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CM"SANM <br />NA-ti\$ffi <br />Planning & Building Ag ency <br />2! Civic Cente.r Piaza Rcss Arnex Smoke & CO <br />Al arm AffidavitP.O. Bcx 1988 (M-19) <br />Santa Ana, CA 927C2 <br />(714) il7-5800 <br />v.r'ifr*/ . sa nta-d ;' a. c r ci <br />INSP.C2 2C'.3 C",' <br />This document moy be found at... <br />(Please use a black or blue ink ball-point pen) <br />Permit Number: <br />State of California requires that smoke and carbon <br />bu ildings. <br />de (CO) alarms are installed in residential <br />California Residential Code (CRC) Section R3t4.L and R315.2 states in part that eiisting 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 />f,leoth boxes betow must be checked: <br />XC"rUon 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 />ftmorc atarms: 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 />man ufacturer's instructions. <br />(check onel Licen Property Owner <br />NOTE: This setf-certificotion is only used for projects that affect the EXTERTOR ol the structure. This <br />process is applicable ONLY to projects where access to the interior of the dwelling by a Sonta Ana <br />lnspector is not required. <br />t <br />Project Addi'ess: <br />20<r<Property Owner: <br />License #:S\Contractor: <br />15,2c:H'ie.Dote:1Signature: <br />I <br />Have this connpteted form and the job-card readily available on final inspection! <br />t <br />t_-_ <br />/,10 b l/. /11/c <br />t-