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B-2017-0611CITY OF CUPERTINO BUILDING PERMIT ' BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0611 10337 VISTA KNOLL BLVD CUPERTINO, CA 95014-1035 (326 13 120) OWNEWBUILDER 10337 VISTA KNOLL OWNER'S NAME: HOANG THUAN T OWNER'S PHONE: 4085642481 LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor OWNER/BUILDER Date 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. hereby affirm under penalty of perjury one of the following two 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. 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 Date 04/18/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I 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 -A // permit is issued. 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 sour ulations per the Cupertino Municipal Code, Sectio 9.18. Signat re_ Date 04/18/2017 DATE ISSUED: 04/18/2017 PHONE NO: 4085642481 PERMIT INFO: X BLDG —ELECT _PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REPLACE FURNACE (SAME LOCATION - HALL CLOSET) Sq. Ft Floor Area: l Valuation: $3164.00 "N Number: Occupancy Type: 326 13 120 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: PAUL O'SULLIVAN Date: 04/18/2017 All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature of Applicant: Date: 04/18/2017 ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, apter 9.12 and the Health & Safe e, Sections 25505, 255 , an 5534. Owner or authorized agen : . Date: 04/18/2017 CONSTRUCTION LENDING 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 Professional COMMUNITY DEVELOPMENT. DEPARTMENT • BUILDING DIVISION 10300 TORRE.AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 •FAX 08) 777-3333 • building(d)cupertino.org F1PLUTAIBING MECHA7\TICAL I FLEC'TRICAT. 7MTCC'FT T.ANF.nTTc (��r\ PROJECT ADDRESS,y �y j/ 4 ApN # A ) b 1,:> OIVNTERNAMFPHON ` V C .�P E-MAIL r STREET.ADDRESS /0 C a� �1 CITY ATE, MP �V / FAX CONTACT N 4Et ^ r PHO `2C C� E-MAIL © ? STREET ADDRESS / ® kv'6/�V� M Vr) j C , STATE,, P OWNER ❑ OWNERBVJN UIIAER ❑ OERAGENEl CONTRACTOR CONTRACTOR,IAGEhTT ❑. ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENP.NT CONTTXOR�NAMEr LICEL�v� B � LICENSE TYPE BUS. LIC COMPANY N E-MAIL FAX BEET ADDRESSCI�TAE kip e ARCHITECT/ENGINTEER NAME LICENSE NUMBER BUS. LIC COMPANY NAME E-MAIL FAX STREET ADDRESS I CITY, STATE, ZIP PHONE ' USE OF " ' . ❑ SFD or DLTLEX El MULTI -FAMILY BUILDING: ❑COMMERCIAL PROJECT IN WtLAND ❑ •YES URBAN INTERFACE AREA E] NO PROTECT IN ❑YES FLOOD ZONE El No IS THE BLDG AN ❑ 1TS EICHLER HOME? ❑ NO ^No � � DESCRInTOF\VRI, .iQ- �� ie TOTAL VALUATION: / RECEIVEDBY Tj ---• By my signature below, I certify to each of the following: I am th property owner or authorized agent to act on the p operty owner's behalf. I have read this application and the information I h ovided is correct. ave r ad the Description of'Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relat' g to bu 7d g constructio . I au o e representatives of Cupertino to enter the (a�bgoye-identified property for inspection purposes. Signature of Applicant/Agent: r Date: SIJ! %y SUPPLEMENTAL INFORMATION REQUIRED ,T OWCE "CE USE ONIL 4 O� ER TiIE-COiJ�TER - - EXPRESS..-.-: U ❑ STAN'DA'RD' a - �'❑ LARGE - " ❑, 111.SJOR - MEPAIisc,4pp_2011.doc revised 06/21/11 OWNER -BUILDER DISCLOSURE FORM COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95.014-3255 (408) 777-3228 • FAX (408) 777-3333 - building(5)cupertino.org Dear Property Owner(s): An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at: SITE Affj� �( t (�,� APN {' - BP# �� W61jt NAM Oo O E � 4 t �! J DESCRIPTION OF WORK: A /,1 • -JZ�,y,,Q w We are providing you'with an Owner -Builder Acknowledgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION (DIRECTIONS: Please read and initial each statement below to signify you understand or verify this information.) 1�1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner - Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an.Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. l . I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. X---3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 'P% W - I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. DL -5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. �� 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 1)&-8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 01471e1B2filde7F07777 2010.doc revised 04/14/10 r. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. -6170. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the site address listed above. —1'1: I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If -you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. CONSTRUCTION LENDING AGENCY (DIRECTIONS: Please complete the following construction lending agency information.) I .hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ.) Lender Name: Lender Address: Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the cit maybe required to be presented when the permit is issued to verify the property owner's sig_ Property Owner's Signature: Date:/� __ ------------------------------------------------------------------------------------------------------------------------------------(NOTE: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder). AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): AMA-- 55.5 -4 4t tce rv_-,pIfiA,,e Project Location or Address: 7 'sin kevv It P)I elCVr. / d Name of Authorized Agent: MA W-- 6—'k 1_5Q1V Tel No 9 C13 Address of Authorized Agent: 103311 VIA -It A a C,Ld .r&V6 , CA, 9 Al� I declare under penalty of perjury that 1 am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the city may be required to be presented when the permit is issued to verify the property owner's signature. A A Property Owner's Signature: / Date: OW7te]BZtilde7Fo7771 2010.doc revised 04/14/10 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Pagel of 3) Project Name: Dana Gunderson I Date Prepared: 2017-04-17 A. General Information CHR -ALT -02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented, use one CF111-ALT-02 document for each dwelling unit. 01 Project Name Dana Gunderson 02 Date Prepared 2017-04-17 03 Project Location 10337 Vista Knoll Blvd 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name Dana Gunderson Dwelling UnitConditioned Installing -a 07 Zip Code 95014 08 Floor Area (ft) 2427 { SC System CFA served system a refrigerant Installing new SC Installing Installing Installing Identification or Number of Space by this SC 09 Climate Zone 4 10 Conditioning (SC) Systems in 1 Name Served System (ft) this Dwelling Unit: component? B. Space Conditioning (SC) System Information 4r 01 02 03 04 Oy ®6:_.. :07" OS y69 10 1s the SGi Installing -a SC System SC System CFA served system a refrigerant Installing new SC Installing Installing Installing Identification or Location or Area by this SC ducted containing system more than 40 entirely new entirely new Name Served System (ft) system? component? components? feet of ducts? duct system? SC system? I Alteration Type System 1 whole house 2427 Yes No Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section 150.2(b)1Diib) This section does not apply to this project. Registration Number: 217-A020124248A-000-000-0000000-0000 Registration Date/Time: 2017-04-17 08:07:06 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-17 08:07:41 Schema Version: rev 10-/16 CERTIFICATE OF COMPLIANCE CF1R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 2 of 3) D. Altered Space Conditioning System (Sections 150.2(b)1E and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components Type Value System Type Components Type Value Type Duct Length R -Value Central gas All new No cooling This field or This field or Less than or System 1 furnace heating AFUE 81 No cooling component section is not section is not Setback equal to 40 R-6 components altered applicable applicable feet RRec uired Documentation: CF2R-MCH-01-E - Space Conditioning Systems - Duct insulation requirement for the new portions of supply -air and return -air ducts or plenums: R6 (CZ 1-10,12 and 13) and R8 (CZ 11 and 14-16) CF211 and CF3R-MCH-20-H - Duct Leakage Test required when heating or cooling components are installed in ducted systems, or when more than 40 ft of duct length is replaced -Leakage rate compliance: <=15% or <= 10% leakage to outside, or seal all accessible leaks. CF2R and CF311-MCH-25-1­1'Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2R and CF3R-MCH-23 Airflow Rate >"=,300 CFM perton required when,MCH-25 is required. Exceptions: Duct systems registered with HERS provider as previously sealed are exempt fr6m.MCH-20 Duct Leakage Testing,requirements._ Heating -only systems and Air Handler Furnace changes do not require verification of'Air Flow"MCH 23p'or'Refrigeranf Charge MCH=25'. -Existing duct systems constructed, insulated or sealed with asbestos are exemptfrom MCH'=20 Duct Leakage Testing requirements. E. Entirely New or Complete Replacement Duct4System, with pr without Equipment Changeout (Sections,150.2(b)1Diia_and 150.2(b)1E, F) This section does not apply to this project. F. Entirely New or Complete Replacement Space Conditioning System (Section 150.2(b)1C) This section does not apply to this project. Registration Number: 217-A020124248A-000-000-0000000-0000 Registration Date/Time: 2017-04-17 08:07:06 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-17 08:07:41 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Page 3 of 3) Documentation Author's Declaration Statement 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Miller, Maria Company: Signature Date: COOPER BROTHERS INC 2017-04-17 08:07:06 Address: CEA/ HERS Certification Identification (if applicable): 6017 SHELL AVE SUITE 331 City/State/Zip: Phone: SAN JOSE CA 95123 408-437-2442 Responsible Person's Declaration statement I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy features and performance specifications, materials, components, andmanufactured devices for -the building design,or,system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6,of the California Code of Regulations. 4. The building designfeatures or system design features identified on this Certificate of Compliance are consistent withi the information,provided on oth{er.applicab`le compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for'approva[,,with this building permit application. "' `, ';' , 4 - g copy p tie made"svailable" i S. 1 will ensure that a registered co of this Certificate of,Gom liance shall g p , O ' `,,. _ with_ the liuildin ermit s,issu'ed forifhe',building, and,made ava bie,to the,enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance.is,required to be.included with the documentation the, builder provides to,;the building owner at occupancy. Responsible Designer Name: ;: Responsible Desig.)n. er Signature: `��• , Miller, Maria Company: Date Signed: COOPER BROTHERS INC 2017-04-17 08:07:06 Address: License: 6017 SHELL AVE SUITE 331 874695 City/State/Zip: Phone: SAN JOSE CA 95123 408-437-2442 Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document and in noway implies Registration Provider responsibility for the accuracy of the information. Registration Number: 217-A020124248A-000-000-0000000-0000 Registration Date/Time: 2017-04-17 08:07:06 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-04-17 08:07:41 Schema Version: rev 10/16 SMOKE I CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 - buildinana cuoertinn-nrn PURPO0L This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section R314; R315, 2016 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 8314, R315, 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 bedroom(s) — (Smoke alarms shall not be located within 3 feet of bathroom door) X X On every level of a dwelling unit including basements and habitable attics 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 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 specified below have been tested and are operational, as of the date signed below. Address: /6-07 05__ - k1tM4 ldl(v'<r �,!` ' Frol Permit No. 'M17.- < t Specify Number of Alarms: IIrIkAn/ I9 # Owner (or Owner Smoke Alarms.:- 1 # Carbon Monoxide Detectors I have read and agree to comply with the terms and rnnrlitinn.e of this zfatamanf Name: %Agent's} UQA3 . .........Signature......................................... ............................................................. Date:. -0. 7... Contractor Name: Signature...................................................................... Lic rt ........................................ Date:................... Smoke and CO form.doc revised 01/10/2017 CU.PERTINO Owner Name WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(cbcupertino.org %— 040 Address 1033-? V/s P,7 ff 91111d, C 1_1 mac`+71 Ira a CA-, 9501V V ® s 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? ❑ 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 form and sign bottom of form. ;, 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. 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 form and sign bottom of form. bq 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.. 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). ❑ 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 properly undergoes alterations or improvements). ❑ 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 phurnbing 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 -conserving plumbing fixtures comply with the requirements as indicated in the table on the following page. 1 I Owner or Owner Agent's Signature: I_ �'�—,/ Date: 57I/ /17 I Upon completing and signing thus Certificate, please return it to the Melding Division in order to final your building permit. SB407 2015.ddc revised 01/05/17