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ZO V;d Palermo
CITY OF NEWPORT ]REACH
COMMUNITY DEVELOPMENT DEPARTMENT
BULDING ON
100 Civic Center Drive P O. Box 1768 I Newport ech, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the permittee or homeowner)
Project Address: ZZQ PAL[40*.0
/vt w po 0:tclgcl�
Permit Number:
Property Owner.
Jr✓�S�.-- t��c�kNptNc�
Licensed Contractor
Lic4:zL
The State of California now requires that smoke and carbon monoxide detectors must be
installed in all residential buildings
California Residential Code (CRC) Section R314.1, CRC R315.2 states in part that
existing dwellings be "retrofitted with smoke detectors and carbon monoxide detectors.
CRC Section R314.3, CRC R315.3 defines required locations.
Both boxes below must be checked;
®L Carbon Monoxide Alarm: On the ceiling or wall outside of each separate
sleeping area in the immediate vicinity of bedrooms or in each hallway outside of
the rooms, and each level of the dwelling. Detectors are also required in
bedrooms with gas fired appliances
El Smoke Alarms: Installed in each room used for sleep in
each sleeping area, and on each level of the dwelling unit. g purposes, outside
Retrofitted detectors may be battery operated for buildings where no alterations are
Performed on the interior. Multiple -purpose alarms (carbon monoxide and smoke alarms)
shall comply with all applicable standards and must be approved by the State Fire
Marshall. The devices must be installed per manufacturer's specifications.
1, the undersigned, hereby certify that I am the permittee or homeowner of the
project, I further certify that smoke alarms and carbon monoxide alarms are
present and t t d to be functional in all the following locations:
Signature: c cJ��
Date: Z�
NOTE: This self -certification is only used for projects to the exter or of the structure where access to the
interior the dwelling by the City of Newport Beach Building Inspector is not achieved during the course of
construction.
Forms"mokeDe"ItorandCarrbOnMonoxideSelfcert 02/2ene