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Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1984 (M-'19) <br />Santa Ana. CA 92702 <br />(714) 647.5800 <br />Smoke & CO <br />Alarm Affidavit <br />NSP <br />fhis document moy be found dt... <br />(Please use a black or blue ink ball-point pen) <br />h::3 /i,',, i ', -cr:t3-an3.oaa :r:l <br />Project Address:It €. <br />Permit Number:lorro SSI <br />A h'€ <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild ings. <br />California Residentjal Code (CRC) Section R314.1and R315.2 states in part that exrsting dwellings be <br />"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define <br />the requ ired locations. <br />A ro,n boxes below must be checked: <br />ErCahonmonoxide 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 />y'imoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />room, and on each levei 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 (SFtvl). 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 n ufacturer's instructions. z" <br />Signoture:Dot <br />5 <br />I <br />n <br />"e'+-2 <br />lcheck onel tractor Pro perty Owner <br />NoTE: Ihis sef-c ertilication is only used lor projects thot ollect the ErTERIOR of the structure. This <br />process is dpplicdble ONLY to projects where dccess to the intedot of the dwelling by d Sonta Ano <br />lnspector is not rcquited. <br />e: <br />ensed <br />Have this completed form and the job-card readily available on final inspection! <br />Property Owner: <br />tr