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*-SANTA <br />NA <br />PLNI\G <br />IIIIIDNC <br />IGI\O <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-an a. orq <br />Smoke & CO <br />Alarm Affidavit <br />tNSP-02 2013 CRC <br />This document mdy be lound ot-..http://www. sant a- ata-or!,lBbd! <br />(Please use a black or blue ink ball-point pen) <br />Project Address:l0.Sz f4eazczor /a,r <br />Permit Number: <br />Property Owner:6"iLLgZ/t4C'/6ezz-s <br />Contractor:License #: <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 locations. <br />Asottr boxes below must be checked: <br />E 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 tes tobef tiona l. l,a lso certify that lwill retest the alarms per the <br />manufactu rer's instr rons <br />lcheck Licen sed Contractor trPr pe Owner <br />NOTE; Ihis sef-ceftificotion is only used for projects thot dffect the EXTERIOR of the strudurc. This <br />process is applicoble ONLY to projects where occess to the inte ot of the dwelling by o Santa Ano <br />lnspectot is not rcquired, <br />Dote:ISignoture: <br />Have this completed form and the job-card readily available on final inspection!