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V01-5- 3384
X03 Wa Ravenna
ClfiY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic CwW Drive I P.O. Box 17681 NewpWBeach, COk 92BW4915
www.rmwpomeactca.gov I (M) rA4-VM
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certiPacabon is to be lied and by the permfCCee or homeowner)
Project Address:
Permit Number:
Property Owner:
Licensed Contractor: Gceto d Pay Lic #: 311,,g 2,6 1"
The State of California now requires that smoke and carbon monoxide detectors must be
installed in all residential buildings
California Residential Code (CRC) Section 8314.1, CRC 8315.2 states in part that
existing dwellings be "retrofitted with smoke detectors and carbon monoxide detectors.
CRC Section 8314.3, 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 1 am the permittee or homeowner 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: AZ41 Date:
1�
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.
Forms\SmakeDetectorandCarbonMano) deSelfCert 09/11/14