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CITY OF NEWWEACH
COMMUNITY DEVELOI 'r ifDEPARTMENT
BUILDING 1 ,' `fISION
100 Civic Center Drive I P.O. Box 176 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the permittee or homeowner)
,Project Address:_ lVQ> �JV -- -�k y1 11y'T Nj $�`-ktC-A�
Permit Number: 4200 �� X 2�0 ZQ — 20 f f
.-*-Property Owner: y <�,A,�
Licensed Contractor:
Lic#: 11; �,-Q�l
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
�L: 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 undersi , hereby certify that I am the permittee or homeowner of the
project. I rth r tify that smoke alarms and carbon monoxide alarms are
present an teste Iona all the following locations: V
1 Signature: Date: 1'D— p �I
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\SmokeDetectoraodCaM.,MonoxdeSelfCett 0811b 16
�A�0
Yr: CIT'Y OF NE PORT BEACH
in
s +} 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) 644-3260
SMOKE DETECTOR AND CARBON MONOXIDE
SELF -CERTIFICATION
(this certification is to be filled out by the permittee or homeowner)
-yr-Rroject Address: 2
Permit Number: _
4—Property Owner:
Licensed Contractor: .fL1n
w % 06 i e
'—
Lic #: l 12 kc i>f'\
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 slee rn each sleeping area, and on each level of the dwelling unit. p g purposes, outside
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 or homeowner of the
project. I fu a certi that sm a alarms and carbon monoxide alarms are
present and ste to b�Jnctioppaal i all the following locations:
// ,14
,"Signature:
NOTE: This s ce,hifrcation is only
interior of th dwr�Ning by the City of
Forms\SMOk I)etWlWdCarbonMonoAdeSeNCert 06i1Z 16
0 Date:
for pjojects to the exterior of the structure where access to the
art Efeach Building lnspectoris not achieved during the course of