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*-SNTA <br />NA-ffi <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-s800 <br />www. santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />INSP.O2 2013 CRC <br />This document moy be found at... http://wvwv.santa-ana.org/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:'7 to S. -radilferop sr * P <br />Permit Number:lo / / oz / <o <br />Property Owner: <br />L <br />Leu <br />Contractor:fGL{+ R-ooF"d h License #, /ct V $e S7 <br />State of California requires that smoke and carbon monoxide (CO)alarms are installed in residential <br />buildings. <br />California ResidentialCode (CRC)Section R3l-4.1and 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 required locations. <br />nBoth boxes below must be checked: <br />(CarUon monoxide atarms: 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 />ESrot" 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 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 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 />manufactu rer's instructions. <br />(check onel B Licensed Contractor tr Property <br />NOTE: This self-certification is only used for projects that offect the EXTERIOR of the structure. This <br />process is opplicoble ONLY to projects where occess to the interior of the dwelling by a Santo Ana <br />lnspector is not required. <br />-r' I 4-Dote:4*/* <br />Have this completed form and the job-card readily available on final inspection! <br />Signoture: