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*,,SANTA <br />NA,'ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex Smoke & CO <br />Alarm Affidavit <br />rNSP-02 20r3 CRC <br />fhis document moy be lound at...http://www. sa nt a-ana.orqlpbal <br />(Please use a black or blue ink ball-point pen) <br />Project Address:,i3/6 ,/ {/1rr lyL sk/q A'-Fr <br />Permit Number:t/u,/z3o 2T <br />Property Owner:f/s^ 6r,rv,o.Ji*o <br />Contractor:&vill ,, Or{orot License #:4w-f//// <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings. <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 />A eoth boxes below must be checked: <br />frl Carbon 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 with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />Q Smot e alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />/obm, 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 lwill retest the alarms per the <br />manufacturer's instructions <br />lch Licensed Con tractor tr Pro perty Owner <br />NOTE: fhis sef-certification is only used for projects thot offect the EXTERIOR of the structurc. This <br />process is applicdble ONLY to projects where dccess to the interiot of the dwelling by o Sonto Ano <br />lnspector is not required. <br />Signoturc:te:d <br />Have this completed form and the job-card readily available on final inspection! <br />P.O. Box 1988 (M.19) <br />Santa Ana. CA 92702 <br />(714) 647-s800 <br />www.santa-ana.oro <br />I