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Planning & Building Ag ency
2! Civic Cente.r Piaza Rcss Arnex Smoke & CO
Al arm AffidavitP.O. Bcx 1988 (M-19)
Santa Ana, CA 927C2
(714) il7-5800
v.r'ifr*/ . sa nta-d ;' a. c r ci
INSP.C2 2C'.3 C",'
This document moy be found at...
(Please use a black or blue ink ball-point pen)
Permit Number:
State of California requires that smoke and carbon
bu ildings.
de (CO) alarms are installed in residential
California Residential Code (CRC) Section R3t4.L and R315.2 states in part that eiisting dwellings be
"retrofitted with smoke alarms and carbon monoxide alarms. CRC Section R314.3 and R314.3.3 define
the required locations.
f,leoth boxes betow must be checked:
XC"rUon 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.
ftmorc atarms: 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
man ufacturer's instructions.
(check onel Licen Property Owner
NOTE: This setf-certificotion is only used for projects that affect the EXTERTOR ol the structure. This
process is applicable ONLY to projects where access to the interior of the dwelling by a Sonta Ana
lnspector is not required.
t
Project Addi'ess:
20<r<Property Owner:
License #:S\Contractor:
15,2c:H'ie.Dote:1Signature:
I
Have this connpteted form and the job-card readily available on final inspection!
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