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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex Srnoke & C0 <br />Alari'n Affidavit <br />This document may be Jound ot.,.htto:i ','///.,r'.sa13 a!!.!Ig !a <br />(p/ease use a black or blue ink ball-poinl pen) <br />Project Address:/12/ /t/. ./tn,.2oo4l 4r.. <br />Permit Number:,tot/o2? /1 <br />Prope y Owner €lzzLclL lb"Llrr <br />Contractor:clz.*,. -f,;L; zl-lte-License #, DSSzzl <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ildings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existlng dwellings be <br />"retrofitted with smoke alarms and carbon rnonoxide alarms. CRC Section R314.3 and R315.3 define <br />the required locations. <br />r?\# Il Both boxes below must be checked: <br />P 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. AIarms are recommended in bedrooms with gas-flred <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />p Smot<e alarms: Are installed ln 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 (5FM). Batter.y'life must be 1C yea:'s. <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 carbon monoxide alarms have been installed in compliance with the governing <br />Codes and have been tested to be functional. <br />(check on Licensed C on tractor Pro perty Owner <br />NOTE: This self-certificatian is only used for projects thot olfect the EXTERIOR of the stTucture. This <br />process is applicabte ONLY to projects where occess to the inteior ol the dwelling by o Santa Ana <br />lnspector is not required. <br />Have thls coi'npleted form and the job-ca!'d readily availabtre on final inspectlon! <br />Ddte:2/tz/ze <br />P.O. Box 1988 (ivl-'l9) <br />Santa Ana, CA 92702 <br />(714) 647.5800 <br />I <br />I <br />I <br />lSignature: <br />tr