BLD-2023-1499_Smoke/CODocuSign Envelope ID: 346OC690-2038-41 C5-l39F7-68F87DF5l3D1 1
c
EV
OF
CUPERTINO
PURPOSE:
SMOKE l CARBON MONOXIDE ALARMS
SELF=CERTIFICATION OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
(408) 777-3228 • building aecupertino.org
PERMIT WILL NOT BE FINALED UNTIL THIS CERTIFICATE IS:
COMPLETED, SIGNED, and RETURNED TO THE BUILDING DIVISION
This affidavit is a self -certification for the installation of all required Smoke and Carbon Monoxide Alarms for compliance
with 2022 California Residential Codes (CR.C) 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 required 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: https://osfm.fire.ca.,gov/divisions/fire-
engineermg-and-investigations/building-materials listinaml search building materials listing/ . 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 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:
AREA SMOKE Co ALARM
a auc alu�l
Within each sleeping room- NOTE: Smoke alarms shall be installed not less than 3 feet:
horizontally from the door 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 NFPA 72.
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 Owner's appointed agent of the listed property, 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."
Dermif #Alumhar _ 1.
BLD-2023-1499 1 10161 Miller Ave
Property Owner
Name ...............
Name .Dalcon Electric
................................................................................
........................... Date:.................................
/ —DocuSipned by;
.........................1.. y...a.n rn, 01 /05/24
.....0............. Date:.................................
Smoke and CO form, doe revised 0210212023
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