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**SNIA <br />NA.ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Sanra Ana. CA 92702 <br />(714) 647-5800 <br />www.santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />Project Address:t !J <br />oL- <br />Contractor:License #: <br />fhis document moy be found ot...http:/iwww. santa-ana.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Property Owner: <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 />"retrofatted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />A sotlr boxes below must be checked: <br />dCarbon 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 />ts(S-ot" 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 />manufacturer's instructions. <br />INSP.O: 20 I3 CRC <br />lcheck one\d ntractor Pro erty wner <br />NOTE: fhis sef-certificotion is only used for prcjects thot dffect the EXTERIOR ol the stucture. This <br />process is applicable ONLY to projects where access to the interiot of the dwelling by d Sdnto Ano <br />lnspector is not required, <br />Signdture:Dote: <br />Have this completed form and the job-card readily available on final inspectionl <br />Permit Number:lo L q4504 <br />tr