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CITI"SANM
NA-',liili\l
Planning & Building Agency
20 Civic Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(7141647-5800
www.santa-ana.orq
Smoke & CO
Alarm Affidavit
)
INSP.O2 2013 CRC
This document moy be lound at... htto:/iwww.santa-ana.orq/pba/
(Please use a black or blue ink ball-point pen)
lb7
State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential
buildings.
California Residential Code (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.
fiBoth boxes betow must be checked:
I
E Carbon 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.
I
E S.oL" 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
ma nufacturer's instructions.
(check onel Contractor Property Owner
NOTE: This self-certification is only used for projects thot affect the EXTERIOR of the structure. This
process is opplicable ONLY to projects where occess to the interior of the dwelling by o Santa Ana
lnspector is not required.
Project Address:bVI l) g fioe cfr k".rh AnaCIpl
Permit Number:lo,l O-?cla 3
Property Owner:(-[rnn^ G. ft7,. .
License #:Contractor:r5o Ltnc nf
Dote:
"l lZo / ZoZ1SignatureI
Have this completed form and the job-card readily available on final inspection!