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1 <br />Planning & Building Agency'Smoke & CO <br />Alarm Affidavit <br />20 Civic Center Plaza Ross Annex,SAI'ilA <br />NAffi <br />ftfl <br />rNSP{2 2013 CRC <br />f his document moy be lound at...http:/4,^n,'1,v. sa n ta-a na.orq/oba/ <br />(P/ease use a black or blue ink ball-point pen) <br />Property Owner: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ildi ngs. <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 />4^e",h boxes below must be checked: <br />tsf"rUon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bed ro ms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />appl nces (i.€. hot water heater, cooktop, furnace) or a fireplace <br />Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />lcheck onel Licensed Contractor Pro erty Owner <br />NOTE: Ihis self-certificdtion is only used for projects thot aJlect the EXTERIOR of the structute. This <br />process is applicable ONLY to projects where occess to the interior ol the dwelling by o Sonta Ana <br />lnspector is not required,, <br />Have this completed form and the job-card readily available on final inspectionl v),l <br />Project Address: <br />Permit Number: <br />IuLtl <br />Iolq <br />Contractor:-ful ricense #: 5<lLlci(3 <br />Signature:Doty Qgy arT <br />P.O. Box 1988 (M.19) <br />Santa Ana, CA92702 <br />(714) 647-5800 <br />w./rarv sint3-ana oto <br />I <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 been tested to be functional. l, also, hereby certify that lwill retest the alarms per the <br />man ufactu re/s instructions. <br />tr