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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (lvl-19) <br />Santa Ana, CA 927 02 <br />(714) 647-5800 <br />,r'/,r'/,a/. santa-an a o( <br />rNSP-02 2013 CRCThis document may be Jound at...htto /4,'r','r,,'r. Sa nta-ana.O r lobal <br />/P/ease use a black or blue ink ball-point pen) <br />Project Address: l <br />,)a <br />t_- L <br />o o <br />r\v( ( ( Property Owner:(^ Y'nov\ <br />manufacturer's i tructions <br />Sig n otu re: <br />(ch eck onel Licen sed Contractor <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) 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 definethe req u ired locations. <br />f} ao,h boxes below must be checked: <br />Xcarbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of' 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 />Amoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping' room, and on each level of the dwelling. <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations areperformed Combinatjon smoke/Co alarms must comply with all applicable standards and be approved <br />by the State Fire MarshalJ (SFM). Battery life must be 10 years. <br />I hereby certify that r am the contractor or the property owner of the above project. r further cthat smoke alarms and carbon monoxide alarms have been instalred in compriance with the go <br />codes and have been tested to be functionar. r, also, hereby certify that r wirr retest the ararms <br />e rt ify <br />verning <br />per the <br />Property Owner <br />NoTE: This self'certificotion is only used t'or projects thot allect the EXTERtoR ol the structure. Thisprocess is opplicoble oNLY to proiects where access to the interior oJ the dwetting by o Santa Analnspector is not required. <br />Have this completed form and the job-card readiry avairabre on finar inspection! <br />Contractor: <br />5-21- \Dote: <br />Smoke & CO <br />Alarm Affidavit <br />I <br />-l.U <br />I Permit Number:) <br />Lice nse #: <br />tr