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tNSP-02 2013 CRC <br />fhis document may be found at...httD //www. santa-a na.orq/pba/ <br />(P/ease use a black or blue ink ball-point pen) <br />dz 5.ltlt o 2.--7 ?-z--- <br />Property Owner: <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 R314.1and 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 requ ired locations. <br />4\ eo*h boxes betow must be checked: <br />ffi.CarUon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />Tbetrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />aplliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />fi Smole alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />/rodm, 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 tr Licensed Contractor Property Owner <br />NOTE: Ihrs sef-certification is only used for projects that offect the EXTERtoR of the structure. This <br />Wocess is applicable ONLY to projects where occess to the interior ol the dwelling by o Santo And <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />Signoture:d {J"--Dote 0 t-a7 -ao <br />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 />na.orq <br />Smoke & CO <br />Alarm Affidavit*-SANTA <br />NAJ}ffi <br />Project Address: <br />Permit Number: