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Planning & Building Agency <br />20 Civic Center Plaza Rcss Annex <br />P.O. Box 1988 (M-'19) <br />Santa Ana. CA 92702 <br />(714)647.5800 <br />w'i/, stilt-l"l.irl <br />Project Address:?/? f v,'r.,,n:., <br />/or 6Lt <br />ffn)n./.,^ Yo,h"o,( <br />lry'"r^-n', PuJ;n1Contractor:License #: 3 /?]65' <br />NSP-02 20 I3 CRC <br />This document moy be found at.. <br />performed. Combination Smoke <br />by the St3te Fire Marshall (SFM) <br />f, :,' ),,,,,r,,,r SantS-ala Of l,'pba <br />,l allway outside of a slee ln <br />r <br />(Please use a black or blue ink ball-point pen) <br />Permit Number: <br />Property Owner: <br />State of California requires that smoke and carbon monoxlde {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 required locations. <br />fl eott, uo*.s below must be checked: <br />B onoxide alarms: Are installed outside o lee tn area in the immediate vicinity of <br />bedi'ooms 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 />-d, s-ot" rtar-r, <br />room, and on each <br />Retrofitted detectors may be ba tte ry-o perated for bu ild ings where no interior alterations are <br />Are insta iled i oom used for sleep in <br />level of the dw <br />CO alar wit h all applicable standards and be approved <br />I hereby certify that I am the contractor or the property owner of the above prolect. I further certify <br />that srnoke alarms and carbon monoxide alarms have been installed in compliance with the governrng <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 />Signoture:q-/7 - // <br />lcheck one\Licensed Contracto r Pro perty Owner <br />each <br />each <br />attery life must be 10 years <br />fi,YO'SANTIA <br />NAffi <br />Smoke & CO <br />Alarm Affidavit <br />Ca <br />NOTE: fhis sef-c ertificotion is only used lor projects that oflect the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where access to the interior of the dwelling by d Sonta Ana <br />lnspector is not required. <br />Oate: <br />Have this completed form and the iob-card readily available on final inspection!