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;*$Al'lTA.AI{Ajffi <br />Planning & Building Agency <br />20 Civic Ceoter Plaza Ross Annex <br />P.O. Box 1ga8 (M-19) <br />Santa Ana. CA 92702 <br />(714) 647.5800 <br />Smoke & CO <br />Alarm Affidavit <br />t3 -a i a. cr:t <br />This document moy be lound dt h ii::/,",,r',,,",v. sa n ta -a na.o rc.'cb a,, <br />/.L <br />rNSP-02 2a1l CRC <br />(Please use a black or blue ink ball-point pen) <br />Project Address (o,,4 <br />Permit N umber:,n /1[ ]o <br />Prope rty Owner:tn1, <br />.-1 <br />rn 5 <br />ana{ <br />License #:(A /- <br />,k'c2:: <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 requ ired locations. <br />f\ eo,rl boxes betow must be checked: <br />arbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />oorns anC also on each level of the C,welling. Alarmi are required in bedroor-;rs with gas-f rec <br />pliances ii. e. hot water heater, cooktop, furnace)or a fireplace <br />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 altera ons 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 ha're 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 />ma n ufacturer's instructions. <br />5ig noture:Dote e-t7-l( <br />(check onel tr Property Owner <br />NOTE: fhrs sef-c ertifi cotion is only used lor projects thdt oflect the EXTERTOR of the structure, This <br />process is applicable ONLY to projects where occess to the interiot of the dwelling by a Sontd Ana <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspectionl <br />Contractor:/1 <br />Licensed Contractor