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*,SNTA <br />NAq'ilt <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annet <br />P.O. Bor 1S88 (M-l9) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />www. santa-ana. oaq <br />Smoke & CO <br />Alarm Affidavit <br />IIJSP{2 20] 3 CRC <br />fhis document moy be lound ot...htto://r,,rww.sa nta-ana.oro/oba/ <br />(Please use a black or blue ink ball-poinl pen) <br />Project Address:J oEl <br />Permit Number: <br />E nui', <br />/.rob(rr-L\^, <br />T.r", fin5en <br />License *, 18lOl <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu 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 />,J,", <br />/c"raon <br />h boxes below must be checked: <br />noxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedroo and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired <br />app ces (i.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 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 governrng <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 />Signature <br />lcheck onel Licensed Contractor Property Owner <br />NOTE: fhis sef-certificotion is only used lor projects that dlfect the EXTERTOR of the structurc. fhis <br />prccess is opplicoble ONLY to projectt where occess to the interior ol the dwelling by o Sonta Ano <br />lnspector is not required. <br />Prope rty Owner: <br />Contractor: <br />a*'-w1 Oote:\)l-tr- & <br />Have this completed form and the job-card readily available on final inspection! <br />I