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*-SNTA <br />NA <br />ILI\\NO <br />Etuutic <br />lmo <br />Planning & Building Agency <br />20 Civic Center Ptaza Ross Anner <br />P.O. Box 1988 (M.19) <br />Santa Ana. CA 92702 <br />(714) 647.5400 <br />www. saota-an a.orq <br />Smoke & CO <br />Alarm Affidavit <br />rrsp-c2 2013 CRC <br />This document moy be lound ot..httD./lwww. san ta-ana.o roi obar <br />(P/ease use a black or blue ink ball-point pen) <br />uJ513r0Project Address <br />Permit Number:i <br />I <br />Propert y Owner a- ttr. <br />Contractor Lice n se # <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 required locations. <br />Aeottr boxes below must be checked: <br />E Carbon monoxide alarms: Are instalted 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 />Ef Smokgalarms: 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. l, also, hereby certify that lwill retest the alarms per the <br />ma n ufacturer's instructions. <br />t1 <br />tr Licensed Contractor tr P pe Owner <br />NOTE: Ih,s serf-c ertification is only used for proiects thot offed the ErTERIOR ol the structure. This <br />process is applicable ONLY to projects where occess to the interior oJ the dwelling by a Sonta And <br />lnspector is not requircd. <br />Signoture <br />lcheck onel <br />4l\t,*,lp' <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />I <br />I ooter <br />I