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B-2017-0872CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0872 10181 FIRWOOD DR CUPERTINO, CA 95014-2641 (342 35 036) RANDO AAA HVAC INC SAN JOSE, CA 95125 OWNER'SNAME: CONWAY ANNE A TRUSTEE DATE ISSUED: 06/01/2017 OWNER'S PHONE: 925-381-1000 PHONE NO: (408) 293-4717 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C43 -C20 Lic. #Z6BM Contractor RAN DO AAA HVAC INC Date 09/30/2017 X BLDG —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: REPLACE CONDENSOR - SAME LOCATION 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 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 j ....... Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation: $6747.00 permit is issued. V APPLICANT CERTIFICATION I 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 342 35 036 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. Signature.( L l.�%', Date 06-01-2017 Issued by: Kim Dunbar ` OWNER DECLARATION Date: 06/01/2017 -BUILDER 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: 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) z. I, as owner of the property, am exclusively contracting with licensed Signature of Applicant: contractors to construct the project(Scc.7044, Business & Professions Code). Date: 06-01-2017 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 3. 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 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 Cupertino Municipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety C e, S ctions 25505, 25533, and 25534. Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner or authorized agent APPLICANT CERTIFICATION Date: 06-01-2017 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. 1 understand my plans shall be used as public records. Licensed Signature Date 06-01-2017 Professional B GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 35014-3255 £UPICRTINO (408) 777-3228 • FAX (408) 777-3333 • building(d)cupertino.oro Isca r-� `per' C� ` -v (�JA 0/11 IPT IWTZTMr4 I IMPrT4 AMir AT MVI P(TRI!'AT F-1 MTSf PI i. AMPnTK PROJECT ADDRESS n APN # -L , , S r ® .3 J p �J OWNERNAMEnWtj PHO E-MAIL STREET ADDRESS IM"I l ,ZIP I ClD"ej ,Ely FAX CONTACT NAME PHO /�'� (�/► y o E-MAIL STREET ADDRESS CTfY, .A 4��F ❑ OWNER: ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR CONTRACTOR AGENT ❑ ARCHITECT 11 ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME � Pwd) I LICENSE ' LICENSE M3 BUS. LIC # COMPANY NAMECn(f E-111AItInaM F �� i STREET ADDRESS C P00Ql��, ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LTC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF ❑SFDorDuplex 1.Multi-Family STRUCTURE: ❑ Commercial PROJECT INWILDLAND PROJECT URBAN INTERFACE AREA ❑ Yes ❑ No FLOOD IN ZONE ❑ Yes ❑ NO DESCRIPTION OF WORK `1 / TOTAL VALUATION: RECEIVED , 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 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 onstructio . 1 authorize representatives of Cupertino to enter the abov i ntifi d property for inspection purposes. application and the infoivTation I hav,ffloo Signature of ApplicanUAgenl:Date: SUPP MENTAL INFORMATION REQUIRED 0 USE.ONLY.'_ Y'_, , ❑ `AVER TUS1 064TER' Y, S.❑ © EXPRESS STANDARD'.. U < ❑LARGET ;A ❑ MAJOR MEPMiscApp_2011.doe revised 03116111 Z - f CERTIFICATE OF COMPLIANCE CFiR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT HVAC) (Pagel of 3) Project Name: CRAIG CONWAY I Date Prepared: 2017-05-26 A. General Information CF1R-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 CRAIG CONWAY 02 Date Prepared 2017-05-26 03 Project Location 10181 FIRWOOD DR 04 Building Type Multi -family 05 CA City Cupertino 06 Dwelling Unit Name CRAIG CONWAY -- SC System Dwelling Unit Conditioned CFA served 07 Zip Code 95014 08 Floor Area (ft) 1785 Identification or Location or Area by this SC Number of Space containing 09 Climate Zone 4 10 Conditioning (SC) Systems in 1 Served System (ft) system? component? this Dwelling Unit: feet of ducts? B. Space Conditioning (SC) System Information .` 'vw� Q% 01 02 03 04 05 06 07 08 09 10 Is the SC� Installinga � -- 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? Alteration Type TRANE WHOLE HOUSE 1785 Yes Yes Yes No No No Altered space conditioning system C. Extension of Existing Duct System, Greater Than 40 Feet (Section150.2(b)1Diib) This section does not apply to this project. Registration Number: 217-A020176833A-000-000-0000000-0000 CA Building Energy Efficiency Standards - 2016 Residential Compliance Registration Date/Time: 2017-05-26 10:15:39 Report Version: 2016.1.005 Schema Version: rev 10/16 HERS Provider: CaICERTS Report Generated: 2017-05-26 10:15:40 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -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 No heating This field or This field or Central split Outdoor This field or This field or TRANE furnace component section is not section is not AC condensing SEER 14 Setback section is not section is not altered applicable applicable unit applicable applicable Required 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) CF2R and MR -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 MR -MCH -25-H Refrigerant Charge verification required when refrigerant containing components are installed or altered (applicable in CZ 2, 8-15). CF2R and CF313-MCH-23 Airflow Rate >= 300 CFM per ton required when MCH -25 is required. Exceptions: Duct systems registered with HERS provider as previously sealed are exempt from M,CF!-20 Duct Leakage Testing requirements. Heating -only systems and Air Handler Furnace changes do not require verification of Air Flow MCH -23, r Refngdtant Charge MCH 25 =, Existing duct systems constructed, insulated or sealed with asbesto;mare exempt from MCA' 04 Le Cage Testittg,r�quir�fits. E. Entirely New or Complete Replacement Duct System, with or without Equipment Changeout (Sections 10.2(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-A020176833A-000-000-0000000-0000 Registration Date/Time: 2017-05-26 10:15:39 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-26 10:15:40 Schema Version: rev 10/16 CERTIFICATE OF COMPLIANCE CF1R-ALT-02-E Alterations to Space Conditioning Systems (formerly CF -1R -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: F Rando, Eric �C,�j /e4o Company: Signature Date: RANDO AAA HVAC INC 2017-05-26 10:15:39 Address: CEA/ HERS Certification Identification (if applicable): 1712 STONE AVENUE N/A City/State/Zip: Phone: SAN JOSE CA 95125 408-293-4717 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, and manufactured 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 design features or system design features identified on,this Certificate'of Compliance are capsistent vin!h the iformaYon provided on other applicabkcompliance documents, worksheets, calculations, plans and specifications submitted to the enforcement:agency for approval with, this building permit applicatioi 5. [will ensure that a registered copy of this Certificate of C6mpliance shall be made available wittr_the building permit(s) issued for the building, and made available to the*nforcement agency for all applicable inspections. I understand that a registered copy of thist ertificate of Compliance is required to be included with the documentation the builder provides to -the building owner at occupancy. Responsible Designer Name: -. Responsible Designer Signature: r i f Rando, Eric -;z— Company : Date Signed: RANDO AAA HVAC INC 2017-05-26 10:15:39 Address: License: 1712 STONE AVENUE 768871 City/State/Zip: Phone: SAN JOSE CA 95125 408-293-4717 Easy to Verify 10 at CaICERTS.com Digitally signed by CaICERTS. This digital signature is provided in order to secure the content of this registered document, and in no way implies Registration Provider 1 responsibility for the accuracy of the information. . Registration Number: 217-A020176833A-000-000-0000000-0000 Registration Date/Time: 2017-05-26 10:15:39 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2016 Residential Compliance Report Version: 2016.1.005 Report Generated: 2017-05-26 10:15:40 Schema Version: rev 10/16 PURPOSE This affidavit is a self-ce compliance with 2016 C: for inspections are requi 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 • building(5cupertino.org kation for the installation of all required Smoke and Carbon Monoxide Alarms for Section R314, R315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access GENERAL INFORMAI ION Existing single-family ar d multi -family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. Whei the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R 14, R315, and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarrfs be installed in the following locations: Carbon Monoxide alar are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached arage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 ands all be approved by the Office of the State Fire Marshal. Power Supply: In dwell' g units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling unit , 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 Sect on R314 and CBC Sections 907.2.11.4 and 420,6.2. An electrical permit is required for alarms which must be c nnected to the building wiring. As owner of the above -r ferenced 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 Residenti il Codes. The alarms specified below have been tested and are operational, as of the date signed below. Address: Permit No.� Specify Number of Alarms: 4 Smoke Alarms: 9 Carbon Monoxide Detectors: FI -11 I have read and agree to co ly with th terms nd conditions oft statement caner (or Owner A ent's) Name: AREA SMOKE ALARM CO ALARM Outside of each separate sl bedroom(s) - (Smoke alarn eping area in the immediate vicinity of the s shall not be located within 3 feet of bathroom door) X X On every level of a dwellin unit including basements and habitable attics X X Within each sleeping room X Carbon Monoxide alar are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached arage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 ands all be approved by the Office of the State Fire Marshal. Power Supply: In dwell' g units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling unit , 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 Sect on R314 and CBC Sections 907.2.11.4 and 420,6.2. An electrical permit is required for alarms which must be c nnected to the building wiring. As owner of the above -r ferenced 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 Residenti il Codes. The alarms specified below have been tested and are operational, as of the date signed below. Address: Permit No.� Specify Number of Alarms: 4 Smoke Alarms: 9 Carbon Monoxide Detectors: FI -11 I have read and agree to co ly with th terms nd conditions oft statement caner (or Owner A ent's) Name: Sinature ................. ... .................... .............................. Date:................... Contractor NamRLI e: . Signature....%�(��7tt1II •............. Date: , 1.�... . Lei Smoke and COform.doc revised 01/10/2017 Owner Name Address 1. Is your real property a regi ❑ Yes Civil Code Seel ❑ No Go to Question 2. Does your real property ha plumbing, installation of v ❑ Yes Civil Code Seel ❑ The licensec Skip the rest of ❑ No Go to Question 3. Is water service permanen� ❑ Yes Civil Code Seel ❑ No Go to Question 4. Is your real property built ❑ No My real properl Civil Code Sec ❑ Yes My real proper Civil Code Sec bottom of forte Please check ONE of the fc ❑ My property is a single, On and after January 1; to be replaced with wab compliant plumbing fi property undergoes alte ❑ My property is a vault f On and after January 1, plumbing fixtures to be On or before January 1, conserving plumbing fi: improvements). ❑ My property is a coraanaa On and after January 1, plumbing fixtures to be On or before January plumbing fixtures throu FATER-CONSERVING PLUMBING FIXTURES WNER CERTIFICATE OF COMPLIANCE MMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION X00 TORRE AVENUE • CUPERTINO, CA 95014-3255 8) 777-3228 - FAX (408) 777-3333 • building(a cupertino.org 't'`s. N \P jsg Permit No. 0"') ( ON O�yotL\�A tered historical site? ons 1101.1 through 1.101.8 do not apply. Skip the rest of the form and sign bottom of form. a licensed plumber certifying that, due to the age or configuration of the property or its er-conserving plumbing fixtures is not technically feasible? ns 110 1. 1 through 1101.8 do not apply. lumber's certification has been provided to the Building Division. e form and sign bottom of form. disconnected for your building? is 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. available for use or occupancy on or before January 1, 1994? is built and available for use or occupancy after January 1, 1994. )ns 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn. is built and available for use or occupancy on or before January 1, 1994. )ns 1101.1 through. 1101.8 apply. Check one of the three following statements and sign amily residential real property. See Civil Code Section 1101.4. 2014, building alterations or improvements shall require all non-compliant plumbing fixtures r -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non - aures shall be replaced with water -conserving plumbing fixtures (regardless of whether ations or improvements). nil); residential real property. See Civil Code Section 1101.5. ?014, specified building alterations or improvements shall require non- compliant replaced with water -conserving plumbing fixtures. 2019, all non-compliant plumbing fixtures shall be replaced with water - tures throughout the building (regardless of whether property undergoes alterations or tial real property. See Civil Code Section 1101.5. 014, specified building alterations or improvements shall require non- compliant :placed with water -conserving plumbing fixtures. 2019, all non-compliant plumbing fixtures shall be replaced with Nvater- conseiving ,,out the building (regardless of whether property undergoes alterations or improvements). I. as the owner or owner's gent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date spec ed above with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 1101.8, the curen California Plurfrbing Code and California Green Building Standards Code, and manufacturer's installation requirements, a ad that the wat conser g pl robing fixtures comply with the requirements as indicated in the table on the following paa(. Owner or Owner Agent's Si nature: t Date: Upon completing and sic, ng tlus Certificate, please return it to t1k.Building Division in order to final your building permit. SB407 201520c revised 0105117 CUPERTINO 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 • building(a)cupertino.org ' PURPOSE This affidavit is a self-ce rtification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance with 2016 CRC Section 8314, R315, 2016 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMA ION Existing single-family d 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 Alarr is be installed in the following locations: Carbon Monoxide alarrIs are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached Igarage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and stall be approved by the Office of the State Fire Marshal. Power Supply: In dwell' g units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling unil s, alarms are permitted to be solely battery operated where repairs or alterations do not result in the remov of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Seci 'on R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be c nnected to the building wiring. As owner of the above -r ferenced property, I hereby certify that the alarm(s) referenced above hasihave been installed in accordance Adth 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: Permit No. Z-0 Specify Number of Alarm (_4 Smoke Alarms: ; # Carbon Monoxide Detectors: 1 have read and agree to cor41v with th4termsAnd conditions of t ' statement caner (or Owner A ent's) Name: - - AREA SMOKE ALARM CO ALARM Outside of each separate sleeping bedroom(s) - (Smoke alarnis area in the immediate vicinity of the shall not be located within 3 feet of bathroom door) X X On every level of a dwellir g unit including basements and habitable attics X X Within each sleeping rooA I X Carbon Monoxide alarrIs are not required in dwellings which do not contain fuel -burning appliances and that do not have an attached Igarage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420.6 and stall be approved by the Office of the State Fire Marshal. Power Supply: In dwell' g units with no commercial power supply, alarm(s) may be solely battery operated. In existing dwelling unil s, alarms are permitted to be solely battery operated where repairs or alterations do not result in the remov of wall and ceiling finishes or there is no access by means of attic, basement or crawl space. Refer to CRC Seci 'on R314 and CBC Sections 907.2.11.4 and 420.6.2. An electrical permit is required for alarms which must be c nnected to the building wiring. As owner of the above -r ferenced property, I hereby certify that the alarm(s) referenced above hasihave been installed in accordance Adth 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: Permit No. Z-0 Specify Number of Alarm (_4 Smoke Alarms: ; # Carbon Monoxide Detectors: 1 have read and agree to cor41v with th4termsAnd conditions of t ' statement caner (or Owner A ent's) Name: - - a� --- ---.. - Sinature, i ................. .. s. ..........y......... .................................................... Date:................... Contractor Name: /y Z.D. Signature ....Lic.#JU -l. Date:k:) o Smoke and COforns.doc revised 01/10/2017 CUPERTIN4 Oa7ner Name i ! 1 P, Ac]dress7s\t\ \ `\ 1. i Is your real property a regi ❑ Yes Civil Code Sect ❑ No Go to Question 2. Does your real property ha plumbing, installation of v ❑ Yes Civil Code Sect ❑ The licensee Skip the rest of ❑ No Go to Question K .'Is water service permanent ❑ Yes Civil Code Seci ❑ No Go to Question 4. 1, Is your real property built ❑ No My real prop Civil Code S ❑_.._Yes My real prop Civil Code S bottom of fo: 5. Please check ONE of the f( ❑ My property is a single On and after January 1 to be replaced with -war compliant plumbing f property undergoes alt( ❑ My property is a multi j On and after January 1 plumbing fixtures to b( On or before January 1 conserving plumbing f improvements). ❑ My property is a conxn On and after January 1 plumbing fixtures to b� On or before January plumbing fixtures thro I, as the owner or owner'! replaced prior to date spe- through 1101.8, the curve installation requirements, table on the following pa: TATER -CONSERVING PLUMBING FIXTURES WNER CERTIFICATE OF COMPLIANCE MMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION X00 TORRE AVENUE • CUPERTINO, CA 95014-3255 777-3228 --FAX (408) 777-3333 • buildinaCa�cupertino.org W d historical site? 1101.1 through 1.101.8 do not apply. Skip the rest of the form and sign bottom of form. a licensed plumber certifying that, due to the age or configuration of the property or its :r -conserving plumbing fixtures is not technically feasible? s 110 1. 1 through 1101.8 do not apply. umber's certification has been provided to the Building Division. form and sign bottom of fon-a. disconnected for your building? is 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. available for use or occupancy on or before January 1, 1994? is built and available for use or occupancy after January 1, 1994. >ns 1101.1 through 1101.8 do not apply. Skip the rest of the fonn and sign bottom of fonu. is built and available for use or occupancy on or before January 1, 1994. ins 1101.1 through 1101.8 apply. Check one of the three following statements and sign randZy residential real property. See Civil Code Section 1101.4. 2014, building alterations or improvements shall require all non-compliant pluimbing fixtures :r -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all non- 5tures shall be replaced with water-conseiving plumbing fixtures (regardless of whether •ations or improvements). :nlily residential real property. See Civil Code Section 1101.5. 2014, specified building alterations or improvements shall require non- compliant replaced with water-conseiving plumbing fixtures. 2019, all non-compliant plumbing fixtures shall be replaced with water- ctures throughout the building (regardless of whether property undergoes alterations or 3rcial real property. See Civil Code Section 1101.5. 2014, specified building alterations or improvements shall require non- compliant replaced with water -conserving plumbing fixtures. 1, 2019, all non-compliant plumbing fixtures shall be replaced with water-- conselving Qhout the building (regardless of whether property undergoes alterations or improvements). agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be ified above -NN ith water-conseiving plumbing fu -tures in accordance with Civil Code Sections 1101.1 t California PI `rbing Code and California Green Building Standards Code, and manufacturer's ind that the watetJ consei*g plAmbing fixtures cain. with the requirements as indicated in the Owner orb wner Agent's signature: Upon completing and s' aping this Certificate, please return it to Date: U 1 `?a,0 111 Division in order to final your building permit. SB4072015.doc revised 01/05/17