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Cffi*SNTA <br />NA,ffi <br />Planning & Building Agency Smoke & CO <br />AIarm 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 />ta-ana.orq <br />tNSP-02 2013 CRC <br />This document moy be found dt...http ://www. santa-a na.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b uildings. <br />California ResidentialCode (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 />A so,rr boxes betow must be checked: <br />I 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 />E 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 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 />(check onel tr Licensed Contractor Property Owner <br />NOTE: This sef- certilicotion is only used for projects thot affect the EXTERIOR ol the structure. This <br />process is applicoble ONLY to projects where access to the interiot ol the dwelling by o Sdnta And <br />lnspector is not required. <br />Project Address:1e)t^, ?t:r 51. <br />Permit Number:r o \ \58o6 <br />Property Owner:l{ e ..,^ c.^r. <br />Contractor:A.,C-r-11",' koF.^.License #: n t OO e8 <br />Signoture:s/z r/i Z <br />Have this completed form and the job-card readily available on final inspection! <br />ma n ufactu rer's in structions. <br />Date: