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X2021-(07 b
-::� ,-ie Ig� WCA
CITY OF NEWPORT BEACH
COMM[TNTTY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 17681 Newport Beach, CA 92658-8916
www.newportbeachca.gov 1(949) 644-3200
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be idled out by the permittee or homeowner)
Project Address
Property Owner:
Licensed Contral
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 R316.2 states in part that
existing dwellings be "retrofitted with smoke detectors and carbon monoxide detectors.
CRC Section tt314.3, CRC R315.3 defines required locations.
Both boxes below must be checked.
ULI❑ 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
theoomis and each level of the dwelling. Detectors are also required in
rooms with gas fired appliances
C]
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.
1, the undersigned, hereby certify that I am the permittee or homeowner of the
project. I furthercertify that smoke alarms and carbon monoxide alarms are
present and tested to be functional' In all the following locations:
_tCC
&Signature: (%ate:ftt� vz
NOTE: This sell -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.
ro sZmokeOeteet mdCarbwM ro) ldeSt lfCert 08/12/16
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