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7 !tr Ft'l-'l'Lt <br />a- <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana. CA 92702 <br />(71i1) 647-5800 <br />www.santa-ana-orq <br />Smoke & CO <br />Alarm Affidavit*-SNTA <br />NA.ffi <br />tNSP,02 2013 CRC <br />This document moy be lound ot.htto.//www. sa nta-ana.oro/oba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:) <br />Permit N umber: <br />Contractor: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 />Aso,i, boxes below must be checked: <br />E Carbon monoxide alarms: Are installed outside o t@}l"rr{t area tn the immediate vicinity of <br />bedrooms and also on each level 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 Smote alarms: {re inrt.tt"6'.-'--".!h ,o-ory <br />roorfi-, and on each teve]ifihe a*"ifr[ -.:-sed for sleeping/in eaah hallwa yrutside of a sleeping <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations are <br />performed. Combination Smoke CO alarms must lomplv with all applicable standards and be approved <br />by the State Fire Marshall (SF Battery life must be 10 yea6. ) <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 />ma n ufacturer's instructions. <br />(check onel ice nsed Contractor tr Property O wner <br />NoTE: This sef-certification is only used for projects thot aflect the ExTERtoR of the structure. This <br />process is opplicable ONLY to projects where occess to the interior ol the dwelling by a Sonto Ana <br />lnspector is not required. <br />a <br />Ru--lr,)wSignature:Dote:olrltr <br />Have this completed form and the job-card readily available on final inspection! <br />--I I <br />I <br />I n <br />inl q.;:"3 <br />Property Owner: <br />I