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**$NTA <br />NAffi <br />Planning & Building Agency <br />20 Ci./ic Center PIaz., Ross Annex <br />P.O Box 1983 (M-19) <br />S.nta Ana. C,A 92702 <br />(7 r l) 647.5400 <br />wldr& ! 1. r 1_ 1.-, alr,.l <br />r..i ltP <br />fhis document moy be lound dt... <br />(Please use a black or blue ink ball-point pen <br />Project Address: lZ-lr3 W. /nru, L e- <br />Contractcr:License #: <br />St3te of California req,rires that smoke and carbcn nonoxide (CO) alarms are inst:lled in residential <br />b u ild ings. <br />California ResidentialCode (CRC) Section R314.1rnd R315.2 states in part that existlng dwellings be <br />"retrofitted with sfi.oke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the req u lred location s. <br />A eoai boxes below must be checked: <br />tr0Carbon monoxide alarms: Are instilled outsrde of each sleeping area rn the immediate vicinity of <br />Jedrooms and also on each level of the dwelling Aiarms are required rn bedrooms with gas-fired <br />gplrances (i.e. hot waler heater, cooktop, furnace) or a fireplace. <br />psmote alarms: Are installed in elch room used for steep,ng, in each hallway or,tside of a sleeping <br />.bom, and on each level of the dwelling. <br />Retrofitted detectors may be battery-operatad for buildings where no anterior alterations are <br />performed. Cornbination Smoke/CO alarms must comply with all applicable st3ndards and be approved <br />by the State Fire tularshall (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 carbon monoxide alarms rave been instailed in compliance with the governrng <br />Codes and have been tested to be functional, l, aso, hereby certify that I will retest the alarms per the <br />manufacturer's instructions. <br />Signoture: <br />lcheck one)Licen sad Contracto' <br />lu <br />NOTE: Ihis self-certification is only used lor proj?cts thdt affect the EXT <br />process is applicable ONLY to proiects where access to the interior of th <br />lnspector is not required. <br />Prope!'ty Owner <br />ER\oR ol the structure. fhis <br />e dwblting by d Sdntd Ano <br />Have this completed form and the job-crrd readily available on final inspection! <br />Smoke & CO <br />Alarm Affidavit <br />P"r.,,1..!"r,_ 2dJll Ztgzy' <br />Property Owner: IrALI/r4: <br />Date: <br />tr