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,.;,SANTA <br />NA <br />ILT\II\G <br />I BIII,DIIG <br />IGilN <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana. CA 92702 <br />(714)647-5800 <br />www. sa nta-an a. orq <br />Smoke & CO <br />Alarm Affidavit <br />tNSP-02 2013 CRC <br />This document mdy be found ot...http://www. santa-ana.orq/pbai <br />(Please use a black or blue ink ball-point pen) <br />Project Address:Qto \^\ r^Jert &a^.? <br />Permit Number:lo\qr-kln \ <br />Property Owner M,a^nZ <br />Contractor:Llell<r,,, [.o 6 ^- <br />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 requ ired locations. <br />Both boxes below mus <br />n monoxide ala rms: <br />.t be checked: <br />Are installed outside of each sleeping aregin the immediate vicinity of <br />bedrogms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />app,liances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />U ,antt"t"rrls: Are installed in qach room used for sleepfg, in each hallway outside of a sleeping <br />room, and on each level of the dweiling. --:- :' <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO,al rnust comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM attery life must be 10 yearr <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 I will retest the alarms per the <br />manufacturer's instructions. <br />(check onel tr , Llcensed Contracto r Property Owner <br />NOIE: This self-certificdtion is only used for projeas thot olfed the EXTERIOR ol the strudure. This <br />prccess is dpplicoble ONLY to projeds wherc occess to the interiot of the dwelling by o Sontd Ana <br />lnspector is not required. <br />a <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />I <br />I <br />Signotute:Date: <br />I