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B-2017-0695CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0695 863 BETLIN AVE CUPERTINO, CA 9501413546 (369 27 025) H B KITCHEN BATH INC HAYWARD, CA 94544 DOWNER'S NAME: SKRZYPEK JOSEPH TRUSTEE I JDATE ISSUED: 07/10/2017 1 OWNER'S PHONE: 408-693-5125 License Class a Lic. #1002733 Contractor H B KITCHEN BATH INC Date 04/30/2019 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 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 regulations per the Cupertino Municipal Code, Section 9.18. 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) 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 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. 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 Date 7/10/2017 PHONE NO: (510) 900-6388 BUILDING PERMIT INFO: X BLDG X ELECT X PLUMB X MECH X RESIDENTIAL _ COMMERCIAL JOB DESCRIPTION: BATHROOM REMODEL (110 S.F.); KITCHEN REMODEL (156 S.F.); PANEL UPGRADE (200 AMPS); REPLACE WINDOW (1) -TO MEET EGRESS; (N) FURNACE AND TANKLESS WATER HEATER; REMODEL BEDROOMS AND HALLWAY (346 S.F.) Sq. Ft Floor Area: I Valuation: $90000.00 APN Number: Occupancy Type: 369 27 025 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Jasmine Arch Date: 07/10/2017 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: 7/10/2017 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, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized age D --- Date: 7/10/2017 CONSTRUCTION E D G AGENCY I hereby affirm that there is a construction len ing 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 CUPERTINO CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building4cupertino.org ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI ❑ REVISION / DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS QI '^v Be -+I I, "N # rJIb3 OWNER NAME sGA TSS I PHONE EL Jul 7-�X�IIODfLG l STREET ADDRESS / �e:yI �� CITY TATE,ZIP FAX CONTACT NAME Q ^ fI PHONE � cf .23o -2984 E-MAIL A STREET ADDRESS I 0A' ^bpc�4 1 CITY, ST ZIP f FAX O{ `❑ ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT L' ARCHITECT ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME I -I t -W -N&/ &+ry �(/ LICENSE NUMBSR .5 LICENSE TYP BUS. LIC # } COMPANY V�! `/ 11V / STREET ADDRESS , / �� � i CITY, STA E, [P q_f� PHO / _ ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK j%„ , _ io_ �OO 4:;x(_e � +-e, r r /►,, new l,,allwe,- n -�-Cr/VA( PaM "40V ILV a� ' VNlut CNS 1 � IeSs w4tvrhec4y_ EXISTING USE PROPOSED USE I I CONSTK E I # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM REMODEL AREA j C) l KITCHEN REMODEL AREA 1 lKIPORCH OTHER I REMODEL AREA -34 ( fl l PORCH AREA DECK AREA TOTAL DEC AREA GARAGE AREA: DETACH ATTACH # DWELLING UNITS: IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES BEING ADDED? ❑NO ADDITION? ONO PRE -APPLICATION ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES RECEIVED -BY : UAT ON: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO /VI =TT(9 By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on thproperty 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 buil 'ng construction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Date: 512-1 [1 Signature of Applicant/Agent: SUPPLEMENTAL INFORMATION REQUIRED PLAN CHECK TYPE ROUTING SLIP 11 OVER-THE-COUNTER /! ' J BUH DING PLAN REVIEW UI Y1ClUf _ 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 PLAN REVIEW _ Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD PLANNING L'S 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 -CJ SANITARY SEWER DISTRICT submittal of Building Permit application. ❑ ENVIRONMENTAL HEALTH B[dgApp_2011.doc revised 06/21/11 SMOKE / CARBON MONOXIDE ALARMS rti/' OWNER CERTIFICATE OF COMPLIANCE ~�r COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION UPER 1, Nt3 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 (408)777-3228•FAX(408)777-3333• building(a cupertino.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 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for inspections are required. GENERAL INFORMATION Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms. When the valuation of additions, alterations, or repairs to existing dwelling units exceeds $1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon Monoxide Alarms be installed in the following locations. AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of X X the bedroom(s) On every level of a dwelling unit induding basements X X Within each sleeping room X Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with CBC Section 420 6 and shall be approved by the Office of the State Fire Marshal. Power Supply In dwelling units with no commercial power supply, alarm(s)may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,basement or crawl space. Refer to CRC Section R314 and CBC Sections 907.2.114 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 t /l / Address �� l� ' In i \V } Fe( j<o �` �]c(�(1 Permit No. t3 2 b Specify Number of Alarms: #Smoke Alarms. I ( #Carbon Monoxide Detectors. I 1 I have read and agree to comply with the terms and conditions of this statement Owner(or Owner Agent's)Name: Signature Date: /1'qh -TG✓1 Tst,i I Contractor Name: Signature Lic.# Date: Smoke and CO fonn.doc revised 09/27/16 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR. PERMIT NO.B-2017-0695 863 BETLIN AVE CUPERTINO,CA 95014-4546(369 27 025) H B KITCHEN BATH INC HAYWARD,CA 94544 OWNER'S NAME: SKRZYPEK JOSEPH TRUSTEE DATE ISSUED:07/10/2017 OWNER'S PHONE.408-693-5125 PHONE NO:(510)900-6388 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO. License Class¢ Lic.#1002733 Contractor H B KITCHEN BATH INC Date 04/30/2019 X BLDG X ELECT X PLUMB I hereby affirm that I am licensed under the provisions of Chapter 9(commencing X MECH X RESIDENTIAL_COMMERCIAL with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JOB DESCRIPTION BATHROOM REMODEL(110 S.F);KITCHEN REMODEL(156 S.F); I hereby affirm under penalty of perjury one of the following two declarations: PANEL UPGRADE(200 AMPS);REPLACE WINDOW(1)-TO MEET 1. I have and will maintain a certificate of consent to self-insure for Worker's EGRESS,(N)FURNACE AND TANKLESS WATER HEATER, Compensation,as provided for by Section 3700 of the Labor Code,for the REMODEL BEDROOMS AND HALLWAY(346 S.F) Zl�performance of the work for which this permit is issued. REV#1 CHANGE LOCATION OF AC UNIT-ISSUED 12/18/2017 I have and will maintain Worker's Compensation Insurance,as provided for by Illh t Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$90000.00 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 369 27 025 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 againstsaidCity in stands andce of the hg othis WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally,the applicant understands and will comply with all non-point source regulations per the C .ertino M pal Code,Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION 6/Signature - Date 12/18/2017 Issued by•Arnold Horn Date:07/10/2017 OWNER-BUILDER DEECCLAI2&TION 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 i. 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:12/18/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER i. 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 Code,Sections 25505,25533,and 25534. Labor Code,I must forthwith comply with such provisions or this permit shall 410. be deemed revoked. Own4.°r authorized agent: APPLICANT CERTIFICATION Dater1'2/18/2017 I certify that I have read this application and state that the above information is IN T• I t I► A N correct.I agree to comply with all city and county ordinances and state laws I hereby affirm that there is a construction Fending 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 12/18/2017 Professional ( CONSTRUCTION PERMIT APPLICATION \eft, B COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 s� r, 408 777-3228 • buiIdin (tI cu eI tirto.org PEMIT#B- ( ) g-' P � � t1 - ab�J CUPERTINO REvl DEF ❑ NEW CONSTRUCTION ❑ADDITION ❑ALTERATION ❑T.T. El MEP ElRE-ROOF El SWIMMING POOL/SPA PROTECT o, 7, l\ .�. APNIt ; CO 2-1 01��.— -OWNER NAME y�tt-Rs6PI 1 'A ' PHONE-140c6_,..1 ,s E-MAI ctItswt j STREET ADDRESS g l if A Ave CITY, 5T�' ZIP i Lf-,per-hoe) e� 1'e) ( C_61 q xi CONTRACTOR NAME ❑OWNER-BUILDERIICOMPANY NAME LICENSE NUMBER LICENSE TYPE e. U I''4c(4.ev\IN gA-1-14 ' 1,0073-33 CA- LSTREET ADDRESS Doi CITY.&TATE, ZIP y -% citt 91-4§-ziq . E-MAIL Y PHONE BUS.LIC -- 6 b n c-io-100 63cDc iLttc 3O gss 0 ARCHITECT 11,OWNER ❑OWNER AGENT 0 CONTRACTOR AGENT ENGINEER 0 DEVELOPER 0 TENANT CONTACT NAME �i �" ykp STREET ADDRESS 3 p CITY,STATE,` ZIP n��j - ('�,r� PHONE`f �pp / L IDECRIPTOfy !1 l�(A t f Y'9 I CA t�Cf 1 `TO " s6 ! 1 �� 1 L,� ' b1S vi C ilk-ocok i i Air CJS ❑SINGLE-FAMILY/DUPLEX 0 MULTI-FAMILY 0 INDUSTRIAL 0 COMMERCIAL EXISTING USE EXISTING SF NEW FLOOR SF I PORCH SF DECK SF DEMO SF STORIES I TOTAL NET SF USE TYPE OCC SQ.FT. VALUATION(5) REMODEL REMODEL KITCHEN. REMODELOTHR GARAGE ❑ATTACHED BATHROOM SF SF SF SF 0 DETACHED EXISING 0 YES EICHLER ❑YES SECOND STORY ADDITION ❑YES FIRE SPRINKLERS 0 NO ❑ NO .❑NO DWELLING SECOND DWELLING ❑YES ❑ATTACHED❑.DETACHED OTHER UNITS# UNITADDITON: 0 N S POOLSI ElFIBERGLASS 0 VINYL-LINED 0 GUNITE 0 PREFABRICATED POOL SF - SPA-SF I SPA ATTACHED❑YES 0 NO 1 TOTAL-SF --------) RRCEIVED BY: \TOTAL—VALUATION: Commercial or Multi-Familu Buildings with Public Swimming Pools requires Department of Environmental Heal);approval .--.. icy RE-RO OFI EXISTING ROOF TYPE: ❑BUILT-UP ROOF❑ASPHALT SHINGLES❑WOOD SHAKES❑WOOD SHINGLES❑TILE OTHER(SPECIFY)' REMOVE/REPLACE D NO IF NO PLYWOOD ❑1" 0 3/8" PLYWOOD TYPE: PITCH: ROOF CLASS DYES I OF LAYERS THICKNESS❑5/8" OTHER ❑OSB ❑CDX OTHER :12 A PROPOSED ROOF TYPE:❑BUILT-UP ROOF ❑ASPHALT SHINGLES 0 WOOD SHAKES OWOOD SHINGLES 0 OTHER *Provide a signed copy of the Cupertino's Tear-Off Policy SF /of SQUARES ""- . 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 construction. I authorize representatives of Cupertino to enter the above identified property for inspection pur ores. I acknowledge and authorize all information contained on this application form to\�e made available-for-public record. 7 / Signature of`Applicant/A en ,/`ice Dae t: c 1 2-( 1 /I ' - SUPPLEMENTAL INFORMATION REQUIRED *New SFD/Second Dwelling Units/Multifamily Dwellings:A Demolition permit is required prior to issuance of a building permit for all new construction. *Commercial Buildings: Provide a completed Hazardous Materials Disclosure form if any Hazardous Materials are being used as part of this project. *Copy of Planning Approval Letter or Meeting with Planning prior to submittal of Building Permit application. *HOA-Provide a letter of approval from the Home Owner's Association BIdg.4pp_2017.doc revised 08/01/17 e 8 '� ow ,eo= a - g foo Zo.00 0_. xz o� oz T9woo _1— V I Q 2. 33 00 3z II E eR o K � U 3 4gg..moa�a. aoo 5. o ‘fi ao 6E g I W �6 $8 . $3m � i3w t� 3 v�i¢Z. k 3 V J WW o w��� _ic , F o o�a a <�a�a�o¢v�i ��¢°oaa3a ¢VVsaVw w: I II 1 £ .,... ....._-. ..........a _ ►pry 0 £ N NiN NNN N N --N N aN N _....N N N N `,p 1 4_ d. 1 a Q aiaaa Z e M a a -a a a a i. a ,,. Qom+' ('' ,1 iiIl1 .1B1 g1 'lb ia , i. 1 g � I 0 ' 119b : 1 Y ; " f 9 g ai II ! ;-t �i ' 13 lo 13 Z p £� R£ 1£€ n° hill-10i i} 8 a , li lig, I— gs iEgg I I '}}.y a lit3 55 111$p epi i�<$�CF[sF #'1,yaae�1s5 1111 W g l.E 1ag] £1g¢$ s£ it p i If Mt Z Z- 1 N ��9 e ip 6, 83 ;u" FJ K d] � C V b £ Y. a y p €C dr 0 1 3 Y -$��pRR g6 midi y t gg p �i 666 a 83 8 °aaf{{'�2 @1 i" e�; € $j: 'I { I gggg@@ rfpg i g $!gg1¢'il E iI A da 111 8£ang l i, o g _ i l I. = y p �d N NI N'''N N N N Q N NNN N N N N N N�N N g CC 111 o t ° 1 a 1,z ama; a s a a 2 a « a a as a aQQa S CC ill g 'PI egit i g gggj It I p PI a isi i5 10 ala i ,l $°441 1 1 ,p i _ 1itI 1111 111111I1011 I % F _ phi �1 JJ° p-1 ri ttilli gib ON ' € ' '1g agg i gill a @gs if zpr II & �a i, °� ` E' € g gggg $yP Y� a B.�p 1 , e i § §Fl 1 1x casJ $¢ g B C, U' 6 ii 111 Y6 .. 4 $8 £= F �` -01 &e4 s & g.y V .age I'S n ggg$ yy 3ppp Y O E 3 /1a p lid -.:- _ a is lir t. iii B4._61 ,' F til g S11;1g t_ d £li ffi si.-. ilit,c a N i[ x a p f fid 1181 1'z 1 1 z 3 n -� l g g !jn li„i'llg1. E g --- e g$ W €nri g 1 aft ii g s:i 1 dhigiEli ibtIh11 1 1r � � 1 _ i $i 1 E b. _ , 1 WhT7 W � Li F7 i ,ice I 8 Q cl- o / 4, _ a i o,'s '!', -®® tet : ao a `b_ 5 '' 4 ® *ENE cpe re m � � „ 6£ 868`1-5 iL '”) — ..".. E 4 lin az 9 �w , WIP U a i a s ' s i Y i ? i Y; d i. ., g -,'T� 00 _' UZig 4 w c U oa W Q M8W \ SMOKE / CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,-CA 95014-3255 CUPER i l h1© (408)777-3228•FAX(408)777-3333•buildinq(icupertino.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 �y pE�( v Address: S-6; \ *tt ' . AU C)1 'L3 O1 Permit No. 19- �-O6i d - Specify Number of Alarms #Smoke Alarms ( #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: tfl5� 17s-6A d Signature 6. ' Date: 241 fj11 Contractor Name: Signature Lic.# Date: . Smoke and COform.doc revised 01/10/2017 / '` WATER-CONSERVING PLUMBING FIXTURES L OWNER CERTIFICATE OF COMPLIANCE 1p,�- -- x.r,, COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 44, 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777(3228•FAX(408)777-3333•buiidinq(c�cupertino.org Owner Name A-1156, ' L, f Permit No. g I - ) 'j- Address ,J-e±11n Ave- f f ci. 2f+ Ao CA-- rat Lt 5tiCrEp7-CANNOT B1 NALANCOMPLEITID NITIL TIJ CERTJEKATE I D.9x�� O � ,fpotiwNgo, a1 ° Please refer to the attached California Civil Code Sections 1101.1—1101.8 which are part of this Certification form. 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Sign below and skip the rest of the form. Owner' Signature: Date: 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? Q Yes Civil Code Sections 1101.1 through 1101.8 do not apply. El The licensed plumber's certification has been provided to the Building Division. Sign below and skip the rest of the form. Owner' Signature: Date: iy'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. Sign below and skip the rest of the form. Owner' Signature: Date: ' No Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? LI 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 foiui. Owner' Signature: Date: II 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. 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 of whether property 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 plumbing fixtures to be replaced with water-conserving plumbing fixtures. SB407 2014.doc revised 03/18/14