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*-SA}I'TA <br />NA.ffi <br />Smoke & CO <br />Alarm Affidavit <br />]NSP-02 2']3 CRC <br />santa-ana.orqi oba,'h tto:1/ W.ni',r./ <br />(Please use a black or blue ink ball-point pen) <br />ohv ( <br />Permit N umber:o <br />Property Owner:laurcil 1lflut kr tS <br />Contractor:'/ort luul License *: t/j-/LZL <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 existrng dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the requ ired locations. <br />A eoth boxes below must be checked: <br />lEfcarbon monoxide atarms: Are installed outside of each sleeping 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 />[E/S-ot" alarms: Are installed in each room used for sleeping, in each hallway outside ol 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 1.0 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 compljance with the governtng <br />Codes and have been tested to be functional. l, also, hereby certify that lwill retest the alarms per the <br />ma n ufacturer's instructions. <br />trl Dot ?:c /srlz <br />) <br />lcheck one)E/ Licensed Contractor tr Property Owner <br />NOTE: fhis sef-c ertification is only used lor proiects thdt dlfect the ErTERIOR of the structure. This <br />process is applicable ONLY to projects where occess to the interior ol the dwelling by a Sonto Ana <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspectionl <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1984 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />www santS-ana.ol? <br />fhis document may be lound ot... <br />Project Address: J ,? o LL A) <br />Signature: