B-2016-2067 SMOKE/WATER SMOKEJ CARON MONOXIDE ALARM
OWNER E"FICATE OF Go.�IPLIANCE,
COMMUNITY—DEVELOPMENT DEPARTMENT•BUILDING DIVISION .
10300 TORRE AVENUE•CUPERTINO,CA 95044-3255
(408)777-3228 w FAX(408)771-3333,building(ij),cupertino otg
PURPOSE
niis affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alar s 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-fanmily dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units ex eeds
$1000.00;CRC Section x,314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO'AI i1V,l
Outside of each separate sleeping area in the immediate vicinity of the X
bedroom(s)
On every level of a dwellin, unit including basements X X
Within eacl-t sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contaimfuel-burning appliances d that
do not have an attached garage. Carbon,nor oxide earzns combined with smoke alarms shall com.ply with
C$C Section 4201.6 and shall be approved by the Office of the State Eire Marshal.
Power Supply:In dwelling units with no coamercial power supply,alarm(s)may be solely battery Operated.
In exrstiEng,dwelling units alarms are perm,rtted to be solely battery operated where repairs or alterat o 1s do,
not result in the removal of wall gild ceiling finisites or there is no access by means of attic,baserne-nt o, crawl
space..Refer to CRC Section R314 and CBC Sections 90=7.2'.11.4 and 420.6..2.An electrical permit is req a ped.for:
alaxins which must be coiliaected to the building wiri..g.
As owner of the above-referenced property,l hereby certify that the alarms)referenced above has/ha e been
installed in accordance with the manufacturers in-struactions and in compliance with the California BuJ ldkzg.
and Cal fonua Residential Codes.T, e alarms.l have been tested and are operational,as of the date sigil d
below.
t have read!and a cee to:com.,:f- with.,tfie terms and condrtion:s 0f this statement'
,.....,bane. ...................
S not ......
..:. ........:......... Date
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-33 3•building0-cupertino.org P
Owner Name S�✓ VA t i J kt Permit No. V' 2,L)®6— 0,b 7
Address 130S * v�
1. Is your real property a registered historical site?
El Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom o fonn.
' 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 c r its
plumbing,installation of water-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.
Skip the rest of the form and sign bottom of form.
No Go to Question 3.
3. Is water service permanently disconnected for your building?
El Yes Civil Code Sections 1101.1 through 1101.8 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?
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.
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 plumb' g 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 properly undergoes alterations c r
improvements).
❑ My property is a commercial real properly. 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- con ervmg
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 f xtures 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 man facturer'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: /C
Upon completing and signing this icate,please return it to the Building Division in order to final your building permit.
SE4072015.do revised 08/26115