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*,,SANTA <br />NA-ffi <br />oke & CO <br />Affidavit <br />S <br />AI <br />-5Project Address: <br />Permit Number: <br />Property Owner: <br />LicenseContractor: <br />2-O %Signature: <br />This document maY be found at... <br />(Please use a black or blue ink ball'point pen) <br />State of California requires that smoke and carbon monoxide (CO) al rms are installed in residential <br />buildings. <br />California Residential Code <br />"retrofitted with smoke ala <br />the required locations. <br />rms and carbon monoxide alarms. CRC n R314.3 and R314.3.3 define <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 />www.santa-ana. oro <br />htt <br />INSP.O2 3 CRC <br />rea in the immediate vicinitY of <br />in bedrooms with gas-fired <br />san <br />(CRC) Section R31-4.1and R315'2 states in part that existing dwellings be <br />Aeoah boxes below must be checked: <br />E[Carbon monoxide alarms: Are installed outside of each sleeping <br />belrooms and also on each level of the dwelling, Alarms are require <br />that smoke alarms and carbon monoxide alarms have been installed <br />Codes and have been tested to be functional. l, also, hereby certify t <br />appliances (i.e. hot water heater, cooktop, furnace)or a fireplace' <br />EBSmoke alarms: Are installed in each room used for sleeping, in e <br />,Lo., and on each level of the dwelling. <br />h hallway outside of a sleePing <br />Retrofitted detectors may be battery-operated for buildings where interior alterations are <br />performed. combination Smoke/co alarms must comply with all a <br />by the State Fire Marshall (SFM). Battery life must be 10 years' <br />icable standards and be aPProved <br />I hereby certify that I am the contractor or the property owner of above project. I further certifY <br />n compliance with the governing <br />at I will retest the alarms Per the <br />manufactu rer's instructions. <br />(check onel fif Licensed (P er <br />NOTE: This self-certification is only used for proieas that dffect the of the structure. This <br />process is appticable ,NLY to proiects where occess to the interior <br />lnspector is not required, <br />the dwelling by o Santa Ano <br />Have this completed form and the iob-card readily avail le on final insPection!