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OfiOISAM <br />NAffi <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-s800 <br />www.santa-ana.orq <br />Smoke & CO <br />Alarm Affidavit <br />I <br />rN.sP-02 201 3 <br />This document moy be found at,., htto./lwYvlv sai1!a -at t;,r.oi'cli pba/ <br />(Please use a black or blue ink ball'point pen) <br />1 eroject Address ID <br />Permit Nurnber:zoll s77; <br />Property Owner: <br />I <br />1 Contractor:License # <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential <br />buildings. <br />California Residenilat Code (CRC) Section R314.1 and R315.2 states in part that existing dwellings be <br />"retrofittecl with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3'3 define <br />the required locations. <br />f\sotL boxes below must be checked: <br />ffirAonmonoxide 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 />6^o,^"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 aoplicable 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 conrractor 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 />manufactu s instructio ns <br />lcheck onel tr LicenseC Contractor roperty Owner <br />NOTE: This self-certificotion is only used for projects thdt aflect the EXTERIOR of the structure. This <br />process is applicable ONLY to projects where dccess to the interior of the dwelling by a Santa Ana <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection! <br />qarl <br />l <br />I <br />I