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ilSNTA <br />ANA,"ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647-5800 <br />WW,V. Santa-a n a- oro <br />This document moy be found at... <br />INSP.O2 <br />n <br />(Please use a black or blue ink ball-point pen) <br />state of california requires that smoke and carbon monoxide (co) al <br />buildings. <br />california Residentialcode (CRC) section R314.1and R315.2 states in that existing dwelltngs be <br />ms are installed in residential <br />ion R314.3 and R314.3.3 define"retrofitted with smoke alarms and carbon monoxide alarms. cRC se <br />the required locations. <br />f\eoah boxes betow must be checked: <br />p caruon monoxide atarms: Are instailed outside of each sleeping a <br />bedrooms and also on each level of the dweiling, Alarms are required <br />appliances (i.e, hot water heater, cooktop, furnace) or a fireplace. <br />r in the immediate vicinity of <br />bed rooms with gas-firedn <br />Froo <br />Smoke alarms: Are installed in each room used for sleeping, in <br />m, and on each level of the dwelling. <br />hallway outside of a sleeping <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations are <br />performed. combination smoke/co alarms must comply with all appl <br />by the State Fire Marshall (SFM). Battery life must be 10 years. <br />ble standards and be approved <br />I hereby certify that I am the contractor or the property owner of the <br />that smoke alarms and carbon monoxide alarms have been installed i <br />project. I further certify <br />compliance with the governing <br />codes and have been tested to be functional. l, also, hereby certify t <br />man ufactu rer's instructions. <br />I will retest the alarms per the- <br />lcheck onel p censed ctor tr P ner <br />NorE: This self-certification is onty used for projects that affect the of the structure. This <br />process is applicable oNLY to projects where dccess to the interior ol <br />lnspector is not required. <br />dwelling by a Santa Ana <br />AI <br />oke & CO <br />rm Affidavit <br />Project Address:7/8 5- /aAil,&Az -97 z tB <br />Permit Number:o,/ <br />Property Owner:L*u <br />Contractor:7zs(4 R4afttJ6 License i |-loqdLel <br />Signoture:-Z/ootl:4-/r^ <br />Have this completed form and the job-card readily avaitab on final inspection! <br />l-