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Planning & Building Agency <br />20 Civic Center Plaza Rcss Annex <br />P.O. Box 1988 (tu|-19) <br />Santa Ana. CA 92702 <br />(714) 647.5800 <br />rrr'rv., sl_ r.1-1. I :r.'l <br />Smoke & CO <br />Alarm Affidavit <br />NSp-02 20rl cRC <br />This document mqy be lound at i-:1: ,,, !,,, sl-:a-t.? ar:l :rl <br />U SI- <br />t <br />(Please use a black or blue ink ball-point pen) <br />Project Address:,2 <br />Permit N umber: <br />Property Owner: <br />D <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ildings. <br />California Residential Code (CRC) Section R314.L 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 eo,h boxes below must be checked: <br />E Carbon 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 bedr'ooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />El Smoke alarms: Are instailed in each room used for sleeping, in each hallway outside of a sleeping <br />room, and on each level of the dwelling. <br />Retrofjtted detectors may be battery-operated for buildings where no interior alteratjons are <br />performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved <br />by the State Fire Marshail (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 func onal. l, also, hereby certify that I will retest the alarms per the <br />ma n ufacturer's in ctron <br />s <br />nelcheck o L rcense d Conti'acto r Property Owner <br />NOTE: Ihrs self-certification is only used lot projects thot dflect the EXTERIOR of the structure. This <br />process is dpplicdble ONLY to projects where occess to the interior of the dwelling by d Santo Ana <br />lnspectot is not required. <br />Ta-, <br />to <br />Contractor:License #: <br />Have this completed form and the iob-card readily available on final inspection! <br />*,,SANTIA <br />NAffi