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**SANIA <br />NAffi <br />Plan ning & Building Agency <br />20 Cr./rc Center Plazl Ross Annex <br />P.O B)x 1983 {M-19) <br />Santa Ana. CA 92702 <br />(7 r {) 6.17.5400 <br />,lv.e.u ll.rl-r.l trl <br />Smoke & CO <br />Alarm Affidavit <br />r., S <br />fhis document mqy be lound at ht) r ',,,.,\/ \, 311:1-3-3 3r1,3[3 <br />(Please use a black or blue ink ball-point pen, <br />Project Address: E!3 v{HNr 5r <br />Permit Number: ; /D/D fizr <br />Property Owner: NtCUtr , AX/7 <br />Contractor:cense #://ao?fZ <br />St3te of Califcrnia requires that smoke and cai'b,:n rnonoxide (CO) alarms are inst:lled in residential <br />b u ild ings. <br />California Residential Code (CRC) Sect on R 314. 13nd R315.2 states in part that existlng dwellings be <br />"retrofitted with srnoke alarmi and carbon monoxide alarms. CRC Section R314,3 and R3l:1.3.3 define <br />the requ ired locations. <br />f)"*n boxes betow must be checked: <br />Ef Carbon monoxide alarms: Are inst3lled outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the dwelling Alarms are requirad in bedrooms with gas-fired <br />agglynces (1. e. hot water he:ter, cooktop, furnace) or a fireplace. <br />O Smote alarms: Are instarled in e:ch room used for sleeprng, in eich hallway outside of a sleeping <br />room, and on each level of the dwelling. <br />Retrofitted detectors may be ba ttery-operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarms musl comply with all applicable st3ndards and be approved <br />by the State Fire Marshall (SFM), Battery life must be l0 years. <br />I hereby certify that I am the contractor or the poperty owner of the above project. I further certify <br />that smoke alarms and carbon monoxide alarms rave been installed in comp ance with the governing <br />Codes and have been tes to be functronal. l. a so, hereby certify that I will retest the alarms per the <br />manuf acturer's instructi <br />Signdture:2aazz> <br />lcheck onel L,censed Con tracto tr Property O ner <br />NOTE: fhis self-certificdtion is only used for prcject: that dllect the E)(TERIOR ol the structure. This <br />process is opplicoble ONLY to proiects where acess to the interior of the dwelling by o Santd And <br />lnspector is not requited, <br />Oote: /O t <br />Have this completed form and the job-card readily available on final inspection! <br />5