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,^-SANTA <br />ANA <br />ru\]IIC <br />[il[Dll6 <br />lct\0 <br />Smoke & CO <br />Alarm Affidavit <br />20 Civic Cent€r Plaza Ross Annex <br />P.O. Box 1988 (M.19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />wwu/.santa-ana.orq <br />INSP,O2 2013 CRC <br />This document moy be lound ot.-.http ://www. sa nt a- an a.or el ob a I <br />(Please use a black or blue ink ba -point pen) <br />Project Address:t\o? 5 JA.l'-SqN <br />Permit Number:t\,la) <br />fZor tn c hcNo <br />License #: <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC) Section R314.1 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 requ ired locations. <br />Aeot?r boxes below must be checked: <br />@L(arbon 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 />Etlmoke 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. Comblnation 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 certlfy 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. <br />lcheck onel tr Licens Contractor v Property Owner <br />NOTE: This self-certificotion is only used for projects thot allect the EXTERIOR oI the studure. This <br />process is applicable ONLY to projects where occess to the interior of the dwelling by o Sonta Ano <br />lnspector is not requited. <br />Signoture:Date 8-rE-Zl <br />Planning & Building Agency <br />Property Owner: <br />Contractor: <br />/7 <br />)L <br />Have this completed form and the job-card readily available on final inspection!