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Planning & Building Agency Smoke & CO <br />Alarm Affidavit <br />20 Civic Center Plaza Ross Annex <br />lflsP-02 2013 (:RC <br />This document may be Jound at,..hiio / .,.t ;;,,t sa nl-a- a n a.o rq t c o a., <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address: <br />Permit Nurnber:o <br />a tA e <br />Contractor: <br />State of California requires that smoke and carbon monoxide (Co) alarms are installed in residential <br />b u ildings. <br />California Residential Code (CRC) Section R314.1 and R315.2 states in part that existing dwellings be"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3,3 define <br />the req u ired locations. <br /># tleoth boxes below must be checked: <br />E}4arbon 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 in bedrooms with gas-fired <br />appliarrces (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />E{moke 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 areperformed. 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 property owner of the above p roject. I further certify <br />that smoke alarms and carbon monoxide ararms have been insta[ed in com pliance with the govei-ning <br />Codes and have been tested to be functional. l, also e i-e by certify that lwill retest the alarms per the <br />man ufactu rer's instructions- <br />(check onel L tce ns Con c to r tr Property owner <br />NOTE: This self'certiJicotion is only used for projects thc/t dffect the EXfERtoR of the structure. Thisprocess is applicdble 0NLY to proiects where dccess to the interior ol the dwetling by o sdnta Ano <br />:nspector is not fequired. <br />License #:2-a ioxc< <br />/uL I Co o <br />Signoture:Date:-L-1s -Z-a <br />Have this completed form and the job-card readily available on final inspection! <br />P.O. Box 1988 (M-'19) <br />Santa Ana. CA 92702 <br />(714) 647.s800 <br />vt rl' 54at 1-aqa ol._t <br />Property Owner: