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Planning & Building Agency Smoke & CO <br />Alarm Affidavit <br />20 Clvic Center Plaza Ross Annex <br />rNSp-02 2013 CRC <br />This document mdy be found at htto.i, r,v",,ilv. san ta-a na.o rqloba,/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:0 <br />Permit Number:D 00q <br />Property Owner:h <br />Co ntractor:License #:[z'l0 <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu 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 u ired locations. <br />f,\ ao*' boxes below must be checked: <br />Fcarbon 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 />I <br />Ssmoke 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 prolect. I further certify <br />that smoke alarms and carbon monoxide alarms have been installed in compliance with the governlng <br />Codes and have been tested to be functional. l, also, hereby certify that lwill retest the alarms per the <br />m a nufacture r's instruction s. <br />Signdture:7,(f <br />(check onel License d Contractor E P opert Owner <br />NoIE This self-certificotion is only used lor projects thdt dffect the EXTERtoR ol the structure. This <br />process is opplicoble ONLY to projects where occess to the interior oJ the dwetling by o Santo Ana <br />lnspector is not required. <br />/-,/_Da te: <br />Have this completed form and the job-card readily available on final inspection! <br />P.O. Box 1988 (M.19) <br />Santa Ana, CA92702 <br />(714) 647-s800 <br />,&Ytl/. s3n ta-a n a. ol al <br />tr