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*,JNIA <br />NA.ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex Smoke & CO <br />Alarm Affidavit <br />!NSP,D2 20,3 :RC <br />This document mqy be lound ot...htto: ,'rr.,,r,,v sa n ta-a na.orqi obai <br />(Please use a black or blue ink ball-point pen) <br />Project Address: <br />Permit N umber: <br />70(, <br />Property Owner: <br />Contractor License #:olq3 <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ing s. <br />California Residential Code (CRC) Section R31rt l and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R31.4.3 and R314.3.3 define <br />the req uired locations. <br />A so,t boxes below must be checked: <br />p CarUon monoxide alarms: Are installed outside of each sleeping area in the immediate vrcinity of <br />bedrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />appli ces (i.e. hot water heater, cooktop, furnace) or a fireplace <br />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 apgroved <br />by the State Fire Marshall {SFM). Battery life must be 10 years, <br />I hereby certlfy 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 governrng <br />Codes and have been tested to be functional l, also, hereby certify that I will retest the alarrns pe,'the <br />manufacturer's instructions. ---- <br />Signature:Dote:O-2047 <br />lcheck onel Licensed Con l13ctor P ro perty Owner <br />NoTE: fhis sef-c ertification is only used for projects thdt dffect the ErTERIOR of the structure. This <br />procets is applicable ONLY to projects where occess to the interior of the dwelling by o Sonta Ano <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspectionl <br />P.O Bor 1988 (M-19) <br />Santa Ana. CA 92702 <br />(714) 647.s800 <br />ww.r/ sSntJ-ana.or? <br />tr