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*,,SANTA <br />NA,ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 6.17-5800 <br />w.Ml/.santa-ana orq <br />Smoke & CO <br />Alarm Affidavit <br />INSP-02 20] 3 CRC <br />f his document may be found ot... h ltc:l ',!)rti. Sa n !e -a na.orq 'pba <br />(Please use a black or blue ink ball-point pen) <br />Project Address ful on- utia*irz4; z..E-. 5*^frk&a!Ac4 <br />Permit Number: <br />-r- <br />lot qq365 <br />Property Owner:fo4tO %rt'foc <br />Contractor:License#,65rO.11 <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu 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 req uired locataons. <br />f,\roan boxes below must be checked: <br />dfarUon 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 />lAlmoke 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 pro.iect. 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 />lch eck one ce nsed ontractor tr P ro per ty Owner <br />NOTE: fh,s serl-certification is only used for projects thot dlfect the EXTERIOR ol the structure. This <br />process is opplicoble ONLY to ptojects where occess to the interior of the dwelling by o Sonta And <br />lnspectot is not required. <br />Signotur Dote:ro)at/n <br />Have this completed form and the job-card readily available on final inspection!