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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, CA92702 <br />(714) 647-s800 <br />www.santa-an a.orq <br />Smoke & CO <br />Alarm Affidavit <br />rNSP-02 2013 CRC <br />This document may be lound at...http ://wvrw. sa nta-a na.o rqlpbal <br />(Please use a black or blue ink ball-point pen) <br />Project Address:\1\0 \4, \\zv-ytrl, sl <br />l0 r4l j <br />Property Owner:\rrvc M.rt r t <br />Contractor:5nt- N $ (--o1i"q License #, t.-rTlqAS <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ildings. <br />California Residential Code (CRC) Section R314.1 and 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 required locations. <br />A sotl, boxes below must be checked: <br />p Carbon 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 />p Smoke 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 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 (5FM). 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 re r's instructions. <br />lcheck onel g Lice nsed Contracto r Property ner <br />NoTE: This self-certilicotion is only used for projects thdt oflect the EXTERI/OR oI the structure. This <br />process is applicoble ONLY to projects where occess to the interior of the dwelling by d Sonto Ano <br />lnspector is not required. <br />Signoture:Ddte:ll t4 tl <br />Have this completed form and the job-card readily available on final inspection! <br />Permit Number: <br />tr