BLD-2023-1663_Smoke/COCLlPtJtTINO
SMOKE / CARBON MONOXIDE ALARMS
SELF-CERTIFICATION OF COMPLIANCE
COMMUNITY' DEVELOPMENT DEPARTMENT - BUILDING DMSION
10300 TORRE AVENUE - CUPERTINO, CA 95014-3255
(408) 777-3228 a buildinq@cupertino.orq
PEfflT WILL NOTB:E FINALED UNTIL THIS CERTIFICATE IS:
COMPLETED, SIGNED and RET RNP,D TO THE BUILDING'DIVISION
PURPOSE:
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance
with 2022 California Residential Codes (CRC) Section R314 & R315, where no interior access for inspections is required.
You may also grant the inspector access into the residence for on-site verification in lieu of completion of this affidavit.
Note: On site verification of smoke & Co alarms is re uired when inspection area is within the residence.
GENERAL INFORMATION:
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon Monoxide alarms.
Alarms must be models approved and listed by the State Fire Marshal, found at: htt)is:[//osfit"i.(ire.ca.gov/divisions/J'ire-
enginecring-and-investigations7building-inatrrials-listing/1:iml-searcli-l-iriilding-inaterials4isting/ . Smoke alarms shall be
listed in accordance with UL 217. Combination smoke and carbon monoxide alarms shall be permitted to be used in lieu
of smoke alarms. Provided they are listed in accordance with UL 217 and U'L 2034. When the valuation of additions,
alterations, or repairs to existing dwelling units exceeds $1,000.00, the CRC Section R314 & R315 requires that Smoke
Alarms and/or Carbon Monoxide Alarms be installed and functioning in the following locations:
-AREA SMOKE
_ALARM
Co ALARM
Within each sleeping room- !: Smoke alarms shall be installed not less than 3 teet :
horizontally from the door or opening of a bathroom that contains a bathtub or shower, from the tip of the
blade of a ceiling-suspended (paddle) fan, and horizontal path from the supply registers of a forced air
heating or cooling system and shall be installed outside of the direct airflow from those registers.
'For additional requirements or clarification see NFPA 72.
x
On every level of a dwelling unit including basements and habitable attics x x
Outside each separate sleeping area in the immediate vicinity of the
bedroom(s).x x
NOTE: Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage.
Power Supply: In existing dwelling units with no commercial electrical supplied to alarms, the smoke and Co alarm(s)
may be solely battery operated. In existing dwelling units, alarms are permitted to be solely battery operated where
repairs or alterations do not result in the removal of wall and ceiling finishes or there is no access by means of attic,
basement, or crawl space. Refer to CRC Section R314 & R315. An electrical permit is required for alarms which must be
connected to the building electrical system.
"As Owner or OwneYs appointed agent of the listed property, I hereby certify that the alam(s) referettced above are
installed in accordance with the manufacturer's instmctions and irt comp(iance with the Califomia Residential Codes."
Permit #Number:Cupertino Property address:
nto-H3-1(g&a lbftl/ C(;>L F3)/AV(
Property Owner
Name.._)..('.A.!'S..'.,,,,:,,-,('-:,f".,q,v,:'-P,,,$: h [1, (_'Signature a.-..-.-.....;.'l,A-..<€.'-.7.a.,,,!!,",,,;'..:'...J.-!i'.J'....'(.7.'7u-l*'y!.(:'J.54.a7>,..... Date:..'TX.'..!,,X,-,4,\:.....
Licensed Contractor x
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Name .....................................................................
//
Signature................................................................................................................... Date:............................,,,,,,
Smoke and CO form.doc revised 02/02/2023