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*-SNTA <br />NA-'ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Anner Smoke & CO <br />Alarm AffidavitoP.O. Box 1988 ([4-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />wwr,v,saa t3-ana or e <br />This document moy be found ot <br />INSP-02 2013 CRC <br />h ttp://taruvr,v SA n ta-a na.o ro/oba/ <br />(Please use a black or blue ink ball_point pen) <br />Project Address <br />State of California requires that smoke and carb <br />b u ild ings. <br />on monoxide (CO) alarms are installed in residential <br />o <br />california Residentialcode (CRC) Section R314.1and R315.2 states in part that existing dwellings be"retrofitted with smoke alarms and carbon monoxide alarms. cRC Section R314.3 and R314.3.3 detinethe req uired locations. <br />4\ eo,h boxes betow must be checked: <br />Bt:10"" monoxide alarms: Are installed outside of each sleeping area in the immediate vicanity ofbedrooms and also on each rever of the dwelang. Ararms are required in bedrooms with gas_fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />Es-ot<e alarms: Are insta,erJ in each room used for sreeping, in each harway outside of a sreepingroom, and on each level of the dwelling. <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations areperformed combination smoke/Co ararms must compry with air appricabre standards and be approvedby the State Fire Marshall (SFM). Battery life must be 10 years. <br />I hereby certify that lam the con <br />that smoke alarms and carbon m <br />Codes and have been tested to b <br />man uf actu re r's instructions <br />tractor or the property owner of the above project. I further certify <br />onoxide alarms have been installed in compliance with the governrng <br />e functional. l, also, hereby certify that I will retest the alarms per the <br />Signoture: <br />(check onel Licensed Cont ractor P ro pert yO wner <br />O <br />NorE: This self-certilicotion is onry used for projects thot ofJect the EXTERIoR of the structure. rhisprocess is opplicable oNLy to projects where access to the interior ol the dwefiing by o sonta Anolnspector is not required. <br />S SF4/?- 37-oz, <br />Permit Number: <br />Property Owner:/ rc4 r'') <br />/o/?7/ G, ? <br />Contractor tloCu,rn License *: br{37 OO <br />Ddte:(/ IL/ <br />ave this completed form and the job-card readiry avairabre on finar inspectionrs