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*,SNTA <br />NAJffi <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 />Project Address:lq23 {ttt l/V & <br />Permit Number:t o //o77aO <br />Property Owner:Aw ft, <br />Contractor:License #: <br />lNSP,02 2013 CRC <br />This document moy be found at-..htto://www. sa nta-a na.oro/oba/ <br />(Please use a black or blue ink ba -point pen) <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings. <br />California Residential Code (CRC) Section R31.4.1and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. cRC section R314.3 and R314.3.3 define <br />the required locations. <br />f\ eoth boxes betow 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 to be functional. l, also, hereby certify that I will retest the alarms per the <br />ma nufactu rer's instructions. <br />(check onel tr Licensed Contractor Pro erty Owner <br />NorE: rhrs serl-c ertiftcotion is only used for projects thot offect the EXTERI1R of the structure. This <br />process is applicoble ONLY to proiects where occess to the interior of the dwelling by a Sdnto And <br />lnspector is not required. <br />.t't/<-/',4-1 S C,c._Ddte:tlq I 7d <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />Signature: <br />l <br />)