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,,*SNTA <br />NA/hH* <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) 647-5800 <br />www.santa-ana.orc <br />Smoke & CO <br />Alarm Affidavit <br />|NSP,02 2013 CRC <br />This document moy be lound at...http://www. sa nta-ana. orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />ZoOz- W R.n mLrrr-n)t , Sn'^l^ Anq <br />Permit Number:touo6t93 <br />Property Owner:C-Ar,cfine V^"g <br />Contractor:9olaiTtn",(-'lticense*: lofl+57 <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />bu ild ings. <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 />Asoat boxes below must be checked: <br />ElCarbon 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 Bas-fired <br />appli4nces (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />B6moke 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 lwill retest the alarms per the <br />manufacturer's instructions. <br />lcheck onel Licensed Contractor tr Property Owner <br />NOTE: fh,s serf-certificotion is only used for projects thdt olled the EXTERIOR of the strudure. This <br />prccess is applicable ONLY to projects wherc dccess to the interior of the dwelling by a Sdnto Ano <br />lnspedor is not required. <br />Signoture:w z/zz/2. zt <br />Have this completed form and the job-card readily available on final inspection! <br />I Dote: <br />Project Address: