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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box'1988 (iU.19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />'.l ,T /i sIn:a-ar:n.ari] <br />Srnoke & eO <br />A t^-- A!l:J^,,:rFtlcrtrll Al I ludvlL <br />This document may be Jound at...htlcti !\,.,'r,,i. sa ata-a na.oro, <br />(p/ease use a black or blue ink ball-point pen) <br />/(/ 1 Rt-L l--^,1 A.r. <br />Permit Number:,/2flo'3,o /z <br />\ esa / c, e --,, <br />Contractor:Clo,- Ir:1,^'\;'te-License #:/o fr"1t <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residentral <br />bu ildings. <br />California Residential Code (CRC) Section R314.1 and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon rnonoxide alarms. CRC Section R314,3 and R315.3 define <br />the requ ired locations. <br />/\\# E eoth boxes below must be checked: <br />Bl Carbon 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 recommended in bedrooms with gas-f;red <br />appliances (i. e. hot water heater, cooktop, furnace) or a fireplace. <br />E Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />room, and or each level of the dwelling. <br />Retrofitted detectors may be battery-operated for bulldings 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). Batteri life must be L0 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. <br />(check one\tr'Licensed Co ntracto r Pro perty Owner <br />NOTE: This self-certificatian is only used for prcjecB thot offect the EXTERIOR of the structure. This <br />process is dpplicable ONLY ta prcjects where dccess to the interior of the dwelling by a Sontd And <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />Signoture:Zan Dote: <br />Project Address: <br />Property Owner: <br />] <br />I <br />.7