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*;SNTA <br />.NA,,ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Rocs Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647.5800 <br />wwiv. Sa n ta-an a_ oro <br />This document mdy be found at...a <br />rNSP-02 201 <br />are installed in residential <br />on R314.3 and R314.3.3 define <br />e standards and be approved <br />bove project. I further certify <br />compliance with the governing <br />I will retest the alarms per the <br />(Please use a black or blue ink bail-point pen) <br />state of california requires that smoke and carbon monoxide (co) a <br />buildings. <br />california Residential code (cRC) section R3i.4.1and R315.2 states in rt that existing dwellings be"retrofitted with smoke alarms and carbon monoxide alarms. cRC <br />the required locations. <br />ABoth boxes below must be checkedr <br />fr crruon monoxide atarms: Are installed 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 />a in the immediate vicinity of <br />bed rooms with gas-fired <br />flsmot<e alarms: Are installed in each room used for sleeping, in e <br />foom, and on each level of the dwelling. <br />hallway outside of a sleeping <br />Retrofitted detectors may be battery-operated for buildings where no 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 />that smoke alarms and carbon monoxide alarms have been installed <br />codes and have been tested to be functional, l, also, hereby certify th <br />man ufactu rer's instructions. <br />lcheck onel P License Owner <br />NorE: This self-certification is only used for projects thot 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 Santa Ana <br />Contractor tr P <br />AI <br />oke & CO <br />rm Affidavit <br />Project Address:J-1z 'ft( <br />Permit Number: <br />Property Owner:t-*u <br />Contractor:TRLA tzob,A^J h License I t: l2/66s/ <br />Signature -'l Ooti,:,/*7d <br />Have this completed form and the iob-card readily on final inspection!