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*,,SANTA <br />NA'ffi <br />Planning & Building AgencY <br />20 Clvlc Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647-5800 <br />ww,v.santa-ana. orq <br />This document may be lound ot... <br />(Please use a black or blue ink <br />anta <br />INSP.O2 2013 CRC <br />rea in the immediate vicinitY of <br />in bedrooms with gas-fired <br />ball-point pen) <br />state of california requires that smoke and carbon monoxide (co) al ms are installed in residential <br />buildings <br />california Residential code (cRC) section R314.1and R315.2 states i part that existing dwellings be <br />,,retrofitted with smoke alarms and carbon monoxide alarms. cRC se ion R314.3 and R314.3.3 define <br />the required locations. <br />ABoth boxes below must be checked: <br />S.caruon monoxide atarms: Are installed outside of each sleeping <br />bedrooms and also on each level of the dwelling. Alarms are require <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace' <br />ES-ot " alarms: Are installed in each room used for sleeping, in <br />room, and on each level of the dwelling. <br />h hallway outside of a sleePing <br />Retrofitted detectors may be battery-operated for buildings where interior alterations are <br />performed. Combination Smoke/CO alarms must comply with all a <br />by the State Fire Marshall (SFM). Battery life must be 10 years. <br />icable standards and be aPProved <br />I hereby certify that I am the contractor or the property owner of above project. I further certifY <br />that smoke alarms and carbon monoxide alarms have been installed n compliance with the governing <br />Codes and have been tested to be functional. l, also, hereby certlfy <br />man ufactu rer's instructions. <br />t I will retest the alarms Per the <br />lcheck onel Licensed Contractor Owner <br />NOTE: This setf-certificotion is only used for proiects that affect the 'RIOR ol the structure. This <br />process is appticoble ONLY to proiects where occess to the interior <br />lnspector is not required. <br />the dwelling by a Sonta Ana <br />oke & CO <br />rm Affidavit <br />S <br />AI <br />L7/0 \r.7MProject Address: <br />/o//oJ/.7oPermit Number: <br />L*uProperty Owner: <br />I: /0(649rLicense(ec* Rpatrdb-Contractor: <br />24Signature <br />Have this completed form and the job-card readily on final inspection!