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B-2016-2162 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2016-2162 20697 GARDEN GATE DR CUPERTINO,CA 95014-1905(326 33 01�) ACME ROOFING SERVICES INC LOS BANOS,CA 93635 OWNER'S NAME: ZHANG HE AND HU FANG TRUSTEE DATE ISSUED:06/20/2016 OWNER'S PHONE:510-585-6618 PHONE NO:(408)482-3883 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-39 Lic.#1001790 Contractor ACME ROOFING SERVICES INC Date 03/31/2017 X BLDG —ELECT —PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing MECH X RESIDENTIAL COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my \ license is in full force and effect. JOB DESCRIPTION: TEAR OFF;INSTALL CDX;INSTALL ASPHALT SHINGLES(7 SQ'S) I hereby affirm under penalty of perjury one of the following two declarations: i LI have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labo 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 vork for which this permit is issued. Sq.Ft Floor Area: Valuation:$1800.00 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 APN Number: Occupancy Type: and state laws relating to building construction,and hereby authorize 326 33 017 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 PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.''8. 180 DAYS FROM LAST CALLED INSPECTION. Signature Date_Q/2012016 Issued by:Abby A e� n , Date:06/20/2016 (�1 � OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS- following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for compensation,will do the work,and the structure is not intended or offered for inspection. sale(Sec.7044,Business&Professions Code) 2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant: �✓ contractors to construct the project(Sec.7044,Business&Professions Code). Date:6/20/2016 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER r. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code,for the performance of the ovork for which this California Health&Safety Code,Sections 25505,25533,and 25534. 1 will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become(subject to the air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If,after makin this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent: a!9_� APPLICANT CERTIFICATION Date:6/20/201 I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY correct.I agree to comply with all city and county ordinances anc�state laws I hereby affirm that there is a construction lending agency for the performance relating to building construction,and hereby authorize representatives of this city of work's for which this permit is issued(Sec.3097,Civ C.) to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments,costs,and expenses which may accrue against said City in Lender's Address consequence of the granting of this permit. Additionally,the appl'cant understands and will comply with all non-point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code,Section 9.18. 1 understand my plans shall be used as public records. Licensed Signature Date 6/20 2016 i Professional C REROOF PERMIT APPLICATION COMMUNITY DEVELOP ENT DEPARTMENT-BUILDING DIVISION 10300 TORRE AVENUE CUPERTINO, CA 95014-3255 GUPERTI[�iQ (408)7'77-3228 • FAX(4 8)777-3333-buildinoQcupertino.ora 11 rpi $—ZoL ' ZLCo2 PROJECT ADDRESS ^O 6 Cj,?- ©r` APN n ��� 2 J I O 1 OWNER NAME p` PHONE ' E-MAILQ qp STREET ADDRESS CITY, STATE,ZIP FAX p e.Imo. w 01,VV I,q CONTACT NAME PHONE E-MAIL 4 W2_ 59TO #Wfdeip�9G'J�e:2GbI' Gry Ctt<Ldw� STREET ADDRESS CITY,STATE, ZIP FAX 2- fLo 3Lvoodt C-91- Lo 5 Ery CA7 q,3635— /9'S'.e- ❑ OWNER ❑ OWNER-BUILDER ❑ OWNTERAGENT bNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC. w. sear �s 1. � /00 r c-s 4C�4�5 COMPANY NAME E-MAIL FAX fL "0 ✓V(C0) I V.I-- STREET ADDRESS CITY,STATE,ZIP PHONE 1-11- s .[ cr 10 9-0s Aft-,-S- Co 63 I Z uv-3 A-RCHITECT/FNGrNEERNAME - ARCHITECT/ENGINEERNAME LICENSE NUMBER BUS.LIC:, COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE 4 USE OF 9-1FD or Duplex El Multi-Family ROOF AREA: VALUATION: f STRUCTURE: ❑ Commercial bb r��o EXISTING ROOF TYPE: ❑BUILT-UP ROOF 6-ASPHALT SIIINT`GLES 1:1 WOOD SHAKES ❑WOOD SHINGLES El OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO, PLYWOO - El w, 11PLYWD 11OSB PITCH: ROOF ❑NO R LAYERS THICKI3EI6I S ❑ S/S" TYPE: ®CDX :12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF XASPHALT SHLNLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT R DESCRIPTION OF WORK: 01+x.CL vSkAt1 COLif TIMbprLwu apftoxdt-�. By my signature below,I certify to each of the following: I am he property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply-,with all applicable local ordinances and state laws relating to building construction. I aut�lorize representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: 6 121=0/-Z-o e L� SUPPLEMEINTAL INFORMATION RF UIRED x z Y . If building is associated with a Home Owvner's Assoc ation,provide letter PLAn ci cxTYPEr _. __ ztozrr ncsLrn r. �.� ' of approval from HOA. "ovER THE COUI\TER § a # ~ s L $TJLL b1TG PLAA,�2EVSEP _Provide Planning approval to verify if there any restrictions. NExPxEss � flp3I�II�GpLtAn REViE�'a ;: r Provide copy of Manufacturer's Installation Specifications. ?fl s�Al.na>zn ti L, FrRF]3EpT � Provide signed copy of Cupertino's Tear-Off Policy. wg- LS ,' Reroof4pp_2011.doc revised 03/16/11 7 REROOF TEAR OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 (408)777-3228 • FAX (40 )777-3333•building alcupertino.org PROJECT ADDRESSI APN 2 0(9G1 Wi Oak- OWNER NAME PHONE E-MAIL -Ti q_ �o� ✓L sco C16, STREET ADDRESS CITY,STATE,ZIP I FAX (0 v✓L Ct / rk OA q 0 i N CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.R v eva- 100IT010 COMPANY NAME E-NIAM FAX STREET ADDRESS CITY,STATE,ZIP PHONE (Lo Co 5 6 D17 631— kog C4 n is?V-3 I UNDERSTATED AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply wi all applicable provisions of the 2013 California Codes. 2. An inspection request can be schedul d up to one business day before the requested inspection date. Please schedule inspections online or call (408) 777-3228 from 7:30-3:30pin(Mon-Thurs) or 7:30- 2:30pm (Friday) to schedule inspecti6n. For Tear-Off and Nailing Inspections,you must also call on the day of the inspection only after thatphase of the work is completed. The building inspector will be available within one hour. The hours for this service are: 7:30-10:30am and 12:30-3:30 (Mon-Thurs) .and 7:30-10:30am and 12:30-2:30 (+riday). Final Inspections will be given a two hour window. 3. Tear-Off Inspection is required. Aay and all dry-rotted wood shall be replaced prior to this inspection. Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either completely knocked-down or remo ed prior to this inspection. 4. If plywood is installed, a plywood Nailing Inspection is required. 5. Roofing shall not be.applied without irst obtaining all prior inspection and written approvals from the building inspector. Any roofing whic h is applied without first obtaining an approved inspection will require the removal of all new mater'il down to the sheathing so.a proper inspection can be performed. 6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is completed. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of V4"per foot of slope and demonstrate there is no ponding. b. Listings from approved testi g agencies for all pre-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed. 7. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged are-inspection fee. The re-inspection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I understand and agree.to comply with the re-roof policy stated above. I also understand that smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R3 14 and R315 of the 2013 California Residential Cg4e. Signature of Applicant/Agent: Date:_�fiLu &o�G Reroo)Policy_2014.doc revised 01/15/14 SMOKE 1 CARBON MONOXIDE ALARMS �L OWNER CERTIFICATE-OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION CUPERt'FI o 10300 TORRE AVENUE m CUPERTINO,CA 95014-3255 (408)777-3228 o FAX(408)777-3333• buildina(a,cupertino.ora Permit No.�S ZOt6 .2/`L Address 2060' 0/8CO(Ix q mitt Dr- #of Alarms Smoke: $ Carbon Monoxide 2 PERNIIT CANNOT B FINLED,. tll COMPLETED,'UNTIL THIS GERM IFCA�E H S I3EET1 � �II "T TRNF T) y r O LDS GDI`QIIO H BiII gw PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. 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-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 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 Owner(or Owner Age 's)Name: r Q �� `V Si nature............. .... :... Date: 2 ractor NaammeM �j(i_ r ""/ �Z Signature."), i nature. Lic.#..`4.�< 1.Q...........Date: /if Smoke and CO form.doe revised 03118/14 WATER-CONSERVING PLUMBING FIXTURES FIL OWNER CERTIFICATE OF COMPLIANCE7 1 E ---�_�77�24 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION �'{ cOPI RTiII O 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777- 228•F (408)777-3333 building(@cupertino.org Owner Name Permit No. 26 6 2/6 Address _ PIL( l 1. Is your real prope registered his site?, ❑ Yes Civil Co Sections 1101.1 through 1.101.8 do not apply. Skip the res of the form and sign bottom of for C�/o 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 is not technically feasible? Wes Civil Code Sections 110 1.1 through 1101.8 do not apply. The licensed plumber's certification has been provided to the Building.Division., Skip the rest of the form and sign bottom of form. Lio 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. o Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1',_1994? iNo 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. W,Aes 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. Ple4se check ONE of the following. y 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 unprovements). ❑ My property is 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 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). ❑ My property is a commer&ial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will.be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature: Date: Upon completing and signing this Certif e,please return it to the Building Division in order to final your b ilding jerinit. .SB4072015.doe revised 08126115 S7ILDIluG pEIIT��.L�TflT��FINALED CQN�IL;ETED��TII,THIS mz_ .�,mx •�;usxvnzxm ,rscs•mr„-„y „exnw,.uu�. „„.•«a...�t� r.•m...�r.sN ..-nssxrmxY.sra�r.usrxu�i•;a.�:ro .:.nra»;r.,•:a.rr;,s•;urs�s«. rn vsxsttv.re.. '.•a=�-s:.+µx"i u �z< c.r Non-Compliant Water-Conserving Plumbing Fixture Plumbing Fixture (Fixture Complying with Current Code Applicable to New Construction) Maximum Water Usa a/Flow Rate Fixture Type 2013 CPC Ch. 4 2013 CPC Ch.4. 2013 CPC Ch.4 Water Usage 2013 CALGreen Div.4.3 2013 CALGreen Div.4.3 2013 CALGreen Div. 5.3 /FlowRate Single-Family Multi-Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets ,1.28 gallons/flush effective flush volume (the composite, ” avera e flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead) For multiple showerheads serving one shower,the combined flow rate of all showerheads and/or other shower outlets controlled by'a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow onl one shower outlet to be in operation at a time. Faucets— Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets— Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons per minute 1,8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 ' minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi,and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable,aerators or reduction. other means may used,to achieve reduction. 1. If the existing plumbing fixture water usage/flow rate is equal to or lower than the figure shown,it is not required to be upgraded. SB40 7 2015.doc revised 08/26115 SMOKE / CARSON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE ZZ;� COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 01 10300 TORRE AVENUE.CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228.FAX(408)777-3333.building(a)cupertino.org Permit No.4 2016 .2/(Z Address 20692' Oh n (,¢1 q mt� Q - ##of Alarms Smoke: $ Carbon Monoxide:2 P RMiT CANNQT SE FINAI�ED AN➢COMPLETEAwUNTIL THIS CERTIFIC�ITE. � � JFI�.S B��� IG111E13�RF"1<'T1Rl�II�'>�TO THFI;SUII�bNG�Y � SIGN PURPOSE This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. 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 I 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: Iii 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 8314 and CSC 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 Owner(or Owner Agels)Name: ` Signature............ ...... .................................................... .....Date: 2 actor Name: e 1 ileG r �Z Signature. .........:. Lic.#.. !/ ` Q.,.........Date: 7.I2 Smoke and CO form.doe revised 03/18/14 WATER-CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE ` COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION S CUPE TINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777- 228•F4X(408)777-3333•build in .cupertino.org Owner Name Permit No. Address _ Y Y� ls� / J 1 1. Is your real prope registered historical site?. CI Yes Civil Co Sections 1101.1 through 1.101.8 do not apply. Skip the res of the form and sign bottom of form. E7/o 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 is not technically feasible? Eales Civil Code Sections 1101.1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. Skip the rest of the form and sign bottom offorn. Cixo 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. o Go to Question 4. 4. Isyourreal property built and available for use or occupancy on or before January 1, 1994:' Am 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. N/'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. Ple4se check ONE of the following. "y property is a single-family r sidential 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). ❑ My property is 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 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). My property is a commercial real property. See Civil Code Section 1101.5. On and after January 1,2014,specified building alterations or improvements shall require non-compliant plumbing fixtures to be replaced with water-conserving plumbing fixtures. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements). I,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manufacturer's installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. Owner or Owner Agent's Signature, - Date: ; Upon completing and signing this Cee,please return it to the Building Division in order to final your bifilding ermit. SB4072015.doc revised 08126115