BLD-2020-1279OWNER CERTIFICATEOF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT ^ BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 < FAX (408) 777-3333 ^ building@cupertino.org
lPERI I1 T CANNOT BE lE'IT AL ED U1 TIL, THIS CERTIFICATE HAS BEEN
COTMPI,ETED, SIGNET). AMID 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
bedrooms) - (Smoke alarms shall not be located within 3 feet of bathroom door)
X
X
On every level of a dwelling unit including basements and habitable attics
X
X
Within each sleeping room
I X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-buming 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. NCA
Address: � g� �1� 1` `(,� � ��( 1�(7 Permit No._ �2-]
Specify Number of Alarms: r Smoke Alarms: , T_ T Carbon Monoxide Detectors: ;1
I have read and agree to comply with the terms and conditions of this statement
Owner (or Owner Agent's) Name:
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Smoke and CO forrn.doc eizsed 01/1012017
BUILDING PERMIT
CITY HALL
10300 Torre Avenue • Cupertino, CA 95014-3255
PHONE 408-777-3228
WWW.CUPERTINO.ORG
BUILDING ADDRESS: 21785 HYANNISPORT DR Cupertino APN: 356 13 042 PERMIT NO: BLD-2020-1279
OWNER'S NAME: KRITZER THOMAS R AND JACQUELINE A TRUSTEE OWNER'S PHONE: Not Provided
CONTRACTOR: MUST RETRIEVE DATA.CONTRACTOR PHONE:
DATE ISSUED 9/14/2020 2:08:22 PM ISSUED BY:VALUATION: $12623
JOB DESCRIPTION
RE Roof - tear off one layer of shake and install OSB and one layer of comp 25 sq
LICENSED CONTRACTOR INFORMATION
CONTRACTOR: MUST RETRIEVE DATA.
LICENSED CLASS: MUST RETRIEVE DATA
LICENSED NO: MUST RETRIEVE DATA.
EXP DATE: MUST RETRIEVE DATA.
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 penatly 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 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, l must forthwith
comply with such provisions or this permit shall be deemed revoked.
I understand and agree that I am electronically signing and filing this application and that checking the box below has the same legal effect as manual signature. I also
understand that I have the option of filing a paper copy of this application with a manual signature but have chosen instead to file this application electronically.