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*,SNIA <br />NA.ffi <br />Planping & Building Agency <br />20 Civic Center Plaua Ross Annel <br />P,O. Box 1988 (M.'19) <br />Santa Ana. CA 92702 <br />(71r) 547.5800 <br />w.i a/ santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />NSP-02 2011CRC <br />fhis document moy be lound ot...http:/,vIMr.santa-ana.or q, Pba, <br />fPlease use a black or blue ink ball-point pen) <br />)rt1 c-I <br />Property Owner: <br />RY <br />l1t <br />5oo License #:clvzl frr <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 R31.5.2 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 />A eo,h boxes below must be checked: <br />il Carbon 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 />Q Smot<e alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeprnB <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. Combinatjon Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (5FM). Battery life must be 1.C year.s. <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 monoxide 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 />manufacturer's instructions. <br />Signoture:ote: <br />lcheck onel tr Llcen sed Con tractor Property Owner <br />NOTE: fh,s sef-c ertification is only used for projects thdt offect the EXTERIOR ol the structure. This <br />ptocess is opplicable ONLY to projects where occess to the inte ot of the dwelling by o Sonta Ano <br />lnspector is not required. <br />Have this completed form and the j(.ble on final inspection ! <br />t <br />I <br />I Project Address: <br />Permit N umber: <br />Contractor: <br />//z