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Planning & Building Agency <br />20 Civic Center PIaza Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana, CA 92702 <br />(7'14) 647-5800 <br />'N...sanla-ana.ot al <br />rNsP,02 2013 CRC <br />This document moy be found at h tto.i/,,,r,,r,'i. sa rtr -3n-i.o.q. ooa' <br />(Please use a black or blue ink ball-point pen) <br />Project Addres s: <br />Permit Number:totq€v <br />Contractor:6;.. 5,o\an-License #:o <br />State of California requires that smoke and carbon monoxlde (CO) alarms are installed in residential <br />buildings. <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 alarms. CRC Section R314.3 and R314.3,3 define <br />the required locatio ns. <br />4\ eo,h boxes betow must be checked: <br />SC"rUon 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 />fl 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 (5FM). 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 />m an ufactu rer's instruction s. <br />Signoture:3 o 2ot <br />lcheck onel Lice n se d Con tractor tr P ropert Owner <br />NoTE: rhrs self-certiJicotion is only used lor projects that aflect the ErTERIOR of the structure. This <br />process is opplicable ONLY to projects where access to the interior of the dwelling by a Santo Ano <br />lnspector is not required. <br />?oo K <br />J e <br />Dot e: <br />Have this completed form and the job-card readily available on final inspection! <br />Smoke & CO <br />Alarm AffidavitI <br />i Property Owner: <br />I <br />l L I