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*-SANIA <br />NA.ffi <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 sant3-3na.cri <br />Project Address: <br />License #: <br />rNSP,02 20r 3 CRC <br />This document moy be found dt...http //v,ffAv. sa nta-a n a.oralobal <br />(Please use a black or blue ink ball-point pen) <br />2l (?rt <br />Property Owner: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ildings. <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 />f\ eoah 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 />manufacturer's instructions. <br />(check onel tr Licensed Contractor Property Owner <br />NOTE: Ihr's sef-certificotion is only used lor projects thot affect the EXTERIOR of the structure. This <br />process is applicoble ONLY to projects where occess to the interior of the dwelling by o Sdntd Ano <br />lnspector is not rcquired. <br />Signdturc:Ddte:I71b <br />Have this completed form and the job-card readily available on final inspection! <br />Smoke & CO <br />Alarm Affidavit <br />Permit Number: <br />I <br />Contractor: <br />tr