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AFFID 2;VIT:SELF-CERflFICATIOt
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: _ I Gs( CAL.%F i isliv sue" A lea 01 A a f 6.f.A Ck Eaa.-r,rn Sr.
Permit Number: EC.EC 2-1 ,_:I 6-71 . . -
Brief Job Description: tt:ir-C- 5E42-4%c.E. .0 st"r.)6R-
Number of smoke alarms installed::. ( . :.PE 2 00 ►-r
Number of carbon monoxide alarms installed: I .. .f n2 'N.l
When alterations, repairs or additions requiring a permit occur, or sleeping rooms are created,
Smoke alarms shall be installed in each sleeping :room, and outside each separate
sleeping area.in the immediate vicinity of the bedrooms,, and..on each additional story 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 require d 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. httpa/osfm:fire,ca.govllicensingli'stings/licenselistinq : brill . searchcotest.php
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 pa;.alty of perjury that the foregoing is true and correct, and th.,t this
declaration was executed.on (Date) I- ? r Z.I. at Arc_,dia, California.
Owner% Name (panted/ .a). OE W
Signature of Own f:'r: , -v�-°� (,�1'
This affidavit must be returned to the City of Arcadia inspector prior to final inspection.
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