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*nsAl[A <br />NAffi <br />Planning & Building Agency Smoke & CO <br />Alarm Affidavit <br />20 Cavic Center Plaza Ross Annex <br />P.O. Box 19AA (lrrl-19) <br />Santa Ana. CA 92702 <br />(7r.1) 647-5800 <br />w ,t/.,! s 1.l l,l r. I )r1 <br />rNSP-02 2013 CRCl::: ,,,,',,', s,r:"r:.r-?-I l.: 3:l <br />(P/ease use a black or blue ink ball-point pen) <br />7 3 sta 4 Fr a-LTrl ,4, L .7?'A .i2 7.t/ <br />Permit Number:/Ol .tS_ / z(? <br />Property Owner:\ ot/tzo tt,;, { / atg n44a / <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxjde {CO) alarms are installed in residentjal <br />b u ildings. <br />California Residential Code {CRC) Section R314.1and R315.2 states in part that existing dwellings be <br />"retrofitled with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the req u ired location s. <br />{\ro*, boxes below must be checked: <br />d C"rUon 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 />agFliances (r. e. hot water heater, cooktop, furnace)or a fireplace. <br />l <br />Cl S-oke alarms:Are installed in each room used for sleep;ng, in each hallway outside of s 5lssprpg <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 Srate Fire lvlarshall (SFM). Battery life must be 10 years. <br />I hereby certify that I am the contractor or the property owner of the above pro.iect. 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 />man ufactu rer's instructions. <br />Signoture:Da t e l-\6- <br />lcheck onel tr Lrcen sed Contractor .Q|l P roperty owner <br />NoTE: rhis self-certificdtion is only used for proiects that dffect the ExTERtoR ol the structure. This <br />process is opplicable ONLY to projects where occess to the interior of the dwelling by d Santa A,na <br />lnspector is not requited. <br />Have this completed form and the job-card readily available on final inspection! <br />This document moy be found ot... <br />Project Address: <br />ax Y