15110115 SMOKE/WATER OKE f CARBON MONOXIDE ALARM
COMMUNITY DEVELOPMENT DEPARTMENT>BUILDING DIVISION
-OWNERZERTIFICATE017 COMPLIANCE
URI 10300TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)777-3228¢FAX(408)777-3333 building(a-cupertino.mg
Address . d.° \Y" of,mon, Crbon;Moioxide' .
PERMIT CANNOT BE FIN ALED ANTI) COMPLETED UNTIL TIRE CERTIFICATE
HAS BEEN SIC.IN. AND ItETIIR�TED TO THE UILDLN I3I ' SIt
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
_i p o_. r_
u CJ�CCI`ltli tJ CES 3-Cqtltl e'Ct-.-'-`-`--` -
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.
_�—�2 C�IJi1Ttg'"tl YlfClLil lb-lAt"lils, LLLct1Ii ES Celt-�J��""�r1�21"'LeLC�`��jG1C1�Z��il'CE`��+��J1- LC� ��1�'tre'i't:- .1S7or-ai-Lera`��rriS ctO
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/1 gave 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€he terms and conditions of this statement ,
o V er?orOwner Agents'Name.
r
G'a \ Si nature..... ...........
Cmiractcr Name; -
c�f��"'vD.Pys'' � SI nal ..... .... ...... ......Lic.#.. ......,10.6......bate:
Smoke and CO.form.doc re3=fsed 03IJ8114
WATER-CONSERVING PLUMBING FIXT URES
OWNER CERTIFICA1 E OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO i 10300 TORRE AVENUE • CUPERTINO, CA 05014-3256
&08)'15-322;�SFAX(lC8 1777- 33 b tiidino cuoertino,orc
Owner Name :11Perm,it No.—
Address o.4ddress ► , e �1
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.
E1 NTo Go to Question 2.
2. Does,your real property have a licensed plumber certifying that,due to the age or confguration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
❑ Yes Civil Code Sections 110 1.1 through 1101.8 do not apply.
ED The licensed plumber's certification has been prodded to the Building Division.
Skip the rest of the fonn and sip bottom of form.
9 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 sip bottom of form.
F1 No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
11 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.
W] 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 P ase check ONE-3 of the following:
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).
I My property is a nzultifanzily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014,specified building alterations or irnproveinents shall require non- compliant
piun ouib fixtures to be replaced wi h water-conserving.p turioin fixtures.
On or before January 1, 2019, all non-compliant plurmbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations or
improvements).
Ivry property is a conznzerciaZ real property. See Ci-61 Code Section 1101.5.
On and after January 1, 2014,specified buildings 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).
1,as the o��,,,ner or owner's agent of this property,certify under penalty of perjury that non-compliant pluinbing fixtures will be
replaced prior to date specif ed above with water-conserving plumbing fixtures in accordance with Civil Code Sections 110 1.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,acrd manufacturer's
installation requirements, and that the water-conserving plumbingr s comply with the requirements as indicated in the
table on the following age. l" „
Owner or Owner Agent's Signature: Date:`
B 1
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
,SB407 2015.doc revised 08126115