B-2017-0205CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS:
10582 SANTALUCIARD CUPERTINO, CA 95014-3938 (342 16 131)
OWNER'S NAME: PARRUCK BIDYUT AND SHOBHANAA TRUSTEE
OWNER'S PHONE: 408 728 8130
LICENSED CONTRACTOR'S DECLARATION
License Class C10 C46C46 Lic. #888104
Contractor SOLARCITY CORPORATION Date 12/31/2018
I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business & Professions Code and that my
license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
r. I have and will maintain a certificate of consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
,z. ,I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We) agree to save indemnify and keep harmless the
City of Cupertino against liabilities, judgments, costs, and expenses which
may accrue against said City in consequence of the granting of this permit.
Additionally, the applicant understands and will comply with all non -point
source regulatigns per the Cupertino Municipal Code, Section 9.18.
Signature .N "V" Date 04/10/2017
CONTRACTOR: PERMIT NO: B-2017-0205
SOLARCITY
CORPORATION
SAN MATEO, CA 94402
DATE ISSUED: 02/02/2017
PHONE NO: (650) 963-5100
BUILDING PERNHT INFO:
BLDG X ELECT _ PLUMB
MECH X RESIDENTIAL _ COMMERCIAL
JOB DESCRIPTION:
(l) 12 -PANEL ROOF MOUNTED PV SYSTEM (3.75 KW); NEW
SUBPANEL (125 AMP)
REV # 1 - RELOCATE ALL PANELS TO OPPOSITE SIDE OF ROOF -
ISSUED 4/10/17
Sq. Ft Floor Area: l Valuation: $9000.00
"N Number: Occupancy Type:
342 16 131
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM CALLED INSPECTION.
Issue A et
Date:92 1
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE -ROOFS:
following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is
1. I, as owner of the property, or my employees with wages as their sole installed without fust obtaining an inspection, I agree to remove all new materials for
compensation, will do the work, and the structure is not intended or offered for inspection.
sale (Sec.7044, Business & Professions Code)
z. I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec.7044, Business & Professions Code).
hereby affirm under penalty of perjury one of the following three declarations:
1. I have and will maintain a Certificate of Consent to self -insure for Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
2. I have and will maintain Worker's Compensation Insurance, as provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued.
s. I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Worker's Compensation laws of California. If, after making this certificate of
exemption, I become subject to the Worker's Compensation provisions of the
Labor Code, I must forthwith comply with such provisions or this permit shall
be deemed revoked.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state laws
relating to building construction, and hereby authorize representatives of this city
to enter upon the above mentioned property for inspection purposes. (We) agree
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments, costs, and expenses which may accrue against said City in
consequence of the granting of this permit. Additionally, the applicant understands
and will comply with all non -point source regulations per the Cupertino Municipal
Code, Section 9.18.
Signature,
Signature ofAppl
Date: 04/10/2017
ALL ROOF COVERINGS TO BE CLASS "A"
HAZARDOUS MATERIALS DISCLOSURE
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Section 25532(a) should I store or handle hazardous
material. Additionally, should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and
the Health & Safety Code, Se ons 25505 25P33 and 25534.
Owner or authorized agentM�
Date: 04/10/2017
CONSTRUCTION LEND G AGENCY
I hereby affirm that there is a construction lending agency for the performance
of work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
Lender's Address
ARCHITECT'S DECLARATION
I understand my plans shall be used as public records.
Licensed
Date 04/10/2017 Professional
M
CUPERTINO
CONSTRUCTION PERMIT APPLICATION.
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISIOIU
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingCa-)cupertino.ora
O NEW CONSTRUCTION n ADT)TTToN n AT.TFR ATT0M / TT F1i DVX7TCTn1.T 1 nVrVD1)UT --T—
PROJECT
rn_TT—
B1dgApp_2011.doc revised 06/21/11
PROJECT ADDRESS 1
OWNERNAME i YYV�� kf tP $ )�
V�
PHONE /o _326 _A,„
E-MAIL
STREETADDRESSV �f
CITY, STATE, ZIP �11
FAX
CONTACT NAME j i S C Zc(
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STREET ADDRESS B �j _ -_ J f
t Y�jS r '
CITY, STATE, ZIP
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❑ OWNER ❑ OWNER -BUILDER ❑ OwNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME
�—
_LIEENSE NUMBE
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ory
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-COMPANY NAME a �L
FAX
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-ST_REETADDRESS��/IP/� l . /✓- ITY,-$&T,
ZIP`per
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ARCHITECT/ENGINEER NAME
LIC04SENUMRER
BUS. LIC #
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
DESCRIPTION OF WORK
tom
EXISTING USE
PROPOSED USE CONSTR
TYPE
#! STORIES
USE
TYPE
OCC.
SQ.FT.
VALUATION {$)
EXISTG
NEW FLOOR
DEMO
TOTAL
AREA
AREA
AREA
NET AREA
BATHROOM
KITCHEN
OTHER
REMODEL AREA
REMODEL AREA
REMODEL AREA
PORC!:7
DECK AREA
TOTAL DECKNORCH AREA
GARAGE AREA: DETACH
[3 ATTACH
# DWELLING UNITS:
IS A SECOND UNIT ❑ YES
SECOND STORY ❑ YES
BEING ADDED? ❑ NO
ADDITION? []NO
”
PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF
IS THE BLDG AN ❑ YES
.RECEIVED BY:. - - -
TOTAL VALUATION:
PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER
EICHLER HOME? ❑ NO
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bu' 'ng constructio . I a thorize representatives of Cupertino to enter the above-ide tified pr perty for inspection purposes:
Signature of Applicant/Agent: Date: 10
SUPPLEMENTAL INFORMATION REQUIRED
PLAN cllEcx TYPE
ROUTING stir
❑ OVER-THE-COUNTER
❑ BUILDING PLAN REVIEW
New SFD or Multifamily dwellings: Apply for demolition permit for
existing building(s). Demolition permit is required prior to issuance of building
permit for new building.
❑ EXPRESS
❑ PLANNING PLAN REVIEW
_ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure
El STANDARD
El PUBLIC WORKS
form if any Hazardous Materials are being used as part of this project.
❑ LARGE
❑ FIRE DEPT
_ Copy of Planning Approval Letter or Meeting with Planning prior to
❑ MAJOR
E " SANITARY SEWER DISTRICT
submittal of Building Permit application.
❑ ENVIRONMENTAL HEALTH
B1dgApp_2011.doc revised 06/21/11
CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: CONTRACTOR: PERMIT NO:B-2017-0205
10582 SANTA LUCIA RD CUPERTINO,CA 95014-3938(342 16 131) SOLARCITY
CORPORATION
SAN MATEO,CA 94402
OWNER'S NAME: PARRUCK BIDYUT AND SHOBHANA A TRUSTEE DATE ISSUED:02/02/2017
OWNER'S PHONE:408-728-8130 ' PHONE NO:(650)963-5100
• —I
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class ROOFING Lie.#888104
Contractor SOLARCITY CORPORATION Date 12/31/2018 X BLDG X ELECT _PLUMB
MECH X RESIDENTIAL COMMERCIAL
I hereby affirm that I am licensed under the provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business&Professions Code and that my
license is in full force and effect. JOB DESCRIPTION:
(N)12-PANEL ROOF MOUNTED PV SYSTEM(3.75 KW);NEW
I hereby affirm under penalty of perjury one of the following two declarations: SUBPANEL(125;AMP)
1. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
`}performance of the work for which this permit is issued.
2/.k..-have and will maintain Worke'r's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$9000.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above
information is correct.I agree to comply with all city and county ordinances APN Number: Occupancy Type:
and state laws relating to building construction,and hereby authorize 342 16 131
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep harmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with all non-point
source regulations a ,they( pertino Mun'
pal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION.
-Signature gnature Date 2/2/2017 Issued by:Abby Ayen
de
Date:02/02/2017,
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS:
following two reasons: All roofs shall be inspected prior to any roofmg material being installed.If a roof is
1. I,as owner of the property,or my employees with wages as their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not intended or offered for inspection.
sale(Sec.7044,Business&Professions Code)
2. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&Professions Code). Date:2/2/2017
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insurance,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
a. I certify that in the performance of the work for which this permit is issued,I Health 8z Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to become subject to the material.Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupe lino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensation provisions of the the Health&Safety Code,S• tions 25505,25533,and 5534.
Labor Code,I must forthwith comply with such provisions or this permit shall
be deemed revoked. Owns or authorized agent: •
APPLICANT CERTIFICATION ('Date:2/2/2017
I certify that I have read this application and state that the above information is CONSTRUCTION LENDING AGENCY
correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction lending agency for the performance
relating to building construction,and hereby authorize representatives of this city of work's for which,this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the applicant understands
and will comply with all non-point source regulations per the Cupertino Municipal • ARCHITECT'S DECLARATION
Code,Section 9.18. I understand my plans shall be used as public records.
Licensed
Signature Date 2/2/2017 Professional
•
ALTERNATIVE ENERGY PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISIONE
�yi.,gss 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•buildinq acupertino.orq
PROJECT ADDRESS , g a s 9 ® °► APN Ze_ 1 4,
OWNER
64 UT it) 4 C- — ) Q t 0 E cvatiftirip sQesvere,
STREET ADDRESSa S �. g D CITY�K S 4 ZIP4 Pe9C-14 110t(L1 E-MAIL50-759-8042 EMAIL gigtanloc@solarcity.corn
STREET ADDRESS 391 Foster City Blvd. CITY,STATE,ZIP Foster City,CA,94404 FAX
❑OWNER 0 OWNER-BUILDER 0 OWNER AGENT !I CONTRACTOR 0 CONTRACTOR AGENT 0 ARCHITECT 0 ENGINEER 0 DEVELOPER 0 TENANT
CONTRACTOR NAME SolarCity Corp. LICENSE NUMBER 888104 LICENSE TYPEl0,C46 BUS.LIC#28844
COMPANY NAME SolarCity Corp. E-MAIL gigtanlocsolarcity.com FAX
STREET ADDRESS 3055 Clearview Way CITY,STATE,ZIP San Mateo, CA 94402 PHONE 650-759-8042
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ,c1--SVD or Duplex 0 Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: 0 Commercial SAN INTERFACE AREA 0 Yes ❑ No FLOOD ZONE 0 Yes 0 No
AR PANELS 0 ELECTRIC VEHICLE CHARGING STATION 0 SOLAR WATER HEATING 0 OTHER:
FOR SOLAR PANELS: NUMBER OF PANELS/UNITS: i " KILOWATTS(COMMERCIAL ONLY): TOTAL VALUATION=
l
DESCRIPTION OF WORK
Install ( 1z ) rooftop mounted solar panels,( ;, ) KW
1 & 1-c- 5 e4 Po-0Ze C ( zs A-)
RECEIVED BY: -
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I ha a read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to budding construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date: z--1�S..I I'
SUPPLEMENTAL INFORMATION REQUIRED w_ 'OFFICE UK ONLY
W OVER-TI{E-COUNTER
0.4
E. ❑.EXPRESS .
0 STANDARD
U
Z
❑
LARGE
❑.MAJOR
PVApp_2011.doc revised 03/16/11
DocuSign Envelope ID: 6851D9E4-B3AF-4ABD-8792-DDFC47B17375
CUPERTINO
WATER -CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION
10300 TORRE AVENUE • CUAER11NO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildinn0cuoertino.org
Owner Name Bldyut Parruck Permit No. -921
Address
10582 Santa Lucia Rd, Cupertino, CA 95014, US (SANTA CLARA County)
Please refer to the attached California Civil Code Sections 1101.1-1101.8 which are part of this Certification farm.
Is your real property a registered historical site?
D Yes Civil Code Sections 1101,1 through 1101.8 do not apply. Sign below and skip the rest of the foraL
DOW51oed by:
Owner' Signature: �a1�Yi&
129 No Go to Question 2.
6C758156C6D14DE_._
Date: 3/17/2017
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?
❑ Yes Civil Code Sections 1101,1 through 1101.8 do not apply.
❑ The licensed plumber's certification has beenprovided to the Building Division.
Sign below and skip the rest of the form.
Docusigned by:
,../ Owner' Signature: [fbiy P""Date. 3/17/2017
No GO to Question 3.6C758156MUDE...
3. Is water service permanently disconnected for your building?
1] Yes Civil Code Sections 1101.1 through 1101.5 do not apply. Sign below and slap the rest of the form.
Docu ftwd by:
Owner' ignature: Ea PAY" Date; 3/17/2017
No Go to Question 4.
, 156=14DE
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. Sign below and skip the rest of the farm.
D—S- -d W.
Owner' Signafurebi ("' f anwk Yes 3/17/2017
06C7�,S6G6p,4pE_
Date:
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. Refer to the attached.
® 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).
❑ 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 ofwhetherprgperty undergoes alterations or
improvements).
D Myproperty is a commercial real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or improveanents shall require non- compliant
plumbing fixtures to be replaced with water -conserving plumbing .fixtures.
SB4072014 doc revised 03118114
DocuSign Envelope ID: 6851D9E4-l33AF-4Al3D-8792-DDFC47617375
On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving
plumbing Mures throughout the building (regardless of whether property undergoes alterations or
improvements).
TAVe, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures have been replaced
with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101:8, the current
California Plumbing Code and Cai.ifomia 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 below.
Owner's (or Owner Agent's) Si na#iire: P pate; 3/17/2017
Upon completing and signing this Certificate, please return it to the Building, Division in order to final your permit.
l;. A, uu,e =i-wtmg pimimomng nxture W-accr usageinow race is equal to or iower man ttie itgure shown, it is not required to be upgraded.
SB40 7 2 014. doc revised 03118/11
Non -Compliant
Water -Conserving Plumbing Fixture
Plumbing Fixture
(Fixture Complying with Current Cade Applicable to New Construction)
Fixture Type
Maximum
Maximum Water Usage/Flow Pilate
2013 CPC Ch. 4
2613 CPC Ch. 4
20'13 CPC Ch. 4
Water
!Flaw Rate
2013 CALGreen Div. 4.3
2013 CALGreen Div. 4.3
2.013 CALGreen Div. 5.3
Single -Family
Multi -Family
Commercial
Residential
Residential
Water Closets
Exceed 1.6
Single flush toilets: 1.28 gallons/flush
(Toilets)
Gallons/flush
Dual flush toilets: 1.28 gallons/flush effective flush volume: (the composite,
average flush volume of two reduced flushes and one full flush
Urinals
Exceed 1.0
Gallonslflush
0.5 gallons/flush
Showerheads
Exceed 2.5
2.0 gallons per minute @ 80 psi. Also certified to the performance criteria of
gallons per minute
U.S. EPA WaterSense Specification for Showerheads
(A hand-held shower is considered a showerhead.)
For multiple showerheads serving one shower, the combined flow rate of all
showerheads and/or other shower outlets controlled by a single valve shall not
exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to
allow only one shower outlet to be in operation at a time.
Faucets —
Exceed 2.2 gallons
Maximum 1.5 gallons per
Within units;
0.5 gallons per minute @ 60
Lavatory
per minute
minute @ 60 psi; minimum
Maximum 1.5 gallons
psi
Faucets
0.8 gallons per minute @
per minute @ 60 psi;
20 psi
minimum 0.8 gallons
per minute @ 20 psi
In common and public
use areas: 0.5 gallons
per minute @ 60 psi
1.8 gallons per minute
60 psi
Faucets —
Exceed 2.2 gallons
1.8 gallons per minute @
1.8 gallons per minute
1.8 gallons per minute @ 60
Kitchen
per minute
60 psi
@tis psi
psi
Faucets
May temporarily increase
May temporarily
up to 2.2 gallons per
increase up to 2.2
minute @ 60 psi, and must
gallons per minute @
default to maximum
60 psi, and must
1.8 gallons per minute @
default to maximum
60 psi
1:8 gallons per minute
Where faucets meeting
@ 60 psi
the above are unavailable,
Where faucets meeting
aerators or other means
the above are
may be used to achieve
unavailable, aerators or
reduction.
other means may be
used to achieve
reduction.
l;. A, uu,e =i-wtmg pimimomng nxture W-accr usageinow race is equal to or iower man ttie itgure shown, it is not required to be upgraded.
SB40 7 2 014. doc revised 03118/11
i
DocuSign Envelope ID: 6851D9E4-B3AF-4ABD-8792-DDFC47B17375
I
SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
CUPERTINO 10300TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buitdiny(c.Dcuaertincs.ora
M
Address 10582 Santa Lucia Road Cupertino, CA 95014
PURPOSE
rE3
M
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 CPC Sections 420.5 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existnzg single-family and multi-fainily.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 int the following locations:
AREA
SMOKE ALARM
CO ALARM
Outside of each separate sleeping area in the immediate vicinity -of the
bedroom(s)
X
X
On every level of a dwelling unit incluft basements
X
X
Within: each slee in '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: ha 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 8314 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 California Residential Codes. The alarms have been tested and are operational, as of the date signed
below.
I have read and wree to camDiv with the terms and conditions of this statement
Omer (or Owner Agent's) Mame:
ooeuSkMed bw
Bidyut Parruck
csi naau—re . �� ... Date 3/17/201
Contractor Name:
6c758156csn14De_.
5i nature........ ........... tic.# . . Date:
Smoke and COfonn.doc revised 03118114