Fillable Form 410: Building and Safety Division (City of Rancho Palos Verdes)

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Form 410: Building and Safety Division (City of Rancho Palos Verdes)

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BROWSE CITY OF RANCHO PALOS VERDES (CA) FORMS

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1) Smoke and Carbon Monoxide Alarms: On the ceiling or wall outside of each separate
sleeping area in the immediate vicinity of bedrooms and in each hallway outside of the
bedrooms.
2) Smoke Alarms: In each room used for sleeping purposes.
3) Smoke and Carbon Monoxide Alarms: In each story, including any habitable basement. (Note:
In dwellings or dwelling units with split levels and without an intervening door between the
adjacent levels, smoke and carbon dioxide alarms installed on the upper level shall suffice for
the adjacent lower level provided that the lower level is less than one full story below the upper
level.
SMOKE AND CARBON MONOXIDE ALARM ACKNOWLEDGMENT AND
STATEMENT OF CONFORMANCE WITH ORDINANACE
410
AND
WATER CONSERVING FIXTURES
AND STATEMENT OF CONFORMANCE
WITH CALIFORNIA SENATE BILL 407
I, the undersigned, hereby certify that I am the owner of the below referenced property and that
Smoke alarms and Carbon Monoxide alarms are present and functioning in the locations listed below.
City of Rancho Palos Verdes
Building and Safety Division
NOTE: This statement is also filed with the City of Rancho Palos Verdes
whenever transfer of
title for property has occurred Per City Ordinance 410
which states that no person may transfer
title of a dwelling unit required by this section to be equipped wi
th a smoke detector without
first filing with the City and the purchaser a statement certifying that the dwelling is equipped
with smoke detectors meeting the requirements of this section.
Owner Signature: _____________________________Date_________
*Retrofitted Smoke and Carbon Monoxide Alarms may be battery operated.
*Check box if filing due to sale of property
Calif
ornia Residential Code (CRC) Sections R314.3.1 and R315.2 states, in part, that existing dwellings
shall be retrofitted with smoke and carbon monoxide alarms when a building permit is issued for a scope
of work that is valued at
$1,000 or more. CRC Sections R314.3 and R315.3 defines the required
locations as indicated above.
Dwelling Address: ________________________________________
I further certify that water conserving plumbing fixtures are installed at this property pursuant to CA
Civil Code Section
1101.7 (Water conserving plumbing fixtures not required on transfer of title).
Permit Number ______________________________
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For the complete language of CA SB 407
(2009):
http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=200920100SB407&search_keywords
AFFIDAVIT FOR WATER CONSERVING FIXTURES
According to a new state law that went into effect on January 1, 2014, when a new single family dwelling built before January 1,
1994 applies for a permit for any building alteration or improvement, the permit agency is required to confirm that the residence
has specific water saving plumbing fixtures. The purpose of this Affidavit is to certify the installation of water conserving
plumbing fixtures within existing buildings built and available for use on or before January 1, 1994. This Affidavit is in lieu of a
city inspection for this specific requirement when a permit is issued for building alterations or improvements. A signed copy of
this Affidavit shall be submitted to the Building Inspection Section prior to Final Inspection approval of the project/permit.
Existing water conserving plumbing fixtures must comply with California Senate Bill No. 407 (CA SB 407)/California Civil Code,
Sections 1101.1-1101.8.
Civil Code defines non-compliant plumbing fixtures as follows:
(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 emits more than 2.2 gallons of water per minute.
Non-compliant plumbing fixtures must be replaced with fixtures that are “in compliance with current building
standards applicable to a newly constructed real property of the same type.”
Exceptions: Per Civil Code Section 1101.7, this article shall not apply to any of the following (if applicable circle exception):
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. (NOTE: Must be signed by
Licensed Plumbing Contractor only if exempted).
c) A building for which water service is permanently disconnected.
I hereby affirm that I personally inspected all plumbing fixtures at the above referenced address(es), and that all
existing plumbing fixtures are exempt pursuant to CA Civil Code Section 1101.7.
Print Name: ___________________________________________________________________________________ Date: ___________________________________
Signature: ___________________________________________________________________________________________________________________________________
Plumbing Contractor’s Business Name: ____________________________________________________________ License Number: ________________
CalWater conservation kit available at www.calwater.com
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Form 410: Building and Safety Division (City of Rancho Palos Verdes)

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Completed 4 August 2020

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