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HomeMy WebLinkAboutF2021-0164 - Misc (3)SYSTEM RECORD OF COMPLETION This form is to be completed by the system installation contractor at the lime a(system acceptance and approval. It shall be permitted to modify this form as needed to provide a more compleic cud ar clear record. Insert A,A in all unused lines. Attach additional sheets, data, or calculations as necessary to provide a complete record. Form Completion Date: 5/16/2023 Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Atria Senior Living Address: 393 Hospital Road North Description of property: Senior Living Name of property representative: Dorice Redman Address: Atria Newport Beach Phone: 949,642.5861 Fax: E-mail: Dorice.Redman@atriaseniorliving.com 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: Cal Building Systems Address: 3900 Prospect Ave #B Yorba Linda,Ca. 92886 Phone: 714-993-9650 Fax: E-mail: Service organization: Same as above Address: Phone: Fax: E-mail: Testing organization: Same as above Address: Phone: Fax: E-mail: Effective date for test and inspection contract: Monitoring organization: Grand Central Station Address: 1306 Stealth St, Livermore, CA 94551 Phone: _ 1(800) 255-4273 Fax: E-mail: Account number: CBS30308 Phone line l: Phone line 2: Means of transmission: POTS PRIMARY, CELLULAR SECONDARY Entity to which alarms are retransmitted: Phone: 3. DOCUMENTATION On -site location of [he required record documents and site -specific software: FACR 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ❑ New system ® Modification to existing system Permit number: F2021-0164 NFPA 72 edition: 2016 4.1 Control Unit Manufacturer: KIDDIE Model number: VS-4 4.2 Software and Firmware Firmware revision number: 04.41.00 4.3 Alarm Verification M This system does not incorporate alarm verification. Number of devices subject to alarm verification: 0 Alarm verification set fier seconds Copy right © 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be cooled for mmmerdal sale or distribution, (p- 1 of 3) SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120VAC Overcurrentprotection: Type: Breaker Branch circuit disconnecting means location: Basement electric room 5.1.2 Secondary Power 'type of secondary power: Sealed Lead Acid Batteries Location, if remote from the plant: Calculated capacity of secondary power to drive the system: In standby mode (hours): 24 5.2 Control Unit ❑ This system does not have power extender panels ® Power extender panels are listed on supplementary sheet A 6. CIRCUITS AND PATHWAYS Control panel amps: Amps: 20 Number: In alarm mode (minutes): 15 Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line B 0 Device Power NA Initiating Device NA Notification Appliance B 0 Other (specify): B. INITIATING DEVICES Type Quantity Addressable or Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 7 Addressable Alarm Smoke Detectors 189 Addressable Alarm Duct Smoke Detectors N/A Heat Detectors 2 Addressable Alarm Gas Detectors N/A Waterflow Switches 1 Addressable Alarm Tamper Switches 3 Addressable Supervisory Copyright ® 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. (p 2of3; SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible 96 Low Frequency Horns Visible 27 Strobe Only Combination Audible and Visible 41 Horn Strobes 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold -Open Door Releasing Devices 2 HVAC Shutdown N/A Fire/Smoke Dampers 6 Door Unlocking 1 Elevator Recall 2 Elevator Shunt Trip 2 11. INTERCONNECTED SYSTEMS ® This system does not have interconnected systems. ❑ Interconnected systems are listed on supplementary sheet 12. CERTIFICATION AND APPROVALS 12.1 System Installation Contractor This system as specified herein has been installed according to all NFPA standards cited herein. Signed: Printed time, Jonathan Torres Date: Organization: Cal Building Systems Title: Technician Phone: 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative Testing contractor representative: Property representative: AHJ representative: 5/16/2023 (714) 993-9650 Copyright ® 2012 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale or distrio mon. (p 3 of 3)