B-2016-2884 SMOKE / CARBON MONOXIDE A ARMS
OWNER CERTIFICATE OF COMPLIANCE
01.ty COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE•CUPERTINO,CA 95014-32.5
(408)777-3228•FAX(408)777-3333•buildinq( cuoe ino.orq
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PURPOSE
This affidavit is a self-certification for the installation of all required Smo e and carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 90'2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided wi i Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions,alterations,or repai s to existing dwelling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 requir- that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA • `MOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of X X
the 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 co taro fuel-burning appliances and that
t
do not have an attached garage. Carbon monoxide alarms combined wi smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire arshal.
Power Supply:In dwelling units with no commercial power supply, alar (s)may be solely battery operated.
In existing dwelling units,alarms are permitted to be solely battery oper.ted where repairs or alterations do
not result in the removal of wall and ceiling finishes or there is no access I.y means of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and 420.6...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 alan (s) referenced above has/have been
installed in accordance with the manufacturer's instructions and in com.liance with the California Building
and California Residential Codes.The alarms specified below have been ested and are operational,as of the
date signed below.
Address: 7 R'2 Pe: I
St-vet a.-• Ott pArl7M q l f Permit No. 13—:>s)16—2 -2
Specify Number of Alarms: #Smoke Alarms: I I ' #Carbon Monoxide Detectors: I I
I have read and agree to comply with the terms and connitions of this statement
Owner(or Owner Agent's)Name: o n�
1111E�-1v1 iV E �j Signature �'iA' ,� Date: 12113/112
Contractor Name:
Signature Lic.# Date:
Smoke and CO form.doc revised 09/27/16
\, W TE - O SE IN PLUMBING FIXTURES
r .-i OWNER tCERTIFICATE COMPLIANCE
FIU
,�n�r COMMUNITY Y L3 '�'d= Op1<rlENT DEPARTMENT h1T BUILDING DIVISION — -f
UP R 'll+I 10300 TORRE AVENUE CUP,ERTINO,CA 35014-325.5 f
(408)777=3228,FAX 408)777-3333 buildincacupertino.orq
Owner Name W E1—M A Cr-ITN,� Permit No ®2-V 16--2.41
Address 7 e 4 "aFest rot DV n p&-t( 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?
0 Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
0 The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
= ' Ig 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.
R3 j 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 tl e form and sign bottom of form.
m. .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:
1%5, My property is a singlefamily 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).
0 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.
installationrequirements,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 ,.. —1 j-1j. _ Data!, (2/(-)/-o( 6
Upon completing and signing this Certificate,please return it to the Building Division.n order to final your building permit.
SB4072015.doc revised 08/26/15