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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) 647-s800 <br />ta-ana. orq <br />Smoke & CO <br />Alarm Affidavit <br />This document moy be found at...htto./i W1,vw. san ta-a na.orq/pba/ <br />(Please use a black or blue ink ball-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) Sectaon 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 />A eoah boxes below must be checked: <br />E-c"rUon monoxide alarms: Are installed outiide of each sleeping area in the immediat€ 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 />pkmote 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 batte ry-o perated for bu ild ings 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 ufacturer's instructions, <br />(check onel +Licen sed Contractor Pro perty Owner <br />NOTE: Ihis sef-certification is only used lor projects thot offect the ErTERIoR oI the structure, fhis <br />process is opplicoble ONLY to prcjects where occess to the interior of the dwelling by d Santo Ano <br />lnspector is not required, <br />Have this completed form and the job-card readily available on final inspection! <br />Project Address:33og (-ttA+.tN:lrg sr - gA^{nl <br />Permit Number:t0(96886 <br />Property Owner }AN TRAN <br />Contractor:Tq U conif^cf,i^License #:Qszeo9 <br />Ddte:o <br />NSP-02 2013 CRC <br />Signature: <br />tr