525 S JEANINE ST (2)BUILDING DEPARTMENT
200 S. Anaheim Blvd., Suite 145
Anaheim, CA 92805
714 765-5153
www.anaheim.net/building
SMOKE DETECTORS AND
" Final inspection approval will retlu
-ARBO�•MONOXIDE
re this comaleted form to
2013 CALIFORNIA CODES
CODE CYCLE
01/01/2014
EFFECT /VE DATE
SELF CERTIFICATION
be on site along with the job card.
Permit Number: U 1 /20 7 _ (z L{i Date: 209- �-
'Project address: 2 ala L N�-
Property Owner: Q %A-
1-1 sea
The undersigned does here y certify thab I am fher8perty owner of the above referenced
property. I further certify that smoke alarm' and..carbon monoxide alarms are present and
functional in all the following locations. All boxes must be checked below.- .,: `
ky Smoke Alarms -and Carbon -'Monoxide Alarm: On the, ceiling or wall outside of'each separate
siEeping area in the immediate -vicinity of bedroom/s or in each hallway outside of the rooms.
[!r Smoke Alarms: In each room used for sleeping purposes.
VSmoke 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 with attac ed-ggr7A—gesr—require carbon monoxide detectors.
Signature: Date: %, �O�Q.
Calif6rnia Residential' Code (CRC) Setion R314.6.2,CRC R315.2 States in part that existing dwellings be
"retrofitted with smoke detectors and car n 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 SEPT 2015
www.anaheim.net/building 8842
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