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Planning & Building Agency <br />20 Civlc Center Plaza Floss Annex <br />P.O. Box 198E (Mn9) <br />Santa An8, CA 92702 <br />(714) 647-58fi) <br />$rlNW.Sa nla-ana. oro <br />This document moy be ,ound oa..http:i/www nla-ana.oro/oba/ <br />(please use a black or blue ink ball-point Wn) <br />8W <br />q <br />Property Owner:o <br />Contractor;cense #: <br />State of California requires that smoke and carbon monoxide (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 R315.3 define <br />the required locations. <br />A* *ro below must b€ checked: <br />QC.rton 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 />ESmoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />room, and on each level ofthe 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 proiect. I further certify <br />that smoke alarms and carbon monoxlde alarms have been installed in compliance with the governing <br />Codes and have been tested to be functional. <br />har a^ I <br />Signdturc:,a a/\^o Y.-<{Ddte: <br />lcheck onel o Licensed Contractor Property Owner <br />NOIE: This seff-certificotion is only used lor proiects that alfect the EXfERtoR of the strudurc. This <br />process is opplicobte ONLY to projects where dccess to the interior oI the dwelling by o Sonto Ano <br />tnspector is not required. <br />Have this completed form and the iob-card readily available on final inspection! <br />Permil Number: <br />LCLSO <br />8- rt- i <br />,-*SANTA <br />ANA-,ffifi <br />l <br />Smoke & CO <br />Alarm Affidavit <br />I eroPct Address: I <br />1 I <br />I