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*; Alr'[A' <br />NArffi <br />I ^,{ <br />Planning & Building Agency Smoke & CO <br />Alarm Affidavit <br />20 Civic Center Plaza Ross Annex <br />rNSP-02 2013 CRC <br />This document moy be lound at...h tt o://y1,,r.,,1. sa n la -a n a. orq,/oca' <br />(Please use a black or blue ink ball-point pen) <br />Project Address:(o 0.S"^11-4r+,qL7 7 <br />Permit Number: <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 />fl eo,h boxes below must be checked: <br />arbon 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 />appli a es (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 Ievel 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 />m a n ufacturer's instruction s. <br />7,.1 ? <br />(check onel Licensed Con tractor F Property Owner <br />NOTE: fhis self-certification is only used lor projects thdt dlfect the EXTERIOR of the structure. This <br />process is opplicoble ONLY to projects where occess to the interior of the dwelling by o Sonto Ana <br />lnspector is not required. <br />lql lot ll4t3 ;Tt6ltso <br />Property Owner:?a"t H- /^ <br />License #: <br />Signature: <br />Have this completed form and the job-card readily available on final inspection! <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />(714) 647-5800 <br />wwyl. sa n t a-a n a. orq <br />i <br />I <br />l <br />Contractor: <br />Dote: