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*,,SNIA <br />NA.ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Anner <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647.5A00 <br />w!M^/ sfntt-anl 5t1 <br />Smoke & CO <br />Alarm Affidavit <br />This document mdy be lound ot..httc://','r,,r,'r. san [a-a na.or <br />rNSP-02 2013 CRC <br />perty Owner <br />oi cba' <br />(Please use a black or blue ink balt-point pen) <br />Project Address:VIY d htqlnvt Sr <br />Permit Number:dq3t <br />Property Owner:LD,lIrcJo Alc fttL <br />Contractor:ee,r)h.l L*+,'u hnrrf,)License #: qtbg V 3 <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ild ings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofitted with snloke alarms and carbon monoxide alarms. CRC Section R314-3 and R314.3.3 define <br />the required locations. <br />f\ro,n boxes below must be checked: <br />Ecatbonmonoxide atarms: Are installed outside of each sleeping area in the immedlate vicinity of <br />bedrooms and also on each level of the dwelling. AIarms are required in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />El'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 contractor or the property owner of the above pro1ect. 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 />lcheck onel Licensed C tra cto r tr?r <br />NorE: rhis sef-c ertificdtion is only used lor projects thot affect the ExrERtoR ol the struc'turc, This <br />process is opplicable oNLY to projects where occess to the interior of the dwellinq by o sontd And <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />5ignoture:(:U"4-"ta L4f;',.--"/\lov lt7 <br />I <br />I <br />I <br />I <br />I <br />Oote: I <br />tr