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*-SNIA <br />NAffi <br />Plan ning & Building Agency <br />20 Crvrc Center PlJzl Rcss Anngr <br />P.O. Bor l9aA (U- 19l <br />Santa Ana, CA 9?702 <br />(71{) 6.r7-5d00 <br />ww'x sante-3na cr? <br />fhis document moy be found ot l/iti )\i 53i:e-an3.O <br />(Please use a black or blue ink ball-point pen) <br />Project Address uJ v q o <br />D <br />Property Owner: <br />Contractor License # <br />S:ete oi Ca fori'riJ r:q.rire; thai imoke aad carbon monoxide (CO/ elr.ni j aie ii;ta <br />bui d ng;. <br />Cali'crni: R:srCentirl CoC: (CRC) Section R314.1 and R315.2 strt?s in pa t tha: exiitinA C'ire!lin3s be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Sectlon R314.3 and R314 3.3 d:flne <br />the raq!lred locatlons. <br />f\ sotl, boxes below must be checked <br />p Carbon monoxide alarms: \:e rl^;t3 leC oulsid: oi erch s ::,r.i3 3:ei i. t:: i,^:ti:[:,]:: !raia,: / <br />bed-o,:r:.; ?"rd e jo on erch le,,:: oitre C,,,:11i.3 All.;; a.? reqrli'ed ln beC:oo,T ; vriir 3a;-r':C <br />ap3lili'rce; ( .e. hot w3i:r- he:::r, ccoktoo. fui'nace1 or a ilreglace. <br />( <br />i)') <br />Smoke alarms: Are instailed in eech room u;ed [or sleepin3, in e:ch haliway o,Jtiide of 3 s]eeping <br />m. and on e:ch level oi the d,relling. <br />R.tiof:iec Ce:ectcrr may be ba:::r'7-operatsd fJr bu iCing; wher': no int?rior al:3.lt ons are <br />pericr;-reC. Comcination Snrok:,'CO aiarms mu;i col.rp y \,viti'r a I 3pp cable st3nCar'dj ard be ap3rc!:c <br />o, ti're 5irt3 F,r: l/!arinall (;Fi\t,. BaI:ery life rnu5i be 10 yea;;. <br />I he.eby certlf,/ that I arn t:e conti.actcr or the properi,/ o,,vner of the acove project. I [lr'ther cer:,i7 <br />trJ: si':ok: :l:rri; and car5on nrono(iCe alar:r; ha'ie been insi3lleC ia ccilpiiance /,/itl'ihe grte'-i:; <br />CcCei ai-'C l'are been tested o be functional. t, aiso, hereby certif'/ tiat Iwill retest t,ie alarrns per rhe <br />man,.ttSct.jrer's tn tion <br />Signatu r z:ootr' /O ._2b t? <br />lcheck one)Lice,':sed Co tr P rcpert'/ O','\i ner <br />NOTE: fhls sef-c ertificotion is only used t'or projects that alfect the EXTERIOR of the structwe. This <br />process is opplicable ONLY to prcjects where occess to the intetior of the dwelling bY a Santa Ana <br />lnspector is not requited. <br />Have thrs completed form and the job-card readily available on final inspection: <br />Smoke & CO <br />Alarm Affidavit <br />Permlt N u mber: