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*,SNTA <br />NA <br />[r\lnG <br />tHlJil{ <br />lGTIfl <br />Planning & Building Agency <br />20 Civic Csnter Plaza Ross Annex <br />P.O. Bor 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647-s800 <br />Smoke & CO <br />Alarm Affidavit <br />rNsP-02 2013 CRC <br />fhis document moy be lound ot... <br />(Please use a black or blue ink ball-point pen) <br />Project Address:zSto -D (d3;n itc."- ( ) . <br />Permit Number:to(qS ( So <br />Property Owner:fl/or. Kur T .,/o ,4/ ,(ro , <br />Contractor:(aoFErsro&t !y!,:r,i , ^,,Liceriderl' gc1 oqtl <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <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 ro,r, boxes below must be checked: <br />EI 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 />d 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 />manufacturer's instructions. <br />lcheck onel rce n se d Contractor Pr pe Owner <br />NOTE: This self-certificotion is only used lor projects that ofled the EXIERI0.R of the strudurc. This <br />process is applicable ONLY to projects where gccess to the inteiot ol the dwelling by o Sonto Ano <br />lnsPedot is not requircd. <br />Signdture:a Ddte:,,/rr,l y <br />Have this completed form and the job-card readily available on final inspection! <br />^-=>