Laserfiche WebLink
ftl-,,++- <br />Planning & Building Agency <br />p Smoke alarms: Are insta lled €e, <br />room, and on eac evel of the dwelling <br />Smoke & CO <br />Alarm Affidavit <br />NSP.O22CI]CRC <br />This document moy be lound at... i-::: r,,r',\ Sa-:3-l^l aa:l atl <br />(P/ease use a black or blue ink ball-point pen) <br />Projoct Address ZZzl N. Gxr^rEn- <br />Permit Number:I O\.t)i"l ( <br />Property Owner:/rt nTl.,t L r r\./UgS7..^C,\,,f S <br />Contractor:tJUa U 7hr.r6 (UtoF t t t-License #, llUl* <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild in gs. <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 />A eo,h boxes below must be checked: <br />E Carbon monoxide alarms: Are installed ou f ea ch slee ping area in the immediate vicinaty of <br />20 Civic Center Plaza Ross Annex <br />appliances (i. e. hot water heater, cooktop, furnace) or a fireplace <br />bedrooms and also on each level of the dr,velling. Alarms ai'e required tn bedrooms with gas-fired <br />oom u sed for slee prng, r each o utside of a sleeping <br />nt <br />Retrofitted detectors may be ba tte ry-o perated for bu ild ings where no interior alterations are <br />perfo rmed. Combination Smoke/COa ustromply with a I a pplicable standards and be approved <br />Battery life must be 1.0 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 car onoxide alarms have been installed in compliance with the governing <br />Codes and have been be functional. l, also, hereby certjfy that I will retest the alarms per the <br />ma n ufacturer's ins <br />Signatute:lr <br />tcheck one\Licensed rac tor tr Pro perty Owner <br />NOTE: Ihrs sef-certificdtion is only used for prcjects thdt dflect the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where access to the interior of the dwelling by a Sontd Ano <br />lnspectot is not requhed. <br />ed <br />ct ro <br />Date: <br />Have this completed form and the iob-card readily available on final inspection! <br />?? <br />**SAIflA <br />NA,ffi <br />P.O. Box 1988 (M-'19) <br />Santa Ana, CA 92702 <br />(714) 647-s800 <br />w/r/11/ sl:i:t-r'rI ra:l <br />by the St3te Fire Marshall (SFlVl)