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PART 1: To be completed
2O-z 2, M l iZAM t� ��_
�i�dM
PANEL MAKE #:
STATE
row
PART 2: 77be completed PRIOR TO INSPECTION REQUEST
and placed with jobsite inspection card
DECLARATION:
I,
2. T&NA— — declare that the Pv module make and model
IP�T roved plans. Module
number, quantity, and location are installed as per the approved
umber, fire classifications of modules, and
manufacturer, make, model and n
brackets match the approved plans for the project located at the above
referent ddress within the City of Newport Beach.
ti� i zl
D.\1[ti
(SIGN-ATUREi
GITy OF NEWPORT BEACH
t04 �C� �T e COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
y s P.O. Box 1768 1 Newport Beach, CA 92658-8915
too Civic Centel rive
1(949) 644-3200
�qll FOR_ �,P:
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the permittee or homeowner)
�R-
project Address:
permit Number:
property owner: �,CZ ;�f�R Lic #: 1 0 z.9 (vc14
Licensed Contractor.
The State of California now requires that smoke and carbon monoxide detectors must be
installed in all residential buildings
Section R314.1, CRC R315.2 states in part that
California Residential Code
be "retrofitted with smoke detectors and carbon monoxide detectors.
existing dwellings
CRC Section R314.3, CRC R315.3 defines required locations.
f 6e checked:
Both boxes below mus
iling or wall outside hallway each separate
Carbon Monoxide Alarm: On the ceaarealsorequired m
sleeping area in the immediate vicinity of bedrooms
or in e
the rooms, and each level of the dwelling.
bedrooms with gas fired appliances
XSmoke Alarms: Installed in each room used for sleeping purposes, outside
j
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
aby the St nd smoke farms)
shall comply with all applicable standards and must be approved
te Fire
Marshall. The devices must be installed per manufacturer's specifications.
I, the undersigned, hereby certify that I am the permittee or homeowner of the
project. Aonctio
t- smoke alarms and carbon monoxide alarms are
f present ao al in all the following locations:
DateSignature:N)TE: This d for projects to the exterior of the structure where access to the
!f)ilenpr of the dwelling by the City of Newport Beach Building Inspector is not achieved during the course of
` "Ohj; tction.