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, <br />lllnring& B uitdins Aser'r, <br />20 Civic Cente r plaza Ross Annex <br />P.O. Box igSB (M-19) <br />Santa Ana, CA 92202 <br />(7 14l- 647-5800 <br />qwyr.sa nta.ana,orq <br />Smoke & CO <br />Alarm Affidavit <br />I <br />tNsP-02 2013 <br />This document moy be lound ot... hltp://Utlyw.S-anta-ana.org/pba/ <br />(Please use a black or btue ink ball-point pen) <br />Project Address: <br />Permit Nurnber: <br />Property Owner: <br />\ <br />l,>l lo? 1'lo <br />Vtc <br />Contractor:R.ni hL [t-ar?tt<-.License #: (o4lAoV <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 required locations. <br />nBoth boxes betow must be checked: <br />frC.rUon 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 />FQmofe alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />loom, 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 />manufacturer's instructions. <br />(check onel Licensed Contractor tr Property Owner <br />NOTE: This self'certification ls only used for proiects that alfect the EXTERIdIR of the structura lhis <br />process ls appllcable ONLY to projects where occess to the lnterior of the dwetling by a Sonta Ano <br />lnspedor is not rcquired. <br />Signature:Dote:q- fug- W?r( <br />Have this completed form and the lob.card readlly avallable on flnal lnspection! <br />T <br />IITI'0rs <br />LQ-