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20 Ci./ic Ce6ter Plaz3 Rosi An.er <br />Plannin g & Building Agtncy Smoke & CO <br />AIarm AfficlavitP.O. Box '1 333 (iU-19) <br />Santa Ana, CA 92702 <br />(711) 6.17.sA00 <br />,/u,,arv.s ai:.1-at :l cr <br />This document mqy be frund o'!..h:il / ,),,)sa n:i - l.r i. r'I c5a <br />li.JsP-c22!r3CPa <br />P ro oerty O,/vn e r <br />(Please use a black or blue ink ball-point pen) <br />LZO e- 5l <br />iN <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed ln residential <br />buildings. <br />California Residential Code (CRC) Section 8314.1 and R315.2 states in part that existing dwe lings be <br />"retrofitted !,/ith smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the req u ired loca tions. <br />fr ,orn boxes below must be check:d:JA Carbon monoxide alarms: Are instalied outside of each sleeping area in the immediate vicinity of <br />beC oor:rs anC also on e:ch le,;el of the C, 2lling. Ala:nrs are reqr.tirrC in beCrccrns wit;r g:s-flred <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />Flsmoke alarms: Are inslalled ir e.rch roor:r used ior sleeping. in e:cl' hall'rv:7 or,t;ide of a sleeprng <br />room, and on each level of the dwelling. <br />Retrofitted detectors may be batter.y'-operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarms must comply with all appllcable standards and be approved <br />by the State Fire Marshall (SF&-l). Battery life must be 10 years. <br />I hereby certif.T that I am the contractor or the property owner of the above project. I further certify <br />that smoke alarms and carbon monoxide alarms ha're been installed in compliance with the governing <br />Codes and have been tested to be functionai. l, also, hereby certify that lwill retest the alarms per the <br />manLf act,rrer's instructions. <br />Signature:Dote:t, <br />lcheck one)tr Licensed Con tr'?ctcr <br />NOTE: Ihrs self-certificotion is only used for projects that affect the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where access to the interiot of the dwelling by a Santa Ana <br />lnspectcr is not required. <br />Have this completed form and the job-card readily available on final inspectionl <br />Pr.oject Ad dress <br />0l 1 \-,Permit N umber: <br />Prope rty Owner: <br />N/a