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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (tul-19) <br />Santa Ana, CA 92702 <br />(714) 647-58A0 <br />,rv'l/y/ sant3-ant.orq <br />Smoke & CO <br />Alarm Affidavit <br />ri\rsP,02 2c13 cRC <br />This document mdy be found ot...httO. //,,,r.,,r,,,r. S a nta -a na. o rqi oca' <br />(Please use a black or blue ink ball.point pen) <br />Project Address: <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 R314.1and 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 req uired locations. <br />,n <br />d I eotn boxes below must be checked: <br />E 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. AIarms are required in bedrooms with gas-fired <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 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 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 project. I further certify <br />that smoke alarms and carbon monoxlde alarms have been installed in compliance with the governing <br />Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the <br />m a n ufacturer's instructions. <br />lcheck onel Lice n sed Contracto r Property Owner <br />process is opplicable ONLY to projects where access to the interior of the dwetting by a Sdnta Ana <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />oltv<_ <br />Permit Number: <br />Prope rty Owner:LcI?(Cd-r''r<2,,< AC)+'r <br />Contractor: <br />Signdture:(Dote:/t r- -2b- )4 <br />[i[lIIG <br />-IMIfl <br />License #: <br />tr tr <br />I