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l <br />20 CiYic Center Plaza Ross An.ex <br />Planning & Building Agency Smoke & CO <br />Alarm AffidavitP.O. Box 1 IAA (i!t.19) <br />Santa Ana, CA 92702 <br />(71J) 6.17-sA00 <br />,viv.,r/ slT :l-:t:1t,aa <br />fhis document moy be lound at..h:il /',\),,',,,. se n if -a ra. c r': 'c b a. <br />oc^.- <br />4 Prooe <br />r.rSP-022!1laia <br />a.(d. <br />Owner <br />(Please use a black or blue ink ball-point pen) <br />Project Address <br />Permit N umber:c <br />i Property Owner: <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxlde (CO) alarms are installed in residential <br />bulldings. <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 req u ired loca tions. <br />f\ eotl, boxes below must be checked: <br />El Carbon monoxjde alarms: Are inst3lled outside of each sleeping area in the immediate vlcinity of <br />bedroor":rs anC also on each le'iel cf the C,rv:lling. Aiarnis are req,..lir:d in bedrcorns witn g3s-f reci <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 outside of a sleeprng <br />room, and on each level of the dwelling. <br />Retrofltted 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 Slate Fire l/arshall (SFlvl). Battery life must be 10 yeers. <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 alar,-':rs ha're been installed in compliance with the governrng <br />Codes and have been tested to be functional. l, also, hereby certify that I will ret3st the alarms per the <br />ma n ufa ctu rer's instructions. <br />Signatute:Dat ?: <br />U <br />t, <br />(check one)tr LiCensed Contractor <br />NOTE: fhls sef-c ertilicotion is only used for projects that dffect the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where occess to the intetio( of the dwelling by a Santa Ano <br />lnspector is not tequired. <br />Have this completed form and the job-card readily available on final inspection:-