HomeMy WebLinkAbout101103130 - PermitProiect Addressl.710 S Townsend St
Assessor's Parcel: 109-612-02 Lot: 2
Unrt Bldg: Address Range Suite Range:
Zoning: R3Block: NA Tract: 3391 Historic: No
3
City of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA 92702 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714) 667-2738 lnspector Section. (714) 647-5853
Permit #: 1O1{ 03{ 30
Pin #: {27e$/
Building Use: lrulli-Family (5 or more units) Occupancy: R-2 lst FL Area: Palio:
Job Type: Rercof Conslr Type: V B 2nd FL Area: T.l.Area:
Nalureofwork Re&of code: cBc2019 otherAreas: yards Req.d:
Existing Bldg. & Use: Apartm.nE Flood Zone: X-O60232O257J
proposecr use: # of slories: Garage Area: valuation: $'ll'000'00
Total:
Ooacrlption of Work: Tear olf exlstlng root matarial and inatell n.w comp shingle .oof m.te.iel. Roplace sheathlng aa neoded. 38 8quar6. Handout
given
Planning Conditions:
Owner:
Address:
Phone:
Tenant:
t
CHUNG & YVONNE LAU
315 E MAIN ST
Alhambra, CA 918013958
(626)3794375
Contractor: Tesla Roofing, lnc
Address: 1467 W. Washington Blvd.
Los Angeles, CA 90007
Phone: (213) 640-0906
State Lic #: 1046651
Lic Type: C-39
Bus. Lic #: 375109
Workers' Compensation lnsurance:
Carrier: State Compensation lnsurance Fur
Policy #: 9229688
Expires: 0411412020
Engineer:
Address:
Phone:
License #.
Architect /
Designer:
Address:
Phone:
License #
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd:
Graham, Jeffery Dale: O2l13l2O2O
Date:
Dale: O2l13l2O2O
Subject to Field:
Chavez, Dave910
Misc. Receipt
Misc. Receipt
Misc. Recerpt
07776002
o7776002
07776002
07776002
07776002
57607
5777 0
57672
57600
s7607
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
Fee Total:
Paid to Date:
Balance Due:
$333.06
$3.91
$1.00
$22.95
$57.20
$418 12
$0.00
$418.12
No
No
No
No
Fire lnsp. Req'd: No
Police lnsp. Req'd: No
Flood Zone Cert. Req'd: No 01 1 16002 51600
01't16002 5'1601
01 1 16002 51612
01116002 57770
Account#Total
Every permit issued shall become invalid unless the work on the site authorized by
such permit is commenced within 360 days after its issuance,or if the work authorized
on the site by such permit is suspended o r abandoned for a pe riod of 360 days after
the time the work is commenced.
lnspector MID#: 2020-157753
$22.95
$390.26
$1.00
$3.91
BUILD!NG. INSPECTOR RECORD
Rev.08-07-2015
SITE.WORK DATE ID/SIG.COMMENTS ()wNItR IL)ll,l)ER l)UI-CARATI()N
I hcreby affirnl under fEnalty of perjury that I am cxcnrpl from the Cbnlraalo6' License I:w for the following rcason (Sec.7031.5
tlusiness and Prolcssion Codc): Any Cily or Countv which rcquires a ltrrnil lo con\trucl. atlcr, irnprovc. dem)lish or rcpair any
slnrcture.priorroirs i-rsuance.rlsorequirestheapplicentt()rsuchpermit()tileasignedstatemcnl thatlEorsheislirenscd pursuant
to the pmvisions ol-th(' Contracbr's l.iccnscd liw (Chapter 9. Comnrcncing with Scclion 7(XXl of l)iviNion J ol-thc Busincss and
Proles\iorsCodelorthatheorshcisexempttherefromandthebasisfirrtheallegedexenrption. Anyviolati(trlofSeclion703l.5byaily
rpplicxtrr for il pennir sub.jccls the applicrnl to n civil perrrlty of not more than llve hundred dolhrs ($5{x)).
_1, as owncr ol'tlE prcltny. or my cmployces with wages as lhcir solc compcnsation, will do (hc work and the slructurc is mt
iiledcd or offered for mle (Sc.7044. Busincss 0nd Prcfessions C(xle: Thc Contracbr's Liccn* Law docs not apply lo Bn owncr of
theprrpcfly wlDhuildsorimprowsthe[rtrandwhodoessuchworkhinNclforhcrselIorthroughhisorhcrowilemployecs,
providcd rhal such improvcmnts trc not intcndcd or ollcred lbr salc. Il. howevc( thc building or inprovcmnt is sld within one )ca
ofconrplerk[ the Owner Builbr will luvc lhe buftlen of prcving tlut lE or shc dirl m buikl or impn)ve thc profEny for llt Iruqnr of
sh).
_1, as owner ofthe properly. an exclusively contrrcting with licensed conlraclors to conslrucl tlE pmjecl (Sec. 7O'14, Business
ail.l Pn)fessbn Code: Thc Cotrtncrcr'r l,icense Law does not apply k) an owner ofprolE(y who builds or improves thercon.
and who contracts for such p(+cts with a Contrackr(s) liccn$d pur\uMl to lhc (bilractor's Liccosc [2w).
-lan|etenllnunderSecIit)n-'B'&P,C,ti)rthisreasou,Dale:-
woRKEks' coM PUNsA'tr0N
DESIABAIIAN
I hcrcby alfirm under pcnalty of pcrjury one ofthe following declararions:
_lhaveardwillnraintainaCenilicatcofConscnrtoSelf:lnsureforworkers'compersation,as pnrvidcdforbySection3T00ofthe
LatDr Cflle. for rhc pcrformrce of rhc work lbr which rhc pcrmil i\ issued.
Mhovrrnlwill^aintairworkers compcnsationinsuranc€,as r€quircdbyscction3?00oftheLaborCode,forthctErf(,mh-cofr rhc w(,rk k,r which this pcrmit ls rssural. My workets' comlEnsati()n insurancc cfrier afll lnlty number uc:
Policy a
_l cc(ily rhat in thc l--rfbrnuncc of rhc work for which rhis pcrnil is issucd, I shll not cnlploy any pcrson in any nunncr
so as to tEconE subjcct lo thc workcrs'coilrpcnsation laws olCalilbrnia. dnd sgrcc lhnl il l should becorrc subjcct to the
workers' conrpensatioD provisions ofS.clion 3700 ofthe l-abor Code, I shall, fonhwith comply wilh thos prcvisions.
WARNING: Failurc to sccure workers'comlNnsation covcrugc ir unlawful. und shall subFcl an cmploycr to triminal Fnalties ud
civil fines up to one hundred thousand dollxrs (Slfi).UxD. in nddiliotr to lhe cost ofcomp€nsation. darmgcs ns provided for thc
Section lO76 ofrhe titx,r Cule, interest and attomy's fee\.a
u,,,..' z/ ), / z-o
I)E('I,,\ RATI()N
I hcrcby al lirm undcr p€nalty ol perjury rhal I am Iiccn$d undcr pro!ision ol Chnplcr 9 (cornmencinE with Section 70fi)) ol Dilasion 3
of IIN llusincss and Profcssi(lns Codc. md n)y liccnsc is in full fi)rcc md cffccl.
[,iccore ,NurnMr:D f/
,
CONSTRTJCTION I,ENI)ING AGHNCY
I heBhy aflirnr undcr lEilalty of perjury thal thcre is a con\trudioo lendinS agerey ,i)r lhc pcrformrrce ofthe work lbr which this Jxmrit is
issucd (Soc. :109?, Civ. C.).
lindcr's Nanrc:
APPLICANT DECI,ARATION
I hercby affmrunder penalty of perjury onc of the following declardtions:
DenDlilioD Pernrits-Asbestos Notification Federal ReSulrtions (Title 40, Pnn6)
-Requircd
trtt('r of Notrficalion
I cerlili that rhe fcderal reAuhtions rcgudinS asbesbs rcnx,vill are not flpplicilble kr this projct.
lNp eenity that I havc rcrd rhi\ applicalion and st^le lh.l the abovc information is concct. I agre lo comply with all Ciry and County
I ordiunces and State llws reltilir)g lo bu ilding construd ion. arxj hereby aullDrize represerilatives of this City and County lo enter uF)n the
rlx)!c mcnli()ncd prof-r1y lin' inspcclion purlx)scs.
Applicut or Agcnt
I'(nriler nanre
rhrc ' =/rt/ zo_______7___7-
Set Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/VenVl nsu lation tt ,\,K>
Roof Sheathing +//ff,uru Afttrool ^tDShear Wall
Framing
lnsulation/Eneroy
Drywall
Ext./lnt. Lath
Brown Coat
lMasonry
Pool Fence
T-Bar
Handicap Req
Deputy Final Report
Enqineer Final Report
Flood Zone Certif.
I I ,l //r
F!NAL 7h6Wtu Abtfo,(Y.-{Y
Certificate of Occupancy t I
Notes, Remarks, Etc.
-->
l)rlr
[r'n,ler's Addrcss: _
tNSP-02 2013 CRC
This document may be found at...://urww.san
(Please use a black or blue ink ball-point pen)
Project Address:-//0 S. TacsOSevJD ST #/
Permit Number:/Dlt0.z/zo
Property Owner:/-frt/
764 fsDa/JA License#: /6f6657
State of California requires that smoke and carbon monoxide (CO)alarms are installed in residential
buildings.
California ResidentialCode (CRC)Section R314.1and R315.2 states in part that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define
the required locations.
f\ Both boxes below must be checked:
J
F.(Carbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of
bedrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
p Smot<e alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping
room, and on each level of the dwelling.
Retrofitted detectors may be battery-operated for buildings where no interior alterations are
performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved
by the State Fire Marshall (SFM). Battery life must be 10 years.
I hereby certify that I am the contractor or the property owner of the above project. I further certify
that smoke alarms and carbon monoxide alarms have been installed in compliance with the governing
Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the
manufacturer's instructions.
lcheck onel censed ContraL P Owner
NOTE: This self-certificotion is only used for projects thot offect the EXTERIOR of the structure. This
process is applicable ONLY to projects where occess to the interior of the dwelling by o Santo Ana
lnspector is not required.
Have this completed form and the job-card readily available on final inspection!
Signature:, -/ .-/ .- l,Dote:z-/2"/*
*-SNTA.NAffi
Planning & Building Agency
20 Civic Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647-s800
ww\/v. santa-an a. orq
Smoke & CO
Alarm Affidavit
Contractor:
tr
*-SNTA
NA-ffi
Planning & Building Agency
20 Civic Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647-s800
www. santa-ana.orq
Smoke & CO
Alarm Affidavit
INSP.O2 2013 CRC
This document moy be found at... http://wvwv.santa-ana.org/pba/
(Please use a black or blue ink ball-point pen)
Project Address:'7 to S. -radilferop sr * P
Permit Number:lo / / oz / <o
Property Owner:
L
Leu
Contractor:fGL{+ R-ooF"d h License #, /ct V $e S7
State of California requires that smoke and carbon monoxide (CO)alarms are installed in residential
buildings.
California ResidentialCode (CRC)Section R3l-4.1and R315.2 states in part that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define
the required locations.
nBoth boxes below must be checked:
(CarUon monoxide atarms: Are installed outside of each sleeping area in the immediate vicinity of
bedrooms and also on each level of the dwelling. Alarms are required in bedrooms with gas-fired
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
ESrot" alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping
room, and on each level of the dwelling.
Retrofitted detectors may be battery-operated for buildings where no interior alterations are
performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved
by the State Fire Marshall (SFM). Battery life must be L0 years.
I hereby certify that I am the contractor or the property owner of the above project. I further certify
that smoke alarms and carbon monoxide alarms have been installed in compliance with the governing
Codes and have been tested to be functional, l, also, hereby certify that I will retest the alarms per the
manufactu rer's instructions.
(check onel B Licensed Contractor tr Property
NOTE: This self-certification is only used for projects that offect the EXTERIOR of the structure. This
process is opplicoble ONLY to projects where occess to the interior of the dwelling by a Santo Ana
lnspector is not required.
-r' I 4-Dote:4*/*
Have this completed form and the job-card readily available on final inspection!
Signoture:
rNSP-02 2013 CRC
This document may be lound dt... httO://www.santa-ana.orq/pba/
(Please use a black or blue ink ball-point pen)
State of California requires that smoke and carbon monoxide (CO)alarms are installed in residential
buildings.
California ResidentialCode (CRC)Section R314.1and R315.2 states in part that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define
the required locations.
f\ Both boxes below must be checked:
fiCarUon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of
bedrooms and also on each levelof the dwelling. Alarms are required in bedrooms with gas-fired
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
P Srnot" alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping
?oom, and on each level of the dwelling.
Retrofitted detectors may be battery-operated for buildings where no interior alterations are
performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved
by the State Fire Marshall (SFM). Battery life must be 10 years,
I hereby certify that I am the contractor or the property owner of the above project. I further certify
that smoke alarms and carbon monoxide alarms have been installed in compliance with the governing
Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the
manufacturer's instructions.
(check onel E Licensed Contractor pe
NOTE: This self-certification is only used for projects that offect the EXTERIOR of the structure. This
process is applicable ONLY to projects where occess to the interior of the dwelling by o Santa Ana
lnspector is not required.
Have this completed form and the job-card readily available on final inspection!
Project Address:#
Permit Number:
Property Owner
Contractor:License #, / 0466f/
Signature:/rl Date:y'.-/r,
**SNTA
NA'ffi
Planning & Building Agency
20 Civic Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(71 4) 647-5800
ww.rrr'. santa-a na,orq
Smoke & CO
Alarm Affidavit
lo/ tnZ /4n
t -Ar/
tr
Project Address:o SA\P 5
Permit Number:
Property Owner:
Contractor:6 License#: /A466
INSP-02 2013 CRC
This document mdy be found dt... http://rlrnrwv.santa-ana.orq/pba/
(Please use a black or blue ink ball-point pen)
State of California requires that smoke and carbon monoxide (CO)alarms are installed in residential
bu ildings.
California ResidentialCode (CRC)Section R314.1and R315.2 states in part that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R31,4.3.3 define
the required locations.
nBoth boxes betow must be checked:
flCarbon monoxide alarms: Are installed outside of each sleeping area in the immediate vicinity of
bedrooms and also on each levelof the dwelling. Alarms are required in bedrooms with gas-fired
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
[lsmote alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping
room, and on each level of the dwelling.
Retrofitted detectors may be battery-operated for buildings where no interior alterations are
performed. Combination Smoke/CO alarms must comply with all applicable standards and be approved
by the State Fire Marshall (SFM). Battery life must be 10 years.
I hereby certify that I am the contractor or the property owner of the above project. I further certify
that smoke alarms and carbon monoxide alarms have been installed in compliance with the governing
Codes and have been tested to be functional. l, also, hereby certify that I will retest the alarms per the
man ufactu rer's instructions.
Signature:.-/ ---/-/e.--Dote /,-/*
'^^-+,,.1(check onel Licensed Contractor P ner
NOTE: This self-certification is only used for projects that affect the EXTERIOR of the structure. This
process is applicable ONLY to projects where occess to the interior of the dwelling by a Sdnta Ano
lnspector is not required.
Have this completed form and the job-card readaly available on final inspection!
*-SNTA
NA'ffi
Planning & Building Agency
20 Civic Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647-s800
ww.,v.santa-an a. orq
Smoke & CO
Alarm Affidavit
lDlro 3 ) VO
L4U
tr
t
C*O'SNTA
NAJ,ffi
Planning & Building AgencY
20 Clvlc Center Plaza Ross Annex
P.O. Box 1988 (M.19)
Santa Ana, CA92702
(714) 647-s800
wwlrv.santa-ana. orq
3 CRC
This document may be found at...nta
(Please use a black or blue ink ball'point pen)
state of California requires that smoke and carbon monoxide (co) al rms are installed in residential
buildings.
California Residential Code
"retrofitted with smoke ala
the required locations,
(CRC) Section R3L4.1and R315'2 states i part that existing dwellings be
rms and carbon monoxide alarms. CRC n R314.3 and R314.3.3 define
ABoth boxes below must be checked
Elcarbon monoxide alarms: Are installed outside of each sleeping rea in the immediate vicinitY of
bedrooms and also on each level of the dwelling. Alarms are requi
appliances (i,e. hot water heater, cooktop, furnace) or a fireplace.
fl Smot e alarms: Are installed in each room used for sleeping, in
{oom, and on each level of the dwelling.
in bedrooms with gas-fired
hallway outside of a sleePing
Retrofitted detectors may be battery-operated for buildings where interior alterations are
performed. Combination Smoke/CO alarms must comply with all ap
by the State Fire Marshall (SFM). Battery life must be 10 years.
icable standards and be aPProved
I hereby certify that I am the contractor or the property owner of
that smoke alarms and carbon monoxide alarms have been install ed
above project, lfurther certify
n compliance with the governing
Codes and have been tested to be functional. l, also, hereby certify
manufactu rer's instructions.
I will retest the alarms Per the
(check onel F Licensed P ner
NOTE: This self-certification is only used for proieas that affect the of the structure. This
process is applicable ONLY to proiects where dccess to the interior
lnspector is not required.
the dwelling by a Santo Ana
oke & CO
rm Affidavit
S
AI
ft-f7/O 5 froilsh)D SrProject Address:
/o//o313OPermit Number:
/-o ilProperty Owner:
License #: /o{66LTE4h Eoo,a{hContractor:
4Signature
Have this completed form and the job-card readily avai on final inspection!
*,,SANTA
NA'ffi
Planning & Building AgencY
20 Clvlc Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647-5800
ww,v.santa-ana. orq
This document may be lound ot...
(Please use a black or blue ink
anta
INSP.O2 2013 CRC
rea in the immediate vicinitY of
in bedrooms with gas-fired
ball-point pen)
state of california requires that smoke and carbon monoxide (co) al ms are installed in residential
buildings
california Residential code (cRC) section R314.1and R315.2 states i part that existing dwellings be
,,retrofitted with smoke alarms and carbon monoxide alarms. cRC se ion R314.3 and R314.3.3 define
the required locations.
ABoth boxes below must be checked:
S.caruon monoxide atarms: Are installed outside of each sleeping
bedrooms and also on each level of the dwelling. Alarms are require
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace'
ES-ot " alarms: Are installed in each room used for sleeping, in
room, and on each level of the dwelling.
h hallway outside of a sleePing
Retrofitted detectors may be battery-operated for buildings where interior alterations are
performed. Combination Smoke/CO alarms must comply with all a
by the State Fire Marshall (SFM). Battery life must be 10 years.
icable standards and be aPProved
I hereby certify that I am the contractor or the property owner of above project. I further certifY
that smoke alarms and carbon monoxide alarms have been installed n compliance with the governing
Codes and have been tested to be functional. l, also, hereby certlfy
man ufactu rer's instructions.
t I will retest the alarms Per the
lcheck onel Licensed Contractor Owner
NOTE: This setf-certificotion is only used for proiects that affect the 'RIOR ol the structure. This
process is appticoble ONLY to proiects where occess to the interior
lnspector is not required.
the dwelling by a Sonta Ana
oke & CO
rm Affidavit
S
AI
L7/0 \r.7MProject Address:
/o//oJ/.7oPermit Number:
L*uProperty Owner:
I: /0(649rLicense(ec* Rpatrdb-Contractor:
24Signature
Have this completed form and the job-card readily on final inspection!
*,,SNTA
NAJffi
Planning & Building AgencY
20 Civic Genter Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA92702
(714) 647-5800
ww\,v.santa-ana.orq
201 3
This document moy be found at...na.o
(Please use a btack or blue ink ball'point pen)
state of california requires that smoke and carbon monoxide (co) al
buildings.
s are installed in residential
California Residential Code (
"retrofitted with smoke alar
the required locations'
CRC)Section R314.1 and R315.2 states i part that existing dwellings be
ms and carbon monoxide alarms. CRC n R314.3 and R314.3.3 define
ABoth boxes below must be checked:
F..
bedro
rbon monoxide alarms: Are installed outside of each sleeping in the immediate vicinitY of
oms and also on each level of the dwelling' Alarms are requir in bedrooms with gas-fired
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
pfsmot<e alarms: Are installed in each room used for sleeping, in e
ioo., and on each level of the dwelling.
hallway outside of a sleePing
Retrofitted detectors may be battery-operated for buildings where interior alterations are
performed. combination Smoke/co alarms must comply with all ap
by the State Fire Marshall (SFM). Battery life must be 10 years'
icable standards and be aPProved
I hereby certify that I am the contractor or the property owner of above project. I further certifY
that smoke alarms and carbon
Codes and have been tested to
ma nufactu rer's instructions.
monoxide alarms have been installed n compliance with the governing
be functional. l, also, hereby certify t I will retest the alarms Per the
(check onel fi L cense d Contractor pe
NOTE: This self-certification is only used for proiects thot affect the of the structure. This
process is applicable ONLY to proiects where dccess to the interior
lnspector is not required.
the dwelling by d Sdnta Ano
oke & CO
rm Affidavit
S
AI
#/7b e- 7ooA*ilr sTProject Address:
Permit Number:oo
LiuProperty Owner:
r: Lo4 6 6-f,License ITatA a-oofrdlz-Contractor:
Signature:
Have this completed form and the iob'card readily avai le on final insPection!
*,,SANTA
NA-ffi
oke & CO
Affidavit
S
AI
-5Project Address:
Permit Number:
Property Owner:
LicenseContractor:
2-O %Signature:
This document maY be found at...
(Please use a black or blue ink ball'point pen)
State of California requires that smoke and carbon monoxide (CO) al rms are installed in residential
buildings.
California Residential Code
"retrofitted with smoke ala
the required locations.
rms and carbon monoxide alarms. CRC n R314.3 and R314.3.3 define
Planning & Building AgencY
20 Civic Center Plaza Ross Annex
P.O. Box 1988 (M'19)
Santa Ana, CA92702
(714) 647-5800
www.santa-ana. oro
htt
INSP.O2 3 CRC
rea in the immediate vicinitY of
in bedrooms with gas-fired
san
(CRC) Section R31-4.1and R315'2 states in part that existing dwellings be
Aeoah boxes below must be checked:
E[Carbon monoxide alarms: Are installed outside of each sleeping
belrooms and also on each level of the dwelling, Alarms are require
that smoke alarms and carbon monoxide alarms have been installed
Codes and have been tested to be functional. l, also, hereby certify t
appliances (i.e. hot water heater, cooktop, furnace)or a fireplace'
EBSmoke alarms: Are installed in each room used for sleeping, in e
,Lo., and on each level of the dwelling.
h hallway outside of a sleePing
Retrofitted detectors may be battery-operated for buildings where interior alterations are
performed. combination Smoke/co alarms must comply with all a
by the State Fire Marshall (SFM). Battery life must be 10 years'
icable standards and be aPProved
I hereby certify that I am the contractor or the property owner of above project. I further certifY
n compliance with the governing
at I will retest the alarms Per the
manufactu rer's instructions.
(check onel fif Licensed (P er
NOTE: This self-certification is only used for proieas that dffect the of the structure. This
process is appticable ,NLY to proiects where occess to the interior
lnspector is not required,
the dwelling by o Santa Ano
Have this completed form and the iob-card readily avail le on final insPection!