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*-SANIA <br />NA-"ffiI <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.sa -ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />INSP.O2 2013 CRC <br />This document mqy be found at... http://wvlnw.santa-ana.ofglpbal <br />(Please use a black or blue ink ball-point pen) <br />Project Address:Siz a &#,,/o 4, <br />Permit Number:ifu7cto"rr t' hro|f/{ <br />Property Owner:b4- fer,'.^ha <br />Contractor:K,t,.l"l flr^ry' Sl,License #: /OZ o.rat <br />State of California requires that smoke and carbon monoxide (CO)alarms are installed in residential <br />bu ildings. <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 required locations. <br />n Both boxes below must be checked: <br />dC"rUon 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 />dSrnot" 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 lwill retest the alarms per the <br />manufacturer's instructions. <br />(check onel Licensed Contractor Property Owner <br />NOTE: This self-certificotion is only used for projects that offect the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where occess to the interior of the dwelling by a Sonto Ano <br />lnspector is not required. <br />Signoture Dote 2l <br />Have this completed form and the job-card readily available on final inspection!