B-2016-2622 •
SMOKE / CARBON•MONOXIDE ALARMS _
> OWNER CERTIFICATE OF COMPLIANCE
• COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO10300 TORRE AVENUE• CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333 a building@cupertino.orq
CA
Permit No 1
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Address �15o #of Alarms Smoke: 7 Carbon Monoxide:
PERIVIIT CANNOT BE EINALED AND COMPLETED UNTIL TIAs CERTIFICATE
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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 i X
bedroom(s)
On every level of a•dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are riot 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, alarni(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 alarms) 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 Agent's)Name: i /1 (
Nek C I.�A1A Signature �'!". Date: ( '`Z�3f p
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 03/18/14
WATER-CONSERVING PLUMBING FIXTURES
*9. OWNER CERTIFICATE OF COMPLIANCE
, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
L1PE TING 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255
(408)777-3228• FAX(408)777-3333.•buildinq(@cupertino.orq
Owner Name WI LLI AM Cl T A NA Y' Permit No. R- 2-0 " 261`2-
Address 2_091 Pik QCtO 04E l C PEk7'(t'4C , C kel 5 ü[ �-f
1. 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.
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-conserving plumbing fixtures is not technically feasible?
D 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 foi u and sign bottom of form.
iMNo 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.
Illgr 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 foul,.and sign bottom of form.
0 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. ase check ONE of the following:
PlN 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).
0 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).
Li 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 fixtureswill 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 followina e.
Owner or Owner Agent's Signature: ''�._. Date: !f/2t ( of ,
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB407 2015.doc revised 08/26/15