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<br />Srncke & CO
<br />AI arm Affi davit
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<br />T,ti; dscu,nzni may be fo,tnd t'".,,
<br />In lt ,' r', '/l':f 'f 1-1 ^:i
<br />(Piease use a black or b!ue ink ba!!-point pent
<br />Prcj :ct ACd,'ess Lv.lo W.tt4art( ([
<br />Permit Nurnber: I Olt 01 +53
<br />irte 5n;Prcpe rty Owner:
<br />i Cont ractcr':One gt"S\-Si,1x Licensa #, "\t\1-1 1
<br />Sl-::: of Calif:rni: r:q,tir:; thai;i-o<e acd carbcn nronoride (CO) aiarr"ns ar'e installed in residential
<br />builCing;.
<br />Caiirt,'i.ia Re;idenrial Cc,ie (3Rl) S:cr on F3Ll l-rnd R315.2 stalai in part that erist:ng druetlings be
<br />''ret::iilted
<br />^J,th
<br />smok3 ar3rmi arC car-bon nonoxide alarms. CRC Section R3I-t.3 and R3l4 3 3 define
<br />the r:quired locations.
<br />n Both boxes below must be checked:
<br />E Carbon monoxlde alarnrs: A,': in.;trileC o,ttside of eech sleeping ar-ea in the innmeCiate vicinit'/ of
<br />be,lrcoms an,J also on erch le,rel of tne d,,velling Aiarrns are requirad in bedrooms with gas-fired
<br />aool,ance; (i.e hot w3:er hel:3r, ccokt:p, furnace j or a fireplace.
<br />./
<br />M Smote alarrns: A,': insi:i!ed in -.ach roo.x usrd For sleeping, in each hail'ruay out;ide oia;leeping
<br />roorn, arid on each level of the d',velling
<br />Re:ioiit:ed detectcrs ma,7 be batr:r'l-oper:ted for buildings where no interior alter:t:ons are
<br />perfornned. Cor'y'lbina:torr Srnok:,1CO aiar;'ns mustcomply with ail appiicabl. ;136(ards and be aporoved
<br />by tne Ste:e Fire lVlarshall (SFi\l/. Bal:ery life mus be lJ years.
<br />I herebr/ certif'7 tnat I am the ccnt.lctor or the prcpert/ owner of the abo,re prolect. I further certlfy
<br />that smoke alarms and car5rtn monoxide alarrrsrave been installed in compliance with theSoverning
<br />CoCes and have been test:d to be functional. l, arsc, herebr/ certif'7 that lwill retest l:he alarms perthe
<br />ma n u flct urSr'; in s uct;on5
<br />Signc,tur?' Datz 8 tl t2l
<br />(check o n e)Licen5ed Cont;'ar:tor tr Property C,runer
<br />NOi!: This self -certificat:on is oniy used t'or prcjects that affzct the EXTERTOR of the structure. This
<br />p(cce;i is applicable ONLI to proiect; wherz dc.ess to fne interior of the dwelling by a Santa Ano
<br />lnspectcr is not rzquirzd.
<br />Hlrc this completed fcrm an,J the job-clrd rer'lily available on final inspectionl v
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