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N"''SANTA <br />NA,'ffi <br />Planning & Building Agency <br />20 Civic Center Pleza Roas Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 6.t7-5800 <br />wwJv.santa-ana. oro <br />This document moy be lound at.,. <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 Residential code (cRC)section R3l.4.1and R315.2 states in that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. cRC se <br />the required locations. <br />ABoth boxes betow must be checked: <br />in the immediate vicinity of <br />n bedrooms with gas-fired <br />SSmoke atarms: Are installed in each room used for sleeping, in <br />room, 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 L0 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, atso, hereby certify <br />man ufactu rer's instructions. <br />I will retest the alarms per the <br />{check onel Licensed tr P <br />NorE: This self-certification is only used for projects that affect the ol the structure. This <br />process is applicable oNLY to projects where occess to the interior of <br />lnspector is not required. <br />dwelling by o Santa Ana <br />'ms are installed in residential <br />ion R314.3 and R314.3.3 define <br />E 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 />er <br />AI <br />oke & CO <br />rm Affidavit <br />Project Address:6Disa,to _f,Ae .s.dZ <br />Permit Number:/ <br />Property Owner:L+u <br />Contractor:-r6ti Footr(rJh License I tla466s7 <br />Signature:1./oatl:,/*/r* <br />Have this completed form and the job-card readily on final inspection! <br />I