B-2016-2882 7
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SMOKE [CARBON MONOXIDE ALARMS
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OWNER CERTIFICATE OF COMPLIANCELI�Ib ,ib
wys.�q�s COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildinq(a7cupertinoorq
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PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon onoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where n,o interior access for
inspections are required. II
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 dh,elling units exceeds
$1000.00, CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Ai[arms 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 X X
the bedroom(s)
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-bu ' g appliances and that
do not have art attached garage. Carbon monoxide alarms combined with smoke alarm 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,alarms)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 gperational, as of the
date signed below.
•
Ad (�dress: O12:11-609L5G Per it No. 0• +aviv
Specify Number of Alarms: #Smoke Alarms: I #Carbon Mon xide Detectors: ) 2
I have read and agree to comply with the terms and conditions of this state ent
Owner(or Owner Agent's)Name: ) ,y / i
Signature ..C `3 %fv s Date: f �Z"-(
Contractor Name:
Signature Lic.# Date:
Smoke al*COforin.doc revised 09/27/16
, ' 'ATE -CONSERVING PLUMBING FIXTURES 0 FILi, J
.rA,_10-'1 OWNER CERTIFICATE OF COMPLIANCE '
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�,�- 5>. COMMUNITY DEVELOPMENT DEPARTMENT-BUILDING DIVISION
U i' RTI N`O 10300 TORRE AVENUE CUPERTINO,CA 95014-3255
Cf i (408)777-3228.FAX(408)777-3333 m building( pertino.orq
Owner Namel G,La a l� �G��r°r R.--g
Permit No4 --- ;1"1"
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Address i" /0'5 _ L.®till, L ` S.t.
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.
lNo Go to Question 2.4
2. Does your real property e have a licensed plumber certifyingthat,due to the age or configuration of thepr e or its
p prh'� g ,p �
plumbing,installation of water-conserving plumbing fixtures is not technically feasible?
❑,Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
0 The licensed plumber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
16-No Go to Question 3.gc
{
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 I) ttom of form.
EXNo 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 bhttom of form.
12-"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 state ents and sign
bottom of form..
5. Please check ONE of the following:
V'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 :lumbing fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before Janua 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (rega dless 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-com liant
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 alae ations or
improvements).
O 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-com liant
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 w er- conserving,
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or' provements).
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 Civi.Code Sections 1101.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code, nd manufacturer's
installation requirements,and that the water-conserving plumbing fixtures comply with the requiremens,as indicated in the
table on the following page.
Owner or Owner Agerit's Signature: _1,,,,,,,___c„.././
- '���'l Date,t 1/- (2`1�
Upon completing and signing this Certificate,please return it to the Building Division in order to final your building permit.
SB4 72015.doc revised 08/26/15