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*,,SANTA <br />ANA <br />IL{W\C <br />&ttlult\G <br />IGTIfi <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana, CA 92702 <br />(7r4) 647-5800 <br />wwv/.snnta-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />rNSP-02 2013 CRC <br />fhis document may be lound dt...http://un rw. santa-ana.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />Project Address:3 <br />Permit Number: <br />Property Owner:9a\a,,^neA <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\ eot}r boxes below must be checked: <br />$.,CarUon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />r6edrooms 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 Srof" alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />{oom, 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 nufacturer's instru ns <br />lcheck onel Licensed Contractor Property Owner <br />NOTE: Ih,s serf-certificotion is only used lor projects thot oIled the EXTERIOR ol the strudute. This <br />process is applicoble ONLY to projects where occess to the inteiot of the dwelling by o Sonto Ano <br />lnspector is not requircd, <br />Signdture (--.? / /A-/-tfu Dote:7' t r-so21 <br />Have this completed form and the job-card readily available on final inspection! <br />latl ohTt+-(' <br />I I <br />tr