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C"O'SNIA <br />NA,ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex Smoke & CO <br />Alarm Affidavit <br />fhis document mqy be found ot..sa n ta -ana.orq/pba./ <br />(please use a black or blue ink ball-point pen) <br />0 C <br />Contractor: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.1 and R315.2 states in part that existing dwellings be <br />"retrofitted v/ith smoke alarms and carbon monoxide alarms CRC Section R314.3 and R315.3 define <br />the requ ired locations. <br />f,\ ao,h boxes betow must be checked: <br />LJr <br />A Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of'bedrooms and also on each level of the dwelling, Alarms are recommended in bedrooms with gas-fired <br />appliances (i.e, hot water heater, cooktop, furnace)or a fireplace. <br />|p Smoke 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 b u ild ings 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 certjfy <br />that smoke alarms and carbon monoxide alarms have been installed in compliance with the governing <br />Codes and have been tested to be functi <br />(check onel Lic e e Con t ra cto r tr P ro pert Owner <br />NOTE: This self'certificotion is only used for projects thdt affect the EXTERIOR ol the structure. This <br />process is opplicdble ONLY to projects where occess to the interior ol the dwellinq by o Sonto Ana <br />lnspector is not required. <br />h lto:/A,u/'Av <br />zoloj 7 s /€/o/6Permit N umber: <br />Property Owr re r:f,+r<€r 6ro-t t6t(rvrpr {o,-*-*License * g7J /f6 <br />Signature:.Z Ddte /7 <br />Have this completed form and the job-card readily available on final inspectionl <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647.s800 <br />ww.r.santa-ana.orq <br />Project Address: <br />I <br />-'-4 FA',J