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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />www. santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit*-SA]\ITA <br />NA,'ffi <br />INSP.O2 2013 CRC <br />This document may be found ot...htto.//wvw. sa nta-a n a.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314,1 and 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 requ ired locations. <br />A ro,n boxes below must be checked: <br />f C"rUon 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 />F Smote 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 />ma n ufacturer's instructions. <br />(check onel Lice nsed Contractor tr P roperty Owner <br />NOTE: Ihis sef- certification is only used for projects thot ollect the EXTERTOR of the structure. This <br />process is opplicoble ONLY to projects where occess to the interior oI the dwelling by o Sonto Ano <br />lnspector is not required, <br />Project Address:55lb Li Davil Pl <br />Permit Number:\otq1q8+ <br />Property Owner:Dr,rrnA VvsVq <br />kr\tl,el RooJinq SoeuirtlLicense *' 15(,0'1j <br />Signature: <br />'l.l <br />Dote:/2- 7-/ 7 <br />Have this completed form and the job-card readily available on final inspection! <br />Contractor: