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cmors NTA <br />NA,ffi <br />, <br />Planning & Buitding Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647.s800 <br />ta.anil.ore <br />Smoke & CO <br />Alarm Affidavit <br />TNSP,C:20r3 CRC <br />This document moy be lound ot..n ta.a na.orc,'obahttp:,',i',u/,'/.sa <br />(P/ease use a black or blue ink ball-point pen) <br />Project Address:35tq (-6 <br />l0lt01t1 + <br />Prope(y Owner:T)t./ ,a-.dl4rz:g <br />Contractor:,{) <br />14@{%-@fr ,ry1y;!Ur:!-gta:u+'-- <br />Ltnsea 57 <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 existinB 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 />A sort boxes below must be checked: <br />El'-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 8as-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />El5-moke 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 5moke/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 />manufacturer's instructions. <br />Dote: <br />(check onel tr Licensed Contractor Property Owner <br />NOTE: This sell-certilicotion is only used lor projects that allect the EXTERIOR ol the structure. This <br />process is opplicable ONLY to projects where dccess to the intetiot ol the dwelling by o Sontd Ano <br />lnspectot is not tequired. <br />P-, z - "-( <br />Have this completed form and the job-card readily available on final inspection! <br />Permit Number: <br />,,rn*,,", SS.L{J[4-**_