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ilSNTA <br />NAffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647-s800 <br />,..r'rrr,v. s a nt.r-a n a orq <br />Smoke & CO <br />Alarm Affidavit <br />Project Address q N ,4 <br />t'e u-t l< '/ Sf.Totgtz <br />Property Owner <br />"nse <br />#Contractor: <br />INSP-02 2013 CRC <br />This document mdy be found at...httc.//r,.n,;.,v. sa nta-ana.orolobai <br />(Please use a black or blue ink ball-point pen) <br />State of California requires that smoke and car on monoxide (CO) alarms are installed in residential <br />bu ildings. <br />California Residential Code (CRC)Sectlon R314.1and R315.2 states in part that exlsting dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />f\ Both boxes below 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 />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />EI Smoke 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 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 L0 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 />Signature &^*.n CAr.r orf-r+/Date t o - ?- z o <br />lcheck onel Licensed Contractor ? Property Owner <br />NOTE: This self-certification is only used for projects thot offect the EXTERIOR of the structure. This <br />process is applicoble ONLY to projects where access to the interior of the dwelling by a Sonto Ano <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />t <br />Permit Number: