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B-2017-0737CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0737 10165 VICKSBURG DR CUPERTINO, CA 95014-3318 (369 07 005) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS, TN 38120 OWNER'S NAME: GYGER W AND MAYA TRUSTEE ISSUED: 05/09/2017 OWNER'S PHONE: 408-921-5901 1 I PHONE NO: (901) 271-9700 LICENSED CONTRACTOR'S DECLARATION License Class GENERAL ENGINEERING CONTRACTOR Lic. # 67 5155 Contractor R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC Date 07/31/2018 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. 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 M 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 8/8/2017 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) 2. 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: 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. 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 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. BUILDING PERMIT INFO: X BLDG —ELECT X PLUMB _ MECH X RESIDENTIAL _ COMMERCIAL DESCRIPTION: ,ACE 40 GAL WATER HEATER - SAME LOCATION #1- INSTALL TANKLESS WATER HEATER - SAME LOCATION Sq. Ft Floor Area: I Valuation: $3666.66 APN Number: Occupancy Type: 369 07 005 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Abby Avende Date: 05/09/2017 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 Al Date: 8/8/2017 ALL 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 Mumc' 1 Code, Chapter 9.12 and the Health & Safety C de, Sections 2 5, 25 3, and 25534. Owner or authorized agent: Date: 8/8/201. 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. CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUIREGV48ION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTiNO I (408)777-3228 • FAX (408) 777-3333 • buildingcd-cupertino.org. ❑ NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION / TI a( I. ISION DEFERRED ORIGINAL PERMIT # PROJECT ADDRESS FA N # OWNERNAM\,O Vv, PHOU C I cynO E-MAIL ¢� LZ STREET ADDRESS CITY, S E, ZIP GA 9 'S 1 Wr CONTACT NAME PHONEI 1 D Z E-MAIL- /� STREET ADDRESS� �� � � f CITY, STATE, � ('�,, _ � � Iv� � •��J❑\'[ARCHITECT FAX ❑ OWNER ❑ OWNER -BUILDER 111OWNERAGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME ,� `i LICENSE NUMBER LI NSE TYP BUS. LIC # i2 �Scc V r 7) (RinSS 3 ? 2 t COMPANY NAME E-MAIL � � /� � � ' /' _ FAX STREET ADDRES�® T CITY, STATE, ZIP (�� \� PHONE( /C)�_ (TZ �J ( � L ( ,,,, o ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX , STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK n f EXISTING USE PROPOSID USE CONSUL TYPE # STORIES USE TYPE OCC. SQ.FT, VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NETAREA BATHROOM KITCHEN OTHER AEMODfiL AREA; i 'REMODEL AREA REMODEL AREA .PORCHAREA DECK AREA TOTAL DECK/PORCH 'AREA GARAGEAREA: DETACH f ❑ ATTACH ' .# DWELLING UNITS: ! IS A SECOND UNIT ❑ YES SECOND STORY ❑ YES I BEINGADDED? NO ADDITION? ❑NO PRE -APPLICATION, ❑ YES IF YES, PROVIDE COPY OF IS THE BLDG AN ❑ YES TOTAL VALUATION: PLANNING APPL#' ❑,NO PLANNING ,APPROVAL LETTER EICHLERHOME? El ' a By my signaturebelow, 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 T ave provided is c I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state Paws relatin to building co truction. authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent,: Date: SUPPLEMENTAL INFORMATION REQUIRED. PiAIycHEcxT;irPE _, , -UTIN ROGSLIP ,,, New SFD or Multifamily dwellings: Apply for demolition permit for3 ❑ ❑ existing building(s). Demolition permit is required prior to issuance of building OVER THE COUNTER BUILDING PLAN REVIEW > t permit for new building.LJ ❑ t ❑ EXPRESS PLANNINGPLANRE�7EW Commercial Bldgs: Provide a completed Hazardous Materials Disclosure"Ll"sTaNDaRD ❑ rirBLlc{woxxs _ fonn if any Hazardous Materials are being used as part of this i k project. ❑. LARGE ❑ FIRE DEPT c Copy of Planning Approval Letter or Meeting with Planning g prior to Ai N {*` Y } _ submittal of Building Permit application. �. MA�oR e ❑ sANITARY SEWER DISTRICT z '❑'.'ENVIRONIVIENTAL'IiEALTH i.' ... B1dgApp_2011.doc revised 06121111 ff2i NORITZ Model NR981 Series Residential Tankless Water Heater Specification Sheet • Standard Input - gas consumption ranges from 16,000 BTUh to 199,900 BTU • Capacity Range - flow rates from 0.5 gpm up to 9.8 gpm • Compact Design - ANSI Z21.10.3/CSA 4.3 certified design that can be wall' -mounted indoors (-SV and -DVC models only) or installed outdoors with an -OD model • Durable Steel Casing with Polyester Coating o Heat Exchanger - manufactured with commercial grade copper, 25% thicker piping than standard models Venting Options - available in Power Vent (-SV),Outdoor (-OD), or Concentric Direct Vent (-,DVC) model that requires either 4" Category III or 5"/3"Noritz concentric stainless steel pipe • Direct Electronic Ignition' • Quick -Connect - two identical units can be linked together by using the optional Quick Connect Cord (#QC -2) for twice the hot water capacity • Energy Factor- 0.82 (NG) 0.88 (LP) for all NR981 Series models •Thermal Efficiency- 84% efficient for use with natural gas or propane • Temperature Controls -'includes remote thermostat that can precisely adjust the output temperature from 100°F to 140*F with the capability to display temperatures in both *Qand °F • Power Cord Installation Kit - 6' power cord is included with -SV and -DVC models (assembly required for SV models) • Safety Devices - Flame�Sensor, Overheat Prevention Device, Lightning Protection Device, Freeze Protection • Additional Features -;Temperature Lockout, High Elevation Adjustment, Service Reminder Function • 12 -Year* Limited Heat,Exchanger Warranty for Residential Use • 5 -Year Limited Parts Warranty • 1 -Year Reasonable Labor • Approvals - CSA, UPC**, NSF, Low NOx Approved by SCAQMD [<14ng/J or 20ppm], SV Model OD Model DVC Model Model NR981 - ❑ SV(StandardVent) ❑ OD (Outdoor Vent) ❑ DVC (Concentric Direct Vent) Accessories ❑ Isolation Valves (#IK -WV -200-1) ❑ Pipe Cover forSV/OD Model (#PC -2S) ❑ Pipe Cover for DVC Model (#PC -5S) ❑ Recess Box for OD Model (#RB -700-1) ❑ Quick Connect Cord (#QC -2) f O� ©LOW LEAD i;o *Heat Exchanger warranty is maintained at 12 years or6500 operational hours, whichever occurs first when used in a single family dwelling in conjunction with a controlled recirculation system (ori aquastat being the minimum pump control requirement) in accordance with the Installation Manual. Refer to the Noritz Limited Warranty for complete coverpge;details **This product complies with California AB 1953 Low Lead Law and Section 1417(d) of theSafe Drinking WaterAct NORiIZ AMERC4 CORP01Ri4TION 11160 Grace Avenue, Fountaire Valley, CA 92708 Tel.1-866-7NORTZ www.noritz.com Flow Rates Temperature 30 40 45 50 60 70 80 90 100 Rise (°F) Gas Supply Pressure NG: 4.0"- 10.5" LP: 8.0"-14.0" - Water Holding Capacity 05 Gallon 0.8 L) 02 Gallon (1.0 L) _ Flow Rate Water Inlet 84 41 7 67 c 56 4.8 4.2 3.7 3.4 (GPM)98 Gas Inlet _ Power _Supply 120VAC MHz), less than 2 amperes For peak flow rates in shaded areas, contact Noritz for proper setting Pressure Loss 30 25 a 20 N d 10 5 0 60 s0 40 v A 0 x 30 `o LL 20 10 0 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 11.0 Flow Rate (gpm) Specifications Model Name NR981-SV NR981-OD NR981-DVC Weight 54 (pounds) 58 (pounds) ' Operating Pressure _ 15 - 150 psi Gas Supply Pressure NG: 4.0"- 10.5" LP: 8.0"-14.0" - Water Holding Capacity 05 Gallon 0.8 L) 02 Gallon (1.0 L) _ Water Inlet 3/4" Connection Sizes Hof Water Outlet 3/4" ' Gas Inlet 3/4" Power _Supply 120VAC MHz), less than 2 amperes Consumption NG: 65W LP: 69W Freeze Prevention 193W NG: 65W LP: 67W Freeze Prevention 161W NG: 80W LP: 83W Freeze Prevention 193W Freeze Protection Indoor: -30°F Outdoor: -4°F Indoor: -30°F Temperature Settings °F Mode 100-140T(In 5°Fintervals) (9 Options) °C Mode 37-48°C (In 1°C intervals), 50,55,60'C (In 5°C intervals) (15 Options) Default Temperature Options 'F Mode 120,135,1407 (Default is 1209 °C Mode _ _ 50, 57, 60°C (Default is 50°Q Noritz America reserves the right to discontinue, or change at any time, the designs and/or specifications of its products without notice. Rev. 07/15 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-0737 10165 VICKSBURG DR CUPERTINO, CA 95014-3318 (369 07 005) A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC MEMPHIS, TN 38120 OWNER'S NAME: GYGER W AND MAYA TRUSTEE DATE ISSUED: 05/09/2017 OWNER'S PHONE: 408-921-5901 PHONE NO: (901) 271-9700 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class C-36: C-420 A Lic. #765155 X BLDG X PLUMB Contractor A R S AMERICAN RESIDENTIAL SERVICES OF CALIFORNIA INC _ELECT MECH X RESIDENTIAL _ COMMERCLAL Date 07/31/2018 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 JOB DESCRIPTION: license is in full force and effect. REPLACE 40 GAL WATER HEATER - 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 Sq. Ft Floor Area: Valuation: $3666.66 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 Number: Occupancy Type: information is correct. I agree to comply with all city and county ordinances 69 369 07 005 3 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 PERMIT EXPIRES IF WORK IS NOT STARTED City of Cupertino against liabilities, judgments, costs, and expenses which WITHIN 180 DAYS OF PERMIT ISSUANCE OR may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point 180 DAYS FROM LAST CALLED INSPECTION. sourc regulations per the Cupertino Municipal Code, Section 9.18. Issued by: Abby Avende Signatur Date 5/9/2017 Date: 05/09/2017 OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the RF 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 following two reasons: 1. I, as owner of the property, or my employees with wages as their sole inspection. compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) Signature of Applicant: 2. I, as owner of the property, am exclusively contracting with licensed Date: 5/9/2017 contractors to construct the project(Sec.7044, Business & Professions Code). ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the z. I have and will maintain Worker's Compensation Insurance, as provided for by California Health & Safety Code, Sections 25505, 25533, and 25534. I will Section 3700 of the Labor Code, for the performance of the work for which this maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous permit is issued. material. Additionally, should I use equipment or devices which emit hazardous s. I certify that in the performance of the work for which this permit is issued, I air contaminants as defined by the Bay Area Air Quality Management District I shall not employ any person in any manner so as to become subject tthe will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and Worker's Compensation laws of California. If, after making this certificate of the Health & Safety C e, Sections 25505, 25533, and 25534. 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 Owner or authorized agent: be deemed revoked. Date: 5/9/2017 LENDINGA N APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is CONSTRUCTION .Y I hereby affirm that there is a construction lending agency for the performance correct. I agree to comply with all city and county ordinances and state laws of work's for which this permit is issued (Sec. 3097, Civ C.) relating to building construction, and hereby authorize representatives of this city Lender's Name to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Address to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in ARCHITECT'S DECLARATION consequence of the granting of this permit. Additionally, the applicant understands I understand my plans shall be used as public records. and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Licensed GENERAL PERMIT APPLICATION MEP COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 M 1 R t CUPERTI!NO ❑PLUMBING ❑MECHANICAL [—]ELECTRICAL ❑MISCELLANEOUS (408) 777-3228 •FAX (408) 777-3333 • buiidina(d-)cupertino.or PN r 3 (A- U o PROJECT ADDRESS j ^ ` �u ( D r t OWNER NAME + , ^ � � PHONE ` b � � ' ` E-MAIL STREET.ADDRESS 10 I v � r CITY, S t P L n 61( FAX CONTACT NAME ` r ^L C/ PHONE O�-� �,Z �, `_ STREETADDRESSi+jV rL CITY, STATE; ZIP �" ^�v71 1 FAX ElOw'NER 171I OWNER --BUILDER ❑ OWNERAGENi ^ONTRACTOR 13 CONTRACTOR AGENT ❑ ARCHITECT 1:1ENGWEER ❑ DEVELOPER ❑ TENANTCONTRACTOR NAME JLS ak o (jok::)1 ` r LICENSE NUMBER r ) LICeE TYPPE� BUS. LIC COMPANY NAME E-14AIL V c-cl Q C' V" FAX STREET ADDRESi22F� n. y� r CITY, STATE, ZIP--"�v r ' I PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE USE OF SFD or DUPLEX ElMULTI-FAMILYPROJECT LN NOTLDLAND ElYES BUILDING: El WNIMERCLAL URBAN INTERFACE AREA ❑ NO PROJECT IN ElYES FLOOD ZONE ❑ NO IS THE BLDG AN ❑ YL -S EICHLER HOME? ❑ NO DESCRIPTION OF WORK W CCU�- Y 1 I � TOTAL V.ALUATION: 22 RECEIVED BY: By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owne 's behal . 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 relat' to build' struction. I authorize representatives of Cupertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED OFFICE USE ONLY w ❑ O\'ER-THE-COUNTER I-' r ElEXPRESS U ❑.STANDARD z < ❑.LARGE' MAJOR A1EPA1iscApp_2011.doc revised 05/21111 Film E SMOKE 1 CARBON MONOXIDE ALARMS fim all OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION C u P E RTI H O 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 buildinp(Qcupertino.org PERMIT CANNOT BE. FINAtEU UNTIL THIS CERTIFICATE HAS BEEN COMPLETED, SIGNED. AND RETURNED TO THE BUILDING D"ION PURPOSE This affidavit is a self -certification 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 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 bedroom (s} — (Smoke alarms shall not be located within 3 feet of bathroom door). X X On every level of a dwellin unit includin basements and habitable attics X X Within each slccping room X Carbon Monoxide alarms are not required in dwellings wlvch 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 907.2.11 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 10 Address Permit No. _& Specify Number of Alarms # Smoke Alarms, # Carbon Monoxide Detectors 1 have read and agree to comply with the terms and. conditions of this statement Owner (or Owner Agent's) Name: Sinature ......... .... ..................................................__.......... ,... _.._..............__ Date:.............,.,... Contractor Name: .00p, /1 �_I Signature ..... Lic.# . Date: Sinoke and COJbrm.doc revised 01/1012017 WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT - BUILDING DIVISION, 10300 TORRE-AVENUE - CUPERTINO, CA 95014-3255 (y /77-3228 - FAX (408) 777-3333 - building(Ocupertino.ong Address U(W� MS WIS M 1: Is your real property a registered historical site? �7s Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of fonn. WyO" 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 v�latcr-conserving plumbing fixtures is not technically fasible? El Yes. Civil Code Sections 1101.1 through 1101.8 do not apply. El The licensed thitribees certification has been prorvidedto the Building Division. Skip the rest of the form and sign bottom of form. 8"'No Go to Question 3. 3. Is, water service permanently disconnected for your building? i4F1 V -S Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of forrm c) Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? 0 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. Lel 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., 5. Please check ONE of the following,: 0 Ilypropei ty is a single -fancily residential real property. Set Civil Code Section 1101.4. On and after January 1, 2014, building alterations or improvements shall require all.non-oompliant plumbing fixtures to be replaced with crater -conserving plumbing fixtures throughout the building. On or before January 1, 2017, all cion- compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless of whether property undergoes alterations or improvements). 0 -Myproperty isa7nultiainil 'f y i' e�y i idvit' , al real property. See Civil Code Section 1161.5. _ 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), 1:1 Mypropertyis a coinniercial real property, See Civil Code Section 1101.5. On and after January 1, 2014, specified building alterations or irnproveinents shall require non- compliant plumbing fixtures to be replaced with water-conseiving plumbing fixtures. On or before Januar 1, 2019, all non-compliant plumbing fixtures shall be replaced -with water- conserving January t:> plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improverhents). 1, as the owner or mvner's agent of this property, certify under penalty ofpeijury 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 Z, through 1101.8, the current California Plumbing Code and California Green Building Standards Code, and nianufacturer's installation requirements, and that the water -conserving plumbing fixtures comply with the requirements as indicated in the table, on the following page. it to theQLujding Division in order to final your SB4072015.doc revised 01105117