15080152 SMOKE/WATER SMOKE / CARBON MONOXIDE. ALARMS
- --' -OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT BUILDING DIVISION
10300 TORRE AVENUE.CUPERTINO,CA 95014-3255
(4Q8)777-3228"-FAX(408)777-3333 building(t)cupertlno.org
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Address i r- koi Alar w-smoke: Carbon 11do11ox
PERMIT CA.NIOT BE FI4;ALED AND CON, VL II- TIIIS C - A-TE
RAS BEE,N SIG D ; NT°D TO THE BUTLLDLNG I3WISION
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
GENERAL INFORMA'T'ION
Existing single-family and multi-family dwellings shall be provided'Wi&Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling 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
bedrooms)
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)maybe solely battery operated,
'-Tr�eXLStrr`td�vesh-nb�ui�iz��aiaTInS arepcin 7 0,tted-tosbe Sol ely-bat-t ery-tflper2ted-w112r-2= e pa3T s'0r-aI eT-al0-iis�-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
and Califon-Lia Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to com l- with the terms and conditions of this statement
E,wrier(or dimer r ers f'ss Nla-me:
Si nate.e. , �?1n .... �....( .Io.. t:..... ............... .. ... ..........Date: ......
€ t crcr Name: j
Snare . Ue:- :....Dat . r
Smoke a)7d CO.form.doc revised 03118/14
MATER-CONSERVING PLUMBING FIXTURES
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OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE• CUPERTINO, CA 05014-3255
CCfFERi [NO
(408)777-3228•FAX(408)777-3333• buildina0-cuoertino,org
Owner Name_u_ ' it-er - 14, 1Permit No.
Address �0 3J� a,- I
L V re
l. Is your real property a registered historical site?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn.
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 water-cone-wing plumbing fixtures is not technically feasible?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
Ct The licensed plurnber's certification has been provided to the Building Division.
Skip the rest of the'forrn and sign bottom of form.
91 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.
C No Go to Question 4.
4. Is your.real property built and available for use or occupancy on or before January 1, 1994?
VNo 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.
JZ 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 tlu•ee following statements and sign
bottom of form..
5. PIease check ONTE-of the following:
❑ My property is a single ftnily 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 wafer-conserving plumbing fixtures throughout the building.On or before January 1,2017, all non-
compliant plumbing fixtures shall be replacedd with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements).
9 My property is a nzuZtiiftnity residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or nnprovements shall require non- compliant
plu-mbing fixtures to be replaced witrl watcr-consenuig jp umbing 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 corrarnerciaZ 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=conservi:ng plumbing fixtures comply with the requirements as indicated in the
table on the following page. 1 11 h r
Owner or Owner Agent's Signature:. , li-K CA Date: llr—do� l
Upon completing and signing this Certificate,please retuIt to the Building Division in order to anal your building permit.
SB40 7 201 .doc retired 082 Jill