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*,SANTA <br />NA,Iffi <br />5r' <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA92702 <br />{714) 647.5800 <br />// /r ,a SIr:-l-l-l r): i <br />Smoke & CO <br />Alarm Affidavit <br />rNSP,02 2013 CRC <br />This document moy be lound ot.,, <br />(Please use a black or blue ink ball-point pen) <br />ProjectAddress: J.t5 :. On(p q <br />Permit Number:\ or (o?566 <br />Property Owner: t Jefu..r.Nf Mfrt-Cr <br />Contractor:License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />b u ild in gs. <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 req u ired locations. <br />.f\ eoth boxes below must be checked: <br />p/Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />betrooms 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 />ffSmoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleepinga\ <br />robm, 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 />m a n ufactur r's in ctaon s <br />Signoture: <br />lcheck onel tr Licensed Contractor Property Owner <br />NOTE: Ihis sef-c ertification is only used for projects thot olfect the EXTERIoR ol the strudwe. This <br />process is opplicoble ONLY to projects where access to the interior of the dwelling by o Sonto Ano <br />lnspector is not required. <br />Date: <br />Have this completed form and the job-card readily available on final inspection!