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C''*SANIA <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 />(714) 647-s800 <br />wwlr'/.santa-an a. orq <br />Smoke & CO <br />Alarm Affidavit <br />Permit Number: <br />Property Owner: <br />oo ia t <br />rNsP-02 2013 CRC <br />This document mdy be found dt...htto./ivwv,,v. santa-ana.o r qlobal <br />(Please use a black or blue ink ball-point pen) <br />0lq"+ <br />QoAvi <br />License#: Q <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residentjal <br />bu ildings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofltted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the requ ired locations. <br />f,) ao*r boxes betow must be checked: <br />E[ 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 required in bedrooms with gas-fired <br />applfces (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />EISmote 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 detectors may be batte ry-o pe rated 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 lwill retest the alarms per the <br />m an ufactu rer's in structions <br />(check onel Licensed Con tracto r P--- Property Owner <br />No'lE: This self-certificotion is only used for projects thot offect the ErTERIOR of the structure. This <br />process is opplicoble ONLY to projects where occess to the interior of the dwetling by a Sonto Ana <br />lnspector is not required. <br />a <br />Signature:L^!'":l w lrs ltK <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />l <br />] Project Address: <br />] <br />lContractor:I <br />l