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*,,SNTA <br />NAJffi <br />Planning & Building AgencY <br />20 Civic Genter Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647-5800 <br />ww\,v.santa-ana.orq <br />201 3 <br />This document moy be found at...na.o <br />(Please use a btack or blue ink ball'point pen) <br />state of california requires that smoke and carbon monoxide (co) al <br />buildings. <br />s are installed in residential <br />California Residential Code ( <br />"retrofitted with smoke alar <br />the required locations' <br />CRC)Section R314.1 and R315.2 states i part that existing dwellings be <br />ms and carbon monoxide alarms. CRC n R314.3 and R314.3.3 define <br />ABoth boxes below must be checked: <br />F.. <br />bedro <br />rbon monoxide alarms: Are installed outside of each sleeping in the immediate vicinitY of <br />oms and also on each level of the dwelling' Alarms are requir in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />pfsmot<e alarms: Are installed in each room used for sleeping, in e <br />ioo., and on each level of the dwelling. <br />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 ap <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 />that smoke alarms and carbon <br />Codes and have been tested to <br />ma nufactu rer's instructions. <br />monoxide alarms have been installed n compliance with the governing <br />be functional. l, also, hereby certify t I will retest the alarms Per the <br />(check onel fi L cense d Contractor pe <br />NOTE: This self-certification is only used for proiects thot affect the of the structure. This <br />process is applicable ONLY to proiects where dccess to the interior <br />lnspector is not required. <br />the dwelling by d Sdnta Ano <br />oke & CO <br />rm Affidavit <br />S <br />AI <br />#/7b e- 7ooA*ilr sTProject Address: <br />Permit Number:oo <br />LiuProperty Owner: <br />r: Lo4 6 6-f,License ITatA a-oofrdlz-Contractor: <br />Signature: <br />Have this completed form and the iob'card readily avai le on final insPection!