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*,,SANTA <br />NA-'ffi\i <br />I <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana, CA 92702 <br />(7't4) 647-s8oo <br />www.santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />fhis document moy be lound dt...http://www.santa-ana.ora/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:?a2.r'a-d-,"Jo*J z/.--t <br />Permit Number: <br />Property Owner:.Z.,zzs ,4 6)zZ--2- r <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ild ings. <br />California Residential 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 R3l-4.3 and R314.3.3 define <br />the required locations. <br />flro,n boxes betow must be checked: <br />2 <br />ECarbon 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 />appliTnces (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />YS^oXealarms: 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 lwill retest the alarms per the <br />manufacturer's instructions. <br />lcheck onel Lice n se d tractorn f,-P rop Owner <br />NOTE: Ihrs sef-c ertificotion is only used lor projects that affed the EXTERIOR of the structure. This <br />process is opplicoble ONLY to projects where access to the inteior ol the dwelling by o Sdnto Ano <br />lnspector is not required, <br />Signature:,%-. ,,2 /r Dote:a <._ <br />Have this completed form and the job-card readily available on final inspection! <br />tNSP-02 2013 CRC <br />I