1006 N. WANDA DRCITY OF ANAHEIM
BUILDING DEPARTMENT 2016 CALIFORNIAC CODES
CODE CYCLE
200 S.Anaheim Blvd., Suite 145 01/01/2017
Anaheim, CA 92805 EFFEC7nTDAM
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: ���—-o���00r3l Date: �� L
Project address: o J txIr.J, oa-
Property Owner: V t Ry T Dist hyS
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
ZSrnfumntonal in all the following locations. All boxes must be checked below
Alarms and Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
s ping area in the immediate vicinity of bedroom/s or in each hallway outside of the rooms.
Wlce Alarms: In each room used for sleeping purposes.
:;m
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 ttached garages require carbon monoxide detectors.
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, Califomia 92805 (714)765-5153 Phone (714)7654607 Fax FES 2018
w .anaheim.netlbuilding B842