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*,SAI'[A <br />NA.ffi <br />Planning & Building Agency Smoke & CO <br />Alarm AffidavitP.O. Box 1gEA {M- 19 ) <br />Santa Ana. CA 92702 <br />(7!4)647.5a00 <br />www santa.ana or|] <br />rNSP-o:2'llllPa <br />fhis document mqy be found ot. <br />(Please use a black or blue ink ball.point pen) <br />Project Address: <br />hil: 'r,',,,'r, s: n ta -a na.orq/pba,' <br />IC IIC (.2 a, <br />Property Owner:f€odct,; QtlyiNJ <br />Contractor:License #: <br />State of California requir:s that smoke and c:rbon monoxide (C0) alarms are installed in residential <br />buildings <br />California Residential Code (CRJ) Section RSLl l and R315.2 states in pdrt that existinB d'I/ellrngs be <br />"retrofitted with smoke alarms and carbon nonoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required loca tions. <br />/j E eoth boxes below must be checked; <br />EI Carbon monoxide alarms: Are installed oitiid: of elch sleeping area in the immedlate vicinit'7 of <br />bedrooms and also on each level of the dwellrnt Alarms are required in bedrooms with gas-fired <br />appliances (i.e. hot water hetter, cooktop, f:rnace)or a fireplace. <br />,BS.ote alarms: Are installed in each room used for sleeping, in each hallway outsade of a sleeping <br />room, and on each level of the d',velling <br />Retrofitted detectors may be ba trery-operaieC 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), Bdttery 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 alarrns have been installed in compliance with the governrng <br />Codes and have been tested to be functional.l, also, hereby certify that lwill retest the alarms per the <br />manufacturer's instructions. <br />lcheck onel Licensed Contractor q Property owner <br />Permit Number: <br />Signature: l- /.. .'1,' t :.:12,\,.,.4..--l\Date:/tlc.2. ,)b) o <br />Have this completed form and the iob-card readily available on final inspection! <br />I <br />20 Civic Center Pl,rz: Ross Anrer <br />I I <br />I <br />tr <br />NOTE: fhis sef-c ertificotion is only used for projects thot aflect the ExTERIoR of the strudure. This <br />process is applicable ONLY to projeds where occess to the interiot oI the dwelling by a Sant(, Ano <br />lnspector is not requircd.