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Planning & Building Agency <br />P.O. Box 1988 (M-l9) <br />Santa Ana, CA 92702 <br />(7 't4) 647 -5E00 <br />,r/'/^/,r. s a n ta-aa a.oraJ <br />Smoke & CO <br />Alarm Affidavit <br />Permit Number: <br />Property Owner: <br />Contractor:),lne{License *, 137btC <br />rfrsP-02 2013 cRc <br />This document moy be found at h ttc./i,,1 ,,r.,v. sa n t a-ara.o,q,tobal <br />(PIease use a black or blue ink ball-point pen) <br />Project Address:IClq \1.)l+Sr <br />tul OZ <br />l6yrEd <br />State of California requires that smoke and carbon monoxide <br />S'r5 <br />(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 <br />"retrofitted with smoke alarms and carbon monoxide atarms. CRC Section R314,3 and R314.3.3 define <br />the req u ired locations. <br />4) eotir boxes betow must be checked: <br />El 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 required in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />Vsmoke 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 certlfy 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. I , also, hereby certify that I will retest the alarms per the <br />m a n ufacturer's instruction <br />(check onel Licen sed Cont racto r Pro perty Owner <br />NoTE: Ihrs seff-certificotion is only used lor projects that olfect the EXTERIOR ol the structurc. This <br />process is opplicoble ONLY to projects where access to the interior of the dwetting by a Santo Ano <br />lnspector is not required. <br />Signoture:i Dote:-1 12u le> <br />Have this completed form and the job-card readily available on final inspection! <br />lfficl <br />20 Civic Center PIaza Ross Annex <br />CS.^icrasf.S <br />I