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*,,sAll'[A <br />NA.ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box '1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647-s800 <br />w.Ma/. sa n ta-a n a- orq <br />Smoke & CO <br />Alarm Affidavit <br />Project Address:lt110 s (>r^/rn<0./ <br />n0 alg'7-l Lq <br />Property Owner:AuurioL,u 6".-^l <br />Contractor:V1 t000t71 <br />rNsP-02 2013 CRC <br />This document may be lound ot.http://1,^,,nv. sanla-a na orq,'pba / <br />(Please use a black or blue ink ball-point pen) <br />Permit Number: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <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 req u ired locations. <br />f,\ soil, boxes below must be checked: <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations are <br />performed. Combinatron Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Battery Iife must be 10 years. <br />I hereby certify that I am the contractor or the prope(y 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 on tr Licen sed actor P roperty Owner <br />NOTE: This self-certificdtion is only used lor projeas that ollect the EXTERIOR of the structure. This <br />process is opplicoble ONLY to projects where dccess to the interior of the dwelling by o Sonto Ano <br />lnspector is not required. <br />Y <br />Signatur?:I ; /z-L / t) <br />Have this completed form and the job-card readily available on final inspection! <br />License #: <br />L, <br />YCarbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />{edrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />a'o/inces (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />I S]""f" alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />y'oYm, and on each level of the dwelling. <br />Dote: