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a <br />P.O. Box 1988 (M-19) <br />Santa Ana. CA 92702 <br />(714) 647-s800 <br />wv/w.santa-ana_orq <br />Smoke & CO <br />AIarm Affidavit <br />tNSP-02 2013 CRC <br />This document mdy be found ot...http://www. santa-ana.oro/pba/ <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address: <br />Permit Number:lD //7A<4 <br />Property Owner: <br />Contractor:lt)z*r"& /"1 License f{"q ttLtU <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residentlal <br />bu 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 R31.4.3 and R314.3.3 define <br />the required locations. <br />4l sorl, boxes below must be checked:N/ <br />U(C"rbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />b8drooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />1p{liances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />H€rnof." alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />roord, 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 ufactu rer's instruction <br />lcheck onel Licensed Contractor tr Pro erty o wner <br />\ <br />NOTE: Ih,s sef-certification is only used for projects thdt dffect the EXTERIOR of the structure.This <br />process is opplicable ONLY to projects where access to the interior of the dwelling by o Santo And <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />Signdtute:Dote I <br />*,,SNTA <br />NA-"ffit <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />I