706 S ELDERLDING DIVISION
CITY OF ANAHEIM 2016 CALIFORNIA CODES
BUILDING DEPARTMENT CODE CYCLE
200 S. Anaheim Blvd., Suite 145 01/01/2017
Anaheim, CA 9280S EFFECTNEDATE
714 765-5153
w .anaheim.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: yFjLbZ�Z�✓�d%� Date:
Project address:
Property Owner:. ✓6
The undersigned does hereby certify that I am the property owner of the above referenced
property. I further certify that smoke alarms and carbon monoxide alarms are present and
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inal in all the following locations. All boxes must be checked below
ke Alarms and Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
s(2aping area in the immediate vicinity of bedroom/s or in each hallway outside of the rooms.
S I, e Alarms: In each room used for sleeping purposes.
Smoke Alarm and Carbon Monoxide Alarm: 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, 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 upper level.) Z--� >
All dwellingits with ttactf ara es r arbon monoxide detectors. /
California esl ial Code (CRC) Sectio I��4.6.2,CRC R315.2 states in part that existing dwellings be
"retrofitted wl s ke detectors and carbon monoxide detectors when a building permit is issued for work on or
in a building that is valued at $1,000 or more." CRC Section R314.3, CRC R315.2 defines required locations as
indicted above.
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 FEB018
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www.anaheim.net/building B842
SMOKE/ CO ALARM REQUIRED LOCATIONS
Bedroom Bedroom
6
y _
6 [ Bedroom
Kitchen
Living Room
�n
Figure 7
Attic
6
Bedroom
Living Room
6@0
Basement
0
Family Room Bedroom
p�p
VD
Dining
Living Room
Kitchen
®
Bedroom OD B��fD�m
Figure 2
Bedroom
Kitchen
Figure 3
REQUIRED SMOKE ALARM LOCATION
~® REQUIRED CARBON MONOXIDE ALARM LOCATION
4'
Acceptable J 4-
Here Never -
Hem fir
Top of Detector
Accepteble Here
Garage
Figure 4