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*,,SNTA <br />NA,ffi <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 />www.santa-ana.orq <br />Smoke & CO <br />AIarm Affidavit <br />Signature:(Wn\\(v vt <br />-bLl <br />rNSP-02 2013 CRC <br />fhis document moy be lound ot..h ltp://www. sa nt a-ana.orqlgbal <br />(Please use a black or blue ink ball-point pen) <br />Project Address:(tD6 S Raifr.5r' <br />Permit Number:l0 tct 3c55 <br />Property Owner:0v\a,l \ \f d <br />Contractor:*Lv' "License #:tu/p <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 Section R314.3 and R314.3.3 define <br />the req uired locations. <br />A eoah boxes below must be checked: <br />ffCarbon 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 wrth gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace, <br />Efsmoke 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. lfurther certify <br />that smoke alarms and carbon monoxide alarms have been installed in compliance with the governing <br />Codes and have en tested to be functional. l, also, hereby certify that I will retest the alarms per the <br />ma nufactu rer's i tru ons <br />lcheck onel Licen sed Contractor P roperty wner <br />NOTE: Ihls sef-c ertificdtion is only used for projects thdt dlfect the EXTERIOR of the strudure. This <br />process is applicoble ONLY to projects where occess to the interior of the dwelling by a Sdntd Ano <br />lnspector is not rcquircd. <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />Dote: I 05 z^ (T