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B-2017-0775CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0775 7481 HEATHERWOOD DR CUPERTINO, CA 95014-5823 (359 26 049) NGUYEN CONSTRUCTION COMPANY HAYWARD, CA 94541 OWNER'S NAME: BLACHLY BRAD L OWNER'S PHONE: 412-352-8035 License Class B Lic. #657745 Contractor NGUYEN CONSTRUCTION COMPANY Date 10/31/2018 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: 1. I have and will maintain a certificate of consent to self -insure for Worker's N; "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 6/26/2017 OWNERD �C�LTIOV I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1. 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) z. 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 DATE ISSUED: 05/19/2017 PHONE NO: (510) 381-4167 BUILDING PERMIT INFO: BLDG —ELECT —PLUMB MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: REMODEL MASTER BATHROOM AND HALLWAY BATHROOM (150 S.F.); RELOCATE INTERIOR WALLS, RAISE CEILING HEIGHT AT HALLWAY, BEDROOM AND LIVING ROOM (446 S.F.); INSTALL NEW SLIDING DOOR IN MASTER BEDROOM; REPLACE WINDOW IN DINING ROOM REV #1 - ADD COFFERED CEILING TO DINING ROOM - ISSUED 6/26/2017 Sq. Ft Floor Area: I Valuation: $25000.00 APN Number: Occupancy Type: 359 26 049 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ABBY AYENDE RE -ROOFS: 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: 26/2017 Compensation, as provided for by Section 3700 of the Labor Code, for the I ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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. 3. 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 1 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. Date 6/26/2017 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, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: 6/26/2017 CONSTRUCTI I hereby affirm that there is a construction le cy 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 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0775 7481 HEATHERWOOD DR CUPERTINO, CA 95014-5823 (359 26 049) NGUYEN CONSTRUCTION COMPANY HAYWARD, CA 94541 OWNER'S NAME: BLACHLY BRAD L DATE ISSUED: 05/19/2017 OWNER'S PHONE: 412--352-8035 PHONE NO: (510) 381-4167 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class @ Lic. #657745 Contractor NGUYEN CONSTRUCTION COMPANY Date 10/31/2018 X BLDG X ELECT —PLUMB X 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: REMODEL MASTER BATHROOM AND HALLWAY BATHROOM (150 I hereby affirm under penalty of perjury one of the following two declarations: S.F.); RELOCATE INTERIOR WALLS, RAISE CEILING HEIGHT AT t. I have and will maintain a certificate of consent to self -insure for Worker's HALLWAY, BEDROOM AND LIVING ROOM (446 S.F.); INSTALL Compensation, as provided for by Section 3700 of the Labor Code, for the NEW SLIDING DOOR IN MASTER BEDROOM; REPLACE WINDOW Lperformance of the work for which this permit is issued. IN DINING ROOM f 2YT I have and will maintain Worker's Compensation Insurance, as provided for by REV #2 - PANEL UPGRADE 200 AMP; (N) FURNACE - ISSUED Section 3700 of the Labor Code, for the performance of the work for which this 4/18/2017 permit is issued. REV #1 - ADD COFFERED CEILING TO DINING ROOM - ISSUED APPLICANT CERTIFICATION 6/26/2017 1 certify that I have read this application and state that the above Sq. Ft Floor Area: Valuation: $25000.00 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize APN Number: Occupancy Type: representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the 359 26 049 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. PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR Signature ate 07/18/2017 180 DAYS FROM LAST CALLED INSPECTION. OWNER-BUILDERIssued by: Kim Dunbar I hereby affirm that I am exempt from the Contractor's License Law for one of the Date: 05/19/2017 following two reasons: 1. I, as owner of the property, or my employees with wages as their sole RE -ROOFS: compensation, will do the work, and the structure is not intended or offered for All roofs shall be inspected prior to any roofing material being installed. If a roof is sale (Sec.7044, Business & Professions Code) installed without first obtaining an inspection, I agree to remove all new materials for z. I, as owner of the property, am exclusively contracting with licensed inspection. contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: Signature of Applicant: r. I have and will maintain a Certificate of Consent to self -insure for Worker's Date: 07/18/2017 Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the 3. I certify that in the performance of the work for which this permit is issued, I California Health & Safety Code, Sections 25505, 25533, and 25534. I will shall not employ any person in any manner so as to become subject to the maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Worker's Compensation laws of California. If, after making this certificate of Health & Safety Code, Section 25532(a) should I store or handle hazardous exemption, I become subject to the Worker's Compensation provisions of the material. Additionally, should I use equipment or devices which emit hazardous Labor Code, I must forthwith comply with such provisions or this permit shall air contaminants as defined by the Bay Area Air Quality Management District I be deemed revoked. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is Owner or authorized agent: correct. I agree to comply with all city and county ordinances and state laws Date: 07/18/2017 relating to building construction, and hereby authorize representatives of this city CONSTRUCTION LEDRM'�'PAGENC, to enter upon the above mentioned property for inspection purposes. (We) agree I hereby affirm that there is a construction lendi agenc the performance to save indemnify and keep harmless the City of Cupertino against liabilities, of work's for which this permit is issued (Sec. 309 , iv C.) judgments, costs, and expenses which may accrue against said City in Lender's Name consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Lender's Address Code, Section 9.18. Signature Date 07/18/2017 ARCHITECT'S DECLARATION 1 understand my plans shall be used as public records. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION 10300 TORRE AVENUE - CUPERTINO, CA 95014-3255 Cl1PERT1N0 (408) 777-3228 - FAX (408) 777-3333 - buildin cu ertino.or --0-7I ❑ NEW CONSTRUCTION ❑ ADDITION 4V ALTERATION / TI ® REVISIO /DEFERRED ORIGINAL PERMIT # PROJECT ADD OWNERNAt PHO E-MAIL / STREET ADDRESS �/ (,1'(� CITY, STATE, ZIP JFAX ! CONTACT NAME ` l �J PHONE S(O_ '� 1 E-MAII STREET ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTORAGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR N SE LICEffPE BUS. LIC # COMPANYNAME E-MAIL FAX STREET ADDRESS - CITY, ZIP+ PHONE ARCHITECf/ENGINEER NAME ENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ,FT. VALUATION (S) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: El DETACH ❑ ATTACH # DWELLING UN17JS1. 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 FTEFi%— 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 thV 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 building co n. I authorizereprese tatives of Cupertino to enter the above -i entified pr perry for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INTF T hI_ N CHECK nrr R, 0 UT LN G sctp �jj _ New SFD or Multifamily dwellings: Apply for demolition permit for ❑ iI:- _ I ❑ existing building(s). Demolition permit is required prior to issuance of building O� InT core rFz z rir �i� c i �� ��F� ri n permit for new building. ❑ rxl,PFSS ❑ PLANNING PLAN RFN :1_w Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STaw.aTir; ❑ PI 13 LIC v r,1. c form if any Hazardous Materials are being used as part of this project. ❑ L-.r-.cr ❑' _ Copy of Planning Approval Letter or Meeting with Planning prior to ❑ �L� raiz ❑ submittal of Building Permit application. S ,NIT %Ru SEWER DISTPJCT ❑-. r\V1I20NtiIENTAL HE.4LTH BldgApp_1011.doc revised 06/21111 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0775 7481 HEATHERWOOD DR CUPERTINO, CA 95014-5823 (359 26 049) NGUYEN CONSTRUCTION COMPANY HAYWARD, CA 94541 OWNER'S NAME: BLACHLY BRAD L DATE ISSUED: 05/19/2017 OWNER'S PHONE: 412-352-8035 PHONE NO: (510) 381-4167 LI ..NC .D CONTR ACTOR'S DECTARATION BUILDING PERMIT INFO: License Class E3 Lic. #657745 Contractor NGUYEN CONSTRUCTION COMPANY Date 10/31/2018 X BLDG —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: REMODEL MASTER BATHROOM AND HALLWAY BATHROOM (150 1 hereby affirm under penalty of perjury one of the following two declarations: S.F.); RELOCATE INTERIOR WALLS, RAISE CEILING HEIGHT AT t. I have and will maintain a certificate of consent to self-insure for Worker's HALLWAY, BEDROOM AND LIVING ROOM (446 S.F.); INSTALL Compensation, as provided for by Section 3700 of the Labor Code, for the NEW SLIDING DOOR IN MASTER BEDROOM; REPLACE WINDOW performance of the work for which this permit is issued. IN DINING ROOM 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 Sq. Ft Floor Area: Valuation: $25000.00 permit is issued. APPLICANT CERTIFICATION certify that I have read this application and state that the above APN Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize 359 26 049 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 per the Cupertino Municipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. i Signature Z Pete 05/19-2017 Issued by: Kim Dunbar OWNER-BUILDER DECLARATLION Date: 05/19/2017 I hereby affirm that I am exempt from the Contractor's License Law for one of the RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is following two reasons: t. 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: 05/19-2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER t. 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. 1 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. 1 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 & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous shall not employ any person in any manner so as to become subject to the 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 Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. _ Owner or authorized agent: 1 APPLICANT CERTIFICATION Date: 05/19-2017 !, 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 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 DECL.ARRATION 1 understand my plans shall be used as public records. Code, Section 9.18. Licensed Signature Date 05/19-2017 professional CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building(a)cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / Ti ❑ REVISION /DEFERRED ORIGINAL PERMIT # a] PROJECT ADDRESS/�7 r,JO/7 �� �TcA �� na � APN OWNER NAME Q / T� (�f L/ tJ �l��H�C�t/C� YMfi PHONE E-MAIL� STREET ADDRESS CITY, STATE, ZIP W TJ�/� G���� FAX CONTACT NAME /" PHONE i/-/2 E-MAIL O IU li M� " C STREETADDRESS A-4 CITY, STATE, ZIP FAX T3/1/✓ � OWNER ❑ OwNER-BUTAER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME 1 4t G t ou r& / LICENSE NUMBER / 3 LICENSE TYPE SUS. LIC # COMPANY NAME ,I /�`_^/� / /'�/ CrAlSGT7RV� /T (I _ _ / E MAIL, b �p �� FAX STREET ADDRESS ,/Cj A/J / ft nV�l ��l/ CITY, STATE, ZIP ��,�/1A *p /• ll QL / PHONE ARCHITECT/ENGINEER NAME ( Y, //W/ LICENSE NUMBER ' r/ /'C Y �/ri / T BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE �eQ � DESCRIPTION OF WORK EXISTING USE PROPOSED USE CONSTR TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION (S) EXISTO NEW FLOOR DEMO TOTAL AREA/ 6) b SF.' AREA AREA p NET AREA'�,e BATHROOMKITCHEN OTHER REMODEL AREA 13-19 REMODEL AREA O REMODEL AREA PORCH AREA DECK AREA TOTAL DECK/PORCH AREA I GARAGE AREA: U DETACH []ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES 1 BEING ADDED? ;gNO ADDITION? JANO PRE -APPLICATION El YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES D BY', "' - TOT VALUATION: PLANNING ADPL# 1�N0 PLANNING APPROVAL LETTER EICHLER HOMEI �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 building co on. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: JG�i Date: SUPPLEMENTAL INFORMATION REQUIRED "' ' CHECKTYPE` ROUTING SLIP_, New SFD or Multifamily dwellings: Apply for demolition permit for OVER-THE-COUNTER ' Buu n LArri� w existing building(s). Demolition permit is required prior to issuance of building permit for new building. ❑ EXPRESS_'_ D PLANNINGPLAIa REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure 11STANDARD ❑ PURU, CW O Ks ` 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 ❑ I.iaroR ❑ SANITARY SEWER DISTRICT, submittal of Building Permit application. ` r.. ❑ ENVII20NMENTALBRALTif B ldgApp_2 011. do c revised 06/21/11 SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE ea% COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228•FAX(408)777-3333•building(a,cupertina.orq PERMIT CANNOT BE FINALED UNTIL THIS CERTIFICATE HAS BEEN COMPLETED SIGNED.AND RETURNED TO THE BUILDING=DIVISION PURPOSE 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 R314,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 X X bedroom(s)-(Smoke alarms shall not be located within 3 feet of bathroom door) 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 R314 and CBC Sections 907.2.114 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 al•,c.1I/ GeaAr9-v- `Di L/ Permit No. ; ��'-6775 Specify Number of Alarms #Smoke Alarms I L2; I #Carbon Monoxide Detectors I I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Vest 7ati Signature �--� : Date. ! " !., Contractor Name: Signature Lic.# Date: _ — Smoke and COform.doc revised 01/10/2017