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ffiffiN,tfi <br />#Mffi <br />Planning & Building Agency <br />20 Civic Center Pla:3 Rcss Anner Smoke & CO <br />Alarm Affidavit <br />NSP-02 20r3 CRC <br />This document may be lound ot.-- h ttc./i, ,',r,,i santa-a n a.o rq/oba,/ <br />0 <br />(P/ease use a black or blue ink ball-point pen) <br />Permit Number:it ae\ <br />Property Owner: <br />Lice nse #: \g <br />T-ft <br />State of Californ;a requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings. <br />California Residential Code (CRC) Section R31.+.1and R315.2 states in part that existing dv/ellings be <br />"retrofitted \,vith smoke alarms and carbon monoxide alarms. cRC section R31.4.3 and R314.3.3 define <br />the req u ired Iocations. <br />A\{, Ll Both boxes below must be checked: <br />B Carbon monoxide alarms: Are installed outside of each sleeping area in the imrnediate vicinity of <br />bedrooms and also on each level of the d,.,relling. Alarrns are required in bedrooms u/ith gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />El 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 dwelljng. <br />Retrofitted Cetectors may be battery-operated for buildings lvhere no interior alterations are <br />performed. Combination Smok-./CO alarms must comply \,vith all applicable standards and be approved <br />by the State Fire Marshall (SFt,l). Battery ljfe rl1ust 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 alarr,rs have been installed in compliance \^/ith the governing <br />Codes and hava been testeC to be functjonal. l, also, hereby certify that I will retest the alarms per the <br />ma n ufactu re r's instructions. <br />(check one)tr LicenseC q Pro perty Owneronti.a( <br />NOTE: Ihrs self'certification is only used for projects thot at'fect the EXTERI7R of the structure. This <br />process is applicable ol\lLY to projects where occess to the interior ol the dwe ing by d sdnta And <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />Dct ?:\- \3- )O <br />P.O. Box 1933 (i!l-19) <br />Santa Ana, CA 92702 <br />(711) 6,17-sa00 <br />v/llfl1l,S 3nt!-ana oa5 <br />Project Ad dress:I <br />\O P\ n) <br />lContractor: <br />Signature: I