HomeMy WebLinkAbout20165687 - Permit20 Civic Center Plaza (M-19), Santa Ana, CA 92702
lnspection Requests: (7 1 41 667 -27 38 lnspector Section: (714) 647-5853
Electrical Permit #: 20165687
Pin #: 71773
City of Santa Ana
Permit Counter: (714) 647-5800
Assessor'sParcel: 400-183-06 Lot: POR 13 & POR 1,
Unit:
Block: NA
Bldg:
Tracl: 4159
Address Range:
Historic: No
Suite Range:
Zoning: Rl
pY
Owner:
Address:
Contractor
Address:
Salvador LuJan
614 N Mabury St
Santa Ana, CA 927014110
{7r4) 263-s8s7
Vivint Solar Developer
9847 Pioneer Blvd.
Santa Fe Sprinqs, CA 90670
ls62l942-1270
Fce Typo
01116002 51600 General Plan Update
Amount
21 .25
Fee
$0.00
Qty
000
Notes lnstall(ll) root mounted solar panels. FEES PD lN
FULL ON 10196214.
$0.00
$0.00
$0.00
Phone
Tenant Name:
Phone
State Lic #: 973756
Lic Type: C-10, C46
Bus. Lic #: 345470
Workers' Compensalion lnsurance:
Carrier: Amerlcan Zurlch lns Co
Policy #: WC5096013
Expires: 11l01l201a
Building Use:
Job Type:
Nalure of Work
Planning Conditions:
Planning Approval By:
Single Family Dwelling
Solar
Solar
R-3, U
VB
cEc 2015
Plan Checked By:
Permit lssued By:
Subiect to Field:
Amsden, Julie
Building Permil #: 10'|.96214
Every pemit issued shall become invalid unless the wol* o/, the sito
authotized by such pemit is cofinenced within 180 days aftet its
issuance, ot il the wod< authoized on the site by such peinit is suspendod
or ebendoned fgt a pedod ot 1 80 days aftet the timo the wotu is
cornnpncad.
Date:
Oate:
Oate: 0tr,12312018
Account#
Misc. Receipl:
Misc. Receipl:
Misc. Receipl:
Total
lnspector MID#: 2018-142878
Fee Total:
Paid to Date:
Balance Due
Project Address: 614 N Mabury St
Occupancy;
Constr Type:
Code:
ELECTRICAL-INSPECTOR BECORD
OATE ID/SIG.COMMENTS OWNf,N BULDER Df, L(:AR TION
I h.r.-I,, .rrm und.r Fuhy ot Fr,ry rtd I m .r.rB fron rlE Co Erm Li(.* b* for r,. folt rlrr Er$n ( S.( r0l l 5
Buri6r .rn Pr.tdsirrn C.d.): An, Chy or Cdlry whth Eqrilr . Fna r. Nninar, rbd, irt .w. &mlirh or d?.t sy
rlB1ft. Fin lo ir itffi. i$ r.quiB llr rFla.nl ror ryl' It n to nk r sirEd lrd.ffir lhd L o. lrE i liqEd [r.I[r
lo llE Flvibns of rlE Cod ldt Litnrn br l()rtid 9, ComEir8 sih S..lbn 70d) d Diynion I of llE BNiFs rnd
Brr-.ionr Cod.) dr tltsr l! ( {i ir .rr$ rlEEf.on.!d rlE hGrit fd rlE .llq.n cltrprion An, vi,bri,n of ki,.70ll5hyry
q,rl.. ror . Fmi {bin. rlE .p9lar.r ro t carn FEly ol er mr rhrn n!. huirH dou{i (!1D).
-1.
!{ n*Er o, rlr ForEny- or my crylo}E( * ir,r *!3.. .{ rlEt $t otr{Ensri,n. r'ill d' rlr *rl !,n rh. tlnnE n d
nrdrLil oro,Ynn nrsltsa 7{)ll,l, EuiE$ lnd Eors{i)n\ G'dc: Tli G,.rrdor'r Lxcne Irf, dBto !901yrorosmor
rhc F,Fdy rtb h{ilds or iqmB rhd&nr, lrn uh .lq rMn ft)rt him*lf or h.mlt or thrulth hn or h.r orn .r{'by.6.
!n,vid.d ihr skh inqmtrnh E rl i,{..dol q .ltcRl tu $L. lt lbEE, rlE l[ihil3 or iqfrktnr ii sld *ithin oft Fr
olFnliLrhn. rlr OwEr Bui[cr willhrE llE hrdcn of F'vinS rhd tr or {ltc dn d bir.].r nr{n,E rhc F,pcny n rl.t plrF)sof
_l, {r .sE of rlE r,trIlcnt. !m .rclusi!.ly conr.!.1in8 * ir h ltc,cd ontGroF lo .on(Mr rL F*d rS$ 7l)ll4. Bxiik*
.rn Alilr{n Cod. Th. C.nr(k \ l-i..n\. l-du ddr nor lpp ly ro owncr of proFn, wh) buildr or mpnv.r rncr.o..
rnd wkl c,nh.ri tor soch In,rLk *irh ! Co trn(i) liosn puFu,rr k' rlr G,nrelor! lj.rn€ lrsl
I ao.i.mfl td.t S<rion
lrrl. {hmr
rTotti a[\' (.ol\tPt].is,\ not
DIS.AITIIID
I lir.lNrlln'nunJ.r n mhr.f Frur),trf, rlrh. n,l[,{tr,! Jc.Lirrrk)n\
_l h.!. rn *ill mi.llin r Cd'fr.r. olcomr ro S.lr'lnruE ftr wl6 mlltEn!.rin r! Folildl fo, hy Sdbn l7m otlE
ljrnr,fnd.. tu rhc Ffolffi nf llr s,t lm *,,rEh rlE Fn s nrud.
YihrE lnd u ill tu'i|a m I "rlcr' omlrmrr nn Intu,!B'c. !r EquiEd hy 56r io. l7m ot rh. l.h.r CDdc, ror rtE p.iolm. ol
rh. q'rk hrwhkhihF ICm r t{d My$nrl6 c.ryrislntr in.uEKc,ftr un Fnr'rnuntF m
,**, 4trl n, t-o-n '7"*'r, t
P"*rN,-b.,,@*r*., \V/ / / k
-l
anify GI in E Frlorrm ol rh. *olt fM whrh thk Fnir i irsel.I lhnldn.q!bymy Fmn ht.,luF
r'.rlotE$msbF.llollEw 6 oqE{rnh. hu olc.lifom[ .rn +r lhd ir I nDuB tErofr obFd ro lL
mrts mr{Enubn Flvthnr ol S.<rbn.l?(xr ol rlr l,ll Codc l irll. lnhwnh Nqrly vitrlrE |nvni'n!
tryARNNC FrituG b lle *rtc(' $n{Ensrlr oEra( ir unLlfu( rn ndl .ubFr u .rqrlr,Fr ro dinEd FExas !d
.ivrl fi6 ut ro or hudt d rhouqid dollt^ (ilt ,tlx,). in lrtdirion ro rlr st of oqEmrn'L .,!m8.r .r Fotil.d lor $.
Sdlxrn 1016 ofrh. bhr Cr'd.. lnrcrc{ rn, dnrfty \ fd*r /2,/-4l,s l,t
- DEIIIAAIIIN
I hcEhy umnnundcr FnalryorFlury th l un lttncd u*l.r povishr ol Chr,}r6 9 (mmnENinS wirh Sccl hn 7lxl0) ol Division l
.f rh. Bucilcs.nd Pmldsi,)nrCod.. uri mr li..ns. il innirn,lfid rr"d
e-4u 4l'>t n
ffiev+trp'z ut+z=/+v ltu
I trE$y drEn lrrd FMxy or Frrury 'hd
rllr. i1t dr{Mir hd,.a {.my ror rrr F.r(mNc ortE $.d nn {tih rhi\ Fmi ir
A.TIIIIAtrTDDCIJSAIIAN
Lra.r,y unm undcr Fcnally ofpcrjury oB oflhc knir*inr dehrutions
lXnn'lirion Pcrmn$A\t noi Nohfi.dri,)n ltd.hl R.*ulr(tun1lTnlc 41). Prn6)
--R.qut.d
t rlc. of Nd ff,alirn
_l ( drily rh.r 'tf rcd.nl EslLrnc E3rdrt .rltrln! Emtd E rcr aE t.hk ro rh! pmixr
-11drr,ddIrrEEdrh!.pplrdnn.d{{.rhrrlErlbEinfoldink.ffi.I.!rbo'rtlysihr[Cny.'nCoo,ddills !n St.r. b$ ELriB ro hiuiia odndntr .ql ffiy lrbriz EFtsniE ollhir Cly rn Courr, ro ors qm t E
1,1-rh\. trr' rra.J Ill,ncn! ntr in5FiU{lpu'Fi{r
^ppurmr
or AsFr skDru* *"",1
f'.mirr mm rprlnr': L^4 Ct a/'-17,"/.,0
Site-Work
Underground
Light Standards
Spas, Pool, Fountains
Signs (monument)
Life Sal ety /Low Voltage
Fire Alarm / Dampers
Communications Cable
Building
Under Slab i Floor
Bonding / Grounding / UFER
Transformers
Torqueinq
Sub-Panels
Air Conditioners
Rool Top Equipment
Factory Wired Unit
Walls (Conduit)
Walls (Rough)
Ceilings (Hard & Soffit Rouoh
Ceilinqs (T-Bar Rouoh)
Meter Release
Rough
Service Meter
ffi-rFINAL /it 5. ,rLDr*
Notes, Remarks, Etc.
APPROVALS
aro.d (S< 1097. Civ. C )t l&rtNrr:-
lir(h.s Addrss,
-
Pole Bases
*,,SANTA
NA
ILI\]IIG
iIUut\[
IfiIfi
Planning & Building Agency
Building Safety Division
20 Civic Center Plaza
P.O. Box 1988 (M-'19)
Santa Ana, CA 92702
(714) 647-s800
www.santa-ana.or9
RESIDENT!AL
PHOTOVOLTAIC
CHECKLIST
sol-o1 cBc 2013
Solar Photovoltaic (PV) Checklist for Detached SINGLE FAMILY RESIDENCES Onty
lnstructions: The licensed contraclor of record shall complete all sections, answer the ten questions and
sign the certification section below. A copy of this form shall be attached to each of TWO sets of plans, of
minimum 11" x 17" size. lf answerino NO t o anv of the ouestions. o lan check shall be required.
Project Address:V1a6"\-r
Contractor Company Name:t-!o ta-Ll o LLC
contractor License Number, llll f L,
YES NO Are the following applicable to the proposed project?
Will the PV system layout provide the required three-foot wide clear access pathways
per Section 605.11 of the California Fire Code, and is this shown on the roof plan?
Will the PV system be installed on a rool having only one roofing layer with no
overlays?
Will the PV array be flush mounted to the exasting roof so that the plane of the
modules (panels) are parallel to the plane of the roof?
Will the PV system weigh maximum 4 pounds per square feet or less?
Will the PV system be installed where the modules do not overhang any roof edges
(such as eaves, gabled ends, ridges and hips)?
Will the PV system be installed with a space of 2" minimum to 10" maximum between
the underside of modules and the surface of the roof?
Will the PV system be installed without using any ballast system or counter-weight
system?
Will the anchors be installed with a maximum horizontal ancho[ spacing of 6 feet
and is this maximum horizontal spacing shown on the plans?
Will the minimum 5/16" lag screws be installed with a minimum ot 2-112inch
embedment into roof rafters (with pre-drilled holes) and is this minimum embedment
shown on the plans?
Are ALL the struclural pages ofthe plans stamped and signed by a California
licensed professional engineer? (including prolect speciflc site plan, PV layout,
anchorage spacing, anchorage details and manufacturer's PV support information.)
(u
2 ETE
3 Ertr
4va
5. EI-tr
6 Ertr
7 EItr
8 EI-tr
9 EItr
10 qc
I certity underlp
Print Name: L
e na lty of perjury under the laws of th
L'l^/V
e State of Cali iat h[f,7!.o'" i..,u.'
Signature
Phone Number:67'L q +l)1 o Date
Email Address: fi)etnt t
Rev: 11/'19/2015
Ur*o la,r.u *'t
+ri
1.
EXI,E DITED PE RN,IIT PROCEsS
SIANDARD STtt.ING
Fc)R PV SYsTEITTS
Sr srrvr
The Solar America Board For Codes and S(andards (Solar ABCS) Expedired permir pro-
cess provides a means to di[Ferentiate svsrems that can be permitted quickly and easily
due ro rheir slmilariry wirh rhe majoriry of small-sr:ale PV systems. Those sysrems wlrh
unique characreristics mav be handled wirh small addilions ro rhis Expedired permir
Process or may require much more informarion, depending on the uniqueness of the
rnsrallarion.
The following pages contaln forms for rhe Srandard Srnng Sysrem ro use wirh rhe Expe-
dited Permir Process. The Micro-tnverret AC Module, and Supply-Side Connecrion forms
are also available as interacrive PDF files ar wwwsolarabcs.org/permitring In jurisdic-
rions rhat have adopred the Expedired Permir Process for PV Sysrems. these forms can
be filled our elecrronically and submifted in eirher printed form and via email. An elec-
Ironic format is used so that rhe supplie(l tnformarion is srandardized and legiblc for rhe
local jurisdicrion.
PERITTTTYPE.C,
{o lrn =u-=?e--93-u\I-rn. Y/1 ,,o* 3OI lc
lEx
acHOOt DtsTRtcT
--=&
[,
t-lMt
E
'!
\
rC
t/
I
EXPEDITED PERNlIT PRoCES\ FOR SN,{ALL-SCALE PV SYSTT TS
STANDARD STRINU S\ 5I'ENI
The informarion in this guideline is inrended ro help local jurisdictions and contractors rdenrify ',vhen PV system insaallations
are simlle. needrngonlya basic re.view and when an installalon is nrore complex II is hkely that 50%-75% of all residennal
systems will comply with these simple crireria. For projecs rhat farl to meet rhe simple criteria. resolution steps have been
suggested ro provide as a path to permit approval.
Required Infonnation Jor Permit:
l. Sire plan showing locarion of ma.1or components on the properry This drawing need nol be exactly to scale, bul it
should represenr relalive location of components ar site (see supplied example site plan) PV arrays on dwellings
\vith a l perime[er space ar ridge and srdes may not need seParale frre servlce review
2 Elccrrical diagram showing PV array configurflrion, wiring sysrem, overcurrent prorecrion. invener, disconnec[s.
requlred slgns. and ac connection lo buildrng (see supplied srandard elecarical dlagram).
i qpe.i6.ano,r sheers and insrallation nranuals {if available) for all nlanufafiured conrponents including, but not
lim(ed to, PV modules. inverrer(s). combiner box, disconnects, and moun(lng system
Step 1 : Structural Review of PV Array Mounting System
Is the aray to be mounted on a defrned, permitted roof structure?ves f]n o
lJ Nct tlut LU ttotrtutrqlutt r uul Ut rr gn-/u,rd l,loullr. sutJDlrl iiornplcfc.l ]vo,ltshsel/or lhs sr,1icfurc tv,{s1
Roof lt{ormation:
1. ls the roohng rvpe lighrweighr (Y(:s = cornposiliorr. lightweighr masonry, nlelal, etc.. )comp shingle
II No. submil compleled worksheet Jot rooJ structure Wi(SI (No =
2 Does rh-A roofhave a single roof coveringz Elyes flno
A No, e rmit rofiqtlcLcd worh-\lvel lor rouJ structutu W'KSl-
J. Provldp merhod and lype of 'weatherproohng roof penelr
M ounting Sy st en fformation :
heavy masonry sldte. etc. .)
ations (e g llashi g. callk)flashing
I ls the rficunring Srruclure 3n
benearh the module lrames?Yes
ineered product designcd to nrount PV nlodules wilh no mofe than an 18" gap
No
II No. provide detaib of sffuctural attachment cotijed by a design prolessional.
2. For manufncturcd mountrng 5l-stem5. frll out informiltion on the moun ng syslem belo,v
a Mounnng sysrerr Manutacrurcr E99I3llglProducr \ame a n,1 r."1,y,1g11Rock it
b Total weiqht of PV llodules and Rarls 712.4 lbs
c Total Number of Attachmenr Poinrs22
Weight per Artachment Porn( (b - c,32.4d
e
bs (if grearer !han 45 lbs, see wKS I )
i\,taximum Spacing Berween Altachment Points on a Rarl 48 tnches (see Product manual for
nraxinrum spacing allowftl based on maxrnrunr deslgn wind speed)
I Total Surface Area of PV llodules (sq ussg gssl;246.5 fr:
g Disrribured Weighr of PV X'lodrtle on Roof (b : l)2.9 lbsrfi-
Il distributed w€ight of the Pv system is greater than 5 lbs/fr, see wKSl -
Stap 2 Electrical Rzuie.", oI PV Svstem (Calculatrons [or Electrical Diag,.ar)
In order for a Pv system to be considered for an expedited permit process, the following must apply:
I PV modules. urlrr)-'interaarive inverters. and combrner boxes are idcnUhcd for use rn PV systems
2 The PV arrav rs conrposed ol ,1 senes strtngs or less per inverrer
L The roral rnverter capacity has 3 conrinuous ac polver outpul li.4-10 Watrs or less
-l The ac rnrerconnecrion pornt ls on the [)ad side of servtce disconnec0ng n]e.]ns (590.64(B),.
5. One ol rhe standard electncal djaqrarns(El lE1.la,E1 lb,orEl lcr can be used [o accurarel! represen[ the PV
svstem lnteractive PDF (liagrams arc avarlal)lL at ww'\r'solarabcs orq/perrnlctlng
a/r)rrrlrrl,ira(itL'. I.ro1'rda rt, ,riar'r,t.itit f dkigr,ir,i tt !th nfpraprtl.]t,. ictatl
2 i\t \tIlt, l' rt.t, J Il.r\ [\\ f()li i'\ i\\Tt\lr
SIANT)AIID STI{INC SYSIt,v SITE I,t,AN
2
2
Site Plan
for Small-Scale, Single-Phase PV Systems
Site Name Lq.n Resd.m
Site AddreSS 6i4 Mabu,y 3r
System AC Size:32.
NT5
=o
o
--J
614 IVABURY ST SANTA ANA, CA 92701
51N
roj ule.r6etc lesulcelf plepuels eutl-euo
'.r :azrs cv u.ralsS
aiaI.LU Sat?seU6otUe SdL]SleoSS
's,(,nqer.{ e ssaJppv qIS
ual,]rna !sr.r .auleN alls
|!&dol€^.O iq.S u^r
IE
'/e
'E .fl,
0
OL
I
ccf ollvlnsNt
o z MHU ro o Z-MHHX ro fl Z-NMHI
'oN(J3 tooutcl'E eNtoNnoHe cal
3el ollvtnsNt
D z-M|]a ro D z MHHX To E z NMH1
D Z.MHU ]O D Z.MHHX JD f] Z-NMHT
(x3i) oNoJ ouc ol ulddo3 fEVa V/N
:]ZISldAl.rbrinoro, l.o"io, 1
El rutM
^d
ro tr z-lsn ] I
IItnoNos I lrnaNor ifo fifSr,\Jn1i-orc)c I rdll uoronoNo3 uo Nor-Ldursfo
llnorHlS ro1]r)qNo) oNv l!noNolV
fcou-L33tl
CNIoNROUe
cNtct-'In6
./au3^u r
r.[rM pOpr^Ord
Jr preoejsro
DNt0NnOug VUUy
oNv frnoon No NotlvlJuoJNt
uo-l I xroNSddv lotoc lls
l^ogv yNvtft ur ,V/N, tn,l
scNlllls s,rluis olsnNn 801
t
)
I
(6 Notlcls lotnc lls ostv'sodco a3-IUfnNt aol 9 lroN fls)
CdSO U3-L>ifANl V ,,? SnB V'-o z- NrVn V ;,, iVA orr-lrNVd llt^Sls
(olsn ir)ltlNNocsto ov
(olsn ll) u:1ft'J Nlc
ul laln Ntcv/3c
t3lNNOSSr(1lC5
l,
(
I
l)AUls
lln 1n
1o:sn rt) u:Ntey{oc I
S31ONa3EhJnN lAVd
- llnSU13_l3}lnOS sllHf s ! rurs:rnoor,r - -
a -Ltn3an_13>tnos sltxls ! rurs:rnoolv
otsrq lv!_Lln'JUl3-rJUnOS Sf rU3S
a Nr sS]noot!
I!I]!IITNT.I'!
lrE odlo
ullutANt
(
.)o
'ttn3ul.)-r3unos sltu:s
Nt sStooon -- ql
ffi ffi*
TII]I rI
o rrnolHls 1N]l /drnol
(olsn J) xoa r
AVAUV N d
,rn00y! A.r uvros
NOrldrulslo
r,!vuDVtC -tvf lt-1.),t Il w:ll_\As DNtUt_S cIIVCNV_t\
I
I
L
vvvV
I
I ,o. ,
elecslN
alsAs n d aseq6-a16uig .ro1 ruet
lecrJlcalf prepuels autl-auo loJ saloN
'z 1 :ozls CV uJalsS
elc su,
ls
^,nqer,]lIs
:SSolppv allS
.J6p'rr! usrnr auJeN elts
rro(ld t.^no rstos r(n^A
18erllNfaar)31nd1no cv
9ZL
0vz
cNltvu cd30 xvr!
lNlSunS 3V XVt\l
lev-tto^ cv-lvNlnJoN
c,or @ uranoi xvyr
eNllva lro^ 30 xvt,'l
.{E)iz)(B)rc 069 NtNotrd:3xl uvesna yooz I *r,*
^,ono, "r=9*S ^9"3iA rvlo r sroc'ulLUiANt HJvi uol J\o (s)od3o ul-LUlANt - ---i lo tyrol (a
(6 uolras aphg ees) CN|_LVU 3ualdttv od]o u:uarn Nt or 9Ntouoo3v suo-rcnoNoc (cv) lnculc tndlno ufiufANt tziC(i
ICtNNOSStC lV 0NtlVa Od00 uo N9ts cs 069 cfN No tNfuun3 xv!,I No orsvs suotonoNoo (co) liunos ulMod 3tvtronoroHd 12as (a
I v/N O oN E st^ alNlt{3atnDlu lHl J.tfn.[fy30s uJ13[] slHJ. sfoo ofutnolu ullln NotlwlNfc lt(;
!V/N trON trSl1 ?,lNlgtilulnolu lHl rrf l'r HolMs slH-r sf oo Hcl.tus )rvf ug-l lgtstA v slutno3a ,r,rritrn i G
'16 pu! fxd .oseDrhS) slln)ul5ulll]lANI aol slloN
uv'tos oNV A- ll-Ln) sf 3unos
ltdl_t-lny"/ Aa cJl lfNVd stHl
0rzlSvl]o^ cv tvNlt{oN
dfrrvws uo dnv-s! v A€ ollcfl.ud NsHM aar, ,o .o^o , u ,o r"i=r??i
sllnooyv uoJ fravtdf33v A-nvufNfe JUv suot3noNoo ],06 '9MV ot {q
ult lvt/\ls uo d^v'zt v a o3..,troud NIHM
""=. ,o a"*
"n
, ,o "ri"?}i s3lnoon uol 3-tavldlJJV ,r,IValNf9 3t v saol3noNoS 1,06'9MV z! (e
'(sq1vls oE|Nn lo r'tv)ssf I uo o"lt lo fanJ.vtf,dn31 N9tsJo aooo1no 3H-L cNtsn oNv Joou S^oav,s 0 -tsvf l IV InONOC lnNnS O3lNnO,1-JOOa Nt SA013n0NO3 CNtIUUVS-lNfAUnC
6 NvHt ssfr uo I (Jor
', stvJ scNiuds n rvd) siJvts o]llNn lHr NlJ"t,olltxS loN oo slunrvuidltlf-L Nctslo o/o? s tvrNlnloNnl ivuHsv so0z ( z
3. * lunlvaldy,Er snonNtlNoS Is3HctH Notrvco] No[v] tvrsNt 01u\fltl, s lsoll No[vco-] qvaHSV uoj fun.tvafd],|/31s tns ,(ao %z HINoN lSfH9lH ]\rdHSV NO OSSVS fAn.I\fdldttfl lNllgl,lv SnOnNllNO3 rS3HClH ( Z
3. ! dr Sl lNlt8nv clllf.txl t.sfMot Notrvlot NoU.v]]vlsNl ol !JV-Ii'fls lsot/i Notlvcot fvuHsv Eol tunlvu:rdr lt BtnS A80 :tli|]alx:Nvft^t nnl/,lltN[il 3vuHsv No oltsvg ]anLVutdwll lNltawv lJfdxi rslMot ( I
(0rtAroddv pue EDirE I riolcos 6rxnd SilJJSIM I]n5ut5 lv8XV U6J Slt6N
NOt.tSsNNOC JO -rNtod 3v
nl-tsAs Ad uv-tos
(oiSn lt) IOINNOeSIO 5v
0NV OJCOtfTU:ANt UOt NOtS
9
(xx xxx 9fN) sv NMoHS sllNlulJlS ,looll ]vStulcf 't3 lvNol.tvN
I SJtnro Notrolload lNfaunlul^o = od?o
SeNtMyuo Tlv uo.t SlroN
z0'6
(9 tl()rircs .p nO) t)ts^ @ SCN|IVU ltnoon Ad
s-LtNn lrSurc'c:Irddns JJtoc Jt
tx c"rv" ro trcinJ) :Jfoc dr,Jl-L lo^
('"loog a,ul :cvLro,l xvn
(Md) ulMod y,lnntxvt!
(od3o) fsnJ sfrufs xvlt
(i"t) -Lr.r:uun: irn:rr:-ruoxs
(.oA) fCVt]OA l|nOAtD-NfdO
ldn) tovtton lNtod"utmoakn
(fr r) rruruunc rtto.t-uy,roa xvyl
E09-W06zy!yl I rf oorl r"rnoori
I Jelosolutf lYvhrsrncon
620
0
6Z
00
0 80
It
sn-Ho0Bef Si r:cornr u:ru:,rr.rr
ooDo lglos r rvv! urrui^Nr
(t uotlc6s opiile) scNtlvlJ u l])tl^Nl
SL
81 6
8BC
(, (,\.
ll
l'"
eu
PU
J9Vl tOA ddll 03-LVU
lNlUUnl dll l/t ollvu
snos urMod ltvlto^oloHd
IoINNoCStO 50 UOJ NCtS
I NOll3lS fOtnc :ifs-sNcts
t^\rVHDVl(l lVllY-Lllll yvSI-SAS DNtX.tS CUVCINV.IS UO:t s:tI()N
L
**sAL{lA
NA,ffi
Pian,:ing & ts cildli: g Aget:y
2t Civtc Ce.:e.- Pra:3 Rtss A.net
P.O. 8ox 1988 {u-19)
Sanla A,1a, CA 92702
(7t4) 647.5A0O
Smoke & CO
Alarm Affidavit
fhis docu.nent moy be lound at...
1p,/e.asr use a bl*ck ar blue ink ball-point p€n)
Project Addrass:/114 N. fthnuR.r tn
Permii N Lrrib€ r B l0t zotr"{6 0
Propeny Own:r:t A qrr'rDoR \Uf kn-l
Co ntractli:Vturui-- (r2t.lnr Ljcanse #: 1111 {6
State of California requires that smoke and carbon rnonoxide (CO) alarms are installed in residential
bu ildings.
California Residential Code (CRC) Section R314.1 and R315.2 states in part that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R315.3 define
the required locations.
f\ eoti, uo,..s betow muer be checksd:
'JlA Catton r,roncxide alarms: Are installed outside of each sleeping area in the immediate vicinity of
bedrooms and also on each level of the dwelling. Alarms are recommended in bedrooms with gas-fired
appliances (i.e. hot water heater, cooktop, furnace) or a fireplace.
ff Smoke alarms: Are installed in each room used for sleeping, in each hallway outs;de of a steeping
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.
{check onel Licen-sfd o iactor tr Prope Owner
ItrorE: rhrs sef-c eftificrtioa ls oaly used lcr projects thct olrrct tha EXfiRtoR of he strlcture. This
prccess is opplicable ONLY t2 projects wherz ac*ss tc the inteiot ol the i*eltiag by o lf,ntd And
lnspecor ii not rcquited.
Signatur z:Dal?:,k,1,
Have this comploted fcrrn anC the job-card readity availab{e on final insp€ctio,n:
o
a--I