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Planning & Building Agency <br />20 Civic Center Pla2a Ross Annex <br />P.O. Box'1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />w.]v'& santa-ana orq <br />Smoke & CO <br />Alarm Affidavit <br />INSP-02 2013 CRC <br />This document moy be found ot http :/,/wMr. sa nta-ana.orq/pba,' <br />(P/ease use a black or blue ink ball-point pen) <br />Lt\l Cs&r (t- <br />Permit Number: <br />Property Owner:--(.**,o.-P,.,, i 'bo.,,J (\Acli+. ,,tc," <br />Contractor:I License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bulldings. <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 />f| soatr boxes below must be checked: <br />U. <br />FtCarbon 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 />appliances (i. e. hot water heater, cooktop, furnace) or a fireplace. <br />E Smot e 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 monoxide 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 />ma n ufactu re r'ti <br />Licensed Contractor Prope Owner <br />NOfE: This seff-certificdtion is only used Ior projects thot allect the EXTERIOR of the structure. This <br />process is oppliedble ONLY to projects where access to the interior of the dwelling by a Sdnto Ano <br />lnspector is not required. <br />Signdture:Ddte:t 7tw <br />*,,SANTA <br />NA-',h,ffi <br />Project Address: <br />(check onel <br />"'----'--2.-.-- <br />Have this completed form and the job-card readily available on final inspection!