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CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
s BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
r�"""u-7 www.newportheachea.gov 1 (949) 644-3200
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the perrnittee)
Project Address: lei
Permit Number:
Property Owner: �E,i i2 y. l20/S2-J-
Licensed Contractor: 3� o4,,_o9,,1 %,j.hz Lic #: I01vv73-
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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:
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
Smoke Alarms: Installed in each room used for sleeping purposes, outside each
sleeping area, and on each level of the dwelling unit.
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.
I, the undersigned, hereby certify that I am the permittee of the project. I further
certify that smoke alarms and carbon monoxide alarms are present and tested to
be functional in all the following locations:
Signature: %1c A_J /� //C �7 Date: 1 -7 �J
NOTE: This self -certification is only used for projects to the exterior of the structure where access to the
interior of the dwelling by the City of Newport Beach Building Inspector is not achieved during the course of
construction.
FormslSmokeDeteclorantlCarbonkiommdeSdfCer104/23/ 13