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,--SANTA <br />ANA,'*liilffi <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 />www.santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />Project Address:51 o :- rr) . ''l t\lzik Luo,. <br />Permit Number:lot r\rlgr{t <br />Contractor:fnv - <br />JtJB &o,'c.--.a License #: <br />This document moy be found at... http://www.santa-ana.orq/pbai <br />(please use a black or blue ink ball-point pen) <br />State of California requires that smoke and carbon mono xide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.L and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R3L5.3 define <br />the required locations. <br />nBoth boxes betow must be checked: <br />EI 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 recommended in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />E 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 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. <br />lcheck onel Licensed Contractor Property Owner <br />NOTE: This self-certificotion is only used lor projects that offect the EXTERIOR of the structure. This <br />process is applicoble ONLY to projects where occess to the interior of the dwelling by o Sonta Ana <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />Signoture:S n\u e,l.,.- **.v; .r 6.r'si: I z'ruo <br />I erop"rty owner: I * ,\ , i {,ra.. \r,r ),r q <br />I <br />io Yi{ 9 r-'( I <br />I Dote: <br />I