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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1933 (tul-19) <br />Santa Ana. CA 92702 <br />(714) 6.17-sa00 <br />!t/'rl,i/, s 3 nti -a na or! <br />hrs2-02 20 r3 cRC <br />This document may be found at.-. httc'/^,r,'lv Santa-a na.o ro/oba,/ <br />(Please use a black or blue ink ball-point pen) <br />T-I,t <br />State of California requlres that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.1and R315.2 states in part that existing dv/ellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314,3.3 define <br />the req u ired Iocations. <br /><, IlBoth boxes below must be checked: <br />EI Carbon monoxide alarms: Are insta,led outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the d,,,relling. AIarms are required in bedrooms with gas{ired <br />appliances (i.e, hot water heater, cooktop, furnace) or a fireplace, <br />El Smot<e alarms: Are installed in each room used for sleeping, in each haliway 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 r,^rlth 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 rarith the go,rerning <br />Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the <br />ma n ufacturer's instructions. <br />lcheck one)Licensed ont o(q Pro pe rty O\.^/ner <br />NOTE: This self-certilication is only used fot prcjects that oflect the EXTERIOR ol the structure. This <br />process is applicable olvLY to projects where access to the interior oJ the dwelling by a sdntd And <br />lnspector is not required. <br />a <br />'il aa\Permit N umber:0 <br />Property Owner: <br />c{r License #: \gContractor S <br />Signoture:Dote:\-\i- <br />Have this completed form and the job-card readily available on final inspection! <br />Smoke & CO <br />Alarm Affidavit <br />l Project Ad d ress: <br />I <br />I <br />tr