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*,,SNIA <br />NA.ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Ar nex <br />P.O. Box '1988 {M-19) <br />Santa Ana. CA 92702 <br />(7r4) 647-s800 <br />www santa-ana,orl <br />Smoke & CO <br />Alarm Affidavit <br />INSP,O2 2DI3 CRC <br />fhis document moy be lound ot...'r'l/!', santJ-ana.oro, oba,h tic <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:17_L W cht n ab3 <br />Permit N umber:b6 lQ <br />Property Owner:V { <br />Lice nse #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings. <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 uired locations. <br />A ao,h boxes below must be checked: <br />ElCerUon monoxide alarms: Are installed outside of each sieeping area in the immediate vicinity of <br />bedrooms and also on each levei of the dwelling. Alarms are required in bedrooms with gas-fired <br />appliances (i. e. hot water heater, cooktop, furnace) or a fireplace. <br />A <br />l'tll-tmoke 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 appro'red <br />by the State Fire Marshall (SFM). Battery life must be 10 year:. <br />I hereby certlfy that I am the contractor or the prooerty 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 />manuf acturer's instructi <br />5iq notu re: <br />(check one\Licen sed Con tractor {_ P roperty Owner <br />NOTE: fhrs sef-c ertificdtion is only used for projects thot qffect the EXTERIOR of the structurc. This <br />process is applicable ONLY to projects where access to the interiot of the dwelling by d Sdntd And <br />lnspector is not requited. <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />Contractor: <br />l1Dat e: