Calimesa, CA · Riverside County
Retrofit Verification & Self-Certification Form
Permit owners use this form to certify required smoke and carbon monoxide alarms are installed and functional and applicable plumbing fixtures comply.
What this form is
This form lets a permit owner certify that required smoke and carbon monoxide alarms are installed and functional, and that applicable plumbing fixtures comply with the stated water-flow limits. The form says the self-certification option is only available for exterior construction projects when the City of Calimesa Building Inspector does not access the dwelling interior during construction. It asks for the project address, permit number, permit owner, license number, signature, and date.
Who needs it
A permit owner undertaking an eligible exterior construction project uses this form when the inspector does not access the dwelling interior during construction.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed and dated without a notary; it lists no notarized or sworn attachment, so the permit owner just signs and dates it.
How to submit this form
- 1
Download the Form
Download the Retrofit Verification & Self-Certification Form PDF.
- 2
Complete the Form
Enter the project address, permit number, permit owner, and license number.
- 3
Verify the Requirements
Confirm required alarms are installed and functional and applicable plumbing fixtures comply.
- 4
Sign and Date
The permit owner signs and dates the certification.
- 5
Submit to the City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Retrofit Verification & Self-Certification Form certify?
- The permit owner certifies that required smoke and carbon monoxide alarms are installed and functional and that applicable plumbing fixtures comply with the stated requirements.
- Who can use the self-certification option?
- The form says the option is only available for exterior construction projects when the City of Calimesa Building Inspector does not access the dwelling interior during construction.
- Do I need a notary for the Retrofit Verification & Self-Certification Form?
- No. The form has a permit owner signature and date field but no notary block or notarized attachment; the signer just signs and dates it.
- How do I submit the Retrofit Verification & Self-Certification Form?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Retrofit Verification & Self-Certification Form doesn’t need a notary — but if you have another Calimesa form that does, a commissioned online notary can help.