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*-SNTA <br />NA.ffi <br />Planning & Building Agency Smoke & CO <br />Alarm Affidavit <br />20 Civic Center Plaza Ross Anner <br />P.O. Box '1988 (M-'19) <br />Santa Ana. CA 92702 <br />(71{) 647.s800 <br />w-a/.rv. sa n ta-a n a. orq <br />INSP.O2 201J CRC <br />This document mqy be lound ot...httc:1ir ,!.,V sant3-ana.oro, oba, <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:)\ag Wl-yluvc9- <br />l0lc1L41 \ <br />Property Owner:uQb6- Ifu.w*.)-.L- <br />Contractor: tt(<)^* l.*'vt 1-1 .-License #: <br />State of California re'I!ires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings. <br />California Residentjal 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 />fl so,t boxes betow must be checked: <br />flCarbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the dweiiing. Alarms are required in bedrooms with gas-fired <br />appllances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />flSmote alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeprng <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. Combinatron Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Battery Iife nnust be 1C year.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 ha,re 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 />Signdture:Dot e i1 L t'l- <br />lcheck onel tr P roperty Owner <br />NoTE: Ihrs self-certification is only used for prcjects thdt dffect the EYTERIoR ol the structure. This <br />process is applicable ONLY to projects where occess to the interiot ol the dwelling by d Sontd Ano <br />lnspector is not required. <br />L<-F" <br />Have this completed form and the job-card readily available on final inspectionl <br />Permit N umber: <br />Licensed Con tractor