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*-SANTA <br />NAJ}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) 647-5800 <br />w'J,u../. s a nta-a n a. or-q <br />Smoke & CO <br />Alarm Affidavit <br />INSP-02 2013 CRC <br />This document may be lound at...http ://unw. sa nta-a na.o rqlpbal <br />(Please use a black or blue ink ball-point pen) <br />Project Address: <br />Permit Number <br />Contractor:License #: <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 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 />{rr}Both boxes below must be checked: <br />S 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 />apPnces (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />$Smofe 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 ,ed Contra tor tr Property Owner <br />1- <br />NOTE: This self-certificotion is only used for projects that offea the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where access to the interior of the dwelling by o Sonta Ano <br />lnspector is not required. <br />Signoture -:r I <br />(Date <br />Have this completed form and the job-card readily available on final inspection! <br />Property Owner: <br />tr