809 N NANCITA STDIVISION
CITY OF ANAHEIM
BUILDING DEPARTMENT
200 S. Anaheim Blvd., Suite 145
2016 CALIFORNIA CODES
Anaheim, CA 92805
714 765-5153
www.anaheim.net/building
SMOKE DETECTORS AND CARBON MONOXIDE SELF CERTIFICATION
*Final inspection app roval will require this completed form to be on site along with the job card.
Permit Number:
Project address: &2 9' &n c;1/4
Property Owner: Ca �9, v---l-±s """"-ta..,-'\_,i-e..-:2.__
CODE CYCLE 01/01/2017
EFFECTIVE DATE
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 A'moke Alarms and Carbon Monoxide Alarm: On the ceiling or wall outside of each separatesleeping 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.
□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 betweenthe adjacent levels, a smoke alarm and a carbon monoxide detector installed on the upper levelshall suffice for the adjacent lower level provided that the lower level is less than one full storybelow the upper level.)
rbon monoxide detectors.
I Signature· Date: 21%£/2£
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
www.anaheim.neUbuilding
FEB 2018 B842