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*,SNTA <br />NA,ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Bor 1984 (M-'19) <br />Santa Ana. CA 92702 <br />(714) 647.5800 <br />w,M.! St^13-?da ar! <br />Smoke & CO <br />Alarm Affidavit <br />rNSP42 2013 CRC <br />'This document fidy be found ot...h ft p://\M v. santa-a na.oro,/oba,' <br />(Prease use a black ot blue ink ball-point pen) <br />Project Address / FZo ,tS, /-o:s sll <br />Property Owner: <br />Contractor:t 6agq767-tttL Lromrq/Micense #: gelX rc <br />ull4rw ( 6tu1 LLiiliS+dE-* <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ildings. <br />California Residential Code (CRC) Section R314.1 and R315.2 states in part that existing d\,vellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />f\ ro,n boxes below must be checked: <br />rtrrsonmonoxide 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 />appliances (i. e. hot water heater, cooktop, furnace) or a fireplace. <br />6^oX"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 />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 prop€rty owner of the above project. I further cenify <br />that smok'e 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 I will retest the alarms per the <br />manufacturer's instructions. <br />lcheck onel Lice n se Contractor d Property Owner <br />NOTE: fhrs serr-ce rtiftcdtion is only used for projeds thot dtlect the EXfENOR of the stuclurc, This <br />process is applicable ONLY to projects where dccess to the interior of the dwelling by a Sonto Ana <br />lnspectot is not required. <br />Signoture:1,,^r*)**Dote /o/2+/2o2D <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />I <br />r Permit Number: | / o/ /o+V4+ <br />tr