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INSP,O2 20 1J CRC <br />fhis document may be lound ot...http:/lrlww sa n ta -a na.orq/robai <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 Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana. CA 92702 <br />(714) 647.s800 <br />!r rral, santa-ana.org <br />Smoke & CO <br />Alarm Affidavit <br />Permit N umber: <br />Project Address: 'e bq s k <br />Slxo r,( I <br />Contractor:License # <br />Dote: <br />lcheck onel <br />L <br />NOTE: fhis sef-c ertilicdtion is only used lor projects thot affect the EXTERTOR of the structure. This <br />process is applicoble ONLY to prcjects where access to the intetior ol the dwelling by o Sonto Ano <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />a./ <br />Property Owner: <br />State of California requires that smoke and carbon monoxide {CO) alarms are installed in residential <br />bu ildings. <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 required loca tions. <br />f\ ao,i, boxes below must be checked: <br />El Carbon monoxide alarms: 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 />El 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 ba ttery-operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Bartery life must be 10 yeai.s. <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 I will retest the alarms per the <br />ma n ufactu rer's insti'uctions. <br />Signature: f L.I l(-*-t?zr..r.n L a-q.u--02-..1)tt I rt <br />iI - - li."K."a co