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*-$ANH <br />NA,ffi <br />20 Cryic Caoter Plaza RJSi Annex <br />Planning & Building Agency Smoke & CO <br />Alarm AffidavitP.O Bor 1988 (M-19) <br />Santa Ana. CA 92702 <br />(714) 647-5800 <br />'r/',1/e;l^ri-r.1..1 <br />rNSP-022CrliRC <br />This document mqy be found at h::/'/r/!,'j'i 33:': -a.: c 304 <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:e J <br />e <br />Contractor:Lice nse #: <br />State of California requires that srnoke and carbon monoxide {CO) alarms are installed in residential <br />b u ild ings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofltted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the req u ired locations. <br />A eoar, boxes below must be checkec: <br />El C"rbon monoxide aiarms: Are instarled outside of each sleeping area in tne immediate vicrnrty oi <br />bedrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />appliances (i.e, hot water heater, cooktop, furnace) or a flreplace. <br />p Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />room, and on each level of the dwelling <br />Reti'ofitted detectors may be battery-operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Battery life must be L0 years. <br />I hereby certify that I am the contractor or the property owner of the above project. I further certify <br />that smoke alarms and carbon monoxide alarms have been installed in compiiance with the governing <br />Codes and have been tested to be functional l, also, hereby certjfy that I will retest the alarms per the <br />ma n ufactu rer's instructions. <br />Signature:Dote l-20\Y <br />,q Property Owner(check onel tr Licensed Contr tor <br />NOTE: Ihis self-certificdtion is only used for projects thdt dffect the EXTERIOR of the structure. This <br />process is applicable ONLY to proiecls where access to the interior of the dwelling by a Santd And <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />Permit Number: <br />Property Owner: <br />1L Lt05