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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-s800 <br />www.sanla-ana.orq <br />This document may be lound at...htto://www.san ta-ana.orq/oba/ <br />(please use a black or blue ink ball-point pen) <br />Project Address:fb3z-- UJ t /rpls^n <br />Permit Number:Lo I to 2-1a24 <br />Property Owner:t)+xq LLis-b <br />Contractor:MCC h <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.1 and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R315.3 define <br />the required locations. <br />A eo,h boxes below must be checked: <br />E Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the dwelling. Alarms are recommended in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />El Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />room, and on each level of the dwelling. <br />Retrofitted detectors may be battery-operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Battery life must be 10 years. <br />I hereby certify that I am the contractor or the property owner of the above project. I further certify <br />that smoke alarms and carb monoxide ala s have been installed in compliance with the governingI <br />Codes and have been te to be fu nctiona I <br />lcheck onel se ontra tor EJ.-P perty owner <br />NOTE: Ihis serr- certificotion is only used lor projeds thot olfed the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where occess to the inte ot of the dwelling by a Sonto Ano <br />lnspedot is not required. <br />J1 :I -/Dote )0*0l+ <br />Have this completed lorm and the job-card readily available on final inspection! <br />-,-SANTA <br />NA/riilffi <br />Smoke & CO <br />Alarm Affidavit <br />E] <br />License #: <br />Signoture: