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CMOrS ANM
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?llrning & Buitding Ag"r'ry
20 Civic Center plaza Ross Annex
P.O. Box 1g8B (M-19)
Santa Ana, CA 92702
(7 141 647-5800
lvyvw. sj! nta - a n q..g rp
Smoke & CO
Alarm Affidavit
D
t
Project Address:7D
Permit Nurnber:
Property Owner:
Contractor:s3rLicense #: t
2013 CRC
This document moy be lound ot... http://wranv_.santa-ana.org/p-b-a/
(P/ease use a btack or blue ink ball-point pen)
State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential
buildings.
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 R31.4.3.3 define
the required locations.
ff Both boxes betow must be checked:
pcarUon 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.
f,Fmoke alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping
Ioo^, 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 t0 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 tr Licensed Contractor Property Owner
NOTE: This seff-certificotion is only used lor projects that ollect the EXTERTOR of the structure lhis
process ls opplicable ONLY to projeas where occess to the interior ol the dwelling by o Sonto Ana
lnspedor ls not required.
Signature:Dote:1lr/ol"t
Have this completed form and the fob.card readlly avallable on flnal lnspection!
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