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*,,SNTA <br />NAqffii <br />frk'rlt"'q' <br />{3954 'tn' ' r, <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex Smoke & CO <br />Alarm AffidavitP.O. Box 1988 (M.19) <br />Santa Ana, CAS2702 <br />(714)647-5800 <br />www.santa-ana.orq <br />INSP.O2 2013 CRC <br />This document mdy be found dt...http ://w.rvw. sa nta-ana.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:t1z2-lnzq uJ. -r*{4 €$-. <br />Permit Number:to9bq50 <br />Property Owner:Tqn GonzalsZ- <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ild ings. <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\,o. <br />ilc"raon <br />h boxes below must be checked <br />monoxide alarms: Are installed outside o Glt""pin area in the immediate vicanity of <br />and also on each level of the dwelling. Alarms are required an bedrooms with gas-fired <br />(i.e. hot water heater, cooktop, furnace) or a fireplace. <br />alarms: Are instal di used for slee n hal outside of a sleeping <br />bedrooms <br />a p pliances <br />/s,,not"a <br />TOOm,on eac h level of the dwe tng <br />Retrofitted detectors may be batte ry-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)Ba rY ife must be 10 year s <br />I hereby certify that I am the contractor o <br />that smoke alarms and carbon monoxide alarms ave een r nsta <br />f the above project. I further certify <br />lled 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 ufacturer's instruct <br />(check onel ensed Co EF Property Ownerc <br />NOTE: Ihrs sef-certilication is only used lor projects thot dlfect the EXTERIOR of the struclure. This <br />process is applicoble oNLY to ptojects where occess to the interior oI the dwelling by a sontd Ana <br />lnspector is not required. <br />eac <br />he property owner <br />Signdture:Ddte:oa/oaft,oD <br />cto r <br />Have this completed form and the job-card readily available on final inspection! <br />(