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#SANTIA <br />.,NAffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647.5800 <br />www,santa-ana.otq <br />Smoke & CO <br />Alarm Affidavit <br />r Project Address:tzb cLvnvtttc€7.1 +vEr <br />Permit Number:?) llnst-2- <br />r Property Owner:BAVAil r-|A>t f,t4 <br />'Contractor:.\zS.r I l.l<L c't-License #, ( /0-IA37 <br />State of California requires that smoke and ca on monoxide (CO) alarms are installed in residential <br />b u ild ings. <br />California Residential Code (CRC) Section R3L4.1and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />6\ eo,h boxes below must be checked: <br />frC.rAonmonoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />b\drooms and atso on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />appl ces (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />ro <br />Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />m, 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 ala.rms and carbon monoxide.alarms have been installed in compliance with the governing <br />Codes and have been te <br />ma nufactu rer's iniiructi <br />sted to be fu nctional l, also, hereby certify that I will retest the alarms per the <br />(check onel F_ Licensed ntra or Pr pe Owner <br />NOTE: Ih,s serl-certificotion is only used lor projects that offect the EXTERIOR ol the structure. This <br />process is applicoble ONLY to projects wherc occess to the inteior of the dwelling by a Sonta And <br />lnspector is not rcquired. <br />Signotute:x Date:// <br />Have this completed form and the job-card readily available on final inspection! <br />rNSP-02 2013 CRC <br />This document moy be found ot... htto://www. sa nta-ana.orq/oba/ <br />(Please use a black or blue ink ball-point pen) <br />'----r