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*,,SNIA <br />NA"ffi <br />20 Civic Center Plaza Ross Annex <br />P.o. Box 1988 (Ml9) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />www.santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />INSP.O2 2013 CRC <br />This document moy be lound dt...htto ://wv^r.sa nta-ana.or qlobal <br />(Please use a black or blue ink ball-point pen) <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California ResidentialCode (CRC) Section R3 L4.1 and R315.2 states in part that existing dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Sertion R314.3 and R314.3,3 define <br />the required locations. <br />f\ ao l boxes below must be checked: <br />fi Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />beihooms 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 />fl Smoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />ioom, 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 proiect. I further certify <br />that smoke alarms and carbon monoxide alarms have been installed in compliance with the Boverning <br />Codes and have been tested to be functional. l, also, hereby certify that lwill retest the alarms per the <br />manufacturer's instru ons. <br />lcheck onel Lic e sed Contractor Property Owner <br />NOTE: fhis sef-ce rtification is only used lor projects thdt dffect the EXTERIOR of the structure, This <br />process is opplicdble ONLY to projects where dccess to the interior of the dwelling by a Santa Ano <br />lnspector is not required. <br />Project Address:1q5 W Acter7l 4an1.r,. A,o IA qp*rtt <br />Permit Number:l6ttordf <br />Contractor:io,,jdv/ztt 4,n {nlr,.License #:100t1667; C-t0 <br />Signoture:(l) [irLr>Date:.1a/,a6l ,/ da <br />Have this completed form and the job-card readily available on final inspection! <br />Planning & Building Agency <br />Property Owner: <br />I