Pinole, CA · Contra Costa County
Self-Certification Affidavit for Smoke and CO Alarms
Property owners complete this affidavit to verify that smoke detectors and carbon monoxide alarms are installed and working for a permitted project.
What this form is
This affidavit lets a property owner verify that smoke detectors and carbon monoxide alarms are installed in the listed locations and have been tested and are functional. The permit will not be finalized until the building inspector tests the alarms or the completed form is collected by the inspector. The form asks for the permit number, project address, owner’s name, alarm locations, signature, date, phone number, and email address.
Who needs it
A property owner with a permit must complete this form if the building inspector has not tested the smoke detectors and carbon monoxide alarms.
How to submit it
The permit will not be finalized until the building inspector tests the alarms or this completed form is collected by the inspector.
About notarization
This document is signed without a notary; the owner signs and dates the form and declares under penalty of perjury that the statements are true and correct.
How to submit this form
- 1
Download The Form
Download the Smoke and CO Alarm Self-Certification Affidavit.
- 2
Complete The Affidavit
Enter the permit and project details, verify the listed alarm locations and functionality, and provide the owner’s contact information.
- 3
Sign And Date
The property owner signs and dates the affidavit and makes the declaration under penalty of perjury.
- 4
Provide It To The Inspector
Have the completed form collected by the building inspector, or have the inspector test the alarms.
Frequently asked questions
- Do I need a notary for the Smoke and CO Alarm Affidavit?
- No. The form has no notary block; the owner signs and dates it and declares under penalty of perjury that the statements are true and correct.
- How do I submit the Smoke and CO Alarm Affidavit?
- The building inspector must collect the completed form, unless the inspector tests the alarms. The permit will not be finalized until one of these steps occurs.
- What information does the affidavit request?
- It asks for the permit number, project address, property owner’s name, alarm locations, owner’s signature and date, phone number, and email address.