-3333^ buildingocuoertino.org <^
Owner Name � � X 4 a ( Permit No.
Address , 2.. C'f— �Ucx @
I. 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.
9 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 Nvater-conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
❑ The licensed plumber's certification has been provided to the Building Division,
kip the rest-of the form and signbottom of form.
I 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 farm.
J l No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
No My real property is built and available for use or occupancy after January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
1 Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
❑ My property is a single family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014, building alterations or improvements shall require all non-compliant plumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
9 My property is a nwltifamily residential real property. See Civil Code Section 11.01.5.
On and after January 1, 2014, specified building alterations or improvements shall require non-compliant
__..._ _rriruzr7n-7�t+zEti�-�v u�.regc�v�u2-wzct�r=cbr5a-c.7-vmg'pnrrzarrg-t3xrurc�: .—`_
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).
Il My property is a con,rnercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's
installation requirements, and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following pago. 4J
Owner or Owner Agent's Signature: Date: 1() 3) DQE
Upon,completing i rd i mn s Certificate,please return it to the Building Division in order to final your buil4ingp r_it.
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