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*-SNTA <br />NAffi <br />Plan ning & Building Agency Smoke & CO <br />Alarm Affidavit <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M '19) <br />Santa Ana. CA 92702 <br />(714) 647.s800 <br />www santa-ana.orq <br />rNSP,02 2C'l CRa <br />This document moy be found ot h tiO:/,'/t/"&rv. Sa n ta-a na. Orq/'pba, <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:lq05 t.) Co.v,'q e Dr, t^k 4^^ cA q c1 <br />Permit N umber:(ol 3344 <br />Property Owner:navig Cki n <br />Contractor:Ho*s 7e t License#: 6OA33i <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u 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 required locations. <br />f\ so,r, boxes below must be checked; <br />(CarUon 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 />YSmote 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 alteratlons are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall {5FM). Battery life rnust be 1C 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 monoxjde alarms have been installed in compliance with the governing <br />Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the <br />ma n ufacturer's instructions. <br />5ignature:,t 1)Dot e:7 lso lqt-r14, <br />lcheck onel rcenSe d Con tractor K P roperty Owner <br />NOTE: fhrs self-certification is only used lor projects thot alfect the ErTERIOR of the structurc. This <br />process is opplicable ONLY to projects where occess to the interior of the dwelling by o Sontd Ano <br />lnspectot is not required- <br />Have this completed form and the job-card readily available on final inspectionl <br />2 <br />tr