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*-SNIA <br />NA.ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Sox 19AA (M-19) <br />Santa Ana. CA 92702 <br />(714) 647.5800 <br />w ,r/',v s lalf .tnl fr? <br />Smoke & CO <br />Alarm Affidavit <br />INSP.O2 20I3 CRC <br />This document moy be lound ot <br />Signoturc: <br />h::3 ., ,\,.,,,,/,, S.1r'a-A1e.O.at, CCI <br />(Please use a black or blue ink ball-point pen) <br />Project Address C <br />Permit Number: <br />Property Owner <br />Contractor:L\C.\)(^J License #:C G <br />State of California requires that smoke and carbon rnonoxide {CO) alarms are installed in residential <br />b u ild ings. <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 location s. <br />6\ eoth boxes betow 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 IVarshall (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 />-(t Da <br />tr P rope rty Owner <br />et tz- |-t <br />(check one)cen sed C tractor <br />NOTE: rhrs self-certificotion is only used for proiects that dlfect the EXTERtoR of the structure. This <br />process is applicable ONLY to projects where occess to the interior of the dwelling by d Santd Ano <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />L-.'I