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(this certification SELF"CERT'FICA RBpN
is to be rifled out b ON MONOXIDE
Project Ad y the Permittee or
dress: � J � � home
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The State of �r er S
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California now c r
d in all reside requires �� z r Lic #;S—
ntial buildings that smoke and
California Resid carbon
existin ential CodRC) on monoxide detectors
g dwellings retrofitted Section R31 must be
CRC ng d gs be "
14.3, CRC R315. with smoke detectors and R315.2 states
Both boxes below be 3 defines required carbon atxden part that
Must checked.• mono detectors.
sleeping area in Monoxide Alarm: On
bedro O and the immedieach Iate vicinitthe ceiling or wall
e Ms eve
oms with gas fired aPpl!an f the dW f I �9roor in easche °f each separate
Detectors are also y Outside of
Smoke Alarms: also
each sleepin Installed ' required in
9 area, and on in each room Retrofitted d each level of them used for sleeping
Performed electors may be dwellin Purposes,
shall comply the interior g unit. outside
with Multip battery OPerated for
Marshall. The all aPPlicable purpose alarms buildings where
devices must b standards (carbon no alterations are
1, the a installed per be monoxide s
preProsectunde undersigned hereby cerli manufacture er's speccrifcaon8 theoStatke e Fite)
nt and tested the
oertify that that 1 am
Si be function �n all the f alarms
and car on or h°meo►yner
Signature:
ollowin monoxide °f the
NOTE• This 9lOcations: alarms are
interior of the ofwelen�cation is only use
construction, dwel/inq by the Date: /
City of New for rojects to 2 3
Port Beach Bufldtng Inspector f the structure
s not achievedWhere access to the
course of
For s"$-keDet,clor.,dCarbonM000zid,SelfCert 08112116 during the
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CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
SOLAR CONTRACTOR DECLARATION
_Keep with Inspection card
11 LPART 2: To be completed PRIOR TO INSPECTION REQUEST
and placed with jobsite inspection card
DECLARATION:
I, M��u I�P hc�o zcL declare that the PV module make and model
(PRIM1 I NAME)
number, quantity, and location are installed as per the approved plans. Module
manufacturer, make, model and number, fire classifications of modules, and
brackets match the approved plans for the project located at the above
referenced address within the City of Newport Beach.
( UNATURL) VD
(DATE)
Forms\SolarComrac[orDeclarallon i-7-I6