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*-SNTA <br />NA,ffi <br />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-s800 <br />www.santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />tNsP-02 2013 CRC <br />fhis document moy be lound ot...http://www.sa nta-a na.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address /110b e.Doge* h/A? 6ANri-llAM C4 AN1,l <br />Permit Number: <br />Property Owner MfuLO SOIB 5K <br />Contractor: <br />lcheck onel Licensed Contractor <br />NOTE: fh,s serl-certificotion is only used lor projects thdt alfed the EXTERIOR of the structute. This <br />prccess is opplicoble ONLY to prcjects where occess to the interior ol the dwelling by o Santa And <br />lnspector is not required. <br />Signature:Dote:0 <br />Have this completed form and the job-card readily available on final inspection! <br />License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ildings. <br />California Residential 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\so.t boxes below must be checked: <br />.pCarUon 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 />applignces (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />FS.ote alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping/ room, and on each level of the dwelling. <br />Retrofitted detectors may be battery-operated for buiidings 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 prolect. 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 functronal. l, also, hereby certify that lwill retest the alarms per the <br />ma nufactu rer's instructions./'./- <br />Property Owner <br />I