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*-SANTA <br />NA <br />Ilr\lt\C <br />ur.Dn6 <br />l0N1 <br />Planning & Building Agency Smoke & CO <br />AIarm Affidavit <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />wwY,/ sa nt:l.a n a otq <br />fhis document may be lound ot.,,http ://u^./v/.sa nta-ana.orq/pba1 <br />(Please use a black or blte ink ball-point pen) <br />€to s B,{uvw) <br />2o t 1z +03Permit Number: <br />Property Owner:O t-Lr-r (v <br />Contractor:f,(S o oslg AyCKtC w to q1License #: <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) 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 />4\gott boxes below must be checked: <br />-L <br />F\a+ton 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 required in bedrooms with gas-fired <br />ap liances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />ke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />oom, 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 pro.iect. I further certify <br />that smoke alarms and carbon monoxide alarms have been installed in compliance with the governing <br />Codes and have been tested to be functional, l, also, hereby certify that lwill retest the alarms per the <br />man ufactu rer's instructions <br />(check onel Licensed tractor tr Prope Owne <br />NOfE: This self-certificotion is only used for projects thdt olfed the EXTERIOR ol the strudure. This <br />process is applicdble ONLY to projects where occess to the interior of the dwelling by a Santo Ano <br />tnspector is not requhed. <br />Signoture:tL/ <br />Have this completed form and the job-card readily available on final inspectionl <br />Project Address: <br />I <br />I <br />Dote: