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*-SAIIA <br />NAffi <br />Planning & Building Agency <br />20 Civic Center Plaza Rosi Anner Smoke & CO <br />Alarm AffidavitP.O. Box 1ga8 (M.19) <br />Santa Ana, CA 92702 <br />(714) M7.5800 <br />,r'nr& slnll.rit )rt <br />ll.tsP-0]2arIcRC <br />fhisdocument moybe lound ot... l':1 ,,, ,,,,) : l: ::l - ? - t :, . t : : l <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address: <br />lcheck onel w Licensed Contractor <br />/? <br />Permit N umber: <br />Property Owner:Z4/2 <br />Contractor:4 lnJ /)License #: <br />state of california requires that smoke {^i:fr*^monoxide (co) alarms are installed in residential <br />b u ild ings. <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 requ ired locations. <br />f\ aott' boxes betow 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 />El 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. lfurther 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 />ma n ufacturer's instructions. <br />Siqnoture: <br />Property Owner <br />a. rzt 'o, dz OC tl./ <br />NOTE: fhrs self-certification is only used for projects that alfect the ErTERtoR of the structure. This <br />Process is applicable ONLY to projects where occess to the interior of the dwelling by o Sontd And <br />lntpector is not requircd. <br />j Dote:.l 2z /rrl) <br />Have this completed form and the job-card readily available on final inspection! <br />la- to t? zt ctu ) <br />.l <br />tr