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*,,SANTA <br />NA,'Iffi <br />-Y <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana. CA92702 <br />(714) 647.5800 <br />v,//r,5anta-an.l o rcl <br />Smoke & CO <br />Alarm Affidavit <br />rNsP,02 2013 CRC <br />This document mdy be found ot..htto./ lv.rlv.santa-ana.orq oba <br />(P/ease use a black or blue ink ball-point pen) <br />Project Add rESS:2 \\o G.".^.t.\.:,+Sun\oN...'^ft qllott <br />Permit Number:tn tD2 2 <br />Property Owner:So.*'..il N cC o c-\or(. c^- <br />Contractor: hCe 0n L-11eri67-s ] <br />License*, 4QL023 (3 <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 R314.1 and 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 required locations. <br />f\ eo,t boxes below must be checked:\l <br />{carUon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />/edlooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />agpliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />S S.ot" alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />rdo-m, 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 project. I further cerlfy <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 atarms per the <br />manufacturer's instructions. <br />J a./r1 2DDi <br />lcheck onel tr Licensed Contracto r Property Owner <br />NOTE: This self-certilication is only used for projects thot offect the EXTERTOR ol the structure. This <br />process is opplicable ONLY to projects where occess to the interior of the dwellina by o Santo Ano <br />lnspector is not required. <br />Signature:Dote: <br />Have this completed form and the job-c;rr r "on! <br />c <br />n1,-/^' <br />tr