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Planning & Building Agency <br />20 Civic Center Plaza Rcs; An.e)( <br />P.O. Box 1 3dd (i!l-19) <br />Santa Ana. CA 92702 <br />(711) 6,17-s300 <br />,ri.,,/.,r1 sl-.t.t: f.1 <br />Smoke & CO <br />Alarm Affidavit <br />NisP,02 21111CRa <br />hii: /',r',,;,1 s.l: ia -a r e c::'cba <br />(P/aase use a black or blue ink ball.point pen) <br />Project Address o c L VU <br />0,^&,tl.,,l <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxlde (CO) alarms are installed in residential <br />buildings. <br />California Resldential Code (CRC) Section R314.1and R315.2 strtes 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 />fr aotr, boxes below must be checked <br />fi CrrUon monoxjde alarms: Are installed outside of each sleeping area in the immediat: vicinity of <br />bedroorns anC also on each level cf the C,rvellrng. Ala:rns a:e reqrired in bedrcoms \//ith gas-flreC <br />appiiances (i.e. hot \,vater heater, cooktop, furnace) or a fireplace. <br />fi Srnot" alarms: Are instelled 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 buiidings 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 ltzlarshall (SFfit). 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 ha,re been installed in compliance with the gc,rernrng <br />Codes and have been tested to be functional. l, also, hereby certjfy that lwill retest the alarms per the <br />ma n ufacturer's instructions. <br />Signdtur e:Dat 2: <br />(check one)License C n!'acior P roperty Owner <br />NOTE: fhls self-certificotion is only used for projects that affect the ErTERIOR of the structure. This <br />process is applicable ONLY to project wher? dcce$ to the interiot ol the dwelling by a Sdnta Ano <br />lnspector is not required. <br />Have this completed form and the.iob-card readily available on final inspectionl <br />This document rnay be lound ot... <br />Permit N umber: <br />Prope rty Owner: