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AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
-. . AN
D CARBON MONOXIDE ALARMS .
370 Walnut Ave Arcadia CA 91007
Property Address: . .
Permit Number: SOLR-20-1268
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Number of.smoke alarms installed:9
Number of carbon monoxide alarms.installed:9.
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'201fi
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
gara9es,carbon monoxide alarms shall be installed outside each 'separate Sleeping
area in the,immediate iviejnity 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
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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 Mar_30,_2022
( ) at Arcadia,.California.
Owner's:Name .(printed/typed): Stella Wei •
Signature of Owner: . a; •
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This affidavit must be returned to the City of Arcadia inspector priorto final inspection