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;-SANM <br />NAJffi <br />Planning & Building Ag <br />20 Civic Center Plaza Ross Annex <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714]. 647-5800 <br />ul'lr'ry, sa n ta-an a or,J <br />Smoke & CO <br />Alarm Affi davit <br />Project Address:,10 10 14/ Eo, nLaciol< Ly, <br />Prope rty Owner: <br />Contractor: <br />Permit Number: <br />License #: <br />INSP.O2 2013 CRC <br />Thisdocumentmoybefound at... htt3.l',,i,',',v.santa-an3.orq'cba' <br />(Please use a black or blue ink ball-point pen) <br />State of California requires that smoke and carbon monoxide (CO) alarms are installed in reside.ntial <br />buildings, <br />California ResidentialCode (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 />ff Both boxes below must be checked: <br />Wrbonmonoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of <br />bedrooms and also on each levelof the dwelling. Alarms are required in bedrooms with gas-fired <br />appliances (i.e. hot water heater, cooktop, furnace) or a fireplace. <br />El6.t" alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping <br />room, and on each levelof 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 />m a n ufacturer's instructions. <br />a <br />Signature:Dote aq -- / </ -2oz I <br />(check onel Et- Licensed Contractor tr Property Owner <br />NOTE: This self-cenificotion is only used for projects thot offect the EXTERIOR of the structure. This <br />process is opplicable ONLY to projects where occess to the interior of the dwelting by o Santa Ano <br />lnspector is not required. <br />Have this completed form and the job-card readily available on final inspection!