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*,,SNTA <br />NAffi <br />Planning & Building Agency Smoke & CO <br />Alarm Affidavit <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647.5800 <br />,'!r1il,tt.l l:iI <br />This document may be found ot... <br />(please use a black or blue ink ball-point pen) <br />Project Address:t s zl P.:t..s-lti "- g L. i/". +L^ <br />Permit Number:/0t/ozs:lL I zotToctl <br />Property Owner:fle e^l(l1ag2 <br />Contractor:C lea.^ 71tl; rL, r- ] Li""n," #i / o 3v 3 7 6 <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild in gs. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon rnonoxide alarms. CRC Section R314.3 and R315.3 define <br />the req u ired locations. <br />f\ aotl, boxes betow 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 />Efsmoke 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 Fii'e Marshal! (5FM). Battery life mu5t be 10 yeai.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 governrng <br />Codes and have been tested to be functional. <br />lcheck one|Lice n se d ontractor Property Owner <br />NOIE: This seff-eertification is only used for projects that oflea the EXTERTOR ol the structurc. This <br />process is applicable ONLY to projecls wherc occess to the interior of the dwelling by d Santo And <br />lnspector is not required. <br />Signoture:Date:1/lo/ zo <br />tr <br />Have this completed form and the job-card readily available on final inspection!