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,'O Planning & Building Agency
20 Civic Center Plaza Ross Annex Smoke & CO
Al arm Affi davitP.O. Box 1988 (M-19)
Santa Ana, CA 92702
(7 14) 647-580 0
,l|lr'lt s a n t a-a n a. o'-!l
INSP-02 2013 CRC
This document may be found at,.,htt O'. f '',t;,',..r./. Sa n t e -an a . O retoca
(Please us e a black or blue ink ball-point pen)
Permit Nurnber:o LIZ
I Property Owner:Xoc +(
Contractor:iilrfiiekrte,^/ 3€O License #:7sz3rl3
State of California requires that smoke and carbon monoxide (CO) alarms are installed in residential
buildings.
California ResidentialCode (CRC)Section R314.L and R315.2 states in part that existing dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. CRCSection R314,3 and R314.3.3 define
the required locations.
fl\ Both boxes betow must be checked:
(C.rUon monoxide 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.
fls.ot. 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
m a n ufactu rer's instructions.
(check onel Licensed Contracto r Property Owner
NOTE: This self-certificotion is only used for projects that affect the EXTERTOR of the structure. This
process is applicable ONLY to projects where occess to the interior ol the dwelting by o Sdnta Ana
lnspector is not required.
Project Address:3toS S. Poc){. }rre, S*/Jqenq. cg.?2fu)
Signature -4 Date 7/ ?/ ,r
Have this completed form and the job-card readily available on final inspection!
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