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*,SANTA <br />NA.ffi <br />Planning & Building AgencY <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 193E {tuI-19 ) <br />Santa Ana. CA 92702 <br />(714) 647.5400 <br />Smoke & CO <br />Alarm Affidavit <br />Ll u/r><-- <br />ldil 2q e4(Permit Number: <br />JProperty Owner <br />License #Contractor: <br />lNSP,02 201 I aRC <br />This document mqy be lound ot hlt: /,1,,',v',v san lr-ana.orq lobal <br />(Please use a black or blue ink ball-point pen) <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />california Rasidential Code (CRC) Section R3ll.1and R315.2 states in part that existing dwe lings be <br />,,retrofitted with smoke alarms and carbon rnonoxide alarms. CRC Section R314.3 and R314 3 3 define <br />the required locatlons. <br /># B goth boxes below must be checked: <br />&Crruon monoxide alarms: Ara installed outiide of each sleeping area in the immediate vicinity of <br />'6")>6orr and also on each level of the dwellrng. Alarms are required in bedrooms with gas-fired <br />appliances li.e. hot water he3ter, cooktop, furnace) or a fireplace' <br />Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />r00 and on each level of the dwelling <br />Retrofitted detectors may be ba ttery-ope ra ted for b u ild ings where no interior alterations are <br />performed. combination smoke/co alarrns must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFlvl). BatterY life must be 10 years <br />I hereby certify that I am the conti.actor or the property owner of the above pro.1ect. I further certify <br />that smoke alarms and carbon monoxide alarrns have been installed in compliance with the governing <br />Codes and have been tested to be functional.l, also, hereby certafy that I will retest the alarms per the <br />manufacturer's instructions <br />(check onel Licensed Contractor Property Owner <br />Date:fu-o(- Lo-),jSignature: <br />Have this completed form and the job-card readily available on final inspection! <br />NoTE: Ihis serf-c ertificotion is only used for proiects thdt dllect the ExTERtoR of the sttucture' This <br />pfocess is applicabte oNLY to prciects where occess to the interior ol the dwelling by d sontd Ano <br />lnspectot is not required' <br />Project Address: