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AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: j1- O L .etY)1'±4 J V&& A enc f'ct L/i- 9i '
Permit Number: wail )o 0.2 72.
Brief Job Description: .13/ o ik woi, I 1
Number of smoke alarms installed:
Number:of carbonmonoxide alarms in tailed:
When alterations, repairs or additions requiring a permit occur, or sleeping rooms are created,
Smokealarms shall be installed in each sleeping room, and outside each separate
sleeping area in the immediate vicinity of the bedrooms, and on each additionalstory of the
dwelling, including basements and habitable attics as required by Section R314 of the 2016
California Residential Code (CRC) and California Health and Safety Code Section 13113.7.
For dwellings or sleeping units containing fuel burning appliances or having attached
garages, carbon monoxide alarms shall be installed outside each separate sleeping
area in the immediate vicinity of the bedrooms, and on each additional story of the
dwelling, including basements as, required by Section R315 of the of the 2016 California/ -
Residential Code (CRC).
Multi-purpose alarms (combination carbon monoxide and smoke alarms) may be used.
All alarms shall comply with requirements for listing and approval by the Office of the State Fire
Marshal. htI•://ostm,f ire.ca:•ov/licensin•listin•s/licenselistin• bml searchcotest.•h•
As owner of the above referenced property, I hereby certify that the smoke alarms and carbon
monoxide alarms have been installed in accordance with the manufacturer's instructions and in
compliance with the code sections referenced above.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) __al:L.) 12 0:2.O _ at Arcadia, Califf rnia.
Owner's Name (pri;nted/typed): _but° 1_16191 v✓vt,N6.,:.,....„..„2
.
Signature of Owner: / ''-2"_
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This affidavit must be returned to the City of Arcadia inspector prior to final inspection
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FIRST FLOOR PLAN
C. le SMOKE ALARM -' .CARBON MONOXIDE ALARM
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SECOND FLOOR PLAN
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R TING ACTION
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y CITY OF ARCADtA
[DEVELOPMENT SERVICES DEPARTMENT
el Vito ,
t1.4 !,..,:.'v'14"r 0° FENCE GARDEN. WALL AND/OR RETAINING WALL N
A4mff
ity
PROPERTY LINE f`ELEASE AI. DECLAP TION
1) ADJACENT PRIPERTY OWNER'S DECLA,P ;TION
I, '/a Al riflAf , s owner of the property located -t V 3 Io
hereby �
grant permission to the adjacent property owner located at E,5Lvand"a' 'c ks_
to construct /37 (Feet lineal feel of ee high fence, garden wall, and/or
retaining wall, some of which will be located on my property. acknowledge,
• understand and accept the scope and nature of the proposed work (i.e., col,•r, size,
height, type and location of the fence, garden wall, and/or r "taining wall and the removal
of landscaping).
Name: I-1 o
Telephone Number: 6
Address: I d 3 to ail ri I AA., Dat �'1��y1 .
®ate: /
Signature:
PERMIT APPLICANT'S DECLAk{;.TION
I declare under the penalty of perjury that I have obtained the approval and release from
the owner of the property located at )40.9 L� an '-t,:. �� Arced'* to construct and
locate part of a fence,
g=rden wall, and/or retaining wall en their property.
Name: `ar1 g k Telephone Number: &I—Ai3 S-Sr
Address:/ 00 L0'Gry I f ; (i' •ate: - X.3o
Signature: ;_-
i
c: Applicant's file
Neighbor's file
Job site •
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