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*,SNIA <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 />(711) 647-5800 <br />wr/l^& sanlS-ana.oll <br />Smoke & CO <br />Alarm Affidavit <br />tNSP-02 2C13 CR3 <br />fhis document moy be found ot..http./irv\rw. sant3-ana.o rclpbai <br />{P/ease use a black or blue ink ball-point pen) <br />Permit N umber:/o/?i{-3+ <br />Property Owner:t/7 h/"C:-/ c(L <br />Contractor:N/rt Lice nse #/1, /fr <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofitted with srnoke alarms and carbon monoxide alarms. CRC Section R31.4.3 and R314.3.3 define <br />the required locations. <br />4l rorn boxes betow must be checked: <br />[S Carbon monoxide alarms: Are installed outside of each sleeping area in the inn.nediate vicinity of <br />bedrooms and also on each levei of the dwelling. Alarms are required in bedrooms with gas-fired <br />apgylnces (i. e. hot water heater, cooktop, furnace) or a fireplace. <br />dSrnof" alarms: Are installed in each room used tor sleeping, in each hallway outside ot a sleeprng <br />room, and on each level of the dwelling. <br />Retrofitted detectors may be battery-operated for buildings where no lnterior alterations are <br />performed. Combinalion Smoke/Co alarms must comply with all applicable standards and be approved <br />by the State Firs Marshall (sFM). Battery life must be 1C yeai's. <br />I hereby certjfy that I am the contractor or the property owner of the abo,ze 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 />manuf acturer's instructions. <br />t Signolure: .dYL 9X,rlVe-*Do f-/7-/7e.t <br />Project Address:Cur, e 4u .)fr cl17-/v <br />lcheck one)a*"@;G.t",.V P r.p"rty o**. <br />NOTE: fhis sef-c eftilication is only used Jot ptojeds thot dffect the EXTERIOR ol the structute. This <br />ptoce$ is opplicoble ONLY to projects where occess to the intetior ol the dwelling by a Santo Ano <br />lnspector is not tequired. <br />Have this completed form and the job-card readily available on final inspectionl <br />tr