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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O, Box 1988 (ivt.19) <br />Santa Ana, CA 92702 <br />(7 1 41 647 -58A0 <br />'.! ,./,,J 5I nl',r-:tait crq <br />Srnoke & CO <br />Alarm Affidavit <br />This document moy be Jound at... hlta. ,,,',',,,'i Saiit-3tl.nrci Caa <br />(please use a black or blue ink ball-point pen) <br />Project Address:Z'ZL Drln,".l A,rr. <br />lD//oL1tB <br />/Ylrr, ftr',lo <br />C/.:^ J^,(,,1,r.License #: /Da?57 L <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon rnonoxide alarms. CRC Section R314,3 and R315.3 define <br />the required locations. <br />,\ <br /># t eoth boxes below must be checked: <br />6 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 recommended in bedrooms with gasJired <br />appliances (i. e. hot water heater, cooktop, furnace) or a fireplace, <br />E Smoke 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 cjetectors 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). Satter.i life must be 1C 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. <br />(check on Licensed Contractor Pro perty Owner <br />NOTEi Thb seff-certification is only used lot prcjeds that offed the EXTERIOR of the structure. This <br />process is applicable ONLY to projects wherc dccess to the interior of the dwelling by a Sdntd And <br />lnspector is not reqrired. <br />Have this completed form and the job-card readily availabie on final inspection! <br />zhz/za <br />Permit Number: <br />Property Owner: ] <br />I <br />I <br />Signdturc:Date: <br />l <br />tr <br />Contractor: