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Planning & Building Agency Smoke & CO <br />Alarm Affidavit <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />ta-ana.orq <br />tNSP-02 2013 CRC <br />This document moy be lound at...htto://www. sa nta-ana. orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:.ltot W t\iogt Auc 9a"'|a hn^ ffi 1T <br />Permit Number:io PtgclL6 J <br />Property Owner:?t r0 \Jq t'{t <br />Contractor:License #: <br />c"l <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 />{) soa}r boxes below must be checked: <br />E Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each level of the dwelling. AIarms are required in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />El Smot<e 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 I will retest the alarms per the <br />ma n ufacturer's instructions. <br />tr Licen d Contractor P ro pe Owner <br />NOTE: Ihri sef-certificotion is only used lor projects thdt dlfect the ErTERIOR of the structure. This <br />process is applicoble ONLY to projects where access to the interior oI the dwelling by o Sontd Ano <br />lnspector is not required. <br />Signature:1/,-1 .r treZ'--YD <br />Dote:1/ <br />Have this completed form and the job-card readily available on final inspection! <br />*-SNTA <br />NA,ffi <br />lcheck onel