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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 />www.santa.ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />Dote:7r4vr., tV-tt?Signature: <br />INSP.O2 2013 CRC <br />This document moy be lound dt...http://www.santa-ana.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:611 WateLLY 4.,2- <br />Permit Number:q 5 <br />Property Owner: <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.1and 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 />f,\ eoth boxes below must be checked: <br />SCarbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bbdrooms 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 />Q{moke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />rooh, 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 I will retest the alarms per the <br />ma n ufacturer's instructions. <br />tr Licen dC ontractor tr Prope ner <br />NOTE: Ihr3 sef-certificotion is only used for projeds thdt olfect the EXTERTOR of the strudure. This <br />process is opplicable ONLY to proieds where access to the interior of the dwelling by a Sonto Ano <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />*,SANTA <br />NA;l,lffii <br />lcheck onel