B-2016-2836 ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT m BUILDING DIVISION
10300 TORRE AVENUE s CUPERTINO,CA 95014-3255 Ah
CdpE RT I R 0 {408}777-3228 PAX{408}777-3333 buildin nn cuDertino.targ
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PROJECT ADDRESSAPN# s1 J
OWNERNAME + P ^} P
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STREET ADDRESS 11,
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CONTACT NAME pc1� �t✓C - �Jl� 12-MAIL
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OWNER ❑ OWNER-BUILDER ❑OL1'NERAGENT COl+ITR.i.CCOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ® DEVELOPER C3 TENANT
CONtI2ACTORNAMB L7C£NSETIUM�E$j1 �j LI ETY E� BUS.LIC#
COMPANY NAME o f
E-MAIL FAX
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ARCHITECTJENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ® FD,Or Duple: ❑ L Iulti-Fmnily PROJECT IN WILDLAND PROJECT IN
STRUCTURE: ® Ct MM'DrCial URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD ZONE ❑ Yes ❑ NO
LAR PANELS ❑ FL.ECTRICVEI4ICLECHARGING STATION ❑ SOLARWATER'1-MATING ) D OTHER:
FOR SOLAR PAAELSr NrdMBEROFPANELSfi31\1ITS: KILOWATTS(COMMERCIAL ONLY): �e(� //,rJ, TOTAL VALUATION;
DESCRIPTION OF WORK
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By my signature below,I ceif r to eaohf the fol vig. I'm the property owlter or authorized agent to act on the property owner's behalf, I have read this
application and the information I have OvMe,' co, t. ,ave read the Description of Work and verlfy it is accurate, I agree to comply with all applicable local
ordinances and state laws relatin to b Ildin en cti. thefize representatives of Cupertino to enter the above-ideritifi d propertyor inspeIN cti n purposes.
Signature of Applicant(Agent: pate;
SUPPLEME L rNFORMA T ION REQUIRED
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PTrslpp 2011.doc revised 03116111
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPEE?!TINO 10300 TORRE AVENUE CUPERTINO, CA 95014-3255
(408)777-3228®FAX(408)777-3333- buildinq(j70cupertino.orq
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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 X
bedroom(s)
On ever 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.
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 alarm(s)referenced above has/have been
o_� uuu Ia .
IlnStalled inn aCCCirdaiiCe'JJith th e i [anufact'�,1reT S IITst"iLiCcl'L:c.vi�a ar'e CoiiplianCe Wltln tine Callfolilla DuI1dltng,
and California Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
I have read and agree to ncrpply with:th ems and conditions of this statement
cUNiiTTr or fl ner" ent`s,Name:
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Si n'atu�e. ; L1c _ ?....: ......... ........... Dater
Smoke and CO form.doc revised 03,118114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE-CUPERTINO,DA 95014-3255
{ )777-3228-FAX(408)777-3333 a buiiding(ftupertino.oro
Owner Nam W- G JA.e, Permit No
Address 7 3 _!X [, e �� W C6c er�r�d �j�1
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.
( )KNo 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?
El 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.
.No Go to Question 3.
3. Is water service permanently disconnected for your building?
LYes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
,KNo Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
No My realpropertyis built andavailable 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.
D 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. 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 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 wafer-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).
0My 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 11011,the current California Plumbing Codealifornia Green Building Standards Code,and manufacturer's
installation requirements,and that the water- �iservi plbing fixtures comply with the requirements as indicated in the
table on the followingpage. //
Owner or Owner Agent's Signature 1 Daher-) _Z C_ 0 �G
Upon completing and signing this Certif. ate, ease retur.i44f to the Building Division in order to final your building permit.
SB40072045.doc revised 08126115