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Plan ning & Building Agency <br />20 Civic Center Plaza RJsi Annex <br />P.O. Box 1988 (lvl-19) <br />santa Ana, cA 92702 <br />{714) 647.5800 <br />w.r'il iint3-anl arq <br />Smoke & CO <br />Alarm Affidavit <br />lfrsP-o2 20l l lRC <br />This document mqy be lound ot...hltf, !v1,,'/, Sanl:3-a na orl, cba <br />(Please use a black or blue ink ball-point pen) <br />?lll f, 2il5 s FNI>vrEu ,@ f\ <br />Permit Number lonelc( ( totzfiaot <br />J A-tl,r,Y LY <br />N 6H/A VAN Vtclvtl License #:5621s6 <br />Project Address: <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 R314.1- and R315.2 states in part that existing dwellings be <br />"retrofltted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the required locations. <br />A soat boxes below must be checked: <br />(C"rbon monoxide alarms: Are rnstarled outsrde of each sieeping area in the immediate vicrnrty 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 />KS-ot " alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeprng <br />room, and on each level of the dwelling <br />Retrofitted detectcrs 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 />manufactu re r's instruc n5 <br />Signdture: <br />lcheck onel ense dCo ractor tr P roperty Owner <br />NOTE: fhrs sef-c ertificotion is only used for projects that affect the EXTERIOR ol the structure. This <br />process is applicoble ONLY to projects where access to the interior of the dwelling by d Sdnto And <br />lnspector is not required. <br />Dote:{-zt- I { <br />Have this completed form and the job-card readily available on final inspection! <br />*-$NTA <br />NA.ffi <br />Property Owner: