15040036CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 19771 BDMY DR
CONTRACTOR: KEN PERRY JR DBA
PERMIT NO: 15040036
PERRY ELECTRIC
OWNER'S NAME: YUAN-SHIH CHEN
300 E MCKINLEY AVE
DATE ISSUED: 04/06/2015
OWN 'S PHONE: 5105997194
SUNNYVALE, CA 94086
PHONE NO: (408) 718-7237
LICENSED CONTRACTOR'S DECLARATION
JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL ❑
UPGRADE (E) 100 AMP PANEL TO 200 AMP PANEL, SAME
(� `^
License Class C `� Litc. # 6 �/�
LOCATION
Contractor.9e, fi��a pe" J�� Date Is--
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:
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
Sq. Ft Floor Area:
Valuation: $2000
performance of the work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance, as provided for by
APN Number: 36909051 00
Occupancy Type:
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
PERMIT EXPIRES IF WORK IS NOT STARTED
correct. I agree to comply with all city and county ordinances and state laws relating
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
180 DAYS LED INSPECT ON.
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
Date:
granting of this permit. Additionally, the applicant understands and will compl _
ss
with all non -point sourc egu 'ons er the Cu ertino Municipal Code, Section
918.
Signature Date
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.
❑ OWNER -BUILDER DECLARATION
Signature of Applicant: Date:
I hereby affirm that I am exempt from the Contractor's License Law for one of
the following two reasons:
ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER
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)
I, as owner of the property, am exclusively contracting with licensed contractors to
HAZARDOUS MATERIALS DISCLOSURE
construct the project (Sec.7044, Business & Professions Code).
I have read the hazardous materials requirements under Chapter 6.95 of the
California Health & Safety Code, Sections 25505, 25533, and 25534. I will
I hereby affirm under penalty of perjury one of the following three
maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the
declarations:
Health & Safety Code, Section 25532(a) should I store or handle hazardous
I have and will maintain a Certificate of Consent to self -insure for Worker's
material. Additionally, should I use equipment or devices which emit hazardous
Compensation, as provided for by Section 3700 of the Labor Code, for the
air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued.
will maintain compliance with the Cuper '. o Municipal Code, Chapter 9.12 and
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
the Health & Safety Code, Secti s 5, 2 533 nd 2553
Date:
Owner or authorized agent:
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
CONSTRUCG AGENCY
TION LENDIN
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
I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked.
work's for which this permit is issued (Sec. 3097, Civ C.)
Lender's Name
APPLICANT CERTIFICATION
Lender's Address
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
ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities, judgments,
costs, and expenses which may accrue against said City in consequence of the
I understand my plans shall be used as public records.
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
Licensed Professional
918.
Signature Date
CUPERTINO
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • FAX (408) 777-3333 • buildingacupertino.org
MEP
MISC
❑PLUMBING MECHANICAL LECTRICAL ❑MISCELLANEOUS
PROJECT ADDRESS p� 1 `� V JL.,JL.,APN # /_ Q (99 - 05-1
OWNER NAME �`#1n' I aar�PHONI 51 Lj
l 0 -5111-7T119 nY./^ �thDeis /� C�1-�1 lq
J �al(�J� 11 Y1 Cc)M
STREET ADDRESS, X rJ v �TT_Y, STAT Z O ^ 9 S O 114FAX
CONTACT NAME �L r PHONE , r ��- (? `a E-MAIL
STREET ADDRESS r CITY, STATE(�ZIP FAX
Oo 9'400 P
❑ OWNER ❑ OWNER -BUILDER ❑ OWNER AGENT CONTRACTOR ❑ CONTRACTOR AGENT ❑ ARCHITECT ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME �r LICENSE NUMBS // ^ O LICENSE TYPEBUS. LIC # �, 1 u�r\
E MAIL tlZFAX y V
COMPANY NAME'
�f
EIeC-hn�
-e_1e�
STREET ADDRESS �oO
uS Mc
n
CTTY�STATnZIvQ
Y/
FHO E Y 22'�
J
ARCHITECT/ENGINEERNAME
LICENSE NUMBER
BUS, LIC#
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF ❑ SFD .,DUPLEX ❑ MULTI-FAMQ.Y
BUILDING: ❑ COMMERCIAL
PROJECT IN WILDLAND ❑ YES
URBAN INTERFACE AREA ❑ NO
PROJECT IN
FLOOD ZONE
❑ YES
❑ NO
IS THE BLDG AN ❑ YES
EICHLER HOME? ❑ NO
DESCRIPTION OF WORK
1\0n-r/AAA L
100A1-47' Aro-2DO SMP
t_Vaoak
aril In
TOTAL VALUATION: * OOD , Od
By my signature below, I certify to each of the
application and the information��p
ordinances and state laws relat
Signature of Applicant/Agent:
I am the property owner or auth agent to act on the property o er' alf. I have read this
hav ad the Descri o Work and verify it is accurate. I agfEeTo comply with all applicable local
o 'ere tatives of Cupertino to enter the above -identified property for inspection purposes.
Date: y �! ' Z J /S--
ION REQUIRED21,'oFFtcEosEOI�nI
MEPMiscApp_2011.doc revised 06/21/11
Vm
F� j��i CITY OF CUPERTINO
w—w--miFF.F. F.QTTM A TOR — RI T11,nING DIVISION
611
ADDRESS: 19771 BIXBY DR
DATE: 04/06/2015
REVIEWED BY: MELISSA
Plan Check h'ee:
APN: 369 09 051
BP#:
*VALUATION: $2,000
*PERMIT TYPE: Electrical Permit
PLAN CHECK TYPE: Alteration / Addition / Repair
PRIMARY SFD or Duplex
p
PME Plan Check:
PENTAMATION 1 REAP2
USE:
Permit Fee:
PERMIT TYPE:
WORK
UPGRADE E 100 AMP PANEL TO 200 AMP PANEL SAME LOCATION
SCOPE
PME Unit Fee:
APPLIANCE / EQUIP TYPE FEE ID QTY UNITS BP FEES
Services 1 ERT<200 200 Amps $48
TOTALS: -£ $48.00
Afec:lr. Pleat Check
61ech. Permit Fee:
Other Allah, Irish.
94eck. Insp. Fee,
Numb. Plan Check
Plumb. Permit 1'"ee:
Otlier Plumb Insp. LLJ
Plumb. Invp. Fee:
Elec. Plan Check 10.0 1 hrs $0.00
Elec. Permit Fee: IEPERMIT
Other Elec. Insp. 0.0 1 hrs $48.00
Llec. Insp. FL�e::
NOTE. This estimate does not include fees due to other Departments (tie. riammng, ramic worKs, rtre, January newer u[Jir[ci" acnvw
�. ..I --- :._.c _.__-a
FEE ITEMS (Fee Resolution 11-053Ej. 7/f 1/13)
FEE
QTY/FEE
MISC ITEMS
Plan Check h'ee:
PME Plan Check:
$0.00
Permit Fee:
supl7I. Insp P'L e
PME Unit Fee:
$48.00
PME Permit Fee:
$48.00
Construction Tax:
T -F
Administrative Fee: (ADMIN
$45.00
Work Without Permit? ® Yes (j) No
$0.00
,Idvanced Plarming Pees:
Travel Documentation Fee: ITRAVDOC
$48.00
Strong: Motion Fee: IBSEISMICR
$0.50
Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC
$1.00
$190.50
$0.00 TOTAL FEE:
$190.50
Revised: 02/14/2015
CUPERTINO
Owner Name
Address
WATER -CONSERVING PLUMBING FIXTU
OWNER CERTIFICATE OF COMPLIANCE
!7
COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 % • ,
(408) 77leli
• FAX (408) 777-3333 building(a�cupertino.org ff
�eAl Permit No. ( 5-4-0o U
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 tegistered 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:
No Go to Question 2.
Date:
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.
Sign below and skip the rest of the form.
Owner' Signature:
No Go to Question 3.
Date:
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:
No Go to Question 4.
Date:
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. Sign below and skip the rest of the form.
Owner' Signature: Date:
i1yes 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
tore to be replaced with water -conserving plumbing fixtures throughout the building. On or before January 1,
2017, all T n -compliant plumbing fixtures shall be replaced with water -conserving plumbing fixtures (regardless
kvheze property undergoes alterations or iunprovements).
❑ prope riy is a multifamily residential real properly. 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-coinpliant 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. doe revised 03118114
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/We, the owner(s) of this property, certify under penalty of perjury that non-compliant plumbing fixtures have been replaced
with water -conserving plumbing fixtures in accordance with Civil Code Sections 1101.1 through 110 1.8, the current
California Plumbing Code and California Green Building Standards Code, and manufacturer's installation requirements, and
that the water -conserving plumbing fixtures comply with the requirements indicatpd in the table below.
Owner's (or Owner Agent's) Signature: _ ;;date;:'
Upon completing and signing this Certificate, please. return it to the Building Division in order to final your permit.
If the exis in p u�xrba g fl CAU e�wafe usage/flow rate is equal to or lower than the figu e'shown his neo q� red to e upgra ed.
SB4072014.doc revised 03/18/14
hloln�a�a"replanT
Water-Conserving Plumbing Fixture_
Plumbing Fixture
_ (Fixture Complying with Current Code Applicable to New. Construction)
' Maximum
Water Usage/Flow
Rate
Fixture Type
Water Usage
, 2013 CPC Ch.' 4
2013 CPC Ch. 4
2013 CPC Ch. 4
_
/Flow Rate
l 2013 CALGreen Div. 4.3 -
2013 CALGreen Div. 4.3
2013-CALGreen Div. 5.3-
Single=Family
Multi -Family
Commercial
Residential
Residential
Water Closets 14�xceed
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
5xceed 1.0
0.5 gallons/flush
1`Gallons/flush
ShowerheadsExceed
2.5 :
i2.0 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
i 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 —
18
ceed 2.2 gallons -1
Maximum 1.5 gallons per
Within ubits:
0.5 gallons per minute @ 60
Lavatory
1pe'r
minute 'T,
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
p.
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
der minute
60 psi
@ 60 psi
psi
Faucets
t 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
11.8 gallons per minute @
default to maximum
160 psi
1.8 gallons per minute
Where faucets meeting
@ 60 psi
Ithe above are unavailable,
Where faucets meeting
;aerators or other means
the above are
may be used to achieve
unavailable, aerators or
-' eduction.
other means maybe
rl
used to achieve
reduction.
If the exis in p u�xrba g fl CAU e�wafe usage/flow rate is equal to or lower than the figu e'shown his neo q� red to e upgra ed.
SB4072014.doc revised 03/18/14
CALIFORNIA CIVIL CODE SECTIONS 1101.1-1101.8
Civil Code
Division 2. Property
Part 4. Acquisition of Property
Title 4. Transfer
Chapter 2. Transfer of Real Property
Article 1.4. Installation -.of Water Use Efficiency Improvements ..:..... 110 1. 1 --1101.8
1101.1. The Legislature finds and declares all of the following:
(a) Adequate water supply reliability for all uses is essential to the future economic and environmental health of
California.
(b)..Environmentg4y..sour4 strategies to meet future water supply and wastewater treatment needs are key to
protecting and restoring-aguatic.resources in- Cal€orrua
(c) There is a:pressiiig need"to address.water" supply reliability issues raised by growing urban areas:
-.-".'--:-::-'(d) Economic"analysis by urban water agencies has identified urban water conservation as a cost-effective
approach -to addressing. water.;supply.needs. (0 -There are many water conservation practices that produce significant energy and other resource savings that
should be encouraged as a matter of state policy.
(f) Since the 1991 signing of the "Memorandum of Understanding Regarding Urban Water Conservation in
California," many urban water and wastewater treatment agencies have gained valuable experience that can be
applied to produce significant. statewide savings of water, energy, .and. associated infrastructure costs. This
experience indicates a need to regularly revise and update water conservation methodologies and practices.
(g) To address these concerns; it is the intent of the Legislature to require that residential and commercial real
property built and available for use or occupancy on or before January 1, 1994, be equipped with water -conserving
plumbing fixtures.
(h) It is further the intent of the Legislature that retail water suppliers are encouraged to provide incentives,
financing mechanisms, and funding to assist property owners with these retrofit obligations.
1101.2. Except as provided in Section 1101.7, this article shall apply to residential and commercial real property
built and available for use on or before January 1, 1994.
1101.3. For the purposes of this article:
(a) "Commercial real property" means any real property that is improved with, or consisting of, a building that is
intended for commercial use, including hotels and motels, that is not a single-family residential real property or a
multifamily residential real property.
(b) "Multifamily residential real property" means any real property that is improved with, or consisting of, a
building containing more than one unit that is intended for human habitation, or any mixed residential -commercial
buildings or portions thereof that are intended for human habitation. Multifamily residential real property includes
residential hotels but does not include hotels and motels that are not residential hotels.
(c) "Noncompliant plumbing fixture" means any of the following:
(1) Any toilet manufactured to use more than 1.6 gallons of water per flush.
(2) Any urinal manufactured to use more than one gallon of water per flush.
(3) Any showerhead manufactured to have a flow capacity of more than 2.5 gallons of water per minute.
(4) Any interior faucet that einits more than 2.2 gallons of water per minute.
(d) "Single-family residential real property" means any real property that is improved with, or consisting of, a
building containing not more than one unit that is intended for human habitation.
(e) "Water -conserving plumbing fixture" means any fixture that is in compliance with current building standards
applicable to a newly constructed real property of the same type.
(f) "Sale or transfer" means the sale or transfer of an entire real property estate or the fee interest'm that real
property estate and does not include the sale or transfer of a partial interest, including a leasehold.
1101.4. (a) On and after January 1, 2014, for all building alterations or improvements to single-family residential
real property, as a.condition for issuance of a certificate of final completion and occupancy or final permit approval .
by the local building department, the permit applicant shall replace all noncompliant plumbing fixtures with water -
conserving plumbing fixtures.
S 1
(b) On or before January 1, 2017, noncompliant plumbing fixtures in any single-family residential real property
shall be replaced by the property owner with water -conserving plumbing fixtures.
(c) On and after January 1, 2017, a seller or transferor of single-family residential real property shall disclose in
writing to the prospective purchaser or transferee the requirements of subdivision (b) and whether the real property
includes any noncompliant plumbing fixtures.
110.1.5. (a) Onor before January 1, 2019, all noncompliant plumbing fixtures in -any multifamily -residential real
property and. in any commercial real property shall be replaced with water -conserving plumbing fixtures.._.
(b) An owner or the owner's agent may enter the owner's property for the purpose of installing, repairing, testing,
and maintaining water -conserving plumbing fixtures required by this section, consistent with notice -requirements of
Section 1954.
(c) On -and after January 1°201-9; the water -conserving plumbing fixtures requited by this section shall be
pperating-at- the manufacturer's rated water consumption at the time,that the tenant takes possession A tenant shall -
be'res �onsible`.for roti n :ahe owner. or o.wner's a erit if theaenant becomes aware that a`water-conservm -
P g g g;
bin- fixture withinrhis.or her unit is not o eratin at.the manufacturer's rated water tion The owner:
plum g.... p .._ g; p
or owner's: agent -shall correct an inoperability in a water -conserving plumbing fixture upon notice by.,;the.ten
ant -Or ;
if detected by the owner or the owner's agent. -
(d) (1) On and after January 1, 2014, all noncompliant plumbing fixtures in any multifamily residential real
property and any commercial real property shall be replaced with water -conserving plumbing fixtures in the
following circumstances:
(A) For building additions in which the sum of concurrent building pen -nits by the same permit applicant would
increase the floor area of the space in a building by more than 10 percent, the building permit applicant shall
replace all noncompliant plumbing fixtures in the building.
(B) For building alterations or improvements in which the total construction cost estimated in the building permit
is greater than one hundred fifty thousand dollars ($150,000), the building permit applicant shall replace all
noncompliant plumbing fixtures that service the specific area of the improvement.
(C) Notwithstanding subparagraph (A) or (B), for any alterations or improvements to a room in a building that
require a building permit and that room contains any noncompliant plumbing fixtures, the building permit applicant
shall replace all noncompliant plumbing fixtures in that room.
(2) Replacement of all noncompliant plumbing fixtures with water -conserving plumbing fixtures, as described in
paragraph (1), shall be a condition for issuance of a certificate of final completion and occupancy or final permit
approval by the local building department.
(e) On and after January 1, 2019, a seller or transferor of multifamily residential real property or of commercial
real property shall disclose to the prospective purchaser or transferee, in writing, the requirements of subdivision (a)
and whether the property includes any noncompliant plumbing fixtures. This disclosure may be included in other
transactional documents.
1101.6. The duty of an owner or building permit applicant to comply with the requirements of this article shall be
postponed for one year from the date of issuance of a demolition permit for the building. If the building is
demolished within the one-year postponement, the requirements of this article shall not apply. If the building is not
demolished after the expiration of one year, the provisions of this article shall apply, subject to appeal to the local
building department, even though the demolition permit is still in effect or a new demolition permit has been
issued.
1101.7. This article shall not apply to any of the following:
(a) Registered historical sites.
(b) Real property for which a licensed plumber certifies that, due to the age or configuration of the property or its
plumbing, installation of water -conserving plumbing fixtures is not technically feasible.
(c) A building for which water service is pennanently disconnected.
1101.8. A city, county, or city and county, or a retail water supplier may do either of the following:
(a) Enact local ordinances or establish policies that promote compliance with this article.
(b) Enact local ordinances or establish policies that will result in a greater amount of water savings than those
provided for in this article.
SMOKE / 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 • buildingaQcupertino.org
Address
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 8314 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)
X
X
On every level of a dwellin 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 i1 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
Owner (or Owner Agent's) Name:
CL
Signature �... �� ��............................................................ Date: ...................
CoontractorNam . (�
�{�NirX %_I
Lv �1'1: �........
C `f/llk�.1
Si nature ...........Lic.# ..l..l(/ Date4�r5
Smoke and CO farm.doc revised 03/18/14