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*,SANTA <br />A}{Affi <br />2C Civic Center PlazJ Ross Annex <br />Planning & Building Agency Smoke & CO <br />Alarm AffidavitP.O Box 1933 (M-'19) <br />Santa Ana, CA 92702 <br />(71r) 6J7.5a00 <br />,, ! t il_ l.l'l : 1 <br />fhis document mdy be lound at <br />(please usa a black or blue ink ball-point pen) <br />s I ^:-1-t ^: t' <br />Project Ad dres s <br />Property Owner:at <br />3 (,t a v <br />-1 <br />,\ <br />Contractcr ()License *: V1 ) Z 7 <br />St3te of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild in gs. <br />California Residential Code (CRC) Section R314.1and R115.2 states in pa.t that existing dwelling5 be <br />"retrofltted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R315.3 define <br />the requ ired locations <br />rfl\ eo,i, boxes betow must be checked: <br />{S(Carbon monoxide alarms: Are init3lled outside of each sleeping are3 in the immediat3 vicinity of <br />bedrooms and also on each level of the dwelling. Alarms are recommended in bedrooms witn g3i-iired <br />appliances (i.e. hot w3ler heater, cooktop, furnace)or a fireplace. <br />6Srnok. alarms: Are initrlled ;n e.:ch room used for sleeping, in each hall,,rray outside ot a sleeprng <br />room, and on each level of the d,relling. <br />Relrofitted detectors may be ba tte ry-operated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be appro'red <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 oI the above project. I lurther 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 />Signdture:<-?.t-> <br />lcheck one)P' Licensed Co n tractor tr P roperty Owner <br />NOTE: This selFcertificdtion is only used lot projects that dffect the EXIERIOR ol the structure. fhis <br />process it applicoble ONLY to projec$ where access to the interiu of the d'uelling by a Sonld Ana <br />lnspectot is not required.tHave this completed form and the job-card readily available on final inspection! <br />Permit N umber: