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fliYOTSNIA <br />NAJIffi <br />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 />wl!J/ santa.ili:! orat <br />Smoke & CO <br />Alarm Affidavit <br />tNSP-02 2013 CRC <br />This document mdy be lound ot... httO:1/!,,1,i",v.santa-a na.orct/pba / <br />(Please use a black or blue ink ball-point pen) <br />Project Address:2z 0( 3 ftuc4b <br />ta llol b(o-T <br />Property Owner: <br />License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ildings, <br />California ResidentialCode (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 required locations. <br />4\ eo,r, boxes below must be checked: <br />!,tarbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bpdrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />apptiances (i.e. hot water heater, cooktop, furnace) or a fireplace.l) <br />i Nl/mot<e alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />Y{om, 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 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 lwill retest the alarms per the <br />manufacturer's instructions. <br />lcheck onel tr Licensed Contractor Property Owner <br />NOTE: Ihis sef-c ertificdtion is only used lor projects thot olfect the ErTERIOR oI the sttuctwe. This <br />process is applicoble ONLY to ptojects where dccess to the interiot of the dwelling by o Sonto Ano <br />lnspector is not requked. <br />Signoture:,lzrtzrz DZ I 2a) <br />Have this completed form and the job-card readily available on final inspection! <br />Permit Number: <br />-a <br />Contractor:I <br />Dote: