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20 Civic Cente r plaza Ross Annex
P.O. Box igSB (M-19)
Santa Ana, CA 92202
(7 14l- 647-5800
qwyr.sa nta.ana,orq
Smoke & CO
Alarm Affidavit
I
tNsP-02 2013
This document moy be lound ot... hltp://Utlyw.S-anta-ana.org/pba/
(Please use a black or btue ink ball-point pen)
Project Address:
Permit Nurnber:
Property Owner:
\
l,>l lo? 1'lo
Vtc
Contractor:R.ni hL [t-ar?tt<-.License #: (o4lAoV
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 R314.3.3 define
the required locations.
nBoth boxes betow must be checked:
frC.rUon 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.
FQmofe alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping
loom, 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 Licensed Contractor tr Property Owner
NOTE: This self'certification ls only used for proiects that alfect the EXTERIdIR of the structura lhis
process ls appllcable ONLY to projects where occess to the lnterior of the dwetling by a Sonta Ano
lnspedor is not rcquired.
Signature:Dote:q- fug- W?r(
Have this completed form and the lob.card readlly avallable on flnal lnspection!
T
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