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ffiSNTA <br />NA,ffi <br />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-s800 <br />w'ffr'l. sa n t a,an a. orc.l <br />Smoke & CO <br />Alarm Affidavit <br />Project Address:g an <br />Permit Number: <br />Property Owner: <br />Contractor:OL.A,License #:q to1 q( <br />that smoke alarms and carbon <br />Codes and h ave been tested to <br />m an ufact u rer's instructions. <br />monoxide alarms have be in compliance with the governing <br />(check onel p Licensed Contractor <br />NOTE: Ihis serl-c ertification is only used for projects thot dflect the EXTERTOR of the structute. This <br />process is opplicable ONLY to projects where occess to the interior of the dwelting by o Sdnta Ana <br />lnspector is not required. <br />e <br />be functional. I ereby certify that I will retest the alarms per the <br />Signoture:Date:1l to I e''t <br />Have this completed form and the job-card readily available on final inspection! <br />flsP-02 2013 cRC <br />This document may be found at... httO:/,(,,l,,,,l.santa-:rntr ^.-i ^ha / <br />(Please use a black or blue ink ball-point pen) <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings. <br />California Residential Code (CRC) Sectjon R3L4.L and 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 req u ired locations. <br />{\ eo,h boxes below rnust be checked: <br />$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. AIarms are required in bedrooms with gas-fired <br />appliances {i.e. hot water heater, cooktop, furnace) or a fireplace. <br />Ssmoke alarms: Are installed 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 b attery-ope rated 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 />tr Property Owner <br />L