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*NSNTA <br />NA,ffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Bor 1988 (M-19) <br />Santa Ana. CA 92702 <br />(7'r4)647-s800 <br />w,/tnll santa-anf, orq <br />Smoke & CO <br />Alarm Affidavit <br />iNSP-02 2013 CRC <br />f his document mdy be lound ot... http:/,\,v,r!v ga n ta -a na.ore,'pba.' <br />(Please use a black or blue ink ball-point pen) <br />Permit Number:t0 "1 g <br />Property Owner:n U{v4 <br />Contractor: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u 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 />O r*n boxes betow must be checked: <br />dC"rbonmonoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the dwellin g. Alarms are required in bedrooms with gas-fired <br />appli s (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. lfurther 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 lwill retest the alarms per the <br />manufacturer's instructions. <br />lcheck onel Licen sed Contractor tr Property Owner <br />NOTE: Ihrs sef-certificdtion is only used lor projects thot offect the EXTERIOR of the structure. This <br />process is opplicoble ONLY to prcjects where occess to the interiot of the dwelling by o Sontd Ana <br />lnspector is not required. <br />3t6Project Address:n <br />License #: IOQ {1 lLn <br />ol/zE/ ts <br />Have this completed form and the job-card readily available on final inspection! <br />^(+ <br />Signoture:Oate: <br />I