BLD-2023-2156_Smoke/COSMOKE / CARBON MONOXIDE ALARMS
SELF -CERTIFICATION OF COMPLIANCE
� l COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
ll��I1
C6PFiiTINC3 101W TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228
PERMIT WILL NOT BE FINALED UNTIL. THIS CERTIFICATE IS:
COMPLETED, &U= xnd It jLaL =TO THE BUILDING DIVISION
PURPOSE:
This affidavit is a self-cification for the installation of all required Smoke and Carbon Monoxide Alarms for corpliance
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�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: l:�tlW;/i osfm_ .c -QyLc yl ;-
nine -and- -��°� stigatzvnsfbuil sajteri_A--Listmg:. 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 alarrms. Provided they are listed in accordance with UL 217 and UL 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:
ALA
,SmOItE
ALARM
Co ALARM
Within each sleeping room- NoTE Smoke alarms shall be installed not lees than 3 feet
horizontally from the dom or opening of a bathroom that contains a bathtub or shower, from the tip of the
X
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 WA 77
On every level of a dwelling tout 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 rEot contain fuel -burning appliances d that
do not have an attached garage.
dower 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 Owner's appointed agent of the listed properly, I hereby certify that the alarm(s) referenced above are
installed in accordance with the manufacturer's instructions and in compliance with the California Residential Codes."
permit fiNumiSerCup
BLD 2023-2156
Lw2ff&
10317 Cold Harbor Ave
prooedy owner
—'
Name
Pak's Roofin Inc
Name ..........._........................_............
_.............. .................._...... ................ ....... ......._ .... pate:............... __
Smoke and CO form-doc revised 01i0212013