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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex Smoke & CO <br />Alarm AffidavitP.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />www.santa-ana.orq <br />INSP.O2 2013 CRC <br />This document moy be lound ot.http://!,rr/w. santa-ana.orq/oba/ <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:2o zL Miro =ol 9. Sc"t,'h, AM A\q zlog <br />Permit Number:lovq,+rl9 <br />Property Owner:r <br />Contractor:\\License #: <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 R314.1 and 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 requ ired locations. <br />6\ gotl, boxes below must be checked: <br />dcrrbon 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-fjred <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />Efsmoke 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. Combinatjon 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 ed to be functional. I , also, hereby certify that I will retest the alarms per the <br />ma n ufacturer's inst <br />lcheck onel tr I cens Contractor w Property Owner <br />NOTE: Ihrs sef-c ertificotion is only used Jor projects thot dlfect the EXTERIOR of the structure. This <br />process is applicdble ONLY to ptojects where dccess to the interior of the dwelling by a Sdnta Ana <br />lnspector is not required. <br />Signoture:Y-/Dote:( <br />II <br />Have this completed form and the job-card readily available on final inspection! <br />*,,SNTA <br />NA.ffi