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.--SANTA <br />NA,hffiI <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana. CA 92702 <br />(714) 647-s800 <br />www.santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />NSP.O2 2013 CRC <br />fhis document moy be found ot.,.h tto.//ww/. santa-ana.orq/pbai <br />(Please use a black or blue ink ball-point pen) <br />Project Address:I dal XJ. lou-An €tr] <-..:rq sruA ier-h <br />Property Owner: <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residentral <br />b u ildings. <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 locations. <br />Asotn boxes below must be checked: <br />EtCarbon 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 />S.S.ot e 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 lnterior 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 lwill retest the alarms per the <br />ma n ufacturer's instructions. <br />(check onel trL rce ed Con tractor -ED P roperty Owner <br />NoTE: Ih,s serl-certificotion is only used for projeds that allect the ErTERIOR of the strudure. This <br />process is opplicoble ONLY to prciects where occess to the inte or ol the dwelling by a Santa Ano <br />lnspector is not requircd. <br />signoture: CQ9. St*r"r^rsrd Dote:a J':ltt <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />Permit Number: