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*-SNIA <br />NAffi <br />Planning & Building Agency <br />20 Cavic Center Plsze Ross Annex <br />P.O. Bor 19AA (M-19) <br />Santa Ana. CA 92702 <br />(7r.r) 647.5800 <br />,r.,t'& slnil.rnl cr? <br />Smoke & CO <br />Alarm Affidavit <br />INSP.O2 2013 CRC <br />This document may be lound at... <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address 5o J. [J€ll9Ul+v <br />Permit N umber:lotl j <br />Property Owner Ny,tcx e,JlgE Z\ty.b& <br />Contractor:lf.'rY n'rN g**,,License #:loo t1t2 <br />State of Ca,ifornia requires that smoke and carbon monoxide (CO) alarms are installed an residential <br />b u ildings. <br />California Residentjal 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 />f\ ao,i, boxes betow must be checked: <br />IACarbon 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 />apppnces (r.e. hot water heater, cooktop, furnace) or a fireplace. <br />! smole 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 detectcrs may be batte ry-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,ect. 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 />Signoture:Date:\T,/ir / fT <br />lcheck onel Lrcensed Contractor Pro perty Owner <br />NoTE: rhis self-certificotion is only used lor prcjects thot offect the ErTERI2R of the structure. This <br />process is opplicable ONLY to projects where occess to the interior of the dwelting by d Sonto And <br />lnspector is not requircd. <br />Have this completed form and the job-card readily available on final inspectionl <br />g <br />i l, <br />tr