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I <br />.IG <br />A a*.Dt\GlI mnnAI\ <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647-s800 <br />ww,r.santa-ana orcl <br />Smoke & CO <br />Alarm Affidavit <br />INSP.O2 2013 CRC <br />This document mdy be lound dt...htto./,',,r,,r,,r. sa n ta-ana.orqi pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:t VJ I <br />Permit Number:tb ll <br />LtaProperty Owner: <br />Contractor:}J ori^(;,,.r License #:toolflq q' <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in resldential <br />bu ild ings. <br />California Residential Code (CRC) Section R314,1and 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 requ ired locations. <br />f\ eo,h boxes below must be checked: <br />Elcarbon 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 />*Srnot " 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 Fire Marshall (SFM). Battery life must be L0 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 />m a n ufacturer's instructions. <br />Signature:Dote: <br />lcheck onel tr Licensed Contracto r tr Property owner <br />NoTE: Ihis sef-certificotion is only used for projects thdt olIect the EXIERI,R ol the structure. This <br />process is applicable ONLY to projects where occess to the interior of the dwetling by o Sonta Ano <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection!