(Print Name)
(Print Property Address)
Understand that smoke and carbon monoxide (CO) alarms required by the California Residential Code (CRC)
will need to be installed in the dwelling, in compliance with the CRC and with the manufacturer's instructions
and further understand they will be tested and function properly. These alarms enhance life safety within
dwellings. The CRC sections R314 and R315 require the retrofit of these alarms in existing dwellings
when alterations, repairs or additions requiring a permit with a valuation exceeding $1,000 are made. An
alteration consists of any construction or renovation to an existing structure other than a repair or
addition. A repair is the reconstruction or renewal of any part of an existing building for the purpose of
its maintenance or to correct damage. An addition consists of an extension or increase in floor area or
height of a building or structure. Generally, the alarms must be hard wired (110 volt) with battery
back-up and all alarms are to be interconnected. If the installation of the alarms will require the removal
of a wall or ceiling finishes and there is no access by means of an attic, basement or crawl space, then
alarms may be solely battery operated and not interconnected. Battery-only type smoke alarms must be
equipped with a 10 year battery and have a silence feature. Alarms must be installed in all of the following
locations within the existing dwelling and must be no more than 10 years old, from the date of
manufacture as marked on the unit(s). Without a date of manufacture identified, the alarms must
be replaced:
CITY OF YORBA LINDA
4845 CASA LOMA AVENUE YORBA LINDA, CALIFORNIA 92886
BUILDING DIVISION (714) 961-7120
Owner
Agent for Owner
Licensed Contractor
Date
ATTENTION:
A City Building Inspector will be performing this verification, therefore you must arrange to have an adult
present at the time of inspection and provide a ladder and access to locations of all alarms, if
necessary.
SMOKE AND CARBON MONOXIDE ALARMS
for the property located at __________________________________________________________________
I,_______________________________, the
In all bedrooms (only Smoke Alarms are required)
Immediately outside and in the immediate vicinity of each bedroom area (Smoke and CO Alarms are
required)
In each story level, including basements and habitable attics (Smoke and CO Alarms are required)
Signature
I have read and understand the above requirements and affirm by my signature, that all required alarms
mentioned above will be properly installed and inspected.
Revised 03-21-18
