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*-SANTA <br />NA <br />il\t\c <br />t Bt[.0t\G <br />.{ct\0 <br />Planning & Building Agency <br />20 Civic Cenler Plaza Ross Annex <br />P.O. Box 1 988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647.5800 <br />www.santa-ana.oro <br />Smoke & CO <br />Alarm Affidavit <br />hrt //www. santa-ana.or bai <br />(please use a black ot blue ink ball-point pen) <br />Project Address:2t ZL kr. E\M/ Av/ <br />Permit Number:lo \q11 LL <br />Property Owner:trLr, 7-,-r- t i \r.^r 5 \<-".... <br />Contractor:Ca\,6>,r,r,'rr FJ2F License #: 11t lS - <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 R315.3 define <br />the required locations. <br />f\soil, boxes below must be checked: <br />E 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 recommended in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />E Smoke 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 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. <br />(check onel tr Property Owner <br />Signature:Date <lsl*'l <br />Have this completed form and the lob-card readily available on final inspection! <br />This document moy be lound at... <br />Licensed Contractor <br />NOTE: Ihis sef-certificotion is only used lor projeds thdt dffect the EXTERIOR ol the strudure. This <br />process is applicoUe ANLY to projects where access to the interior of the dwelling by o Sonto Ano <br />lnspector is not required.