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*-SANTA <br />NAqffi <br />a t.a <br />Planning & Building Agency Smoke & CO <br />Alarm 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 />www santa-ana orl <br />INSP.O2 20] 3 CRC <br />This document moy be lound at htlpllu,rmv. santa-ana.oro/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:\0 Fl BoV..,- S+ -s qzid= <br />zofl Lo\D <br />N\\--.\_- -i)e"-az,> <br />J l,q.License #:!J 1A <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild in gs. <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 />A aoar, boxes below must be checked: <br />tsCarUon 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 rn bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />E S.ot " alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <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 mustcomply 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 project. 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, aiso, hereby certify that I will retest the alarms per the <br />manufacturer's instructions, <br />Signoture: <br />lcheck onel Licensed Co ntractor r Property Owner <br />NOTE: fhrs self-certification is only used lor projects thot dffect the EXTERIOR of the structure. This <br />prccess is dpplicoble ONLY to projects where occess to the interior ol the dwelling by o Sdnta Ana <br />lnspector is not required. <br />Permit Number: <br />Property Owner: <br />Dote:z 2DLT <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />I <br />I <br />Contractor: <br />tr