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*,,SNIA <br />NA.ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box '1988 (M-19) <br />Santa Ana, CA 92702 <br />(7r 4) 647.s800 <br />'?vira, s?nt:l-ada cl? <br />Smoke & CO <br />Alarm Affidavit <br />I <br />h/sP{2 2013 CRC <br />This document moy be lound at... h ttc:/h'r,'r,,i. san ta -a na.orci oba,' <br />(Please use a black or blue ink ball-point pen) <br />Project Address: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ildings. <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 R3i.4.3 and R314.3.3 define <br />the required locations. <br />4\ ao,n boxes betow must be checked: <br />E Carbon monoxide atarms: Are installed outside of each sleeping area in 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 Srnoke alarms: Are anstalled in each room used for sleeping, in each hallway outside of 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 10 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. l, also, hereby certify that I will retest the alarms per the <br />manufacturer's instructions <br />lcheck onel tr Licensed Cont ctor Pt erty Owner <br />NOTE: rhiJ sef-c ertificotion is only used for projects thot olfect the ErTERIOR ol the structure, This <br />process is opplicoble oNLY to ptojects where occess to the interiot oI the dwelling by o sdnto Ano <br />lnspector is not required. <br />WK tf)L AU <br />Permit Number:3g <br />Property Owner:1uiltr * <br />Contractor:5c License #:3 <br />Signoture:(. <br />Dote: <br />Have this completed form and the job-card readily available on final inspection!