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This document mdy be found ot... h ttC. /,'//.,,/,,v Sa n ta-ana.orqi pbai <br />(P/ease use a black or blue ink ball-point pen) <br />*-SNIA <br />NA,ffi <br />Planning & Building Agency <br />20 Civic Center Plaz. Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana. CA 92702 <br />(714) 647.s800 <br />wwrr,santa-ana.orc <br />Smoke & CO <br />Alarm Affidavit <br />Project Address:2ct1 ul /^iil(av', tN ,9r,&' t)ra A ,zt <br />Permit Number: <br />Property Owner <br />C ->A <br />N"1 |{trLty€N <br />Contractor: <br />Signoture:in|t Dote:T,n ?-cl Ao t1 <br />(check onel tr Licen sed Con tractor .E P roperty Owner <br />NOTE: fhis sef-c ertification is only used lor projects that dffect the EXTERIOR ol the structure. This <br />process is opplicable ONLY to projects where access to the intetior ol the dwelling by a Sdntd And <br />lnspector is not tequhed. <br />Have this completed form and the job-card readily available on final inspection! <br />t-t <br />License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ing s. <br />California ResidentialCode (CRC) Section R3L4.1and 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 required loca tions. <br />A eoth boxes below must be checked: <br />$Carbon monoxide atarms: Are lnstalled outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each levei oF the dweiling. Alarms are required in bedrooms with gas-fired <br />appliances (i.e, hot water heater, cooktop, furnace) or a fireplace. <br />6-ot" 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. Combanation Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Battery ljfe must be 10 yeais. <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 lwill retest the alarms per the <br />ma n ufacturer's instructions. <br />\