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ilSNIA <br />NAfiiffi <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-s800 <br />na, orq <br />LNSP.02 2013 CRC <br />This document may be lound ot.,. http //u,tn,z. sa nta-ana.o lobai <br />(P/ease use a black or blue ink ball-point pen) <br />IZ <br />Smoke & CO <br />Alarm Affidavit <br />.lA <br />State of California requires that smoke and carbon monoxide (Co) alarms are installed in residential <br />b u ild in gs. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be"retrofitted with smoke alarms and carbon monoxide alarms. cRC Section R314.3 and R314.3.3 define <br />the required locations.nI Eeoth boxes below must be checked: <br />ECarbon 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 />B Smoke 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 con <br />that smoke alarms and carbon m <br />Codes and have been tested to b <br />ma n ufacture r's instructions. <br />the property owner of the above project. I further certify <br />larms have been installed in compliance with the governing <br />al. l, also, hereby certify that I will retest the alarms per the <br />Contracto r <br />tractor or <br />onoxide a <br />e funct <br />(check onel a'Property Owner <br />N0TE: This seff'certificotion is only used for projects thot dffect the ExrERtoR of the structure. This <br />process is opplicdble ONLY to projects where occess to the interior of the dwetling by a Sonto Ano <br />lnspector is not required. <br />e <br />Project Address: <br />Permit Number: <br />Property Owner: <br />Contractor:tu/c License #. ICC <br />Signature:I r Odte:6- zz- tt- <br />I <br />I <br />I <br />I <br />l <br />I I <br />Have this completed form and the job-card readily available on final inspection!