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*-SANTA <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) 647-5800 <br />.sa nta-ana.org <br />Smoke & CO <br />Alarm Affidavit <br />Project Address: <br />Permit Number: <br />Property Owner: <br />Contractor:a;0 License #:6 3 <br />This document may be lound at.,, hti santa-ana.or a lpbalo <br />rNSP-02 2013 CRC <br />Property Owner <br />(Please use a btack or blue ink ba -point pen) <br />(check onel Licensed Contra ctor <br />State of California requires that smoke and carbon monoxide (Co) alarms are installed in residential <br />b u ildin gs. <br />California Residential Code (CRC) section R314.1 and R315.2 states in part that existing dweltings be"retrofitted with smoke alarms and carbon monoxide alarms. cRC section R314.3 and R314.3.3 definethe req u ired locations. <br />f,l go,h boxes below must be checked: <br />@ carbon monoxide alarms: Are in sta lled outside of each sleeping area in the lmmediate vicinity of <br />bedrooms and also on each level of the dwelling. AIarms are required in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnice) or a fireplace. <br />Zl smoke alarms: Are instalied in each room used for sleeping, in each hallway outside of a sleepingroom, and on each level of the dwelling. <br />Retrofitted detectors may be battery-ope rated for buildings where no interior alterations areperformed' combination Smoke/Co alarms must comply,.iith all applicable standards and be approvedby the State Fire Marshall (SFM). Battery life must be 1O'years. <br />I hereby certify that I am the contractor or the property owner of the above project. I further certifythat smoke alarms and carbon monoxide alarms have been installed in compliance with the governingcodes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per them a n ufacturer's instructio ns. <br />No'lE: This self-certilication is onry used for projects thdt alfect the EXTER|IR of the structure, Thisprocess is applicobre oNLy to projects where oicess to the interior of the dwetting by a sqnta Analnspector is not required, <br />lla\ra lhi6 ^^h^t^r^.! r^-- ^.- -, r, . <br />63 Date:o9 /., <br />1 <br />S <br />Signoture; <br />tr