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,^-SANTA <br />NA <br />Ptr\\llc <br />& 8iltDIG <br />rct\t1 <br />Planning & Building Agency Smoke & CO <br />Alarm Affidavit <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />www santa-ana.orq <br />INSP,O2 2013 CRC <br />This document moy be found ot..http://www.santa-ana.o rqlpbal <br />(Please use a black or blue ink ball-point pen) <br />State of California requires that smoke an carbon 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 required locations. <br />A eottr boxes below must be checked: <br />F,CarUon 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 />Q 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 lwill retest the alarms per the <br />manufacturer's instructions. <br />lcheck onel tr Licensed Contractor Property Owner <br />NOTE: Ih,s serf-certification is only used for projeds thot ollect the EXTERIOR oI the structure. This <br />ptocess is opplicable ONLY to projects where access to the interior of the dwelling by d Sdnta And <br />lnspector is not rcquired. <br />Project Address:41 o s trJ. t-L"uu'l Lr ^rcPermit Number:lol4.tq-1 7 I <br />Property Owner:€n*( ltenvtti ..4, Ot' <br />Contractor:atuG",(d#A License #: j-l t 5 3 <br />Signdturc t1 <br />)(a f)Dote -/ <br />Have this completed form and the job-card readily available on final inspection! <br />I <br />I <br />I <br />I <br />I