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,-,'SANTA <br />NA,'}fl^H <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box '1988 (M-19) <br />Santa Ana. CA92702 <br />(714) 647-5800 <br />www.santa-an a.orq <br />Smoke & CO <br />Alarm Affidavit <br />INSP.O2 2013 CRC <br />This document moy be lound at...hrt //www. sa nta-a n a.o bal <br />(Please use a black or blue ink ball-point pen) <br />Project Address: <br />Permit Number:lC.r L1 ) <br />(!&cie-.. <br />V . ;i{r (Y!r.}\ <br />c*j=- lt^I L /\ c\''-'l-.' <br />State 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 R314.1 and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />A eotn 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 required 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. l, also, hereby certify that I will retest the alarms per the <br />man ufacturer's instructiorp <br />lcheck onel tr Licen sed Contracto r Property Owner <br />NOTE: Ihrs self- certilicotion is only used for projects that affect the EXTERIOR of the structure. This <br />process is opplicoble ONLY to projects where occess to the interior of the dwelling by o Sontd And <br />lnspector is not rcquired. <br />Signoture:Dote:C {tl,> <br />Have this completed form and the job-card readily available on final inspection! <br />Property Owner: I <br />Contractor:License #: .l I Ii l(_