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.-,SANTA <br />NA <br />llr\lTlC <br />IBIIIJT(; <br />lct\il <br />Planning & Building Agency <br />20 Civic Center Plaza Ros! Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />Smoke & CO <br />Alarm Affidavit <br />tNsP{2 2013 CRC <br />fhis document moy be lound dt... <br />(Please use a black or blue ink ball-point pen) <br />ASzo-O 5*n,sko,..r 0v<- <br />Permit Number:lo\1.l\o-r ) <br />Property Owner:13h,t--.Ii-, [",,-, <br />Contractor:Ooirg.o*l 5u! cr p*qf r-i""n"e#: Sqcqtq <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 required locations. <br />Asot], 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 tested <br />manufacturer's instructions. <br />, also, hereby certify that I will retest the alarms per theto be <br />lcheck onel Licensed Contractor Property Owner <br />NOTE: This self-certificotion is only used for projeds thot offed the O$ERIOR ol the suucturc. fhis <br />process is opplicoblq ONLY to projects where occess to the interior ol the dwglling by o Sonto And <br />lnspedor is not requircd. <br />Signoture:>7 Dote <br />Have this completed form and the job+ard readily available on final inspectionl <br />Project Address: