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\ SMOKE I CARBON MONOXIDE ALARMS
OWNER CERTIFICATE OF COMPLIANCE
4,s+,4,4 COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTlNO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildin r(7x,cugertino org
of Al
Address 4�• #€ Permit No. 7-°f - 2
Alarms Smoke: 7 Carbon Monoxide:
PERMIT CANNOT BE FI HALED AND COMPLETED UNTIL T13IS CERTIFICATE• j
HAS,BEEN SIGNED AND RETURNED 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 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11,2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carbon
Monoxide alarms. When the valuation of additions, alterations,or repairs to existing dwelling units exceeds
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and/or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM CO ALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling tout including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fel-burning appliances and that
do not have art attached garage. Carbon monoxide alarms combined with smoke alarms shall comply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply,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 and CBC Sections 907.2.11.4 and 420.6.2.An electrical permit is re. i red for
alarms which must be connected to the building wiring.
Vo,
As owner of the above-referenced property,l hereby certify that the alarms)referenced above: / a Ce''e"h
installed in accordance with the manufacturer's instructions and in compliance with the Califo° 'o "=71 g 4
y
and California Residential Codes.The alarms have been tested and are operational, as of the da,-
below.
a,below.
/have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name ° x
V 1�'" y ) Signature .. 1-Zi✓ c } Date r
/Cf/4/
Contractor Name
Signature Lic#. Date
Smoke and CO foi m doc e evrsed 03/18/14