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BUILDING DIVISION
,,n It. CA LIF 1111% b1 iI"
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SMOKE DETECTORS AND CARBON MONOXIDE SELF CERTIFICATION
f d o p�i J--� F I Iy ,It i,qu,,o title
/ con.1,1clad Ig m lobe n site Ilona wnh the Inb rm4
Pormd Number. ll�\J�� `- Q �Sl7J A nD�ale. ,,1n%m
rrojecl address 3 % $ �ol.�+/ $ �'. %}rw ►ti, . CA LI280 4
Property Owner ICNr IJ*4fk'
The undersigned does hereby mfy that I am the property owner of the above Felt -
properly I further certify that smoke alarms and carbon monoxide alarms are orese-• .r
functional In all the following locations. All boxes must be checked below
e( Smoke Alarms and Carbon Monoxide Alarm: On the ceding or wall outside of each Sec-1'.I!-
steeping area In the Immediate vicinity of bedrooms or in each hallway outside of the rnnm,
Ld Smoke Alarms: In each room used for sleeping purposes
Q Smoke Alarm and Carbon Monoxide Alarm. In each story. including any hahltable haserrent.
(Note in dwellings or dwelling units with split levels and wlthcut an intervering drnv b,t.%een
the adjacent levels. a smoke alarm and a carbon monoxide detector installed on the upper
shall suffice for the adjacent tower level provided that the lower level Is less than one full story
below the upper level)
All dwelling units with attached garages require carbon monoxide detectors.
Signature: _Date 10�1817oZK _
California Residential Code ICRC� Section R'146'-.CRC R3151 states in part irm l,c aar ,., .
.retrofitted with smoke detectors and carbon monoxide detectors Ahen a building, pemril 15 ,cued'rr ,,,r� ,,I - r
In a budding that IS valued a! S1 90C or n!ore ' CRC z•ecllnn R114 3 CRC 13315 Cc! 10'. •cgwred ^,-npr„-
trldlcted abdve
NOTE 71-I, 1 rr•' `d wrinJl )- la ih� ,Hier _r �t II : . �'i I ai•r I -
Imp(ti _I.<.... r n rf FrolecI l r i, :C' in It . n?r P, ir'-.7 f
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