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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex Srnoke & CO <br />Alari-,n Affidavit <br />This document mqy be iound dt..httc:l i1i.i/,,,i. sa nt"t-a na. orci pba <br />(p/ease use a black or blue ink ball-point pen) <br />Project Address:243 I Frc*c\a S{. <br />Permit Number:/Drl o zq lD <br />Property Ovrner:a-",p1. ?oae,\ <br />Contractor:Clezq 1".:L.^L,v<.License #: toSESTL <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings. <br />Callfornia Residential Code (CRC) Section R314.1 and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon rnonoxide alarms. CRC Section R314.3 and R315.3 define <br />the req u ired locations. <br />/n\{,t ll Both boxes below must be checked: <br />$ 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 recommended in bedrooms vvith gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />psmote 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 cjetectors may be battery-operated for buildings where no interior alteratlons are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Frre Marshall (SFtl). Battery'Iife must be 1C 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. <br />(check one t-E Licen sed Co ntractor roperty Owner <br />NOTE: This seff-cefiification is only used lat projects that affed the EXTERIOR of the structure. This <br />process is opplicabte ONLY tc projects where occess to the interiot of the dwelling by o Sonta An(l <br />lnspector is not required, <br />Signature:4 Date:Z/tz/>o <br />Have this cornpleted form and the job-ca!'d readily available on final inspectionl <br />P.O. Box 1988 (M.19) <br />Santa Ana, CA 92702 <br />(7 1 4) 647 -58A0 <br />',v',v-,{ 5I nla.aala !rq <br />tr <br />I