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flIYOISAIIIA <br />NA{ffi <br />Planning & Building Agency <br />20 Civic Center ptara Roi a,inu, <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-s800 <br />n la-ana. orq <br />This document may be Jound ot <br />rNsP-02 2013 CRC <br />h tto //wr,/\^,v. sa nta-ana.orqlobai <br />(Please use a black or blue ink ba _point pen) <br />Proj ect Address: I 7_otd n 4u,Permit Number:0 ltz <br />Property Owner: <br />Contractor:License #:lcc <br />state of California requires that smoke and carbon monoxide (Co) alarms are tnstalled in residentialbu ild ings. <br />California Residential code (CRC) section R314.1and R315.2 states in part that existing dwellings be"retrofitted with smoke alarms and carbon monoxide alarms. cRC section R314.3 and R314.3.3 definethe required locations. <br />fl eo,h boxes betow must be checked: <br />[[carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity ofbedrooms and arso on each rever of the dwefling. Alarms are required in bedrooms with gas-firedappliances (i.e. hot water heater, cooktop, furnice) or a fireplace. <br />E smoke alarms: Are instaled.in each room used for sreeping, in each halway outside of a sreepingroom, and on each level of the dwelling. <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations areperformed combination Smoke/Co alarms must compty riittr att applicable standards and be approvedby the State Fire Marshall (SFM). Battery life must be iO years. <br />I hereby certify that I am the contractor or the property owner of the above project. I further certl fythat smoke alarms and carbon monoxide alar ms have been installed in compliance with the goverCodes and have been tested to be functional l, also, hereby certify that I will retest the alarms pe <br />nrng <br />m a nufacture r's instruction s <br />r the <br />(check onel 6 -zz- <br />ensed Contractor O Property owner <br />NorE: This self-certificdtion is onty used for projects thot offect the EXTERT2R ol the structure. Thisprocess is opplicoble oNLy to projects where occess to the interior of the dwelling by o sonto Anolnspector is not required. <br />tu/C <br />Signature:A Dote: <br />Have this completed form and the job-card readiry avairable on finar inspection! <br />Smoke & CO <br />Alarm Affidavit <br />I <br />I