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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) M7.5800 <br />w.r/,rv santa-ana orX <br />Smoke & CO <br />Alarm Affidavit <br />tNSP-02 20r3 CRC <br />This document moy be lound at..h ttp:/i,M,vw. santa-a na.orq/pba,' <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:)lll f 2tl5 J. E+rtzvt\u ,@ f)' <br />Permit Number lonete( ( utzfia1 <br />Jilf;CpY LY <br />Co ntractor:N 6H/A V*N Vtclvtl License #:5621s6 <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 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 requ ired locations. <br />f\ eo,h boxes below must be checked: <br />(C"rbon 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 />6S-ok" alarms: Are installed in each room used for sleeping, in each hallway outsjde of a sleeprng <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 n ufactu rer's instruc NS <br />(check onel ense d Co ractor tr Property Owner <br />NOTE: Ihis sef-c ertificotion is only used fot projects thdt dffect the EXTERIOR ol the structure. This <br />process is applicable ONLY to proiects where dccess to the interior of the dwelling by a Sontd And <br />lnspector is not required. <br />Dote:{-zt- I { <br />Have this completed form and the job-card readily available on final inspection! <br />Property Owner: <br />Signature: