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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647.5800 <br />w./i/w. s a n t a - a n a. o ro <br />Smoke & CO <br />Alarm Affidavit <br />rNSP-02 2013 CRC <br />This document moy be lound at..htto:/r\,. /r.santa-ana.or q'oba <br />(Please use a black or blue ink ball-point pen) <br />Property Owner: <br />Contractor: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u 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 Sec on R314.3 and R314.3.3 define <br />the required locations. <br />,f\ ro,n boxes below must be checked:\r <br />$l 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 />.appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.V <br />lf{ 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 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 functional. l, also, hereby certify that lwill retest the alarms per the <br />m a n ufacturer's i TU <br />lcheck onel censed Contracto r Pr ert Owner <br />NOTE: This sef-certificotion is only used for projects thot offect the EXTERIOR of the structure. This <br />process is applicoble ONLY to projects where dccess to the interior of the dwelting by o Sonto Ana <br />lnspector is not required. <br />Project Address:L^daoi)0il7 S ( <br />Permit Number:roil 0{lqa <br />#rvAra*a lVwl e 1,." <br />License #: <br />Signoture:l Dote:Y w <br />Have this completed form and the job-card readily available on final inspection! <br />,,-SANTA <br />NA,ffi <br />,R