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;-SANM
NAJffi
Planning & Building Ag
20 Civic Center Plaza Ross Annex
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714]. 647-5800
ul'lr'ry, sa n ta-an a or,J
Smoke & CO
Alarm Affi davit
Project Address:,10 10 14/ Eo, nLaciol< Ly,
Prope rty Owner:
Contractor:
Permit Number:
License #:
INSP.O2 2013 CRC
Thisdocumentmoybefound at... htt3.l',,i,',',v.santa-an3.orq'cba'
(Please use a black or blue ink ball-point pen)
State of California requires that smoke and carbon monoxide (CO) alarms are installed in reside.ntial
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.
ff Both boxes below must be checked:
Wrbonmonoxide 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.
El6.t" alarms: Are installed in each room used for sleeping, in each hallway outside of a sleeping
room, and on each levelof 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
m a n ufacturer's instructions.
a
Signature:Dote aq -- / </ -2oz I
(check onel Et- Licensed Contractor tr Property Owner
NOTE: This self-cenificotion is only used for projects thot offect the EXTERIOR of the structure. This
process is opplicable ONLY to projects where occess to the interior of the dwelting by o Santa Ano
lnspector is not required.
Have this completed form and the job-card readily available on final inspection!