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,--SANTA <br />NA <br />ru\\nc <br />ItillJli0 <br />lfl\:o <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(71lt) 647-5800 <br />wv/vJ sintil-:1nil oro <br />Smoke & CO <br />Alarm Affidavit <br />Project Address: <br />4o6oS <br />5 <br />l IV <br />tc <br />? <br />ut- <br />Property Owner:vq <br />Contractor: <br />rNsP-02 2013 CRC <br />fhis document moy be lound ot,,.http:/iun,,^ .santa-ana.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />State of Callfornia requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings, <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 />6\ aoth 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 />E Smoke 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 />man ufactu rer's instructions. <br />lcheck onel tr Licens Contractor F prope yO er <br />NOTE: This self-certificotion is only used for projects thdt offect the EXTERIOR of the strudure. This <br />process is opplicable ONLY to projects where occess to the interior oI the dwelling by o Sdnto Ano <br />lnspector is not required. <br />Signoture:ffJ,t*t t Mo*o-,,^^rl Dote ox ) tt/ t-t <br />Have this completed form and the job-card readily available on final inspection! <br />Permit Number: <br />EA^. f?n-{i,^,,I License #'R1q 9 a a.)