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*-SNIA <br />NAffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Anner <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(7r4) 647.s800 <br />w'lvl& santa-ana.otq <br />Smoke & CO <br />Alarm Affidavit <br />NSP.O? 2C:.] CRC <br />This document moy be lound ot..h ttp:/r,/,/.rw. san ta-a na.or q,'Oba, <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:7o <br />Permit N umber: I |D 3XzD <br />Property Owner:7 <br />Contractor Lice nse #: <br />State of California requires that smoke and carbon monoxide (Co) alarms are installed in residential <br />b u ild ings. <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 locatjons. <br />f}so,h boxes below must be checked: <br />E/Carbon monoxide alarms: Are installed outside of each sleeping area in the innmediate vicinity of <br />bedrooms and also on each level of the dweiling. Alarms are required in bedrooms with gas-fired <br />appli ces (i.e. 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 />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 St3te Fire Marshall (SFM). Battery life nrust be L0 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 monoxide alarms ha're been installed in compliance with the governing <br />Codes and have been tested to be functional. l, also, hereby certjfy that I will retest the alarms per the <br />ma n ufacturel s instructions <br />Siqnatu <br />Licen sed Con tractor Pro ert,/wner <br />NOTE: fhis sef-c ertificdtion is only used lot projects thot olfect the EXTERTOR of the structute. This <br />process is applicoble ONLY to projects where access to the intetior ol the dwelling by o Sonta Ano <br />lnspectot is not requircd. <br />I <br />Date: <br />I <br />{check o\eL <br />I' <br />Have this completed form and the job-card readily available on final inspection!