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15100200
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10832 WILKINSON AVE CONTRACTOR: CALIFORNIA DELTA PERMIT NO: 15100200 MECHANICAL INC OWNER'S NAME: SARANG SRINATH AND RADHIKA S 16056 E BASELINE RD STE 155 1 DATE ISSUED: 10/23/2015 OWNER'S PHONE: 4083162429 F, LICENSED CONTRACTOR'S DEC`L/ARATION Lic3Class G - D L -i Co7ftr36t r I hereby affirm that.1 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 as provided for by Section 3700 of the Labor Code, for the of the work for which this permit is issued. 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. ditionally, the applicant understands and will comply with all non -point sourqSoolations per the Cupertino Municipal Code, Section 9.18. ❑ OWNER -BUILDER DECLARATION 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) 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: 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 G Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. s. 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. MESA, AZ 85206 PHONE NO: (866) 692-5273 JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑ INSTALL (N) AC UNIT ON SIDE OF DWELLING Sq. Ft Floor Area: I Valuation: $7200 APN Number: 35613036.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 D F LAST CALLED INSPECTION. Issued b Date: V 2 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: 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 fuse 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 & SaaCode, Sections 25505, 25533, and 25534. agent: �,� � r (?%� Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CCUPERTINO FI NP.W (11NCTRT T(-TT/)N CONSTRUCTION PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT . BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 /►1 (408) 777-3228 • FAX (408) 777-3333 • buildin-g cupertino.org ATITITTT(1M FI AT TPR ATT0'kT / TT I 1 RFVTQTIIAT / TIRRR1DP1r7n nDT(VTATAT DFAA H'P 4f PROJECT ADDRESS '_-` JAPN # /' I i O lv^ �` OWNER NAME_ L PHONE 8 2/ E-MAIL STREET ADDRESSSTATE, �� C/ ZIP Fv 6- 9 FAX . r &57 , mss%► d CONTACT NAME E-MAIL STREET,ADDRESS CITY, STATE, ZIP FAX ❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE PEBUS. BUS. LIC # 2-0 COMPANY NAME _ _ E-MAIILLf FAX � CL% STREET AD RESS x,7 CITY, STATE, ZIP PHONE ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS. LIC # COMPANY NAME E-MAIL FAX STREET ADDRESS CITY, STATE, ZIP PHONE DESCRIPTION OF WORK j - EXISTING USE PROPOSED USE CONSTR. TYPE # STORIES USE TYPE OCC. SQ.FT. VALUATION ($) EXISTG NEW FLOOR DEMO TOTAL AREA AREA AREA NET AREA BATHROOM KITCHEN OTHER REMODEL AREA REMODEL AREA REMODEL AREA PORCH AREA DECK AREA AREA GARAGE AREA: DETACH 17ECKIPORCH []ATTACH # DWELLING UNITS:___J 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 ,RECEIVE `. TOTAL VALUATION: PLANNING APPL # ❑ NO PLANNING APPROVAL LETTER EICHLER HOME? ❑ NO 72 Q By my signature below, I certify to each of the following: I am the property owner or auttiiiiized agent t 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 a erify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to buil ' ruction. I authorize representative upertino to enter the above -identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLE NTA RMATI UIRED PLAN CHECKTYPE. ROUTING SLIP ❑ OVER THE COUNTER `: -BUILDING PLAN REVIEW 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. , ExrltEss - :EY,,PLANNING PLAN REVIEW _Commercial Bldgs: Provide a completed Hazardous Materials Disclosure ❑ STANDARD PUBLIC WORKS form if any Hazardous Materials are being used as part of this project. ❑ L'ARGE ':` ❑ FIRE DEPT Copy of Planning Approval Letter or Meeting with Planning prior to ❑ MAJOR El SANITARY SEWER DISTRICT submittal of Building Permit application. �. ENVIRONMENTAL HEALTH BldgApp_2011.doc revised 06/21/11 CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: 10832 WILKINSON AVE DATE: 10/23/2015 REVIEWED BY: PHUONG APN: 356-13-036 BP#: *VALUATION: 1$7,200 *PERMIT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration / Addition / Repair PRIMARY SFD or Duplex PENTAMATION FURN/AC USE: I PERMIT TYPE: WORK INSTALL N AC UNIT ON SIDE OF DWELLING SCOPE APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES A/C Units (<=10K cfm) 1BREMAIR 1 # $72 TOTALS: $72.00 VOTE: This estimate does not include fees due to other Departments (i.e. Planning, Public Works, Fire, Sanitary Sewer District, School District, etc.). These fees are based on the preliminary information available and are only an estimate. Contact the Dept for addn'l into. FEE ITEMS (Fee Resolution 11-053 E . 71]ZL32 FEE QTY/FEE MISC ITEMS Plan Check I cue: i Zlpp/. PC Fee PME Plan Check: $0.00 Per int 17ee: Suppl..Insp Fee PME Unit Fee: $72.00 PME Permit Fee: $48.00 Construction Tcrx: Administrative Fee: IADMIN $45.00 Work Without Permit? O Yes (j) No $0.00 ,4.cli,anced Plcrnniiig-.Fees: Travel Documentation Fee: ITRAVDOC $48.00 Stroniz Motion Fee: 1BSEISMICR $0.94 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: � $214.94 $0.00 TOTAL FEE: $214.94 Revised: 10/01/2015 CERTIFICATE OF COMPLIANCE CFIR-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page I of 3 ) Project Name: 10832 Wilkinson Ave Date Prepared: 2015-10-16 i A. General Information CF1R-ALT 02 is applicable to multiple space conditioning systems contained within a single dwelling unit. When multiple dwelling units must be documented,. use one MR -ALT 02 document for each dwelling unit. 01 Project Name 10832 Wilkinson Ave 02 Date Prepared 2015-10-16 03 Project Location 10832 Wlkinsno Ave 04 Building Type Single family 05 CA City Cupertino 06 Dwelling Unit Name 10832 Wilkinson Ave 07 Zip Code 95014 �$ Dwelling Unit Conditioned 2465 CFA served systema refrigerant Floor..Are 2 Installing Installing ;Installing man (jFFI' I m e f S - and t� oning Location or Area 09 Climate Zone 4 ste in is dwelling 1 entirely new entirely new unit: u Served B. Space' Conditioning (SC) 5ystemInformation 01 02 03 04 05n os 07 . tig os Io .Is the.SC . ,. Installing.a w SC System SC System CFA served systema refrigerant Installing -new SC. Installing Installing ;Installing Identification or Location or Area by this SC tlucted containing system more than 40£ entirely new entirely new Name Served System (ft2) system? "component? components? feet of ducts? duct system? SC system? Alteration Type A/C Condenser & Whole Home 2465 YesYes Yes No No No Altered space Coil conditioning system C. Extension of Existing Duct System, Greater Than 40. Feet (Section150.2f b)1Diib) �� f -P VE -L This section does not apply this project. 20'15 113'Y Registration Number: 215-A6360303A-000000000-0000 Registration Date/Time: 2015-10-16 12:18:51 HERS Pro\rider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version:- 2013-1.006 Report Generated: 2015-10-16 12:18:59 V _ Schema. Version: 0.555SDD CERTIFICATE OF COMPLIANCE C171R-ALT 02-E Alterations to Space Conditioning Systems (formerly CF -IR -ALT -HVAC) (Page 2 of 3 ) D. Altered Space Conditioning System (Sections 150.2(b)1E and F) 01 02 03 04 05 06 07 08 09 10 11 12 Heating Cooling. System Heating Altered Heating Minimum Altered Cooling Minimum Required New or Identification System Heating Efficiency Efficiency Cooling Cooling Efficiency Efficiency Thermostat Replaced New Duct or Name Type Components. Type Value System Type Components Type Value Type Duct Length R -Value A/C Condenser Central gas No heating This field or This field or Central split All new This field or This field or & Coil furnace component section is not section is not AC cooling SEER 15 Setback section is not section is not altered applicable applicable components applicable applicable Required Documentation: CF2R-MCN-01-E - Space Conditioning Systems Ducts and Fans -Duct,. insulation requirement for new plenums: R6. MR -MCN -20-H & £173R -MCH -20-H — Duct Leakage testing 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. CF213-MCH-25-H & CF3R-MCH-25-H Refrigerant Charge Verification required when refrigerant containing components are installed or altered (applicable in. CZ 2, 8-15). CF2RCF3R-MCH-23.& CF3R-MCH-23 Air Flow a 300 CFM/ton required when MCH -25 is required. Exceptions: -Duct systems registered with HERS provider as previously sealed are exempt from MCH720 Duct Leakage Testing requirements., -Heating-only systems and.Air'Handler/Furnace changes do not require'verification of Air. Flow MCHs23,:or"Refrigerant Charge MECH 25 :. F.. , Existing.duct systems constructed, insulated or sealed with asbestos, are exempt from MCH=20 Duct Leakage Testmg-.req&6ments. E. Entirely New or Complete Replacement Duct System, with or without -,,Equipment Changeout (Sections 150.2(4)1.Diia-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: 215-A63.60303A-000000000-0000 Registration Date/Time: 2015-10-16 12:18:51 HERS Provider: CaICERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2,013-1.006 Report Generated: 2015-10-16 12:18:59 Schema Version: 0.555SDD 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. I certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: ,�/��CZf� Cl' C9 Frederick, Alanna Company: Signature Date: CALIFORNIA DELTA MECHANICAL INC 2015=10-16 12:18:51 Address: CEA/ HERS Certification Identification (if applicable): 1235 GRAND AVE City/State/Zip.: Phone: .SPRING VALLEY CA 91977 - 48.0-898-0007 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 Compliarice is true and correct. .2. I -am -eligible under Division 3 of the Business and Professions.. Code to accept responsibility for the building design or system design identified on thisCertificateof Compliance (responsible.designer). 3. That the energy features and. performance specifications, materials, components, and manufactured devices for the building design or systern design identified on this Certificate of Compliance conform to the u requirements of Title 24, Part 1 and 136rt.6 of the California Code of Regulations. 4. The building design features or system designfeatures identified onahis Certif cate`of Compliance are consistent witK the iriformat►on provided on,-,o#her applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement,. geney for approvai with this building perrrj t application. 5: l will ensure that a registered copy of"this CerEificate of Compliance st all beoaide'available with.tbe building permit(§), issued forthe building, and'.mad"e ava tableaoahe enforcement agency for all applicable inspections. I understand that a registered, copy of this Certificate of Compliance;!§ required to be,included with the, documentation, the ¢wilder provides to; the building owner at,occupancy. Responsible Designer Name: r .. = Responsible Designer Signature. / .Frederick,. Ala nna Company:.. Date Signed: CALIFORNIA DELTA MECHANICAL INC. 2015-10-16 12:18.:51 Address: License: 1235GRAND AVE 811114 City/State/Zip.: Phone: SPRING VALLEY CA.91977 -480-898-0007 bigitallysigned by CaICERTS. This digital signature is provided in.order to secure the content ofthis registered document, and in noway implies Registration Provider responsibility for the.accuracy ofthe information. Registration Number:215-A6360303A-000000000-0000 Registration Date/Time: 2015-10-16 12:18:51 HERS Provider: CalCERTS CA Building Energy Efficiency Standards - 2013 Residential Compliance Report Version: 2013-1.006 Report Generated: 2015-10-16 12:18:59 Schema Version: 0.555SDD •�r 17e Cz(e e-lre /© /0�>� s k" - ICL ,.- QL4 M cc. in.i. TY f`.'F-�,r_L�Pf"d!T DEPARTMENT ,_ i��'ISIUN - C:UFEP,TlN(� APPR0 VIED ' This set of plans i;;d specifications P -JUST be kept at the ;ch site during construction. It is unlawful to make any chano��s or a►terations on same., or to deviate ;h.erefrom, without, approval from the .Building Official.` H ; he Stamping of this plan and specifications SHALL NOT ,be held to permit or to be an approval of the violation of any provisions of any City Ordinance or State Law: BY DATE PERMIT # ' J Q1- O,P CHECKELD� s `� ®ATEk n --- c C s5 PLANNING DEPT IAv,�5 CUPERTINO BY t- CUPERTINO WATER -CONSERVING PLUMBING FIXTURES OWNER CERTIFICATE OF COMPLIANCE COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 i. (408) 777-3228 ® FAX (408) 777-3333 e building(a)-cupertino.org Owner Name I If "" Permit No. IS �``� tf_PrT Address it 1492— y 1 U el ri/.S(w I�ViF ! C tl-- I -t J L/p 1. Is your real property a registered historical site? ❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. q2-IN'o Go to Question 2. 2. Does your real property have a licensed plumber certifying that, due to the age or configuration of the property or its plumbing, installation of water -conserving plumbing fixtures is not technically feasible? ❑ Yes Civil Code Sections 110 1. 1 through 1101.8 do not apply. ❑ The licensed plumber's certification has been provided to the Building Division. � Skip the rest of the form and sign bottom of form. E , Ivo Go to Question 3. 3. Is water service permanently disconnected for your building? ❑ Y s Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of forni. Go to Question 4. 4. Is your real property built and available for use or occupancy on or before January 1, 1994? ❑ No My real property is built and available for use or occupancy after January 1, .1994. Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form. IN �'es 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: C �Iy 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. On or before January 1, 2019, all non-compliant plumbing fixtures shall be replaced with water- conserving plumbing fixtures throughout the building (regardless of whether property undergoes alterations or improvements). I, as the owner or owner's agent of this property, certify under penalty of perjury that non-compliant plumbing fixtures will be replaced prior to date specified above with water -conserving plumbing fixtures in accordance with Civil Code Sections 110 1. 1 through 110 1.8, the current California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and that the wate�5nserving plumbing fixtures comply with the requirements as indicated in the table on the following nage. 1_71., Owner or Owner Agent's Signatulr�t_ j L-- -,Date'_ZS°''f �/ Upon completing and signing this Certificate, please return it t the Building Division in order to final your building permit. SB4072015.doc revised 08/26/15 DIJILDL G PERIIIT C,NTINOT BE I+EN'ALED AND CO1VJ PLETED'lJ_NTiL THIS CERTIFICATE HAS BEEN STC A2NTD RETITRNTD TO THE BUILDLNG DMSION 1. If the existing plumbing fixture water usagelflow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2015.doc revised 081-26115 Non -Compliant Water -Conserving Plumbing Fixture Fixture (Fixture Complying with Current Code Applicable to New Construction) —Plumbing .Maximum Water Usage/Flow Rate Fixture Type2013 CPC Ch. 4 2013 CPC Ch. 4 2013 CPC Ch. 4 Water Usage 2013 CALGreen Div. 4.3 2013 CALGreen Div. 4.3 2013 CALGreen Div. 5.3 !Flow Rate Single -Family Multi -Family Commercial Residential Residential Water Closets Exceed 1.6 Single flush toilets: 1.28 gallons/flush (Toilets) Gallons/flush Dual flush toilets: 1.28 gallons/flush effective flush volume (the composite, average flush volume of two reduced flushes and one full flush Urinals Exceed 1.0 0.5 gallons/flush Gallons/flush Showerheads Exceed 2.5 2.0 gallons per minute @ 80 psi. Also certified to the performance criteria'of gallons per minute U.S. EPA WaterSense Specification for Showerheads (A hand-held shower is considered a showerhead.) For multiple showerheads serving one shower, the combined flow rate of all showerheads and/or other shower outlets controlled by a single valve shall not exceed 2.0 gallons per minute @ 80 psi, or the shower shall be designed to allow only one shower outlet to be in operation at a time. Faucets — Exceed 2.2 gallons Maximum 1.5 gallons per Within units: 0.5 gallons per minute @ 60 Lavatory per minute minute @ 60 psi; minimum Maximum 1.5 gallons psi Faucets 0.8 gallons per minute @ per minute @ 60 psi; 20 psi minimum 0.8 gallons per minute @ 20 psi In common and public use areas: 0.5 gallons per minute @ 60 psi 1.8 gallons per minute 60 psi Faucets— Exceed 2.2 gallons 1.8 gallons per minute @ 1.8 gallons .per minute 1.8 gallons per minute @ 60 Kitchen per minute 60 psi @ 60 psi psi Faucets May temporarily increase May temporarily up to 2.2 gallons per increase up to 2.2 minute @ 60 psi, and must gallons per minute @ default to maximum 60 psi, and must 1.8 gallons per minute @ default to maximum 60 psi 1.8 gallons per minute Where faucets meeting @ 60 psi the above are unavailable, Where faucets meeting aerators or other means the above are may be used to achieve unavailable, aerators or reduction. other means may be used to achieve reduction. 1. If the existing plumbing fixture water usagelflow rate is equal to or lower than the figure shown, it is not required to be upgraded. SB407 2015.doc revised 081-26115 eCUPERTI!NO PURPOSE SMOKE 9 CARBON MONOXIDE ALARMS OWNER CERTIFICATE OF CODS` PUANCE Hit COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 (408) 777-3228 o FAX (408) 777-3333 • building( -)cu perti no.org �p ` �,�1) ON -00 W l "W i l Cf � PERMIT CANNOT BE FINALED AND COIIIPLETED UNTIL TRIS CERTIFICATE ]IAS BEEN 1_F AND ItETI![tNED TO 'I'IIE BUILDING DIVISION 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 u1 the following locations: AREA SMOKE ALARM CO ALARM Outside of each separate sleeping area in the immediate vicinity of the bedroom(s) X X On every level of a dwelling unit including 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 907.2.11.4 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 have been tested and are operational, as of the date signed below. I have read and agree to comply with the terms and conditions of this statement Qtr "t or Qwn er Agents) -Name: aSiure..... ...... ........................................................................`Dai �Ye:3 .j My)s Coctor`Name: Si • r3 L6 Fe .................................................................. ... .................................... aft- ................... i`� cD Smoke and CO forni.doc remised 03118/14