960 S MICHAEL WAY (6)CITY OF ANABEIM
BUILDING DEPARTMENT 2016 CALIFORNIA CODES
200 S. Anaheim Blvd., Suite 145 cove CYCLE
Ol/01/2017
Anaheim, CA 92805 EFFEClLVE DATE
714 765-5153
w anaheimnet/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: QL� C� — �� Date: �l f
Project address:
Property Owner: IV.'(- y IL' It/ VU
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
functional in all the following locations. All boxes must be checked below
1p�`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.
9/S`n1oke Alarms: In each room used for sleeping purposes.
01-`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.)
All dwelling units � arages require carbon monoxide detecto j
G
Signature: Date:
� �" � -
California Residential Code (CRC) Section R314.6.2,CRC R315.2 states in part that existing dwellings be
"retrofitted with smoke 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 FEB 2018
w .anaheim.net/building B842
SMOKE/ CO ALARM REQUIRED LOCATIONS
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Family Roan
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U*V Room
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Figure 9
REQUIRED SMOKE ALARM LOCATION
CC REQUIRED CARBON MONOXIDE ALARM LOCATION