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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex Smoke & CO <br />Alarm Affidavit <br />loLProject Ad dress:a/!oh(.\r <br />Permit Number:loltot-97? <br />Property Ovrner: <br />Contractor:G)r" C lor"l o roatl o License #: <br />titsP-02 20r3 cRc <br />This document moy be t'ound ot...h tt o:/i ynr',rr,l. santa -a n a.oralgbal <br />(Please use a black or blue ink ball-point pen) <br />State of California requires that smoke anC carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that exjsting drarellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314,3 and R314.3.3 define <br />the req u ired locations. <br /># \eotl, boxes below must be checked: <br />El'carbon monoxjde alarms: Are installed outside of each sleeplng area in the immediate vicinity of <br />bedrooms and also on each level of the dv/elling. Alarms are required in bedrooms with gas-fired <br />appliances (i.e. hot lvater heater, cooktop, furnace) or a fireplace. <br />Elsmoke 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 \,vith all applicable standards and be approved <br />by the State Fire Marshall (SFl,4). 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 r.vith 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 ufactu rer's instructions. <br />lcheck one)icensed on tractor tr Pr rty O,,,/ner <br />NQTE: This self-certilication is only used Jor projects that affect the EXTER|OR ol the structure. This <br />process is applicoble OIYLY to Projects where occess to the interior ol the dwetling by o Sonta Ana <br />lnspector is not required. <br />Signatute:Date:I La'zr2z <br />P.O. Box 1933 (tu1-'19) <br />Santa Ana, CA 92702 <br />(714) 6.17.sa00 <br />v/.M,v. s a nt3 -a n a. orq <br />, <br />Have this completed form and the job-card readily available on final inspection!