B-2016-2878 SMO
KE / CARBON MONOXIDE ALARMS -
rm, OWNER CERTIFICATE OF COMPLIANCE
5iars COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
CUP RTftJO 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
(408)777-3228•FAX(408)777-3333•buildmqOcupertino orq
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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. V
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 V SMOKE ALARM _ CO ALARM �
Outside of each separate sleeping area in the immediate vicinity of X X —I
the bedroom(s)
On every level of a dwelling unit including basements X X
Within each sleeping room X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an 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 emits 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 required for
alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has/have been
installed in accordance with the manufacturer's instructions and in compliance with the California Building
and California Residential Codes. The alarms specified below have been tested and are operational,as of the
date signed below. GC
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Address: KO 1 `�' GC.KC - C ra Permit No��--2D O —2S1 g,
Specify Number of Alarms: #Smoke Alarms:
"L ?y #Carbon Monoxide Detectors: Lir
I have read and agree to comply with the terms and conditions of this statement
Owner(or Owner Agent's)Name:
Signature Date: 11/ii,/ '
Contractor Name: - Z1 f
( 1-1M Cand/O Signature. l . ... .,. V.. ...:...Lic.# ... ...... .. rr Date: 1/14 t�
Smoke and CO fo777m.d0c revised 09/27/16