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*,,SNTA <br />A},[AJ'ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Rots Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647.s800 <br />wwl,v.santa-ana. oro <br />This document mdy be found ot,., <br />(Please use a black or blue ink balt-point pen) <br />state of california requires that smoke and carbon monoxide (co) <br />buildings. <br />california Residentialcode (CRC) section R314.1 and R315.2 states in <br />"retrofitted with smoke alarms and carbon monoxide alarms. cRC <br />the required locations. <br />ABoth boxes below must be checked: <br />p caruon monoxide alarms: Are instailed outside of each sleeping a <br />bedrooms and also on each level of the dwelling. Alarms are required <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />2013 <br />s are installed in residential <br />rt that existing dwellings be <br />n R314.3 and R314.3.3 define <br />a in the immediate vicinity of <br />r bedrooms with gas-firedn <br />flSmot<e alarms: Are installed in each room used for sleeping, in e <br />ioom, and on each level of the dwelling. <br />hallway outside of a sleeping <br />Retrofitted detectors may be battery-operated for buildings where or alterations are <br />performed. combination smoke/co alarms must comply with all appl <br />by the State Fire Marshall (SFM). Battery life must be 1.0 years. <br />I hereby certify that I am the contractor or the property owner of the <br />e standards and be approved <br />bove project. I further certify <br />that smoke alarms and carbon monoxide alarrns have been installed compliance with the governing <br />codes and have been tested to be functional. l, also, hereby certify th I will retest the alarms per the <br />ma nufactu rer's instructions. <br />lcheck onel ,8 Licensed Contra tr erty <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 of <br />lnspector is not required. <br />dwelling by a Santd And <br />AI <br />oke & CO <br />rm Affidavit <br />Project Address:7tB s 7oai%-tYt :7 *3 <br />Permit Number:/o//n 3tz/ <br />Property Owner:t4u <br />Contractor:76(4 72s62)h License r t:1o461il <br />Signature P4 ,/*,/-- <br />Have this completed form and the job-card readily availa on final inspection!