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**SNTA <br />NA.ffi <br />Planning & Building Agency <br />20 Civic Center Pla2a Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana. CA 92702 <br />(711) 647.s800 <br />ww.rr/ 53nta-ana-orq <br />Smoke & CO <br />Alarm Affidavit <br />|NSP{2 2C!3 CRC <br />fhis document moy be found ot.. <br />(P/ease use a black or blue ink ball-point pen) <br />htto:i i'd/.M&. sa nta-a na.or a, oba, <br />Project Address:t v <br />Permit Number: <br />Property Owner:VJ <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ild ing s. <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 uired loca tions. <br />f\ao,h boxes below must be checked: <br />Xc.rUon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />/Uu)roo., and also on each levei of lhe dweliing. Alarms are required in bedrooms with gas-fired <br />appliances (i. e. hot water heater, cooktop, furnace) or a fireplace. <br />A-l <br />)Q Smoke 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 bu ild ings 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 lfe rnust be 10 year;, <br />I hereby certlfy 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. I, also, hereby certify that I will retest the alarms per the <br />man ufacturer's instructio <br />Signoture:Dote:_Ll ll <br />o? <br />) <br />lcheck onel tr Licen Contractor tr P ro perty Owner <br />NOTE: Ihls sell-certification is only used lor proiects thot dffect the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where access to the interiu ol the dwelling by o Sonta Ano <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />\/'-)