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*O'SNTA <br />NAJffi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 6il7-5800 <br />v/ ra.,,,.s ilnt:l-ani olq <br />Smoke & CO <br />AIarm Affidavit <br />rNSP-02 2013 CRC <br />This document mdy be lound at...http://rl,ni,vr. sa nta-ana.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:PsruDua To-tv <br />Z'rl1 ?Yn S-Permit Number: <br />Property Owner:LrrLPr-- <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ildings. <br />California ResidentialCode (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\ro,n 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. Alarms are required in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />d S-ok" 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. 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 />manufacturer's instructions. <br />lcheck onel tr License ontractor Property Owner <br />NOTE: Ihrs sef-c ertificotion is only used lor projeas thdt affect the EXTERIOR ol the sttudure. This <br />process is opplicoble ONLY to projeds wherc occess to the inte ot of the dwelling by o Sontd Ano <br />lnspector is not required. <br />Signoture:Dote:03_ /o- aoat <br />Have this completed form and the job-card readily available on final inspection! <br />27tg N