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ffih$Alffi <br />#.AIffffi <br />Planning & Building Agency <br />20 Ciyic Center Plaza Ross Annex <br />P.O. Box 1938 (tu|-19) <br />Santa Ana, CA 92702 <br />(714) 647-sao0 <br />w'naru.sa nta-a n a. orq <br />Smoke & CO <br />Alarm Affidavit <br />rflsP-oz 2013 cRc <br />This document moy be found ot.-.h ttO:/A,w,r.,,,1. Sa n ta -ana.orq/oba/ <br />(P/ease use a black or blue ink balt-point pen) <br />o'/ <br />State of California requires that smoke and carbon monoxide (CO) atarms are installed in residential <br />bu ildings. <br />California Residential Code (CRC) Section R3L4.1and R315.2 states in part that existing dwellings be <br />"retrofitted \,vith smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />/n\{ $eotn boxes below must be checked: <br />[1 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 vrith gas-fired <br />appliances (i.e. hot water he3ter, cooktop, furnace) or a fireplace. <br />dS^ot,"alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeptng <br />room, and on each level of ihe dlvelling. <br />Retrofitted detectors may be battery-operated for buildings r,vhere 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 lwill retest the alarms per the <br />manufacturer's instructions. <br />Z-,1- Z.t <br />lcheck one)Licensed Contractor )< Property Owner <br />NOTE: fhis sef-c ertification is only used lor proiects thdt alfect the EXTERIOR.of the structure. rhis <br />process is opplicable ?NLY to projects where access to the interior of the dwetting by a sonta And <br />lnspector is not required. <br />Project Address;\r <br />Permit Number: <br />Property Owner:c 2--.1 <br />Contractor:'CabYpYa License #:lo Ltq < 8r <br />Signdtute:Z\lail n-l in Cqbte-ro z)4ldo"* <br />Have this completed form and the job-card readily available on final inspection! <br />] C-an i rt rtr)fi ( ,t<t A 7 <br />blottnzqT.l