Lodi, CA · San Joaquin County
Self-Verification Form for Smoke & Carbon Monoxide Alarms
Property owners use this form to certify that smoke and carbon monoxide alarms are installed for a building permit project when interior access is inconvenient.
What this form is
This form lets a property owner self-certify alarm installation when permitted work, such as reroofing or other exterior work, does not allow convenient access to the dwelling’s interior. The City of Lodi says alarm verification is needed for final permit approval. The form asks for the property address, building permit number, date, owner’s printed name, and signature.
Who needs it
A property owner with a building permit project that makes interior access inconvenient may use this form to certify alarm installation to the Building Department.
How to submit it
The form names the Community Development Department, Building Division, at 221 West Pine St./PO Box 3006, Lodi, CA 95241-1910; it does not state a submission method.
About notarization
This document is signed without a notary; the property owner signs and dates it, and no notarized or sworn attachment is identified.
How to submit this form
- 1
Download The Form
Download the Smoke & Carbon Monoxide Alarm Self-Verification Form.
- 2
Complete The Form
Enter the property address, building permit number, date, and owner’s printed name.
- 3
Sign And Date
The property owner signs and dates the form to certify alarm installation.
- 4
Submit To The City
Submit it to the Community Development Department, Building Division; the form does not specify a submission method.
Frequently asked questions
- Do I need a notary for the Smoke & Carbon Monoxide Alarm Self-Verification Form?
- No. The property owner signs and dates this form without a notary, and the document does not identify a notarized or sworn attachment.
- Who uses the Smoke & Carbon Monoxide Alarm Self-Verification Form?
- A property owner may use it when permitted work, such as reroofing or other exterior work, does not allow convenient access to the dwelling’s interior.
- What information does the form ask for?
- It asks for the property address, building permit number, date, owner’s printed name, and the property owner’s signature certifying alarm installation.
- How do I submit the Smoke & Carbon Monoxide Alarm Self-Verification Form?
- The form lists the Community Development Department, Building Division, at 221 West Pine St./PO Box 3006, Lodi, CA 95241-1910, but does not state how to submit it.
Need something notarized?
This Self-Verification Form for Smoke & Carbon Monoxide Alarms doesn’t need a notary — but if you have another Lodi form that does, a commissioned online notary can help.