Laserfiche WebLink
fr <br />^/ALPlanning & Building Agency <br />20 Civic Center Plaza Rcss Annex <br />P.O. Box '1988 (M-r9) <br />Santa Ana. CA 92702 <br />(714) 647.5800 <br />w rVl! Slr!.1-:t.:l ail <br />INSP,O2 2O I.] CRC <br />This document mqy be found qt <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address: <br />License #: <br />State of California requires that smoke and carbon monoxide (CO)alarms are installed in residential <br />b u ild in gs. <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 />d)r^nboxes betow must be checked: <br />d C"rbon monoxide alarms: Are installed o.tside of each slee <br />bedi'ooms and also on each level <br />a p p/ia nces (i. e. hot wate'heater <br />E smoke alarms: Are instdlled r <br />rn n the immediate vicinity of <br />of the dwelling. Alarms are required in bedrooms with gas-fired <br />, cooktop, furnace) or a flreplace. <br />o cn used for sleeping, in a llwa outside of a slee prng <br />CO a la rms mus <br />room, and on each level of the dwe rng <br />Retrofitted detectors may be batte ry-operated for buildings where no interior alterations are <br />perfo rmed. Combination Smok <br />by the State Fire Marshall (SFl\4 <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 />ma n uf actu rer's structio ns <br />Date *f lL, )r tt <br />(check one)tr Licensed Contractor Pro perty Owner <br />NOTE: fhis self-certificdtion is only used lor projects thdt offect the ErTERIOR ol the structure. This <br />process is applicoble ONLY to projects where access to the interior of the dwelling by d Santa Ano <br />lnspector is not requited. <br />flAtp( PS|Y {frN\fr tufr $ltto)€!a e /Permit Number: <br />Property Owner Oeu'l RaGKI <br />Contractor: <br />rea <br />each eac h <br />Signature <br />Have this completed form and the iob-card readily available on final inspection! <br />**SAI\rlA <br />NA'ffi <br />Smoke & CO <br />Alarm Affidavit <br />r,r\',, Sa n l:f -a'e an'caa' <br />with all applicable standards and be approved <br />rnust be 10 ye3