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**sAl{lA <br />NA.ffi <br />Planning & 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) M7.5800 <br />w-rvw santa-ana.otq <br />rfrsP,02 20r3 cRc <br />fhis document moy be found ot..h tto / ',,,,r'// sant3-ana.Orq/ Oba, <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:0lo 5 Ptnr 0 Zank^ t+'^a ctA q LTDLII <br />Permit N umber:IrctrtZX:4 <br />Property Owner:€u f lr,i O fw.lYele Y <br />Contractor: <br />State of Callfornia requires that smoke and carbon monoxide (CO) alarms are installed in residentiai <br />b u ild ings. <br />California Residential Code (CRC) Section R3L4.1and 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 Iocations. <br />f\ eo,t boxes below must be checked: <br />p,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. Aiarms are required in bedrooms with gas-fired <br />appliances (i. e. hot water heater, cooktop, furnace) or a fireplace. <br />$ Smot e alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />rUom, and on each level of the dwelling. <br />Retrofitted detectors may be ba ttery-operated for buildings where no interior alterations are <br />performed. CombinatiolJ 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 prolect. I further certify <br />that smoke alarms and carbon monoxide alarms have been installed in compliance with the governrng <br />Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the <br />manufacturer's instructions. <br />Signature:Dote: 7 1 <br />lcheck one)tr Licensed Con tractor Property Owner <br />NOTE: Ihis sef'c ertificotion is only used lor prcjects that offect the ErTERIOR ol the structurc. This <br />process is opplicable ONLY to projects where occess to the interior of the dwelling by o Santa Ano <br />lnspector is not rcquired. <br />Have this completed form and the job-card readily available on final inspection! <br />License #: <br />/