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*,SNIA <br />NA.ffi <br />Planning & Building Agency Smoke & CO <br />AIarm Affidavit <br />20 Civic Center Plaza Ross Annex <br />rNSP-02 2013 CRC <br />This document mqy be lound at...htto./i,,wrrur. san ta-ana.orq/oba/ <br />(Please use a black or blue ink ball-point pen) <br />Permit Number:lo l?60 )1 <br />Property Owner hn+l* @WJ.o <br />Contractor: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ild ings. <br />California Resldentjal Code (CRC) Section R3l.4.1and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R31.4.3.3 define <br />the requ ired locations. <br />f\ eotl, boxes below must be checked: <br />d C^rbon 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-fireci <br />appllances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />,Zl Smot e 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 inst uctio <br />lcheck onel tr Property Owner <br />NOTE: fhrs sef-c ertificdtion is only used for projects thdt dllect the EXTERIOR oI the structurc. This <br />process is applicable ONLY to projects where occess to the interiot of the dwelling by o Santa Ano <br />lnspector is not rcquired. <br />Project Address:lkl l, JonoO w<{ <br />{r oote:t, l- /7^ /x <br />Have this completed form and the job-card readily available on final inspection! <br />P.O. Box 1988 (M.19) <br />Santa Ana. CA 92702 <br />(714) 647.5800 <br />w.,r,a,!. sa n ta-anr. otq <br />I <br />I <br />I <br />I <br />License #: <br />Signoture: <br />tr Licensed Contractor