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,--SANTA <br />NA-"'trl[ <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647-5800 <br />www. sa nta-ana.oro <br />Smoke & CO <br />Alarm Affidavit <br />2013 <br />This document moy be lound ot...http://www.santa-ana .org/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address & 'l_5t3 i\,[-a"r-.t^ $an* h\;€. <br />Permit Number:Zot1ot rq <br />Property Owner €-\ <br />Contractor:0n* ) ir- 1o\o-o-License *: Cl/;1,\0f; <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC)Section R314.1and R315.2 states in partthat existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />n Both boxes below must be checked: <br />E Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate 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 />E 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 />Retrofitted 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 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 />manufacturer's instructions. <br />lcheck onel Li d Contractor perty er <br />NOTE: This self-certification is only used lor projects that affect the EXTERIOR of the structure. This <br />process is opplicable ONLY to projects where occess to the interior of the dwelling by a Santo Ano <br />lnspector is not required. <br />Signature:)_--- <br />Date LI <br />Have this completed form and the job-card readily available on fina! inspection! <br />tr