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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647.5800 <br />w'/v.r.sa nta-an a.orq <br />Smoke & CO <br />Alarm Affidavit <br />INSP.O2 2013 CRC <br />This document may be lound at...h tto.i iv,rlr,,r. sa nta-a n a. o !-q'oba./ <br />(Please use a black or blue ink ball-point pen) <br />Permit Number:tott 00- &? I <br />State of California requires that smoke and carbon monoxide (Co) alarms are installed in residential <br />bu ild ings. <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 requ ired locations. <br />fl eo,h boxes betow must be checked: <br />EICarbon 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 />dSmot" 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 10 years. <br />I hereby certify that I am the contractor or the property owner of the above pro1ect. 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 />manufacturer's instructions. <br />lcheck onel tr Licensed Contracto r Property Owner <br />NOTE: This self-certificotion is only used for projects thot offect the EXTERTOR ol the structure. This <br />process is applicable ONLY to projects where occess to the interior of the dwetting by o Sonto Ano <br />lnspector is not rcquired. <br />Project Address:DTtt sEar:rn/4,,1o ca 1A)oL3l <br />Property Owner:L,,r\) t= >_ <br />Contractor:License #: <br />Signature:& ttttt€t-oql ,tt-q Dote:(Jja?oLg_ a <br />Have this compler 'atr"card readily available on final inspection! <br />,,-SANTA <br />NA#ffi <br />4)br4edA /ti