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*,-IANTA <br />NA-'ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex Smoke & CO <br />Alarm AffidavitP.O. Box 1988 (Ml9) <br />Santa Ana, CA 92702 <br />(714) 647.5800 <br />www.santa-ana.orq <br />INSP 02 2013 CRC <br />This document mqy be found ot...h tto ://ww,v. sa nta -a na. o rqlobal <br />(Please use a black or blue ink ball-point pen) <br />Project Address:Zzo ovorle ftt10 <br />Permit Number:to\lozga4; dnrmf <br />Property Owner:$arrrl Nursl€ <br />Contractor <br />l <br />-qJU[N.i8s s$N $Uf C-lo; ltu,{ bo+License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ildings. <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 />4hsotl, boxes below must be checked: <br />El 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 required 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 roorn 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 carbon monoxide alarms have been installed in compliance with the governing <br />Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the <br />ma n ufacture r's instructions. <br />tcense d Contractor E Property Owner <br />NOTE: Ihrs sef-ce rtiJication is only used for projects thdt oflect the EXTERIOR of the structure. This <br />process is opplicdble ONLY to Wojects where occess to the interior of the dwelling by a Sdnta And <br />lnspector is not rcquired. <br />Signoture:6 J Date: <br />Have this completed form and the job-card readily available on final inspection! <br />lcheck one)