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*-sA]\rlA <br />NA.ffi <br />Planning & Building Agency Smoke & CO <br />Alarm Affidavit <br />2C Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana. CA 92702 <br />(7'r4) 647-s800 <br />,// /, ',./ s: a i3- ?:'1I O':l <br />tNSP-02 2C13 CRC <br />This document mdy be lound at..,.,".,',., s?1:3-?nr !', <br />(Please use a black or blue ink ball-point pen) <br />Project Address: "1 tS f nrfx-veen fi <br />Permit Number:l0 lla6o a u <br />Property Owner: <br />Contractor: <br />1 <br />License #: ln+Zaf 4 <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in resrdential <br />bu ild ings. <br />California Residential Code (CRC) Section R3L4.1and 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 req u ired locations. <br />{)eoraboxes below must be checked: <br />ts Carbon monoxide atarms: 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 />app)rlnces (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />M S-ofe alarms: Are installed in each room used for steeping, 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 lwill retest the alarms per the <br />ma n ufacturer's instructions. <br />Signoture:Dote:)ttTlLt <br />lcheck onel Licensed Contractor Property Owner <br />NOTE: This self-certilicdtion is only used for projects thot ollect the EXTERIOR ol the structure. This <br />process is opplicoble ONLY to projects where occess to the interior oI the dwelling by o Santo Ano <br />lnspectot is not required, <br />Have this completed form and the job-card readily available on final inspection! <br />I