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Pla nning & Builcling Agency Smoke & CO <br />Alarm Affidavit <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1938 {lvl-19) <br />Santa Ana, CA 92702 <br />(714) 647-s300 <br />/l' , sznl.z-ane.at <br />ll]sP-02 20r3 cRc <br />f his document moy be t'ound at... htto //v,r,rrv. satta-ane orn.toca' <br />(Please use a black or blue ink ball-point pen) <br />1 Project Address:20tc+ w r, <br />Permit Number:-[ora16 (a{ <br />Property Owner: <br />I <br />License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u 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 requ ired locations.n th boxes beiow must be checked <br />Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the d,,,relling. Alarms are required in bedrooms vrrith gas-fired <br />applian CE (i.e. hot urater heater, cooktop, furnace) or a fireplace <br />moke 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 b attery-operated for buildings where no interior alterations are <br />performed. Combination 5moke/CO alarms must comply with all applicable standards and be approved <br />by th'e State Fire Marshall (5FM), Battery life must be J.0 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 atarms per the <br />m an u factu rer's instructio ns. <br />I signature: I Dote:j-t-t--r8 <br />(check onel Licensed Con ractcr tr Property Owner <br />NOTE: Ihls self'certiJicotion is only used for projects thdt offect the EXTERIOR ol the structure. This <br />process is applicable ONLY to projects where occess to the interior oJ the dwetling by d Sdnto Ana <br />lnspector is not tequired. <br />Contractor: <br />Have this completed form and the job-card readily available on final inspection! <br />I