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*,,SNTA <br />NA,Tffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Sa6ta Ana, CA 92702 <br />(714) 647.5800 <br />ta-ana.oro <br />Smoke & CO <br />Alarm Affidavit <br />rNSP 02 2013 CRC <br />This document moy be lound at...htto.//www sa nta-a na.orq/oba/ <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:6Z t -t= t #q r,(stt- <br />Permit Number:lontqqy <br />Property Owner:-5 € ,,.r2 A Rt r ile-Z-- <br />Contractor:License #: <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 required locations. <br />{-}r",n boxes berow must be checked: <br />W{^rbonmonoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedroo s and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />appl 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 approved <br />by the State Fire Marshall (SFM). Battery life must be 10 years. <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 />manufacturer's instructions. <br />(check onel tr Licensed C ontractor P roperty wner <br />AAN Ao)'6fL <br />NOTE: Ihrs sef-certificdtion is only used for projects that affect the ErTERIOR ol the structwe. This <br />process is opplicoble ONLY to projects where occess to the interiot of the dwelling by o Sonto And <br />lnspector is not rcquired, <br />.43 Ddte: <br />Have this completed form and the job-card readily available on final inspection! <br />Signature:n <br />I