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*,,SNTA <br />NAJ}MH <br />r0/. r(^//{L <br />lll?l:i?"t,?,y::.Qil"fJ!* <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-s800 <br />www.santa-ana.oro <br />Project Address ,w rlrc Si\.,' <br />Permit Number:(o {)I <br />Property Owner: <br />Contractor:License #: <br />INSP42 2013 CRC <br />This document mdy be lound at..http://www san ta-ana.orq/oba/ <br />(Please use a black or blue ink ball-point pen) <br />State of Californaa 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 required locations. <br />f| gott, boxes below must be checked <br />El Carbon monoxide alarms: Are installed outside o(each,s,leeping area in the immediate vicinity of <br />bed rooms 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. <br />E Srnot" alarms: Nre installed each rqgT Vsed for sleepin <br />roorh, and on each level of the dwelling. <br />gfr.' e-;-t-hallwayoutside of a steeping <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations are <br />performed. Combination Smokele,O_aqrll:Jnqgt corrlp-ly_Wilb all applicable standards and be approved <br />by the State Fire Marshail (SFrr,{. Battery tl!9 m:ust !9 1! Veers. '-\ <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 governinB <br />Codes and have been tested to be functional. l, also, hereby certify that lwill retest the alarms per the <br />manufacturer's instructions. <br />(check onel Licensed Contractor Pro erty er <br />NOTE: Ihis serr-certilicotion is only used lor projects thdt dffect the ExTERtoR of the structure. This <br />process is opplicable ONLY to Noiects where dccess to the interior ol the dwetting by a Santo And <br />lnspedor is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />Signature:Ddte:ol rl <br />Smoke & CO <br />Alarm Affidavit <br />t+ <br />t- <br />I <br />I <br />,1 <br />tr