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*,SANIA <br />,NAffi <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 />,.r'r',.,/ s : :::r-1. :! ar <br />rNsP-o2 2013 CRC <br />This document may be found ot.. <br />(Please use a black or blue ink ball-point pen) <br />h ttr://!,,lr",v. sa n ta -ana.orolpba / <br />Project Addrest, I ;l, o 3 N, (.r. r,_^-\t,-l <br />Pe rm it N umber: <br />Property Owner:Ir <br />Contractor:License #: <br />Sta:e of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />California Residential Code (CRC) Section 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 req u ired locations. <br />{,1 l} eotn boxes below must be checked: <br />dCarbonmonoxide atarms: 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 />Eltsmote 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 alteratrons 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 />thet 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 lwill retest the alarms per the <br />manuf acturer's instructions. <br />Signature:lo- >[ - )Lo-7-o <br />lcheck onel lf, Licensed Contractor .4 P roperty Owner <br />NOTE: Ihis sef-certification is only used lor projects thot allect the EIrERIOR ol the structure. I hts <br />. :sess ,i ooutcabie ONLY to projects where occess to the intetior ol the dwelling by a Sonta Ano <br />..:Jector ts not required. <br />a-Date: <br />Have this comoleted form and the iob-card readilv avatlabte on ttnat tnsca. <br />I <br />)Smoke & CO <br />Alarm Affidavit <br />I <br />I <br />I