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*rr$ffi <br />NA'ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Aonex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647.5800 <br />,rr',r'/\r/ s3nte-ana oral <br />Smoke & CO <br />Alarm Affidavit <br />INSP-02 20]3 CRC <br />I <br />This document may be found dt... httO./i,rv.,v.,]i.sania-ana.oTq,i oba,/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:blb ( I-r (,-\l"t n Ar.le <br />Permit Number:lo\nP,Lu <br />Property Owner: <br />Contractor:<-,, <br />License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ild ings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the req u ired locations. <br />f,l so,h boxes betow must be checked: <br />4 Carbon monoxide alarms; Are installed outside of each sleeping area in the immedlate vicinity of <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 fireplace. <br />Wsmoke 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 />Retrofitted detectors may be b attery-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 10 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 compliance with the governing <br />Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the <br />m a n ufacturer's instructions. <br />lcheck onel tr Licensed on tractor Pro perty Owner <br />NoTE; fhls sef-certification is only used for projects thot oflect the ExTERtoR of the structure. This <br />process is opplicdble ONLY to projects where occess to the interior of the dwelling by o Sontd Ano <br />lnspector is not requhed. <br />Have this completed form and the job-card readily available on final inspection! <br />Signoture:I Dote:tt /rq IBI