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*,SA}I'[A <br />NA'ffi <br />I <br />Planning & Building Agency <br />20 Civic Center Plaza Rcss Annex Smoke & CO <br />Alarm Affidavit <br />|NSP,02 2011CRC <br />This document moy be lound ot f il: ,)r', sa":r-a.a or 3Ca <br />(Please use a black or blue ink ball-point pen) <br />Permit Number: <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 required locations. <br />f| eori, boxes below must be checked: <br />ACarbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedi'ooms and also on each level of the dwelling Alarms are required in bedi'ooms with gas-fired <br />applrances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />XSmoke alarms: Are installed inealhIgor,n used for sleeping, in each hallway outside of a sleeping <br />rooh, ard on edch level of the owEillig-l- <br />Retrofitted detectors may be battery-o perated 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 1.0 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 I will retest the alarms per the <br />ma n ufacture r's <br />Signat u r e:Dote <br />(check one\icensed Contractor P ro perty Owner <br />NOTE: fhis self-certification is only used lor projects thot dffect the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where occess to the interior oI the dwelling by a Santd Ano <br />lnspector is not required. <br />Project Address:loob E.Asren 5t 5,Ano" ?z:tot <br />tot q75L5 <br />Property Owner .boqa+ t(o.nc! Eorsn:en <br />Contractor:License # <br />Have this completed form and the iob-card readily available on final inspection! <br />P.O. Box 1988 (M-19) <br />sanla Ana. ca 92702 <br />(714) 647-5800 <br />r&'i/',v illl:l-rn I aii