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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-a na.o rq <br />Smoke & CO <br />Alarm Affidavit <br />This document may be found ot.,,httD://www. santa-ana.orq/Dba/ <br />(please use a black ot blue ink ball-point pen) <br />Project Address: <br />Permit Number: <br />Property Owner: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.1 and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R315.3 define <br />the required locations. <br />A eo,h boxes below must be checked: <br />E Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the dwelling. Alarms are recommended in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />E Smoke alarms: Are installed in each room used for sleeping, in each hallway outsade of a sleeping <br />room, 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 carb monoxide a lar s have been installed in compliance with the governing <br />Codes and have been te to be functional <br />Signoture: <br />lcheck onel SE ontra or EfP perty owner <br />NOTE: Ihis sef- certilicotion is only used for projects thot ollect the EXIERIOR ol the structure. This <br />process is opplicoble ONLY to projects wherc access to the interior oI the dwelling by o Sonto Ano <br />lnspedor is not requircd, <br />3z- w <br />io r Lo 2-1114 <br />L) qroxi:6 <br />Contractor:M'(litn t'""k License *, QZ-{C.L 4 <br />):l -/Dote:n?0l+ <br />Have this completed form and the job-card readily available on final inspection! <br />fl.1\\nc <br />I <br />I <br />tr