15100019 SMOKE/WATER SMOKE / CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT e BUILDING DIVISION
PPEl TINQ 10300 TORRE AVENUE Y CUPERTINO,CA 95014-3255
(448)777-3228 e FAX(408)777-3333•buildino(okupertinomg
Pi eut Flo. ` C c>
Address � 3 �, �� tib�iSmoke: Carboni-1v4o 7axrde:
PERM,IT CANNOT BE FINALED AND COMPLETED UNTIL TMS CERTIFICATE
EAS BEEIN SI01-DU Al4' tE I I t FIS TO THE BUII,I3 G II"I ' SIOi T
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section 8314,2013 CBC Sections 420.6 and 907.2,11.2 where no interior access for
_t`i.n specti ons-are-regzzir-ed.
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 the X X
bedroom(s)
On ever 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-bunging appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Sectiol1420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply Til dwelling units with no=commercial power supply, alarm(s)may be solely battery operated.
—Inexisting---d-weRiuz,--uszits;-alarm-s--a-re-perirLii-ted to be-solely battery opera:Led where-repairs,or--zclteratrons d-o
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 perrhit is required for
alarms which nnust be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s} refere4ed above has/have been
installed in accordance with the manufacturer's instructions and in compl anQe with the California Building
and California Residential Codes.The alarms have been tested and are operational, as ofthe date signed
below. -
i have read and agree to comely with the terms and conditions of this statement
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Smoke and CO.form.doc revised 03118114
WATER-CONSERVING PLUMBING FIXTURES
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUPERTINO � 10300 TORRE AVENUE• CUPERTINO, CA 05014-3255
(40 )777-3228•FAX(408)777-3333• builaina(alcuoertino.org
Owner INTame `(uF- �AIJ G Permit No O c) A
Address 18\J 2) Ra_c �I W Q t ro
1. Is your real property a registered historical site?
11 Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Ship the rest of the form and sign bottom of form.
No Go to Question 2.
2. Does your real property have a licensed plumber certif�4.ng that,due to the age or configuration of the property or its
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
El Yes Civil Code Sections 1101.1 through 1101,8 do not apply.'
❑ The licensed pluintier's certification has been provided to the Building Division.
Skip the rest of the form and sign'bottom of form.
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. Skip the rest of the form and sign bottom of form.
INTO 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.
W) 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. Check one of the three following statements and sign
bottom of form..
5. Please check OlNIE of the following:
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 urith water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or irrrprovements).
9 My property is a muldfa7vily residential real property. See Civil Code Section 1101.5.
On and after January 1, 2014, specified building alterations or Improvements shall require non- compliant
PiU1lrUlllb Ll 111:1 es to Ue 1Gp18i4GQ wat1Y Vt-at CI-'LU11JG1Y121g.1JiLi.111illi 1A LLII GJ..
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
improvemen!s).
Ivry property is a c0724712e7-ciaZ 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-cormpliant plumbing fixtures will be
replaced prior to date specified above with water-consen.-ing plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8,the current California.Pluirlbing Code and California Green wilding Standards Code„and manufacturers
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: Date: ( 201
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4072015.doc revised 08115/1.: