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*-SANIA <br />NA*ffi <br />tJnr,)frb1 <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.oro <br />Smoke & CO <br />Alarm Affidavit <br />rNsP-02 2013 CRC <br />This document may be found at.http ://www.santa-ana.orq/oba/ <br />(Please use a black or blue ink ball-point pen) <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 R3L4.L and 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 Iocations, <br />f\ eoth boxes betow must be checked: <br />(C"rbon 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 />applia ces (i.e, hot water heater, cooktop, furnace) or a fireplace <br />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 rnust comply with all applicable standards and be approved <br />by the State Fire Marshall (SFM). Battery life rnust be L0 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 alarm h ave been installed in compliance with the governing <br />Codes and have been tested to be function lso, hereby certify that I will retest the alarms per thea <br />ma n ufactu rer's instruction <br />.)I 1 <br />(check onel tr Licensed Contractor Pro perty Owner <br />NOTE: Ih,s selr-c ertificotion is only used lor projects thdt dflect the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where sccess to the interior oJ the dwelling by a Santo Ano <br />lnspector is not required, <br />Project Address:Lr.,.r Satlo.. Ona Oh\q, ^J 3V<,vv <br />Property Owner: <br />") <br />L af v 11^e <br />Contractor:License #: 1 3'lOe <br />Date:Ir',oshfl <br />Have this completed form and the job-card readily available on final inspection! <br />' permitNumber: I l01\O1O0O <br />I <br />I lP-eo Pa p^.r\a <br />Signdture: I