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CITI"SANM <br />NA-',liili\l <br />Planning & Building Agency <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(7141647-5800 <br />www.santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />) <br />INSP.O2 2013 CRC <br />This document moy be lound at... htto:/iwww.santa-ana.orq/pba/ <br />(Please use a black or blue ink ball-point pen) <br />lb7 <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residential Code (CRC)Section R314.1and 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 required locations. <br />fiBoth boxes betow must be checked: <br />I <br />E Carbon monoxide atarms: 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 />I <br />E S.oL" 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 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 />ma nufacturer's instructions. <br />(check onel Contractor Property Owner <br />NOTE: This self-certification is only used for projects thot affect the EXTERIOR of the structure. This <br />process is opplicable ONLY to projects where occess to the interior of the dwelling by o Santa Ana <br />lnspector is not required. <br />Project Address:bVI l) g fioe cfr k".rh AnaCIpl <br />Permit Number:lo,l O-?cla 3 <br />Property Owner:(-[rnn^ G. ft7,. . <br />License #:Contractor:r5o Ltnc nf <br />Dote: <br />"l lZo / ZoZ1SignatureI <br />Have this completed form and the job-card readily available on final inspection!