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*-$AI{TA <br />A},IAffi <br />20 CrY,c Center Plaza Ross A.ner <br />Plan ning & Building Agency Smoke & CO <br />Alarm AffidavitP O Box 1988 (&1-19) <br />Santa Ana. CA 92702 <br />1714) &r7-5300 <br />tue^/ i!^il-r.:l a."r <br />NSP.022lr3lRi <br />This document mqy be lound st hlii ,!',,,', iin:l-ri"rt c.?, ob3 <br />(P/ease use a black or blue ink ball-paint pen) <br />Property Owner: <br />Contractor Qu R*1,"License #: t(>C..1E{( <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Resrdential Code (CRC) Section R314.1 and 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 />A eoti, boxes below must be checked: <br />X CrrUon monoxide alarms: Are insta led outside of each sleeping area rn Ine rmmedrate victnrty of <br />bedrooms and also on each level of the dwelling Alarms are required in bedrooms with gas-fired <br />appliances (i. e. hot water heater, cooktop, furnace) or a fireplace. <br />fi S.ote alarms: Are installed in each room used for sleeping, in each hallway outslde of a sleeprng <br />room, and on each level of the dwelling <br />Retrofitted detectors may be batte ry-ope rated for buildings where no interior alterations are <br />performed. Combination Smoke/CO alarrns 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 rnstalled 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 />Project Add re ss : <br />Sig notu re <br />lcheck one\ <br />Itlcr <br />manufacturer's instructions <br />r7/t Jo L. <br />Licensed Co tr 0 <br /><-L <br />tr o pe rtyP wne r <br />NOTEi fhls sef-c ertificdtion is only used t'cr projects thdt dflect the EXTERIOR of the structure. This <br />process is applicable ONLY to projetts where access to the interior ol the dwelling bY d Santa And <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />Permit Number: <br />Dot?: