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*-SAI[[A <br />NA <br />lll\\N <br />.IBTIIJI\I, <br />t[RO <br />o <br />Planning & Building Agency <br />20 Civic C€nter Plaza Ross Annex <br />P.O. Box l96E (tl-l9) <br />Santa Ana, CA 92702 <br />(714) 647.5800 <br />L.,.\ iI.1:r ,i-:, :/l <br />Smoke & CO <br />Alarm Affidavit <br />This document may be lound ot.., <br />Permit Number:l0t <br />N.B a 5 <br />(please use a black or blue ink balt-point pen) <br />Project Address:o/ <br />4{1,{ <br />a <br />o <br />Property Owner:cch4 <br />Contractor:Nt Cor arok-lo License *:bY37oO <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ildings. <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 eo,l, boxes below must be checked: <br />flSarton 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 />fA.Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeprng <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. <br />Sig noture:Zuur,.^j)c /f,,1 ', )-=l-ry <br />lcheck onel tr Licensed Contractor q Property owner <br />NOTE: Ihts sef-certificotion is only used lor proleds thot olfect the EXTERIOR ol the structure. This <br />process is opplicoble ONLY to projects where occess to the inteiot ol the dwelling by o Sonta Ano <br />lnspectot is not requhed. <br />t <br />t\n + <br />Dote <br />Have this completed form and the job-card readily available on final inspection! <br />)