6799 E KENTUCKY AVE (2).. CITY OF ANAHEIM >: "· • •
BUILDING DEPARTMENT 2013 CALIFORNIA CODES
200 S. Anaheim Blvd., Suite 145
Anaheim, CA 92805
714 765-5153
www.anaheirn.net/building
SMOKE DETECTORS AND CARBON MONOXIDE SELF CERTIFICATION
*Final inspection approval will require this completed form to be on site along with the job card.
Permit Number: }Q b'ZOZ.J - D5568 Date: J}1/2otJ.
Project address: (t) 1 C/(!llkl ¥, '&
CODE CYCLE
01/01/2014
EFFECTIVE DATE
Property Owner: -.l....¥...;...;.--=='-"'--=-..::=....t..-�=+------------------The unde • does hereby certify tha I am the property owner of the above referenced property. I further certify that smoke alarms and carbon monoxide alarms are present and functional in all the following locations. All boxes must be checked below
✓s'moke Alarms and Carbon Monoxide Alarm: On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedroom/s or in each hallway outside of the rooms.
/smoke Alarms: In each room used for sleeping purposes. �oke Alarm and Carbon Monoxide Alarm: In each story, including any habitable basement; (Note: in dwellings or dwelling units with s plit levels and without an intervening door between the adjacent levels, a smoke alarm and a carbon monoxide detector 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 u�e level.)
/
All dwelling units a ed garages require carbon monoxide detectors.
Signature: ___________________ D ate :. __ --'-+-+,-+-v_V __ _
California Res· entia Code (CRC) Section R314.6.2,CRC R315.2 States in part that exist ng dwellings be
"retrofitted • sm , e detectors and carbon monoxide detectors when a building permit is issu ct for work on or
in a buildin h rs valued at $1,000 or more." CRC Section R314.3, CRC R315.2 defines required locations as
indicted ab
NOTE: This certification is only used when normal access to the interior of the dwelling by the City of Anaheim
Inspector is not achieved during the course of project construction. It is normally used for exterior projects such
as re-roofing, re-siding, patio covers, solar photovoltaic installations, and similar exterior construction work.
200 S. Anaheim Blvd., Suite 145 Anaheim, California 92805 .(714)765-5153 Phone (714)765-4607 Fax
www.anaheim.net/building
SEPT2015
B842