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Home My WebLink AboutFIRE_5_YR_CERTName: Lido Hoa Occupancy/Use: F1 601 Lido Park Dr. Type IVY'` Address: Construction Type: City: Newport Beach, CA. No. Stories: ZIP: 92663 Year Constructed. Contact: 1VO �"'lc G�.-� Telephone: (949)675-6101 M *M. hl.� And e A,,tef— fl� Inc Name: V Copy sent to: Address: P.Q. BOX 10034 owner Date' 02110/16 City. Santa Ana ❑ Fire AHJ Bate: State: CA, 92711 n Contractor Date: Telephone: (866) 496-4456 NOTES - 1) For specific Inspection, testing, and.malptenance requirements and Information, see NOPA 25, 2011 CA License#: 978587 Edition as imended-by -California Code of Regulations, Title Is, §901 to §908. Job* 40181OF 2) Inspection items may be performed by the owner in Performed by: Yvo (949)-675-6101 Regulations: Title I% accordance with California Code -of9 . §904.1(a) 0 Automate Sprinkler System 5 lea Syr I I it I 0 Standpipe and Hose System 6 0 0 Private Water Supply System 7 0 1 DOM 1:1 0 Fire Pump 0 1011 Water Storage Tank 0 ❑ 0 Water Spray System 10 0 . M El 0 Foam Water Sprinkler System 11 0 ❑0— [I Water Mist System 12 0 F1 1 r-1 11 n Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) [3 yes [I No AES 1 September 3, 2013 F...... Riser Information "'INOW,iZ 00, Main Drain Test (ANNUAL) 1-1/4" 70 70 I Exterior 1-1/2" P This building has more than 8 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 6-Year INSPECTION, TESTING AND MAINTENANCE faciudes ALL (Ruat" �TdAnnaal Inspecttons Tes4;, and 1= Inspection T = Test M = Maintenance Maintenance itenu P=Pass i = FaN AVA NO Applicable 5 77� 1.1 1 Control Valves — Identification Sign 113.1 02M0/16 P 1.2 1 -Control Valves — Inspection 13.3.2 02/10/16 P 1,3 1 Waterflow Alarm Devices 5.2.5 02110/16 P 1.4 1 Supervisory Devices 5.2.5 02/10116 NA 1.5 1 Gauges (Wet Pipe Systems) 5.2.4,1 02110/16 P 1.6 1 Hydraulic Design Information Sign (For hydraullbafty designed systems) 5.2.6 02/10/16 11 1 jEnter Water Supply Pressure Below Riser Check 5.2.4.1 02/10/16 60 psi P 1.8 1 jEnter Water Supply Pressure Above• Riser Check 5.2.4.1 02110/16 60 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 02110/16 P 1.10 1 General Information Sign I t L,�qulred for system prior to 2007 Edition NFPA 13) 5.2.8 02/10/16 NA 1.11 1 Heat Tape 5.2.7 02110/16 NA 1.12 1 1 ISpare Sprinklers 5.2.1.4 02/10/16 P 1.13 1 Fire Department Connections 13.7 02110/16 P 1,14 1 Alarm Valves— Exterior Inspection 13.4.1 02/10116 P 1.15 1 Pressure Reducing Valves 13.5.1.1 02/10116 NA 1.16 1 Backilow Preventers 13.6.1 02l'10116 NA Form AES 2.2 -Sept. 3, 2013 E" AND MAINTENANCE *MAL INSPECTION, T x0i �Wihide AtL q4t�� Inspections (See AES 2. 1) I = Ins 0ection T =Test M = Maintenance n� '_ "0 :Z 1.17 1 Small Hose Connections - Hose Valve* 115.5.1 J1 0116 072110116 NIA 1.18 1 PRV — Fire Sprinkler Systems 115.1.1 02JI10116 P 1.19 1 Buildings (Freeze Protection) 4.1.1.1 02110f16 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 02/10/16 P 1-21 1 Sprinklers - Accessible Concealed Space 6.2.1.1,6 02110/16 P 1.22 1 Pipe and Fillings 5.2.2 02110116 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 02110/16 P, 1.24 1 hangers 5.2.3 02110118 P 1.25 1 lHangers - Accessible Concealed Space 6.23.3 02110/16 P 1.26 1 ISeismic Braces 5,2.3 02110116 P 117 1 Seismic Braces - Accessible Concealed Space 5.2.33 02110116 P 116 1 Unsprinklered Areas CFC 901.4 02110/16 Oyes tio 2.1 T Field Service Test Required Report to Fire Code Offichal 5.3.1 02/10116 N REQUIRED, Enter 'P until results are retumed-from Lab 2.2 T -Send lRecalled Sprinklers ffnot present =Pass; 1fPTesent=Fall Title 19 904,1(c) 02110116 NIA 2.3 T Water Flow Alarm Devices 90 sees a=. Enter time 5.3.3 13.2.6 02110/16 sec. P 2.4 T Main Drain Test (Enter data on Page I of this form) 13.2.5 13.3.3.4 02/10/16 P Z5 T Control Valve - Position 13.3.3,2 , 0211()118 P 2.6 T lControl Valve — Operation 13.3.3.1 02110116 P 2.7 T Isupervisory Devices 13.3.3.5 02/10/16 N/A 2.8 T 113ackflow Preventer Assemblies 13.6.2 02110/16 P 2.9 T Small Hose Connections* w1PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 02/10/16 NIA 2.10 T PRV —Fire Sprinkler Systems 13.5.1.3 02JI0116 N/A 2.11 T Pressure Gauges - Calibration 5.3.2 02/10/16 P 2.12 T ISmall Hose Connections* 13.5.6.2.2 02/10/46 -P * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, 1], of Ill standpipe systems. Form AES 2.2 Sept. 3,2013 11' AgWAL WSMTION, TEVING� AND MAINTENANCE i (See AES ALL 000fterty InSpaati I = Inspection T = Test- M = Maintenance F= Fift tWA = WZ 'T— ............ . e.aK,lz A T 3.1 M Check Valves - Internal inspection 13.4.2 02/10/16 P 3.2 M Control Valves 113A 02110116 N/A 3.3 M FDC - B?,--kflush 14.3.2.3 02/10/16 P 14.3.2.4 3.4 M Internet Pipe Inspection - See Deficlencies and Yes Comments Section for Results. 14,2 02/10/16 RNo P 3.5 M Obstruction investigation Required, if "Yes", see Deficiencies and Comments Section for Results 14.3 02110116 P 3.6 M System Returned to Service 4.5.3 02110/16 9Yes. P No I I ney C Comment tin Wpe) 17 g 2S 1A Check here It additional Oeficiencies and Comments are listed on Form AES 9 Number attached: See Condon Form AM 10 for corrected deficiencies. Number attached: I hereby certify that the flirepratection equipment listed above has been fullylaspected, tested, and maintalned on this state by the company Indicated above, In accordance with CCR, ride 19, Sections 901 to 906 and that the equipment Is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Ant ylor I Signature Date 02/10/16 Form AES 2.2 Sept'3,2013 TestAmenca J 7 THE LEADER IN ENVIRONMENTAL TESTING E } ANALYTICAL REPORT TestAmerica Laboratories, Inc. - TestAmerica Irvine. 17461 Derian Ave Suite 100 i k Irvine, CA 92614-5817 Tel: (949)261-1022`'` TestAmerica Job ID: 440-110799-1 Client Project/Site: Filter Sampling For: Newport Beach Police Department 870 Santa Barbara Drive Newport Beach, California 92660 Attn: Lisa Newman Authorized for release by: 5/27/2015 10:00:18AM Heather Clark, Project Manager 1 (949)261-1022 heather.clark@testamericainc.com ��- Lt wkSns $Vpt�,ao-/. she test results in this report meet all 2003 NELAC and 2009 TNI requirements for accredited >arameters, exceptions are noted in this report. This report may not be reproduced except in full, ind with written approval from the laboratory. For questions please contact the Project Manager it the e-mail address or telephone number listed on this page. phis report has been electronically signed and authorized by the signatory. Electronic signature is mended to be the legally binding equivalent of a traditionally handwritten signature. 2esults relate only to the items tested and the sample(s) as received by the laboratory. � r Client: Newport Beach Police Department TestAmerica Job ID: 440-110799-1° Project/Site: Filter Sampling Table of Contents CoverPage .............................................. Table of Contents ......................................... 2 ;= Sample Summary ......................................... 3 Case Narrative ........................................... 4 Client Sample Results ...................................... 5e' Method Summary ......................................... 6 a. Lab Chronicle 7 ............................................ QC Sample Results ......................................... QC Association Summary ................................... Definitions/Glossary ....................................... 10 Certification Summary ...................................... 11 Chain of Custody .......................................... 12 Receipt Checklists .......................................... 13 e TestAmerica Irvine Page 2 of 13 5/27/2015 Sample Summary Client: Newport Beach Police Department TestAmerica Job ID: 440-110799-1 Project/Site: Filter Sampling Lab Sample ID Client Sample ID Matrix Collected Received 440-110799-1 CABINET Solid 05/21/1513:00 05/21/151312 f y',T,, tF fix?. Y k � TestAmerica Irvine Page 3 of 13 5/27/2015 Case Narrative Client: Newport Beach Police Department Project/Site: Filter Sampling Job ID: 440-110799-1 Laboratory: TestAmerica Irvine Narrative Job Narrative 440-110799-1 Comments No additional comments. { TestAmerica Job ID: 440-110799-1 Receipt The sample was received on 5/21/2015 1:12 PM; the sample arrived in good condition, properly preserved and, where required, on ice. The temperature of the cooler at receipt was 22.60 C. Receipt Exceptions The following sample was received at the laboratory outside the required temperature criteria: CABINET (440-110799-1). The sample was received the same day as sampling, but was not on ice. Metals No analytical or quality issues were noted, other than those described in the Definitions/Glossary page. TestAmerica Irvine Page 4 of 13 5/27/2015 Client Sample Results Client: Newport Beach Police Department Project/Site: Filter Sampling Ciient Sample ID: CABINET Date Collected: 05/21/15 13:00 Date Received: 05/21/15 13:12 Method: 6010B - Metals (ICP) Analyte Result Qualifier RL TestAmerica Job ID: 440-110799-1 --�---_ Lab Sample ID: 440-110799-1 Matrix: Solid MDL Unit D Prepared Analyzed Dil Fac mg/Kg 65/22/15 08:16 05/22/15 19:31 250 r p 3aS , �:Jw1 TestAmerica Irvine Page 5 of 13 5/27/2015 Method Summary^ Client: Newport Beach Police Department TestAmerica Job ID: 440-110799-1 Project/Site: Filter Sampling Method Method Description Protocol Laboratory _ 6010E Metals (ICP) SW846 TAL IRV Protocol References: SW846 = "Test Methods For Evaluating Solid Waste, Physical/Chemical Methods", Third Edition, November 1986 And Its Updates. ` Laboratory References: TAL IRV = TestAmerica Irvine, 17461 Derian Ave, Suite 100, Irvine, CA 92614-5817, TEL (949)261-1022 TestAmerica Irvine Page 6 of 13 5/27/2015 Client: Newport Beach Police Department Project/Site: Filter Sampling --- ------ ----- - ----------- -------------------- Client Sample ID: CABINET Date Collected: 05/21/15 13:00 Date Received: 05/21/15 13:12 Batch Batch Prep Type Type Method Run Total/NA Prep 3050E Total/NA Analysis 6010E Lab" Chronicle " TestAmerica Job ID: 440-110799-1" _-----------.----______:-- - Lab Sample ID: 440-110799-1 Matrix: Solid ;. "J -_- Dil --. Initial Final Batch --- Prepared Factor Amount Amount Number or Analyzed Analyst Lab 2.02 g 50 mL 256764 05/22/15 08:16 DT TAL IRV 250 2.02 g 50 mL 256991 05/22/15 19:31 EN TAL IRV Laboratory References: TAL IRV = TestAmerica Irvine, 17461 Derian Ave, Suite 100, Irvine, CA 92614-5817, TEL (949)261-1022 TestAmerica Irvine Page 7 of 13 5/27/2015 QC Sample Results. Client: Newport Beach Police Department TestAmerica Job ID: 440-110799-1 Project/Site: Filter Sampling Method: 6010B - Metals (ICP) --- --- Lab Sam--ple ID: MB 440-256764/1-A A 5 - -- - - - -----------------------.__.—_--- —Client Sample p: MethodBlank Matrix: Solid Prep ypeTtaI/NA Analysis Batch: 256958 MB MB Prep Batch: 256764 NEI Analyte Result Qualifier RL MDL Unit D Prepared Analyzed Dil Fac kT'° Lead ND 2.0 mg/Kg 05/22/15 08:16' 05/22/15 16:46 5 Lab Sample ID: LCS 440-25676412-A 15 Client Sample ID: Lab Control Sample / Matrix: Solid Prep Type: Total/NA Analysis Batch: 256958 Prep Batch: 256764 WJ Spike LCS LCS %Rec. Analyte Added Result Qualifier Unit .13 %Rec Limits Lead 49.5 46.5 mg/Kg 94 80 -120 TestAmerica Irvine Page 8 of 13 5/27/2015 QC Association Summary Client: Newport Beach Police Department Project/Site: Filter Sampling TestAmerica Job ID: 440-110799-1 Metals Prep Batch: 256764 ,hk Lab Sample ID Client Sample ID Prep Type Matrix Method Prep Batch 440-110799-1 CABINET Total/NA Solid 3050B LT LCS 440-256764/2-A ^5 Lab Control Sample Total/NA Solid 3050B MB 440-256764/1-A ^5 Method Blank Total/NA Solid 3050E ~, 4 Analysis Batch: 256958 Lab Sample ID Client Sample ID Prep Type Matrix Method Prep Batch LCS 440-256764/2-A ^5 Lab Control Sample Total/NA Solid 6010B 256764= MB 440-256764/1-A ^5 Method Blank Total/NA Solid 6010E 256764 g Analysis Batch: 256991 13 Lab Sample ID Client Sample ID Prep Type Matrix Method Prep Batch ' - - 440-110799-1 CABINET Total/NA Solid 60106 256764 -' 0 TestAmerica Irvine Page 9 of 13 5/27/2015 Definitions/Glossary`" Client: Newport Beach Police Department TestAmerica Job ID: 440-110799-1 Project/Site: Filter Sampling Glossary Abbreviation These commonly used abbreviations may or may not be present in this report. ZE Listed under the "D" column to designate that the result is reported on a dry weight basis %R Percent Recovery CFL Contains Free Liquid CNF Contains no Free Liquid E DER Duplicate error ratio (normalized absolute difference) _ F Dil Fac Dilution Factor DL, RA, RE, IN Indicates a Dilution, Re -analysis, Re -extraction, or additional Initial metals/anion analysis of the sample DLC Decision level concentration ; ! MDA Minimum detectable activity ,# EDL Estimated Detection Limit ( A. [ ' MDC Minimum detectable concentration MDL Method Detection Limit ML Minimum Level (Dioxin) NC Not Calculated ND Not detected at the reporting limit (or MDL or EDL if shown) PQL Practical Quantitation Limit QC Quality Control RER Relative error ratio t t RL Reporting Limit or Requested Limit (Radiochemistry) RPD Relative Percent Difference, a measure of the relative difference between two pointsw` TEF Toxicity Equivalent Factor (Dioxin) TEQ Toxicity Equivalent Quotient (Dioxin) TestAmerica Irvine Page 10 of 13 5/27/2015 Certification Summary Client: Newport Beach Police Department Project/Site: Filter Sampling Laboratory: TestAmerica Irvine All certifications held by this laboratory are listed. Not all certifications are applicable to this report. TestAmerica Job ID: 440-110799-1 Authority Program EPA Region Certification ID Expiration Date Alaska State Program 10 CA01531 06-30-15 Arizona State Program 9 AZ0671 10-13-15 California LA Cty Sanitation Districts 9 10256 01-31-16 California State Program 9 2706 06-30-16 Guam State Program 9 Cert. No. 12.002r 01-23-16 Hawaii State Program 9 NIA 01-29-16 Nevada State Program 9 CA015312007A 07-31-15 New Mexico State Program 6 N/A 01-29-15 Northern Mariana Islands State Program 9 MP0002 01-29-15 Oregon NELAP 10 4005 01-29-16 USDA Federal P330-09-00080 06-06-15 * Certification renewal pending - certification considered valid. TestAmerica Irvine Page 11 of 13 5/27/2015 TestAmarica Iryine 17461 Berian Ave Suite 100 Irvim CA 92614 Phone: 949.261.1022 Fax: Chain of Custody Record Regulatory Program: n Dw n NPDES M RCRA I-1 other: 0 2 7 6 6 3 TestAmedca THE LEADER IN ENVIRONMENTAL TESTING TestAmerica Laboratories, Inc. I TAL-8210107131 Client Contact Project Manager: 1 L Site Contact: Date: COC No: Company Name: Tel/Fax: Lab Contact: Carrier: — of COCs Address: Analysis Turnaround Time Z „ r `V) m m u Z j ca 1 a Sampler: City/State/Zip: ❑ CALENDAR DAYS ❑ WORKING DAYS For Lab Use Only: Walk-in Client: Lab Sampling: Phone: TAT if different from Below ❑ z weeks Wn' `i� 1 week W ❑ z days ❑ Iday Fax: Project Name: 4 910 f 315 0 Site: Job ! SDG No.: PO# Sample Identification Sample Dat Sample Time Sample Type (C=Comp, G=Grab) Matrix # of Cont. Sample Specific Notes: 130a •G 440-110799 Chain of Custody WON SIMON 5 Possible Hazard Identification: Are any "samples from a listed EPA Hazardous Waste? Please List any EPA Waste Codes for the sample in the Comments Section if the lab is to dispose of the sample. , Sample Disposal (A fee may be assessed if samples are retained longer than 1 month) ❑ Return to Client ❑ Disposal by Lab ❑ Archive for Months ❑ Non -Hazard ❑ Flammable ❑ Skin Irritant ❑ Poison 8 ❑ Unknown Special Instructions= Requirements & Comments: nW -let, Custody Seals Intact: ❑ Yes '❑ No Custody Seal No.: Cooler Temp. (C): Obs'd: Corr'd: Therm ID No.: e Inquls a Company: !BafeMMPI 5 Mir,e: Received by: Company: Dateffime: elinquishe by: Company: Received by: Company: Date/Time: elinquished by: Company: Datefl•ime:• R i e .in Laboratory by: Comp' ny: Qa 'Ri SPUN- S' �j i i • � 1' '� I ~_ � 3 :,....w � - ;.. �61 �� r""i. �}�{_'1--.5 �.:ya-c x ri. � .�:�.. � .,ra Client: Newport Beach Police Department Login Number: 110799 List Number: 1 Creator: Blocker, Kristina M Question Login Sample Receipt Checklist Answer Comment Radioactivity wasn't checked or is </= background as measured by a True survey meter. The cooler's custody seal, if present, is intact. True Sample custody seals, if present, are intact. True The cooler or samples do not appear to have been compromised or True tampered with. Samples were received on ice. False Cooler Temperature is acceptable. True Cooler Temperature is recorded. True COC is present. True COC is filled out in ink and legible. True COC is filled out with all pertinent information. True Is the Field Sampler's name present on COC? True There are no discrepancies between the containers received and the COC. True Samples are received within Holding Time. True Sample containers have legible labels. True Containers are not broken or leaking. True Sample collection date/times are provided. True Appropriate sample containers are used. True Sample bottles are completely filled. True Sample Preservation Verified. N/A There is sufficient vol. for all requested analyses, incl. any requested True MS/MSDs Containers requiring zero headspace have no headspace or bubble is True <6mm (1/4"). Multiphasic samples are not present. True Samples do not require splitting or compositing. True Residual Chlorine Checked. N/A Job Number: 440-110799-1 List Source: TestAmerica Irvine L- IJ Refer to Job Narrative for details. TestAmerica Irvine Page 13 of 13 5/27/2015 PC--ALA-rz-Fac))S—bDs-i SYSTEM RECORD OF COMPLETION This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modem this form as needed to provide a more complete and/or clear record. Insert N/A in all unused -lines. Attach additional sheets, data, or calculations as necessary to provide a complete record. Form Completion Date: 4/18/16 Supplemental Pages Attached: 1. PROPERTY INFORMATION Nameofproperty: The Walk Parking Ada ti Westcliff Dr. Newport Beach Description of property: Parking Structure Name of property representative: Address: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: West Coast Fire & Integration Address: 3199-D Airport Loop Drive, Costa Mesa, CA. 92626 Phone: (714) 957-5750 Fax: (714) 957-5749 E-mail: Service organization: West Coast Fire & Integration Address: 3199-D Airport Loop Drive, Costa Mesa, CA. 92626 Phone: (714) 957-5750 Fax: (714) 957-5749 E-mail: Testing organization: West Coast Fire & Integration Address: 3199-D Airport Loop Drive, Costa Mesa, CA. 92626 Phone: (714) 957-5750 Fax: (714) 957-5749 E-mail: Effective date for test and inspection contract: Monitoring organization: Address: Phone: Fax: E-mail: Account number: Means of transmission: Entity to which alarms are retransmitted: 3. DOCUMENTATION Phone line 1: On -site location of the required record documents and site -specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: FE1 New system ❑ Modification to existing system Permit number: NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: Notifier 4.2 Software and Firmware Firmware revision number: 4.3 Alarm Verification Number of devices subject to alarm verification: Phone line 2: Phone: Model number: NFW2-100 ❑ This system does not incorporate alarm verification. Alarm verification set for seconds Copyright ©2012 National Fire Protection Association. This form maybe copied for individual use other than for resale. It may not be copied for commercial 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: 1 20V Overcurrent protection: Type: Breaker Branch circuit disconnecting means location: 5.1.2 Secondary Power Control panel amps: 2.20 Amps: 20 Electric Room Number: Type of secondary power: Battery Location, if remote from the plant: Calculated capacity of secondary power to drive the system: In standby mode (hours): 24 In alarm mode (minutes): 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 Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line Device Power Initiating Device Notification Appliance Other (specify): 7. REMOTE ANNUNCIATORS Location 8. INITIATING DEVICES Type Quantity Addressable or Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 1 A A Smoke Detectors 3 A A Duct Smoke Detectors - Heat Detectors 3 A A Gas Detectors - Waterflow Switches 3 A A Tamper Switches 5 A S Copyright ©2012 National Fire Protection Association. This form maybe copied for individual use other than for resale. It may not be copied for commercial sale or distribution. (p. 2 of 3) 4 SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible 1 Horn Visible Combination Audible and Visible 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold -Open Door Releasing Devices HVAC Shutdown Fire/Smoke Dampers 1 Door Unlocking Elevator Recall 1 Elevator Shunt Trip 1 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. ,ik:-Signed: Printed name: Date: Organization: West Coast Fire & Integratio Title: Install 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: West Coast Fire & Integratio Title: Install Phone: 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJrepresentative: N A:��\ Oc MaV A--, — K)bEL� Copyright ©2012 National Fire Protection Association. This form maybe copied for individual use other then for resale. It may not be copied for commercial sale or distribution. (p. 3 of 3) L4—I , �AERF Certificate of Flame Resistance Q- OF LtR O r "-\ �z Issued By• h Y � one T MF ° ET Pam SERGE FERRARI NORTH AMERICA Registered Fabric 1460 SW 6TH COURT or Concern Number F-44401 POMPANO BEACH, FL 33069 FIR mNC8 Date treated or manufactured: 02/18/2016 This is to certify that the materials described below have been treated with a flame-retardant chemical or are inherently nonflammable. FOR: Trivantage, LLC ciTY: Glen Raven Certification is hereby made that: (Check "a" or "b") ADDREss: 1831 North Park Ave. STATE: NC 27217 (a) The articles described at the bottom of this Certificate have been treated with a flame-retardant chemical F1 approved and registered by the State Fire Marshal and the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used: Method of application: Chemical Registration #: 1(b) The articles described at the bottom of this Certificate are made from a flame -resistant fabric or material X registered and approved by the State Fire Marshal for such use. Trade Name of flame -resistant fabric or material used: PRECONTRAINT 502 Registration #: F-44401 The Flame -Retardant Process Used Will Not Be Removed By Washing LUDOVIC ROLLIN Name of Applicator or Production Superintendent RCN # CUSTOMER ORDER NO. QUALITY MANAGER Title 00000000001037096479 000000000 Platmun X CUSTOMER INVOICE NO. 1125177 YARDS OR QUANTITY 143.00 DESCRIPTION Serqe Ferrari Precontraint 502 #2135 70.8" Sand Beige (Sand)(Standard Pack 54 Yards) ITEM NUMBER 878991 We hereby certify the above to accurately reflect the information contained within a "CERTIFICATE OF FLAME RESISTANCE" issued to Trivantage, LLC from the registrant set forth above. A copy of the original Certificate of Flame Resistance is available upon request to Trivantage, LLC and the registration information set forth above is on record with the Califomia State Fire Marshal. J MILLER CANVAS MAILING ADDRESS 2429 S BIRCH ST SANTA ANA, CA 92707-3406 STATE OF CALIFORNIA—FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 4-2000) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DEPARTMENT OF SOCIAL SERVICES (714) 703 - 2840 CCL-RESIDENTIAL EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE NAOMI TETER 306004738 7A - SEE NOTE CODES 1. ORIGINAL A. FIRE CLEARANCE �- LICENSING STATE OF CA DEPT. OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY AGENCY COMMUNITY CARE LICENSING DIVISION NAME AND 770 THE CITY DRIVE, SUITE 7100 3. CAPACITY CHANGE ADDRESS ORANGE, CA 92868 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 160 160 FACILITY NAME LICENSE CATEGORY NEWPORT BEACH PLAZA RCFE STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 1455 SUPERIOR AVENUE 1 CITY RESTRAINT NEWPORT BEACH, CA 92663 NO FACILITY CONTACT PERSONS NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS LIANA FOOTE 949.645.6233 7/24 Hrs SPECIAL CONDITIONS PLEASE ADVISE OF ANY DELAYED EGRESS FEATURES AND/OR LOCKED PERIMETERS. TO BE COMPLETED BY INSPECTING AUTHORITY F FIRE NEWPORT BEACH FIRE DEPARTMENT AUTHORITY PO BOX 1768 NAME AND NEWPORT BEACH, CA 92658-8915 ADDRESS L� 01 INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS NAA\,iNL Md94q-&4Lj-31DS 3C'0,SSg 'cal INSPECTION DATE INSPECTOR'S SIGNATURE (Typed orPrinted) 5 —CV—I co -,& NJ ctA,,✓1A-e. AA EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS CLEARANCE /DENIAL CODE 1 ~ IRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER Newport Beach Plaza 1455 Superior Ave Newport Beach, CA 92663 State Fire Clearance Special Conditions Two corridor exit doors have been equipped with delayed egress doors as approved on the tenant improvement plan. One additional corridor door was equipped with delayed egress to ensure residents do not wan er into an area of the facility not designated for dementia or Alzheimer residents. Delayed egress doors are highlighted in yellow on the attached copy of page A001 from the approved set of plans. COMPARTMENT "F COMPARTMENT "A" ..�SF r:raaaac}..iaiiy.i.+�asa: r , ( r GONT7Ua,47 TO SAFE DIDRRSA. t A•REA AT RTbrrT CF /WY. OCCUPANCY TYPES •. 'A-3' Occ. a'A-3' Acc. ® 'B' Occ. 0 'R-2.1' Occ. R2.1 Incedental rem} 1%.14T KEYNOTES -O 51UP""'""' �"A� R°°IS; ,__ W a11_ y ^101jA " LO ROO 14Yt FlRE ERP CSC 707 t0 TOILET ROOM -SIGH ON DO( 1!4'THICK, LOCATED ON DOf -- Ex. 49R RIER GSC707 1127 7. SEE TROOMS �Oc NEW PANIC HARDWARE EQUIPPED EXIT DEVICE t2 ELA CRESS DEVI DWysd."r.udsAwsatW a ----�4 EXISTING PANIC HARDWARE EQUIPPED FOOT DEVICE 1. TMoors unlock oWar *I &WI syri¢n. -.------0 EXISTING PRE EXTINGUISHER CABINET 2 TM daces Imk.k upar loss o 21 Th prs...hM �--0. NEW4.LUMINATED E7ITSIGN 2.2TManwlad.Mctb 2.3 M-of sq-2, ..---0 EXISTING ILLUMINATED EXIT SIGN 3. TM door Wks *A haw 01. Is,in an.PPI baBpn• �O EX DOOR III MAGNETIC HOLD OPEN 4. TM W W1bn Ann knw.N. a.0adawfwrabwofnotma rolsaa. d.0- ki4bnaf tIa k PROVIDE TACTILE SIGN. RAISED LETTERS AND BRAILLE STATING Acln4y of th. door. 0.. M do 6 '�---OS)ar&ACCESS'(PER CSC 118.703 J ADDITIONAL APPROVED r.4s.Fg d.Am. r.bcft shall Low{EV.LEXIT SOS WHICH ARE INTERNALLY CR 4.h spnsacprtddsAaah.t EXTERNALLYILUMINATED PHOTOLWOESCENTOR SELF 12.1 regu&&W by the DMsbnc LUMINOUS. SHALL BE PROVIDED N ALL INTERIOR CORRIDORS. (PER CRC 1011.7) 184042.9. � (� �.r:e:=h �••ac � Y-R�.. ,w-w :�:::c�n: �� - - - - - 711�:a-.sm�.t,�� 9 COMPAIRTMENT "C" (NO CHANGE) �♦ %. IRIA AT R76NT OF YNY. RO� lOQbTIIAaD¢T r=1=Y ).- /MUM CAPACITY;Wa'. SEE TNa fscityhouaa Aldmiam's a dsmsnS. Harts. a duty of rot man ban 30 M 09PW -onds Is pamalsd. !rTES:SY-V2CI5 5. A sign "be pmAdad a, 61. doorbutad &Ww and within 12 kmMs (30S mm) TOSS ofMraWudsAd-I 1OEEP PUSHING. THIS DOOR WILL OPEN N 30 STAG COL PER SECONDS. ALMM WLLSWND'Slpr 4lwkq atW Nat Masitkc7l (25 mm)b 4 Ilsl9ht and ahal M'w a a.ok. ofnol lace Ern 1A 11(32-1. 5.1.Atntle alwMEN wdkh camIB-7W.s. SEEDET O/A0.Emary.nry0ph oftlr falbwinQ ah. M"..js%_xWV. sf a door. tMYg shalt rMr.grir. man fun an. opast0n. . Th.9. dMSAaton.nbtldq ofM aprsa.awrtrold.Nca A. 1005. I bya aILFW korrl ■ swidr slW�mar"manna oNy at an door. C OTIE EXIS NUBS S tr t.bh in not more tlar, W 4 09pfad br 1 saaond b tlr Mla an.uddla siOtW k,M A ATOK D YED E ON WILL TO CONTINUNJ.YPRESSED FOR30SECONDS TO OPERATE DOOK ACTUATOR oYtr aPP6Ca§M0floteabh. TM 61e. d.by.st.blaMd for BUTTON 1fALL BE E7WEF?N AND 44 ABOVE 'app9utlm bled I.S.ofon a C_Pk_. ace. CMpbr M. ---'--&GGAATE _ ACCESS ONLY. STANDARD LEVER AND LOCKSETTo TO0 µ5 --__.�y� InW .oaoaona0t daAna b WraT tM op.ration o/.riafng af5rp y.as dogs grid V apMaON wbdwra b a ma+dnwm or4'_ DOOR RATING LEGEND G DOM RATIH65 ON 1165 SLEer IPEFL wr THE HDNI"1114 ftaMtW KATI". 5W COOK 5,HaWLt: CH%eEr A600 FOR ACTUAL 5FEC F=Coo III RJ.T7N6. PUNS II CILYtlYN G .RS. (451 RRA, oPOOR (201III'ATmDom ro M17r RAILED (1101 Coe - - -so- 14R ) Al RAT®E aT eawc� a (HER ese 1010OFCrRN6S ID SE F2FE RATED 143 1COURTYARD A.a.mblyUntarxxnlatad ss,ss.M CtlaYa 662SF ITS 145 45 121 MCLIVNG 'A.TCoo. Assam IlrroncVrrtrat.d tabbs and duke 20 SF 15 1t 121a MED.Iwo- Isuain.ssA- 03SF iW 1 A 123 MCACTIVITWOINNG AWOoa AaNm Unmrrankabd and ch*. BuaWaax An+a S02 SF 75 34 A 123b ACT. W. 13, om fo6SF 100 2 A 124 UNIT AI R-21'Ooo. R.aOantlsi 4243F 20D 3 125 W.C.a. C. 'A-TA AramA Msdr. 70 SF 300 I A 125 UNIT 62 R•21'Oc RstldwltW SW SF 200 4 A 128 UNIT 82 7 10- RssidsnlW a60SF 200 4 129 UNITAI R•21'Oae. Raaidantlsi 351 SF 200 2 A 130 UNIT B2 R-27'Ooe. RaaManfLl NO SF 20D 4 131 UNRA1 R•21'Ooe. R.aa"n1W 3SSSF 200 2 MC100 CORRDOR R-21'Oa. ndu 564 SF A 132 133 UNITS3 MANT. R-2POoa. R21 R-I 807SF 200 S F bm.d bd Aoo.ssgySbrags Anas, Malt 55 SF 300 1 F 134 UNIT 02 R41'Ooc. R.fidan6sl do SF 20D 4 F 135 OFFlCE Ts 'Om, BuaaaasAnas 67SF 100 1 F 136 UNTTAi R-21'O- RsaldantLl 409 SF 200 3 F '31 EQUIP. R21 Incaeanm Aauaory Sbn9. A, Mach. run 72 SF 300 1 F 136 UN(TAI R-21'Oa. RsaCanSsi 409 SF 200 3 F 130 VEST. R-21' 0- (nova 61 SF F 140 UNITAI R-21'O- al R.&I 109 SF 2W 3 F 141 OFFlCE Ti'Ooe. BualmaArua 52SF 100 11 1 F 142 UNIT81 R•21'Occ. Rssid.n6a1 642SF 210 4 F MC10f CORRIDOR R-21'Ooc, nqw) 61D SF F IST FLOOR MOTNR CALCULATIONS COMPARTMENT& COMPARTMENTF: 100 OCCJ2 EXITS • So OCmwt,l 24 OCCJ2 EXITS . 12 Oaup-tLut Ed Width R.goktl. Sox x. IS EtdtWM6 RagWtW: 113.6- EWW1dNProAMd:36'cdtdaonPnMM Ext Wldfl PmM.d: 36'.40oon W.Aded RESTROOM SIGNAGE DETAILS OONFLY rmm + •uA. IWV.L44CNRFD t .•�'�. V, Sr6NAde COWRA F5THB� 3.�'� COM440NTe25T6m"61!- L HONTAT&rTOCCNIlSe- 1.3M OF SWN FROM FLOM 143 mkL4OL*nw 5rG40e TO me LOGITCD ON LATCH SIDE OP DOOR c4f,w OFDR71e-31'@a5. HOMTAT 60' TO Ct wamDe OF sr" FROM FLOCK S2 Keyworm t0 FOR LO_'ATTON ON FLAN. cm" Z g a LL Q U) W U- N � Q to U m [Z JJ Q Z a m (u 5 Z 03 LU ir a 02 �- a Z W Lo Z JOB NO: 21426.1 PLOT DATE 9.21120159:14AS AM DATE: 04t14ry5 SCALE: As kldnMd DRAWN: Aut- CHICKD: Ch.dnr SHEET NO.: A003 Ar Paae-J-af 7 Inspection, Testing, and Maintenance Cover Sheet f NFPA 25 as amended by CCR, Title 196?ov Property Information: Name: Harbor Woods Homeowners Association Occupancy / Use: Residential CAt,l,�. Address: 100-109 Harbor Woods Place Construction Type: Wood/Stucco'��" City: Newport Beach No. Stories: 3 Zip: 92660 Year Constructed: 1984 Contact: Nancy Blasco REM Telephone: (949) 372-4014 Contractor Information: Number of System Risers Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln Owner Date 5-31-16 City: Orange Fire AHJ Date 5-31-16 State: California 92866-2605 ❑ Contractor Date Telephone: 714-974-9025 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and information, see NFPA 25, 2002 Edition as amended by Job # California Code of Regulations, Title 19 §901 Performed by: Kamil & Josh to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms included with this report FP te5 Cha❑X Number of Forms N/A FAIL* PASS Automatic Sprinkler System 5 1 X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form JUN 0 2 2016 NEWPORT BEACH FIRE DEPARTMENT P.O, BOX 1768 NEWPOR T BWK 8A 98668.8915 State Fire Marshal AES2 qk eZori Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 System Riser ID: 100 Property Information: Type of System: ppA4 c�� Name: Harbor Woods Homeowners Association ❑X Wet Pipe .� ova Dry Pipe � Address: 100 —109 Harbor Woods Place Preaction Deluge City: Newport Beach Main Drain Test Results: (See attached sheet for multiple risers) Initial Static Pressure: 90 (psi) Residual Pressure: L 8 (psi) Restored Static Pressure: 90 (psi) Abbreviation Key: I = Inspection T = Test M' = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valve — Enclosure tem erature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure temperature 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16. ik `�. I Quarterly Backflow Preventers 12.6.1 X 1.17. 1 Annually Buildings 5.2.5 X State Fire Marshal AES2 Paae 3 of 7 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 System Riser ID: 100 Property Information: Type of System: Cq{r�o ❑X Wet Pipe Name: Harbor Woods Homeowners Association A Address: 100 —109 Harbor Woods Place ❑ Dry Pipe C . Preaction Deluge City: Newport Beach Item Activity Frequency Description NFPA 25 Fail N/A Pass Reference 1.18 I Annually Hangers 5.2.3 X 1.19 I Annually Seismic Braces 5.2.3 X 1.20 I 5 Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 I 5 Years Seismic Braces (Accessible concealed 5.2.3.3 X spaces) 1.22 I 5 Years Pipe and Fittings (Accessible concealed 5.2.2.3 X spaces) 1.23 I 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 I 5 Years Alarm Valves — (Interior Inspection) 12.4.1.2 X 1.25 I 5 Years Alarm Valves — Strainers, filters, orifices 12.4.1.2 X 1.26 I 5 Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 I 5 Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 I 5 Years Preaction/Deluge Valves — Strainers, filters, 12.4.3.1.8 X orifices 1.29 I 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 I 5 Years Dry Pipe Valves — Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 Sec) 5.3.3 5. 2 7 X 12.2.6 2.2 T Annually Main Drain Test (Enter data on Page 1) 12.2.6.1 X 12.3.3.4 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES2 Page 4 of 7 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: System Riser ID: 100 Type of System: of ca4�a X Wet �� O Pipe p Dry Pipe _$�`� Preaction�� MPQS`Z' Deluge Name: Address: Harbor Woods Homeowners Association 100 —109 Harbor Woods Place City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick -Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assembly 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure Reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinklers manufactured prior to 1920 - Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES2 Page 5 of 7 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: System Riser ID: 100 Type of System: Cr,N ❑X Wet Pipe ElDry Pipe 11 PreactionR f' ❑ Deluge Name: Harbor Woods Homeowners Association Address: 100 —109 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: 1.10 1 — Provide chrome Horizontal Side Wall (HSW) 1650 Y2" for Spare Head Box (SHB) 1.10 2 — Provide Rasco 1650 br'/2" concealed SSP & cover for SHB ' 1.10 1 — Provide RC-1 concealed wrench for SHB 1.10 1 — Provide Vertical Side wall (VSW) 1650 Y2" br for SHB 1.5 1 — Provide bell sign 1.4 1 — Provide Control Valve sign for BFV 1.8 1 — Provide 2' of 1 %" pipe with 900 (1 %") for main drain, there is currently no piping for main drain 1.4 1 — Provide main drain sign 1.4 1 — Provide ITV sign 1.7 1 — Replace faded system calculation plate and relocate it to the electrical room with/ SHB 1.4 1 — Replace broken lock on BFV on Riser 2.1 1 — Local bell is not on a dedicated circuit and is wired to the walkway lights. Recommend electrician to give the local bell a dedicated 110v circuit. 1.9 1 — Please provide access to unit 105 ❑X See Continuation Pages(s) F2� (Indicate the number of continuation pages) ❑X PASS ❑FAIL Signature: Date: 5-31-16 Jered Stock State Fire Marshal AES2 Page 6 of 7 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: Type of System: ❑X Sprinklers (Chapter 5) or aaA o System Riser ID: Standpipe (Chapter 6) �, H Private Fire Main (Chapter 7) ❑ Fire Pump (Chapter 8)�i�E MP¢� Fire Pump No. or ID: Water Storage Tank (Chapter 9) HWater Spray System (Chapter 10) System Riser ID: ❑ Foam -Water System (Chapter 11) System Riser ID: Name: Address: Harbor Woods Homeowners 100 —109 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments Deficiencies and Comments item number must correspond to the item number of the Activity listed above: Unit 101 1.9 5 — Painted 1st floor living room concealed covers 1.9 1 — Provide cover main floor closet across from bathroom 1.9 Recommend the resident remove fishing poles from sprinkler piping 1.9 Recommend the resident remove hanging curtains from fire sprinkler piping 1.9 1 — Painted 2Id floor bedroom closet (resident to provide access prior to our arrival) 1.9 1 — Provided concealed cover master bedroom closet 1st one when entering 1.9 1 — Painted in master bedroom closet 2nd closet Unit 103 1.9 2 — Painted Central A 1650 br V SSU in the garage 1.9 1 — Provide concealed cover front closet 1.9 1 — Provide concealed cover in guest room closet Unit 107 1.9 1 — Provide concealed cover guest bedroom closet Signature: VDate: Jered Stock 5-31-16 U State Fire Marshal AES2 Paae 7 of 7 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: Name: Harbor Woods Homeowners Type of System: ❑X Sprinklers (Chapter 5) Hof d-A—`4 System Riser ID: y v ' Standpipe (Chapter 6) HPrivate Fire Main (Chapter 7) ❑ Fire Pump (Chapter 8) E MP' Fire Pump No: or ID: Water Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: ❑ Foam -Water System (Chapter 11) System Riser ID: Address: 100 —109 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments Deficiencies and Comments item number must correspond to the item number of the Activity listed above: Unit 109 1.9 3 — Replace painted covers in guest bedroom, 1 in closet, resident to provide access to sprinkler heads in closets prior to repairs be completed Unit 102 1.9 3 — Painted cover in front entrance closet, small bedroom, and small bedroom closet Unit 108 1.9 2 — Downstairs restroom & closet 1.9 2 — in 2"d floor both closet Above repairs completed in May by Kamil/George/Josh of OCFP. System certified (5-Year) dated 5-2016 by OCFP. Note: 2'/2" Flow Switch is slightly starting to stick. Ok for now but if it worsens it will need to be replaced Note: Local Bell was wired to FS incorrectly upon arrival. Incorrect wiring is causing bell to ring. Someone has placed a piece of cardboard to prevent the bell from ringing even though the bell is actively trying to ring. Corrected at time of inspection. Signature: Date: 5-31-16 Jered Stock State Fire Marshal AES2 Paae Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: Name: Harbor Woods Homeowners Association Occupancy / Use: I Residential Address: 200-309 Harbor Woods Place Construction Type: Wood/Stucco City: Newport Beach No. Stories: to Zip: 1 92660 Year Constructed: 1984 �Ir MP Contact: Nancy Blasco Telephone: (949) 372-4014 Contractor Information: I ` i Number of System Risers Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln a Owner Date 5-31-16 City: Orange Fire AHJ Date 5-31-16 State: California 92865-2606 ❑ Contractor Date Telephone: 714-974-9025 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and information, see NFPA 25, 2002 Edition as amended by Job # California Code of Regulations, Title 19 §901 Performed by: Kamil &Josh to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms included with this report NFPA 25 Chapter Number of Forms N/A FAIL* PASS 0 Automatic Sprinkler System 5 2 X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form JUN 0 2 2016 NEWPORT BEACH FIRE DEPAMMW P.O. BOX 1768 NEWPORT BEACH, CA =15J9 M5 State Fire Marshal AES2 Date of I Property Name: Address City: Main Drain Test Results: (See attached sheet for multiple risers) Initial Static Pressure: 83 (psi) _ Residual Pressure: 71 (psi) Restored Static Pressure: 83 (psi) Abbreviation Key: I = Inspection T = Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valve — Enclosure temperature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure temperature 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES2 Pacie 3 of 6 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: System Riser ID: 200 Type of System: �oF cA[�;� , �X Wet Pipe �4. 9 Dry Pipe v Preaction 9 MpQ� Deluge NFPA 25 Fail N/A Pass Reference Name: Harbor Woods Homeowners Association Address: 200 — 209 Harbor Woods Place City: Newport Beach Item Activity Frequency Description 1.18 1 Annually Hangers 5.2.3 X 1.19 I Annually Seismic Braces 5.2.3 X 1.20 I 5 Years Hangers (Accessible concealed spaces) 6.2.3.3 X 1.21 I 5 Years Seismic Braces (Accessible concealed s aces 5.2.3.3 X 1.22 I 5 Years Pipe and Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 I 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 I 5 Years Alarm Valves — (Interior Inspection) 12.4.1.2 X 1.25 1 5 Years Alarm Valves — Strainers, filters, orifices 12.4.1.2 X 1.26 1 5 Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5 Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5 Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 I 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 I 5 Years Dry Pipe Valves — Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 Sec) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES2 Paae 4 of 6 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: Name: Harbor Woods Homeowners Association System Riser ID: 200 Type of System: Fx—] Wet Pipe Dry Pipe y ❑ Preaction e M 45�Q Deluge Address: 200 — 209 Harbor Woods Place City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4; 4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick -Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assembly 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure Reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinklers manufactured prior to 1920 - Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES2 Paae 5 of 6 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: System'Riser ID: 200 Type of System: QF Cat ❑X e Wet Pip Dry Pipe Preaction Deluge Name: Harbor Woods Homeowners Association Address: 200 — 209 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: 1.4 1 — Provide control valve sing for BFV on riser 1.4 1 — Provide main drain sign 1.4 1 — Provide ITV sign 1.8 1 — Provide 2" of 1 %" pipe with a 1 %" 90° for main drain that does not currently have piping. Please trim back bushes and provide 3' of clearance around the riser prior to doing the repairs 1.7 1 — Replace faded hydraulic calculation plate and relocate it to the electoral room with SHB 1.4 1 — Replace broken lock on OS&Y in front of 200 2.6 1 — BFV tamper did not receive at the panel recommend to be corrected by the Fire Alarm Company 1.10 2 — Provide CSC 1650 br 1/" concealed SSP w/ cover for SHB 1.10 1 — Provide concealed wrench SHB 1.10 1 — CSC standard wrench SHB 1.9 1 — Please provide access to unit 201 Unit 207 1.9 1 — Provide concealed cover 2"d floor restroom Unit 203 1.9 1 — Painted concealed cover main floor closet near entry FX See Continuation Pages(s) FI-1 (Indicate the number of continuation pages) X❑ PASS FAIL Signature: Date: 5-31-16 77 Jered Stock IJ State Fire Marshal AES2 Paste 6 of 6 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: Name: Harbor Woods Homeowners Type of System: ❑X Sprinklers (Chapter 5) Of ca[�,�o System Riser ID: ❑ Standpipe (Chapter 6) Private Fire Main (Chapter 7) y ❑ Fire Pump (Chapter 8) Re MP�' Fire Pump No. or ID: H]Water Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: ❑ Foam -Water System (Chapter 11) System Riser ID: Address: 200 — 209 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments Deficiencies and Comments item number must correspond to the item number of the Activity listed above: Unit 204 1.9 2 — Missing covers in bedroom closets 1.9 1 — Painted head top of stairs Unit 200 1.9 1 — Painted cover 1 st floor restroom Unit 209 1.9 1 — Corroded in 1st floor restroom 1.9 8 - Painted heads in living room plus kitchen 1.9 9 — Painted upstairs all concealed heads painted Unit 206 1.9 Missing cover 1 st floor top of stairs 1.9 2 — Painted coves in bedroom closets Above repairs completed in May by Kamil/George/Josh of OCFP. System certified (6-Year) dated 5-2016 by OCFP. Signature: Jered Stock Date: 5.31-16 State Fire Marshal AES2 (� Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 26. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 'Property Information: Name: Harbor Woods Homeowners Association Address: 300 — 309 Harbor Woods Place City: Newport Beach System Riser ID: 300 Type of System: of CA�� ❑X Wet Pipe aQ`, ❑ Dry Pipe ❑ Preaction Fib ❑ Deluge I of 5 Main Drain Test Results: (See attached sheet for multiple risers) Initial Static Pressure: 84 (psi) Residual Pressure: 76 (psi) _ Restored Static Pressure: 84 (psi) Abbreviation Key: I = Inspection " T = Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPAn a 25 Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valve — Enclosure temperature 12.4.3.1 X 1.2 I Daily Weekl Dry Pipe Valves — Enclosure temperature 12.4.4.1.1 X 1.3 I Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4. 5.2.4.3 X 1.4 I Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X , 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 ' X 1.16 I Quarterly Backflow Preventers 12.6.1 X 1.17 I Annually Buildings 5.2.5 X State Fire Marshal AES2 Paoe 2 of 5 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: System Riser ID: 300 Type of System: f CA, I a Wet Pipe Dry Pipe Preaction�� P Deluge Name: Harbor Woods Homeowners Association Address: City: 300 — 309 Harbor Woods Place Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Braces 5.2.3 X 1.20 1 5 Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5 Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5 Years Pipe and Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5 Years Alarm Valves — (Interior Inspection) 12.4.1.2 X 1.25 1 5 Years Alarm Valves — Strainers, filters, orifices 12.4.1.2 X 1.26 1 5 Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5 Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5 Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5 Years Dry Pipe Valves — Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 Sec) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES2 Paae 3 of 5 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: System Riser ID: 300 Type of System: �oF ca4/� . Wet Pipe Op ' r Dry Pipe Preaction�i4e Deluge NFPA 25 Reference Fail N/A Pass Name: Harbor Woods Homeowners Association Address: 300 — 309 Harbor Woods Place City: Newport Beach Item Activity Frequency Description 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick -Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assembly 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure Reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 6.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinklers manufactured prior to 1920 - Re lace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES2 Paae 4 of 5 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: Name: Harbor Woods Homeowners Association System Riser ID: 300 Type of System: �'Of C El�p Fx—] Wet Pipe Dry Pipe Preaction`- .,_�..-'� �Re MpQ` Deluge Address: 300 — 309 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: 1.4 1 — Provide control valve sign for BFV on riser 1.4 1 — Provide main drain sign 1.4 1 — Provide ITV sign 1.8 1 — Provide 2' of " pipe with 1 %" 900 for main drain 1.7 1 — Replace faded hydraulic calculation plate and relocate to electrical room with spare head box 1.10 2 — Provide CSC 1650 br Y2" concealed SSP and cover for SHB 1.10 1 — Provide concealed wrench for SHB 1.10 1 — Provide HSW or VSW 1650 br'/" 1.10 1 — CSC standard wrench for SHB Unit 301 1.9 8 — painted concealed covers above fridge, in cabinet, main floor 1.9 1 — Painted CSC 1650 br Y2" SSU at entrance to garage 1.9 1 — Painted CSC 1650 br Y2" SSU in garage 1.9 7 — Painted concealed covers 2"d floor 1.9 1 — Painted cover in stairwell, will need little gaint 1.9 18 total concealed heads in unit recommend changing all to match Unit 302 1.9 1 — painted head right bedroom closet ❑X See Continuation Pages(s) FI-1 (Indicate the number of continuation pages) ❑X PASS FAIL Signature: Date: 5.31-16 Jered Stock State Fire Marshal AES2 Page 5 of 5 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: Type of System: ❑X Sprinklers (Chapter 5) System Riser ID: Standpipe (Chapter 6) HPrivate Fire Main (Chapter 7) ❑ Fire Pump (Chapter 8) Fire Pump No. or ID: ❑ Water Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: ❑ Foam -Water System (Chapter 11) System Riser ID: ` Name: Harbor Woods Homeowners Address: 300 — 309 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments Deficiencies and Comments item number must correspond to the item number of the Activity listed above: Unit 304 1.9 1 — Painted head in closet @ entrance, resident must remove electronics 1.9 1 — cover in master bedroom closet Unit 306 1.9 2 — missing covers living room, small bedroom closet Unit 300 1.9 6 paint 1st floor concealed 1.9 8 — Painted 2"d floor concealed Unit 305 1.9 1 — Provide concealed cover in guest bedroom Unit 309 1.9 1 — Painted cover 1st floor restroom 1.9 1 - Painted cover bedroom on right in closet. Resident to prove access prior to our arrival Above repairs completed in May by Kamil/George/Josh of OCFP. System certified (5-Year) dated 5-2016 by OCFP. LSignature: Jered Stock Date: 5-31-16 u State Fire Marshal AES2 Paqe 1 of 7 Inspection, Testing, and Maintenance Cover Sheet col NFPA 25 as amended by CCR, Title 19 a I Property Information: Name: Harbor Woods Homeowners Ass Occupancy / Use: Residential CAC1r Address: 400-509 Harbor Woods Place Construction Type: Wood/Stucco �pF City: Newport Beach No. Stories: 3 Zip:92660 Year Constructed: 1984. �E MPS' Contact: Nancy Blasco Telephone: (949) 372-4014 Contractor Information: ❑2 Number of System Risers Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln Owner Date 5-31-16 City: Orange a Fire AHJ Date 5-31-16 State: California 92865-2605 ❑ Contractor Date Telephone: 714-974-9025 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and information, see NFPA 25, 2002 Edition as amended by Job # California Code of Regulations, Title 19 §901 Performed by: K - Josh to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms included with this report FP te5 Cha❑X Number of Forms N/A FAIL* PASS Automatic Sprinkler System 5 2 X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form State Fire Marshal AES2 NEWPORT BEACH FIRE DEPARTMENT P.O. BOX 1168 NEWPORT BEACH, CA 9265M15 JUN 0 2 2016 2ot7 inspection, Testing, ana maintenance i-ire sprinKier system NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 System Riser ID: 400 Property Information: Type of System: Wet Pipe X Dry Pipe Preaction CA47�p �Q z Name: Harbor Woods Homeowners Association Address: 400 — 409 Harbor Woods Place City: Deluge PQ� Newport Beach Main Drain Test Results: (See attached sheet for multiple risers) Initial Static Pressure: 85 (psi) Residual Pressure: 75 (psi) Restored Static Pressure: 1 85 (psi) Abbreviation Key: I = Inspection T =Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valve — Enclosure temperature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure temperature 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES2 Paae 3 of 7 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: System Riser ID: 400 Type of System: ❑X Wet Pipe ❑ Dry Pipe ❑ Preaction` ❑ Deluge NFPA 25 Fail N/A Pass Reference Name: Harbor Woods Homeowners Association Address: 1 400 — 409 Harbor Woods Place City: Newport Beach Item Activity Frequency Description 1.18 I Annually Hangers 5.2.3 X 1.19 I Annually Seismic Braces 5.2.3 X 1.20 I 5 Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 I 5 Years Seismic Braces (Accessible concealed s aces 5.2.3.3 X 1.22 I 5 Years Pipe and Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 I 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 I 5 Years Alarm Valves — (Interior Inspection) 12.4.1.2 X 1.25 I 5 Years Alarm Valves — Strainers, filters, orifices 12.4.1.2 X 1.26 I 5 Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 I 5 Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 I 5 Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5 Years Dry Pipe Valves — Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 Sec) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES2 Paae 4 of 7 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 26, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: System Riser ID: 400 Type of System: ocAE��p ❑X Wet Pipe Dry Pipe Preaction �RE MP�� ❑ Deluge Name: Harbor Woods Homeowners Association Address: 400 — 409 Harbor Woods Place City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick -Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assembly 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure Reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinklers manufactured prior to 1920 - Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation- Chapter 13 X State Fire Marshal AES2 Paae 5 of 7 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 12/97/2015 System Riser ID: 400 Property Information: Type of System: Q"'i Name: �Qp ❑X t Pipe Harbor Woods Homeowners Association We Address: n 400 - 409 Harbor Woods Place Dry Pipe .r Preaction 4Q Deluge City: Newport Beach Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: 1.10 1 — Provide CSC 165° br'/" concealed SSP and cover plate for SHB 1.10 1 — Provide CSC concealed wrench for SHB 1.10 1 — HSW or VSW 165' br %" for SHB 1.4 1 -Provide ITV sign 1.4 1 — Provide Control Valve sign for BFV 1.4 1 — Provide main drain sign 1.8 1 — Provide 2' of 1 %" galvanized pipe with 1 %" 900 for main drain which currently does not have any piping 1.8 Note: Recommend galvanized for all (5) buildings main drain piping 1.7 1 — Recommend replacing fated hydraulic calculation plate and relocate to electrical closet with SHB 2.1 1 — Replace bell that did not ring. Flow switch is ok and has power. 1.8 1 -replace 1 %" main drain valve the is leaking 1.9 1 — Please provide access to Unit 400 Unit 402 1.9 Remove tape in closet next to garage, front closet 1.9 10 — painted covers 1.9 2 — heads See Continuation Pages(s) a (Indicate the number of continuation pages) PASS FAIL Signature: Date: 5-31-16 - Jered Stock 71 State Fire Marshal AES2 Page 6 of 7 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 12/17/20,5 Property Information: Type of System: ❑X Sprinklers (Chapter 5) of GA4, System Riser ID: ❑ Standpipe (Chapter 6) Private Fire Main (Chapter 7) y J Q ❑ Fire Pump (Chapter 8)Re MP�y� Fire Pump No. or ID: HWater Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: ❑ Foam -Water System (Chapter 11) System Riser ID: Name: Harbor Woods Homeowners Address: 400 — 409 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments Deficiencies and Comments item number must correspond to the item number of the Activity listed above: Unit 408 1.9 1 -Painted head @ entrance 1.9 5 covers on 1 st floor 1.9 7 — painted br CSC A 16501/2" SSU garage area 1.9 9 — covers on second floor Unit 401 1.9 5 — Provide missing covers main floor 1.9 9 — Provide missing covers 2"d floor Unit 409 1.9 8 — Replace/provide missing painted covers on 1st floor 1.9 1 — Painted CSC 165' br'/" SSU at entrance to garage 1.9 7 — Painted/provide for missing covers 2"d floor 1.9 2 - Painted small dome style heads in guest bedroom. Appear to be Globe dome style heads Unit 407 1.9 2 — Provide concealed cover in master bedroom closet and guest bedroom closet Signature: Jered Stock Date: 5-31.16 V State Fire Marshal AES2 Pane 7 of 7 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 12/17/2015El Property Information: Type of System: Sprinklers (Chapter 5) of CA -'Z' System Riser ID: Standpipe (Chapter 6) �. HPrivate Fire Main (Chapter 7) y Q ❑ Fire Pump (Chapter 8)A¢ Fire Pump No. or ID: ❑ Water Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: ❑ Foam -Water System (Chapter 11) System Riser ID: Name: Harbor Woods Homeowners Address: 400 — 409 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments Deficiencies and Comments item number must correspond to the item number of the Activity listed above: Unit 405 1.9 4 — Painted 165° br'/2' SSU in garage 1.9 1 — Provide cover in 2"d floor master bedroom closet 1.9 1 — Provide cover in 2"d floor bathroom 1.9 1 — Provide cover in 2"d floor guest closet 1.9 1 - Provide cover in master bedroom in front of closet Above repairs completed in May by Kamil/George/Josh of OCFP. System certified (5-Year) dated 5-2016 by OCFP. Signature: Jered Stock Date: 5.31-16 State Fire Marshal AES2 Page 1 of 6 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 112/17/2015 System Riser ID: 500 Property Information: Type of System: ca ❑X Wet Pipe s, Name: Harbor Woods Homeowners Association. Address: Dry Pipe 500 — 509 Harbor Woods Place Preaction` �Aa Deluge City: Newport Beach Main Drain Test Results: (See attached sheet for multiple risers) Abbreviation Key: Initial Static Pressure: 84 (psi) I = Inspection T = Test Residual Pressure: 75 (psi) M = Maintenance A-O = After Operation Restored Static Pressure: 84 (psi) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Preaction/Deluge Valve — Enclosure 12.4.3.1 X Weekly temperature 1.2 I Daily Dry Pipe Valves — Enclosure temperature 12.4.4.1.1 X Weekly 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 6.2.4. .2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 I Annually Buildings 5.2.5 X State Fire Marshal AES2 Page 2 of 6 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 1 12/17/2015 Property Information: System Riser ID: 500 Type of System: OF cq�r�p Wet Pipe i� Dry Pipe y Preaction ❑ Deluge Name: Harbor Woods Homeowners Association Address: 500 — 509 Harbor Woods Place City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail NIA Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Braces 5.2.3 X 1.20 1 5 Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5 Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5 Years Pipe and Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5 Years Alarm Valves — (Interior Inspection) 12.4.1.2 X 1.25 1 5 Years Alarm Valves — Strainers, filters, orifices 12.4.1.2 X 1.26 1 5 Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5 Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5 Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5 Years Dry Pipe Valves — Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 Sec) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES2 Paqe 3 of 6 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 112/17/2015 Property Information: System Riser ID: 500 Type of System: CA Wet Pipe erg. 9 Dry Pipe X 1.- Preaction Deluge Name: Harbor Woods Homeowners Association Address: 500 — 509 Harbor Woods Place City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X . 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick -Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assembly 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure Reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinklers manufactured prior to 1920 - Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.8.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES2 Date c Propei Name; Addre; City: Item 1.4 1.4 1.4 1.8 1.7 2.1 1.11 1.8 1.10 1.10 1.9 1.9 1.9 1.9 1.9 v State Fire Marshal AES2 Page 5 of 6 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: Name: Harbor Woods Homeowners Type of System: ❑X Sprinklers (Chapter 5) �pF GR[� O System Riser ID: Standpipe (Chapter 6) - H Private Fire Main (Chapter 7) ❑ Fire Pump (Chapter 8),!ka.Mp Fire Pump No. or ID: ❑ Water Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: ❑ Foam -Water System (Chapter 11) System Riser ID: Address: 500 — 509 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments Deficiencies and Comments item number must correspond to the item number of the Activity listed above: Unit 509 1.9 1 -Replace painted in front of 509 1.9 1 — Replace painted concealed head in stairwell 1.9 1 — Replace painted concealed cover 1st floor head closest to stairs Unit 607 1.9 1 — Painted cover near stairs leading to garage 1.9 4 — Painted CSC 1650 br 1/" SSU in garage 1.9 1 — Painted cover guest bedroom closet 1.9 1 — Provide cover master bedroom bathroom 1.9 1 — Panted concealed head master bedroom closet Unit 604 1.9 2 — Missing covers, 1 small bedroom closet, 1 closet at entrance Unit 508 1.9 3 — Painted on 1st floor restroom, closet, kitchen Signature: Jered Stock Date: 6-31-16 State Fire Marshal AES2 Paae 6 of 6 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 12/17/2015 Property Information: Type of System: ❑X Sprinklers (Chapter 5) oT-a ctr,�o System Riser ID: Standpipe (Chapter 6) y a HPrivate Fire Main (Chapter 7) ❑ Fire Pump (Chapter 8) ''�e Fire Pump No. or ID: Water Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: ❑ Foam -Water System (Chapter 11) System Riser ID: Name: Harbor Woods Homeowners Address: 500 — 509 Harbor Woods Place City: Newport Beach Item Deficiencies and Comments Deficiencies and Comments item number must correspond to the item number of the Activity listed above: Unit 500 1.9 5 — painted heads 15t floor 1.9 1 — painted cover 1 st floor 1.9 3 — Painted on 2"d floor, one blocked on floor closet 1.9 1 — Missing cover Above repairs completed in May by Kamil/George/Josh of OCFP. System certified (5-Year) dated 5-2016 by OCFP. Signature: .,aDate: 5-31-16 Jered Stock State Fire Marshal AES2 0 I SYSTEM RECORD OF COMPLETION Fa O 1 Is^ O 4 This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. �� Insert N/A in all unused lines. Attach additional sheets, data, or calculations as necessary to provide a complete record.'�.%��-T` Form Completion Date: July 01, 2016 Supplemental Pages Attached: 1 1. PROPERTY INFORMATION Name of property: FARMHOUSE CAFE AT ROGER'S GARDENS _ Address: 2301 SAN JOAQUIN ROAD, CORONA DEL MAR, CA 92625 Description of property: CAFE / RESTUARANT Name of property representative: GAVIN HERBERT Address: ROGER'S GARDENS, 2301 SAN JOAQUIN ROAD, CORONA DEL MAR,CA 92625 Phone: 949-640-4446 Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: BILL'S SOUND & SECURITY Address: 3190-C AIRPORT LOOP DR., COSTA MESA, CA 92626 Phone: 714-540-9800 Fax: 714-540-1516 E-mail: ENGINEERING@BILSSOUND.COM Service organization: BILL'S SOUND & SECURITY Address: (SAME) Phone: Fax: E-mail: SERVICE@BILLSSOUND.COM Testing organization: BILL'S SOUND & SECURITY Address: (SAME) Phone: Fax: E-mail: TESTING@BILLSSOUND.COM Effective date for test and inspection contract: JULY 01, 2016 Monitoring organization: BILL'S SOUND & SECURITY Address: SECURITY PARTNERS, 4420 W. DIABLO DR., LAS VEGAS, NA ;89118 Phone: 800-540-3808 Fax: E-mail: Account number: bss 8519 Phone line 1: N/A Phone line 2! N/A Means of transmission: GMS Entity to which alarms are retransmitted: NEWPORT BEACH FIRE DEPT. Phone: 714-780-0981 3. DOCUMENTATION On -site location of the required record documents and site -specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ® New system ❑ Modification to existing system Permit number: F2016-0288 NFPA 72 edition: 2013 4.1 Contror Unit Manufacturer: POTTER SIGNAL Model number: P-100 4.2 Software and Firmware //�� Firmware revision number: 3 • bl f 4.3 Alarm Verification Number of devices subject to alarm verification: ® This system does not incorporate alarm verification. Alarm verification set for seconds 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. 1 of 3) f SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120 VAC Overcurrent protection: Type: CIR BREAKER Branch circuit disconnecting means location: BACK OF KITCHEN 5.1.2 Secondary Power Type of secondary power: SEALED LEAD BATTERIES Location, if remote from the plant: (PANEL) 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 R CIRCUITS ANn PATHWAYS Control panel amps: Amps: 20 AMP Number: PNL'B' Cir 15 3 AMP In alarm mode (minutes): 5 Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line B 0 Device Power N/A N/A Initiating Device B 0 Notification Appliance Other (specify): 7. REMOTE ANNUNCIATORS Type Location NONE 8. INITIATING DEVICES Type Quantity Addressable or Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations NONE Smoke Detectors 1 ADDRESSABLE ALARM PHOTO Duct Smoke Detectors NONE Heat Detectors NONE Gas Detectors NONE Waterflow Switches 1 CONV MADDRESS ALARM Tamper Switches 2 CONV MADDRESS SUPRVISORY 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. 2 of 3) SYSTEM RECORD OF COMPLETION (continued) A NOTIFICATION APPLIANCES Type Quantity Description Audible NONE Visible NONE Combination Audible and Visible NONE in CYCTFM R[1NTPn1 FI INCTInNS Type Quantity Hold -Open Door Releasing Devices NONE HVAC Shutdown NONE Fire/Smoke Dampers NONE Door Unlocking NONE Elevator Recall NONE Elevator Shunt Trip NONE 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 name: BILL BOODMAN Date: July 1, 2016 Organization: BILL'S SOUND & SECURITY Title: Q, N�i'-�tiiA Phone: 714-540-9800 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: Printed name: BILL BOODMAN Date: July 1, 2016 Organization: BILL'S SOUND & SECURITY Title: Q`I.es �.Qt,� Phone: 714-540-9800 12.3 Acceptance Test Date and time of acceptance test: Installing contractor representative: Testing contractor representative: Property representative: AHJ representative: 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. 3 of 3) Y Li INITIATING DEVICE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING This form is a supplement to the System Record of Inspection and Testing. It includes an initiating device test record. This form is to be completed by the system inspection and testing contractor at the time of the inspection and/or test. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Inspection/Test Start Date/Time: JULY 1, 2016 Inspection/Test Completion Date/Time: JULY 1, 2016 Number of Supplemental Pages Attached: 1 1. PROPERTY INFORMATION Name of property: FARMHOUSE CAFE @ ROGER'S GARDEN Address: 2301 SAN JOAQUIN ROAD, CORONA DEL MAR, CA 92625 2. INITIATING DEVICE TEST RESULTS Device Type Devices ID Address Point Name Zone / Group Name Pass Comments SMOKE DET 05 OVER FACU �{ �l WATER FLOW 11 BUILDING RISER PIV 12 OS&Y 13 ANSUL 15 HOOD EXT. KITCHEN El El See main System Record of Inspection and Testing for additional information, certifications, and approvals. 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, 1 of 1) Morris, Nadine From: Sent: To: Subject: Attachments: Hi Inspector Morris: sales@billssound.com Friday, July 1, 2016 4:22 PM Morris, Nadine 2301 San Joaquin Road- Famhouse Cafe central station report.pdf Ruben our technician wanted me to send this to you... Please see the attached report from our central station. Regarding the Cellular Radio Supervision to the Central Station.... On 6-17-16 we powered up the Cellular Radio Unit. conducted a few tests and powered down the unit. A Communication Fail came in at 12:07pm. We were back at the job site on 6-30-16 to power up the unit and conduct more testing. 6:30am shows a restore. We are also working on the Record of Completion and should have that ready for you on Tues July 5. We will give you a call. Thanks Bill Uiu's ��iliHO a �cultry MW Bill Boodman President BILL'S SOUND & SECURITY 3190-C Airport Loop Drive Costa Mesa, CA 92626 (714)540-9800 Fax (714) 540-1516 www.billssound.com 1 p 06130116 07:=913 S553519 E305 - System -esv E3O5 DO p ,06130/1607:35:23' SSS8519 41 -FIRE -ANSUL HOOD SYSTSM EL10 I5 KITCHEN ® 06130116 07:21:36 SSS8519 R373 - Reston- Fre ;r:,aa:e 9373 5 SMOKE DETECTOR OVER FIRE PANEL Q• 06/30/IE07-21:19 BS58519 E373- Fire l`cr.b:e E373 5 SMOKE`DETECTOROVER FIRE PANEL p 06130116 07:21:07 aSS85l9 9110 - Restore F;rc R2! 0 5 SMOKE DETECTOR OVER FIRE PANEL J7 06/3Gy16 07:20.5ix ;BSSSs 19 E305 - System reset E305 DO p D6130116 07: i 9:21 BSS8519 58 - FIFE - SMOKE Dc`T ECIOP El 10 5 SMOKE DETECTOR OVER FIRE PANEL P' 613Pf16.07:17:16 ;SSS8519 Al10-Restore Fire -R110 15 •KM.7fEN p 06130126 07:17:01 8S58519 E305 -System reset C-305 DO `Q6QJ16` 07i1o`, _34' f$SS9519 ,41 - FIRE-ANS-UL HOOD SYSTEM •E110 IS 'KITCHEN p O6/30/15 07.15:08 BSS8519 E625 - Time/Date reset E625 User 0 p 00/30/1b,07:07:pG WSS5519 2000-RESTORE R203 12 SENSOR P 06130116 07:02.36 PIP8519 PLACED ON TEST OLD All Points p 46130/I6 R7:02:36 BSS6S29' PLACED ON TEST DL0 A# Points p 06/30116 07:02:25 BS58519 ACCOUNT WAS PLACED ON TEST / SEE HISTORY DLD p 0613jU 07:0.'2:05 !WI BS19 ACCOUNT PUTINTO SERVICE DLD p 06130116 07:01:27 SSS8519 ACCOUNT PUT INTO SERVICE DLD j7 i06J3dj16,:06,35�9. 8558519 -PIN Verified DLD RUBEN.{Dewier) p 06/30/16 66:54:03 BSS8529 E302 - AC POWER FAIL E3O1 DO P • • t16 30%1 it 06:43:OZ i8SS6S19 R373 - Restore Fur tr•uble P373 IS ;1Q7CHEN p 06l30116 06:41:44 BSW519 E373 - Fire Tro!.&e E373 15 KITCHEN p=. #06.I kY,*4 06:40:.42 •8S53519 P302 - ResitDie Low system battery R302 DO p O6/-i0/16 06:40.36 SSS8519 E302 - Low sestem battery E302 DO -1o40 S6 06;40;13 T - :85S9519 487 - VALVE TAMPER - P-I-V. E203 12 ,0 06130116 06:40:00 M8519 E305 - System reset E305 DO h7' AW$9116 "'i ". • 6S-1130 005 - System reset E305 DO ; , r ;I] 06I30fIS 06:39:39 BSS8519 YK - 2E57CRAL of Norral Panel Communications W. 9 p=c- 1M37/1532:07OS :` =_EJS$8519 ' �632T-COMHUFf1Ca7ONFAT .yr g + p ObJ17116 11.02.05 SSS8519 E351 - Telto Lane I TROUBLE E351 p ;06117116 31:Q1:IO :8558S19 •487 - VALVE TAMPER - P.I.V. E203 12 " a7 06/17/!6 11:00:52 •HS58519 E373 - Fke TroclzTe E373 5 SMOKE DETECTOR OVER FIRE PANEL :p-•06/1J/1trY2;A0.?3,.4; - :6558519 'E305- System reset P 0611711610;59:22 SS53519 E305 - System reset E305 DO t p Oo/t7�LS 3b:59:2?.; .._: $5595F$.':Y C REs� OPFI or�Vorai Panel Com un rat as YK 9 - �] 06106/16 14:25:07 SSS8519 - 6327 - COMPIUNICA" Tall FAIL YC 9 Ob, D ACCOUNT KQp" ,P 06/06/16 09:56.53 SSS8519 PIN Verified KIQ BILL 800Dh1AN (D6 P W05/16 09:39:09 P.IP8519 RI10 - Restore fire R210 15 �aaM STATE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 4-2000) See instructions on reverse. AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUESTDATE PROGRAM Susan Seyboth 714-567-2906 07/7/2016 Licensing and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Susan Seyboth IA CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY LICENSING I California Department of Public Health AGENCY Licensing and Certification NAME AND 681 South Parker Street 3. CAPACITY CHANGE ADDRESS Suite 200 4. OWNERSHIP CHANGE Orange, CA 92868 5. ADDRESS CHANGE L 6. NAME CHANGE T OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 0 0 FACILITY NAME LICENSE CATEGORY Hoag Memorial Hospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive CITY RESTRAINT Newport Beach, CA 92658 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS High Level Disinfection (HLD) Project Completion on 2 East TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE /DENIA/L CODE Newport Beach Fire Department 1 CODES FIRE CLEARANCE GRANTED FIRE PO Box 1768 AUTHORITY Newport Beach, CA 92658 NAME AND 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS L B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS a, E. HOUSEKEEPING SPECIAL F. HAZARD G. OTHER INSPE TI DATE INSPEC R'S SI NATURE (TyPSgtOP:Printed) EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS a cosco�6- yam_ •-��•@-• Fire Protection J Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 v7 Cosco Wo 1505-0293 _ Property Information: Name: NEWPORT MEDICAL PARKING Occupancy/Use: Utility-Misc. �oF CAc,��9 Construction Type: 1A Address: 1441 -1401 AVOCADO AVE v No. Stories. 1 City: NEWPORT BEACH CA Year Constructed: 1978/ M�Q Zip: 92660 Monitoring Company: ENG POSTED Contact: ROB GRAVES Phone Number: N/A i' Phone: 949-279-1257 Time system off-line: 5:00am/ Time system on-line: 2:00pm Contractor Information: Name: COSCO FIRE PROTECTION Address: 1075 W LAMBERT ROAD BLDG D City: BREA State: CA Phone: 714-989-1800 CA License# C-10/C-16-577621 Job # 1505-0293 Performed by: ROBERT HARRIS (Print) Note: Contractor information may be pre-printed 1-2 WET Number of System Risers Copy sent to: Owner Date Fire AHJ Contractor 05/09/2015 NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2002 Edition as amended by California Code of Regulations, Title 19, 901 to 906. 2) Inspection Items may be performed by the Owner in accordance with California Code of Regulations Title 19 901.1(a) ` Forms included with the report NFPA Chapte5 Number of Forms N/A FAIL* PASS Automatic Sprinkler System 5 5 Year ❑ 0 ❑ Standpipe and Hose Systems 6 R ❑ ❑ ❑ Private Water Supply System 7 ❑ ❑ ❑ Fire Pump 8 ❑ ❑ ❑ Water Storage Tank 9 ❑ ❑ ❑ Water Spray System 10 R ❑ ❑ ❑ Foam Water Sprinkler System 11 ❑ ❑ *See "Deficiencies and Comments" section at end of each respective form> I • ► ,, 1 mm f a,� Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco WO 1505-0293 Page 1 of 4 AES 2 Date Inspection, Testing, Maintenance: 05/09/2015 Date Last Five Year Inspection: 02/01/2010 ❑ Unknown System Riser ID: 1-2 WET Frequency:5 Year Property Information: Type of system: or- cgt�,�o Name: NEWPORT MEDICAL PARKING R1 Wet Pipe y 9� Address: 1441 -1401 AVOCADO AVE ❑ Dry Pipe a City: NEWPORT BEACH CA ❑ Preaction 9� M Zip: 92660 ❑ Deluge Main Drain Test Results: Abbreviation Key: Initial Static Pressure: 75 (psi) I = Inspection Residual Pressure: 65 (psi) T = Test M = Maintenance Restored Static Pressure: 75 (psi) A-0 = After Operation Recovery Time: 1 (sec) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA25 Fail N/A Pass Reference 1.1 1 Daily PREACTION/DELUGE VALVES - 12.4.3.1 ❑ Rl ❑ Weekly ENCLOSURE TEMPERATURE 1.2, I Daily DRY PIPE VALVES - ENCLOSURE 12.4.4.1.1 ❑ •. Q ❑ Weekly TEMPERATURE 1.3 I Quarter) y GAUGES ( DRY, PREACTION, DELUGE 5.2.4.2 ❑ ❑ SYSTEMS) 5.2.4.3 1.4 1 Quarterly CONTROL VALVES 12.3.2.1 ❑ ❑ 1.5 1 Quarterly ALARM - DEVICES 5.2.6 ❑ ❑ 1.6 I Quarterly GAUGES (WET PIPE SYSTEMS) 5.2.4.1 ❑ ❑ 1.7 1 Quarterly HYDRAULIC NAMEPLATE 5.2.7 ❑ ❑ 1.8 1 Quarterly PIPE AND FITTINGS 5.2.2 ❑ ❑ R 1.9 1 Quarterly SPRINKLERS 5.2.1 ❑ ❑ 0 1.10 1 Quarterly SPARE SPRINKLERS 5.2.1.3 ❑ ❑ ❑Q 1.11 1 Quarterly FIRE DEPARTMENT CONNECTIONS 12.7.1 ❑ ❑ 0 1.12 1 Quarterly ALARM VALVES - EXTERIOR INSPECTION 12.4.1.1 ❑ ❑ 121 1.13 I Quarter) y PREACTION/DELUGE VALVES - EXTERIOR 12.4.3.1.E ❑ ❑� ❑ INSPECTION 1.14 1 Quarterly PRESSURE REDUCING VALVES 12.5.1.1 ❑ R ❑ 1.15 1 Quarterly DRY PIPE VALVES - EXTERIOR 12.4.4.1.4 ❑ ❑ INSPECTION 1.1E I Quarterly BACKFLOW PREVENTERS 12.6.1 ❑ ❑ 1.17 I Annually BUILDINGS 5.2.5 ❑ R1 ❑ ® Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco WO 1505-0293 Date of Inspection, Testing, Maintenance: 5/9/2015 Property Information: Name: NEWPORT MEDICAL PARKING Address: 1441 -1401 AVOCADO AVE City: NEWPORT BEACH CA 92660 System Riser ID: 1-2 WET Frequency:5 Year Type of System: 0 Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Page 2 of 41 AES 2 Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually HANGERS 5.2.3 ❑ ❑ ❑Q 1.19 1 Annually SEISMIC BRACES 5.2.3 ❑ ❑ 91 1.20 1 5 year HANGERS (Accessible Concealed Spaces) 5.2.3.3 ❑ ❑ R1 1.21 1 5 year SEISMIC BRACES (Accessible Concealed Spaces) 5.2.3.3 ❑ ❑ 1.22 1 5 year PIPE AND FITTINGS (Accessible Concealed Spaces) 5.2.2.3 ❑ ❑ 0 1.23 1 5 year SPRINKLERS (Accessible Concealed Spaces) 5.2.1.1.4 ❑ ❑ 1.24 1 5 year ALARM VALVES - INTERIOR INSPECTION 12.4.1.2 ❑ ❑ 0 1.25 1 5 year ALARM VALVES - STRAINERS, FILTERS, ORIFICES 12.4.1.2 ❑ ❑ RI 1.26 1 5 year CHECK VALVES - INTERIOR INSPECTION 12.4.2.1 ❑ ❑ R1 1.27 1 5 year PREACTION/DELUGE VALVES - INTERIOR INSPECTION 12.4.3.1.7 ❑ 0 ❑ 1.28 1 5 year PREACTION/DELUGE VALVES - STRAINERS, FILTERS, ORIFICES 12.4.3.1.8 ❑ 1 ❑ 1.29 1 5 year DRY PIPE VALVES - INTERIOR INSPECTION 12.4.4.1.5 ❑ 0 Ely 1.30 1 5 year DRY PIPE VALVES - STRAINERS, FILTERS, ORIFICES 12.4.4.1.6 ❑ R ❑ 2.1 T Annually ALARM DEVICES (90 SEC) 5.3.3-12.2.7 ❑ ❑ 2.2 T Annually MAIN DRAIN TEST (ENTER DATA ON PAGE 1) 12.2.6 12.2.6.1 12.3.3.4 ❑ ❑ R1 2.3 T Annually ANTIFREEZE TEST 5.3.4 ❑ 0 ❑ 2.4 T Annually CONTROL VALVE - POSITION 12.3.3.1 ❑ ❑ 0 2.5 T Annually CONTROL VALVE - OPERATION 12.3.3.1 ❑ ❑ w 2.6 T Annually SUPERVISORY 12.3.3.5 ❑ ❑ R1 2.7 T Annually PREACTION VALVE - PRIMING WATER 12.4.3.2.1 ❑ 271 ❑ 2.8 T Annually PREACTION VALVE - LOW AIR PRESSURE ALARM 12.4.3.2.10 ❑ ❑ 2.9 T I Annually PREACTION - FULL FLOW TRIP TEST 12.4.3.2.2 1 ❑ R ❑ i. •- • Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems NFPA 25, Chapter 5 as amended by CCR, Title 19 WO 1505-0293 Inspection, Testing, Maintenance: 5/9/2015 Name. Information: NEWPORT MEDICAL PARKING Address: 1441 -1401 AVOCADO AVE City: NEWPORT BEACH CA Tin' 92660 System Riser ID: 1-2 WET =requency:5 Year Type of System: R1 Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Page 3 of AES 2 P i Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually DRY PIPE VALVE - PRIMING WATER 12.4.4.2.1 ❑ 2 ❑ 2.11 T Annually DRY PIPE VALVE - LOW AIR PREASSURE 12.4.4.2.6 ❑ 0 ❑ 2.12 T Annually DRY PIPE VALVE - QUICK -OPENING DEVICE 12.4.4.2.4 ❑ ❑ 2.13 T Annually DRY PIPE VALVE - TRIP TEST 12.4.4.2.2 ❑ ❑ 2.14 T Annually BACKFLOW PREVENTER ASSEMBLIES 12.6.2 ❑ ❑ 2.15 T 3 year DRY PIPE VALVE - FULL FLOW TRIP TEST 12.4.4.2.2.2 ❑ 2 ❑ 2.16 T 5 year GAUGES 5.3.2 ❑ ❑ 2.17 T 5 year PRESSURE REDUCING VALVES 12.5.1.2 ❑ Q ❑ 2.18 T 5 year FIRE DEPARTMENT CONNECTION BACKFLUSH 12.7.4 ❑ ❑ ❑� 2.19 T 5 year SPRINKLERS - EXTRA HIGH TEMPERATURE 5.3.1.1.1.3 ❑ 0 ❑ 2.20 T 5 year SPRINKLERS - CORROSIVE ENVIRONMENT OR CORROSIVE WATER 5.3.1.1.2 ❑ ❑Q ❑ 2.21 T 10 year SPRINKLER - DRY 5.3.1.1.1.5 ❑ 0 ❑ 2.22 T 20 year SPRINKLERS - FAST RESPONSE 5.3.1.1.1.2 ❑ 0 ❑ 2.23 T 50 year SPRINKLERS 5.3.1.1.1 ❑ W ❑ 2.24 T 75 year SPRINKLERS 75 YEARS IN SERVICE 5.3.1.1.1.4 ❑ 2 ❑ 2.25 T SPRINKLERS MANUFACTURED PRIOR TO 1920 - REPLACE 5.3.1.1.1.1 ❑ ❑ 3.1 M Annually CONTROL VALVES 12.3.4 ❑ ❑ 0 3.2 M Annually PREACTION/DELUGE VALVES 12.4.3.3.2 ❑ 0 ❑ 3.3 M Annually DRY PIPE VALVES/QUICK-OPENING DEVICES 12.4.4.3.2 ❑ ❑ 3.4 M Annually DRY PIPE VALVE - LOW POINT DRAINS 12.4.4.3.3 ❑ ❑ 3.5 M 5 year OBSTRUCTION INVESTIGATION Chapter 13 ❑ ❑ Q ....�.. CO'9CC► Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems Page 4 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco WO 1505-0293 AES 2 Date Inspection, Testing, Maintenance: 5/9/2015 System Riser ID: 1-2 WET Frequency:5 Year a�c� C44�.�0 Property Information: Type of System: y 9� Name: NEWPORT MEDICAL PARKING R1 Wet Pipe Address: 1441 -1401 AVOCADO AVE ElDry Pipe City: NEWPORT BEACH CA ❑ Preaction Zip: 92660 ❑ Deluge Item Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above: Comments: FIRE SPRINKLER SYSTEM'S IN GOOD WORKING ORDER. THESE (2) FIRE SPRINKLER SYSTEMS ARE NOT TIED INTO ANY FIRE PUMP. CITY PRESSURE ONLY. R PASS ❑ FAIL ❑ See continuation Page(s) E� (Indicate the number of continuation pages) LIABILITY RELEASE STATEMENT: The Owner and/or its designated representative acknowledge that the Owner has full responsibility for the operating condition of the fire protection system(s) including its component parts at the time of this inspection. This inspection/test report is governed by terms and conditions of Cosco Fire Protection Inspection signed agreement. Without in any way limiting such terms and conditions, the Owner acknowledges that the Contractor does not have any obligation to correct any deficiencies Contractor has identified in report and Owner shall have full responsibility for corrections of any such deficiencies. As an additional service, however, the Owner and/or its designated representative may enter into a separate, written repair or maintenance contract with Contractor for the correction of such deficiencies. During our work in your building, our representatives may have noticed items on your fire protection system that may need further investigation. These items are not part of the normal NFPA Standards inspection, testing or maintenance functions, but we are providing you with notice of these concerns as a courtesy. This does not constitute or represent that we have performed a full analysis of fire protection system(s) in this building and there may be other items of concern that we have not identified because this type of analysis is beyond the scope of what we were hired to do in accordance with NFPA Standards. Customer Name Customer Signature Not Available ❑ Inspector Name ROBERT HARRIS Inspector Signature Date Date 5/9/2015 :0000+: I C®SCO Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems AES 9 NFPA 25, Chapter 5 as amended by CCR, Title 19 Continuation Form for Deficiencies and Comments Cosco WO 1505-0293 Page Date Inspection, Testing, Maintenance: 5/9/2015 Property Information: Name: NEWPORT MEDICAL PARKING Address. 1441 -1401 AVOCADO AVE City: NEWPORT BEACH CA Zip: 92660 Frequency:5 Year Type of System: �oV ca<,a Sprinkler (Chapter 5)� Standpipe (Chapter 6) 'v Syst. Riser ID: 1-2 WET X Private Fire Main (Chapter 7) Fire Pump (Chapter 8) Fire Pump No. or ID: Water Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: 1-2 WET Foam -Water System (Chapter 11) System Riser ID: 1-2 WET Item IDeficiencies and Comments Item number must correspond to the Item number of the Activity listed above: LIABILITY RELEASE STATEMENT: The Owner and/or its designated representative acknowledge that the Owner has full responsibility for the operating condition of the fire protection system(s) including its component parts at the time of this inspection. This inspection/test report is governed by terms and conditions of Cosco Fire Protection Inspection signed agreement. Without in any way limiting such terms and conditions, the Owner acknowledges that the Contractor does not have any obligation to correct any deficiencies Contractor has identified in report and Owner shall have full responsibility for corrections of any such deficiencies. As an additional service, however, the Owner and/or its designated representative may enter into a separate, written repair or maintenance contract with Contractor for the correction of such deficiencies. During our work in your building, our representatives may have noticed items on your fire protection system that may need further investigation. These items are not part of the normal NFPA Standards inspection, testing or maintenance functions, but we are providing you with notice of these concerns as a courtesy. This does not constitute or represent that we have performed a full analysis of fire protection system(s) in this building and there may be other items of concern that we have not identified because this type of analysis is beyond the scope of what we were hired to do in accordance with NFPA Standards. Customer Name Inspector Name ROBERT HARRIS Customer Signature Inspector Signature Date Date 5/9/2015 Fire Protection ; Comments and.'Rec. 1505=0293_ _ oimirrmendations cos�owo Although these comments are not the results of any engineering review, the following improvements are recommended: Tech Note: System Descriptions: LIABILITY RELEASE STATEMENT: The Owner and/or its designated representative acknowledge that the Owner has full responsibility for the operating condition of the fire protection system(s) including its component parts at the time of this inspection. This inspection/test report is governed by terms and conditions of Cosco Fire Protection Inspection signed agreement. Without in any way limiting such terms and conditions, the Owner acknowledges that the Contractor does not have any obligation to correct any deficiencies Contractor has identified in report and Owner shall have full responsibility for corrections of any such deficiencies. As an additional service, however, the Owner and/or its designated representative may enter into a separate, written repair or maintenance contract with Contractor for the correction of such deficiencies. During our work in your building, our representatives may have noticed items on your fire protection system that may need further investigation. These items are not part of the normal NFPA Standards inspection, testing or maintenance functions, but we are -providing you with notice of these concerns as a courtesy. This does not constitute or represent that we have performed a full analysis of fire protection system(s) in this building and there may be other items of concern that we have not identified because this type of analysis is beyond the scope of what we were hired to do in accordance with NFPA Standards. Customer Name Inspector Name ROBERT HARRIS Inspector Signature Customer Signature Date Date 5/9/2015 Fire Safety First December 16, 2015 Barbara Lakin CRYSTAL COVE CLUBHOUSE c/o Keystone Pacific 16845 Von Karman, Suite 200 Irvine, CA 92606 Re: Title 19, 5-Year, Reports and Repair Quotation Crystal Cove Community Association Dear Barbara: L� Q0,7� r� I would like to thank you for giving Fire Safety First the opportunity to complete the Title 19, 5-Year Certification of the fire sprinkler system(s). The final testing and repairs have now been completed and a certification tag has been affixed to the standpipe. Enclosed is a copy of the Title 19 Certification Report. Please keep this report in a secure place with your building safety documentation for a minimum of 5 Years. You will likely be asked to present the report to the fire department and your insurance company. If you should have any questions please feel free to call me at (714) 836-4800, ext. 139. Sincerely, Brandon Bridgford FIRE SAFETY FIRST C10/C16/C36-599761 JAWPDOCS\Sprinkler Department\Sprinkler\00_Keystone Pacific\Crystal Cove Clubhouse 2\2015\ReefPoint 22828_5YrCertLtr 121615.doe oat 4 7��Oq-� Fire FIRE SPRINKLER & STANDPIPE INSPECTION REPORT Safety ❑ Monthly ❑ Quarterly First ❑ Annual N 5-Year Project Name: Crystal Cove Canyon Club Building #: Clubhouse, Pool, Pay. #1, Pay. #2 Address: 22828 Reef Point Drive City/State/Zip: Newport Coast, CA Riser #: 1-4 ® Automatic Fire ❑ Dry Pipe ❑ Combination Fire ❑ Standpipe Class ❑ Preaction System Sprinkler System Sprinkler System Sprinkler System ❑ Wet ❑ Dry ❑ Deluge System N/A N/t ® ❑ ❑ ❑ 1 Are all FDC connections in satisfactory condition? (No leaks, check valves tight, threads not damaged, caps in Fire place, couplings swivel freely, gaskets in place and undamaged) Department N ❑ ❑ ❑ 2. Is the FDC painted red and correctly identified? Connection ® ❑ ❑ ❑ 3. Is there 36" access and clearance around the FDC &are outlets 18" to 48" above the adjacent grade? N ❑ ❑ ❑ 1. Are all sprinkler system control valves open? N ❑ ❑ ❑ 2. Are all other control valves open? (Main, Sectionals and Standpipe Controls) Control ® ❑ ❑ ❑ 3. Are all control valves in good condition, operate freely, locked open and/or supervised? Valves ® ❑ ❑ ❑ 4. Are all control valves unobstructed, accessible and properly identified? Z ❑ ❑ ❑ 5. Is sight glass in good condition and are "open/shut" indicators properly aligned in sight glass? N ❑ ❑ ❑ 1. Are pipe hangers and earthquake sway bracing adequately secured? Piping N ❑ ❑ ❑ 2. Is piping and fittings in good condition, not corroded, damaged or leaking? N ❑ ❑ ❑ 1. Are all pressure gauges in good condition and showing normal supply pressures? N ❑ ❑ ❑ 2. Is there 36" access and clearance around fire sprinkler riser? Riser N ❑ ❑ ❑ 3. Is the Fire Sprinkler Alarm Bell working properly, free from leaks and correctly identified? N ❑ ❑ ❑ 4. Is the spare head box correctly stocked with extra sprinkler heads and wrenches? Z ❑ ❑ ❑ 5 Is the main drain test satisfactory? N ❑ ❑ ❑ 1. Are all sprinkler heads in good condition? No evidence of leaks, un-obstructed & free of corrosion and paint? Sprinklers N ❑ ❑ ❑ 2. Are all cover -plates, escutcheons and/or skirts in place and in good condition? N ❑ ❑ ❑ 3. Is all stock and storage maintained at least 18" below sprinkler heads? ❑ ❑ N ❑ 1. Are hoses in good condition, lined, within current test date, and gaskets in place? 1 Y ' Fire ❑ ❑ N ❑ 2. Are correct nozzles provided, in good condition and gaskets in place? Hose ❑ ❑ N ❑ 3. Are cabinets and stations in good condition with the hoses properly racked? Stations ❑ ❑ N ❑ 4. Is there 36" access and clearance around fire hose stations? ❑ ❑ Z ❑ 5. Are all fire hose valves, piping, hangers and brackets in good condition and free from leaks? 2 '/2" Outlet ❑ ❑ N ❑ 1. Are all valve outlets in good condition, free of leaks, with caps, gaskets and hand -wheels in place? Valves ❑ ❑ N ❑ 2. Are valves closed, unobstructed, and is piping, hangers and brackets in good condition? ❑ ❑ N ❑ 1. Are all hydrant stems, threads, caps and paint in satisfactory condition? ❑ ❑ Z ❑ 2. Were hydrants flushed & all outlets on each hydrant fully opened & closed to insure smooth operation? Private ❑ ❑ N ❑ 3. Are hydrants painted the proper color per local jurisdiction requirements? Fire ❑ ❑ N ❑ 4. Are all hydrant roadway/shut-off valve covers visible, undamaged & painted red? Hydrants ❑ ❑ N ❑ 5. Are blue dot reflectors visible and in good condition? ❑ ❑ N ❑ 6. Is there 36" access and clearance around all fire hydrants and are outlets 14" to 24" above grade? ❑ ❑ Z ❑ 7. Are all necessary crash posts painted and in good condition? YES I Component in ood condition I NO I Component needs repair or replacement _ : 'N/A I No Com onent.in'Plade '„N/1 I NotIns ected at this time Riser PSI Readings Main Drain Test Results (Annual Only) ❑ Common Area Inspection only ❑ See Deficiency Report dated for all "NO" answers. Riser Supply System Static Residual Restored Club - 155 155 110 155 House NOTES: Pool - 159 159 140 159 Building PV #1 - 158 158 140 158 PV #2 158 158 140 158 Inspection & Testing Performed By: B. Bridgford, K. Saia Inspection Date: 1 12/16/2015 J:\WPDOCS\Sprinkler Department\Sprinkler\00_Keystone Pacific\Crystal Cove Clubhouse 2\2015\ReefPoint_22828_SpkCheckoff 121615.docx Fire Page 1 of 1 Safety ; FIRE PROTECTION INSPECTION First DEFICIENCY REPORT Customer: Crystal Cove Clubhouse Date: December 16, 2015 Location: 22828 Reef Point, Newport Coast Type: 5 Year (4th Quarter) ITEM # EXPLANATION OF DEFICIENCIES * I No deficiencies found at this inspection FIRE SAFETY FIRST • 1170 E. FRUIT ST. • SANTA ANA • CA • 92701 • (714) 836-4800 • (714) 836-4120 FAX J:\WPDOCS\SprinklerDepartment\Sprinkler\00_Keystone Pacific\Crystal Cove Clubhouse 2\2015\ReefPoint 22828_Spk5YrDef 121615.doc Safety Fire Alarm Inspection and Test First 0 CUSTOMER„NAME TEST DATE` TESTING; INTERVAL Keystone Pacific 12/16/2016 ❑ Monthly ❑ Quarterly ❑ Semi -An ® Annual JOBSITE-NAME' „- .. CONTACT NAMES Crystal Cove Community Association — Club House Barbara Lakin ADDRESS_ , - .:.... PHONE'NUMBER,- ' - 22828 Reef Point Dr., Newport Coast, CA 92657 (949) 833-0919 CON,T<ROL'PANEL MODEL LOCATION, OF FIRE ALARM CONTROL.P..ANEL MIS C. INFORMATION' , MANOF. - _ Radionics 7412G Barbara Lakin's Office CIRCUIT .BREAKER, LOCATION . ,PANEL,#,,.- .' 'BREAKER# . •LO.CKED;CIRC,UIT -'DEDICATED:CIRCWT' Banquet Hall Electrical Room SL 15 ❑ Yes ® No ® Yes ❑ No :BATTERY- INSTALL VOLTAGE BATTERY QUANTITY, SIZE & TYPE DATE - 04/2009 With Charger: 13.8 Voltage After Test: N/A ❑ 12.2 4 12V x 7AH ) Without Charger: 12.5 Note #: GENERAL ZONE,TROUBL;E' A/C LOS$, ;GRQU,ND FAULT , :EMERG. GENERATOR TROUBLE T,ROUB t ; _ - .- ,..- „. . -.. , _ 'CONDITIONS Normal: ® Normal: ® Normal: ® Normal: ® Normal: ❑ N/A Note #: Note #: Note #: Note #: Note #: MONITORING;- COMPANY. ,. , .. : - . - " PHONE, _ ` - .-'.." ; _, ACCOUNT-# ,.. ' • PRIMARY',LINE,;' -,, SECONDARY LINE NMC % Fire Safety First (800) 259-0047 L30-1414 1 (949) 376-4937 1 (949) 376-4903 .•• • ®®®®®�®®®■® KONEEThermal Detectors Ion Detectors Duct Detectors Plenum Detectors Elevator Recall Water • Water Flow Swit h Size Supervision Horns/StrobesTamper Aux. Power Supply 0-re/Action System Annunciator Completed By: B. Bridgford, K. Saia I Date: 12/16/2015 Customer # 1538903 Fire Safety First•1170 E. Fruit Street, Santa Ana, CA 92701 • (714)836-4800• Lic #: 599761 J-\WPDOCS\Sprinkler Department\Sprinkler\00 Keystone Pacific\Crystal Cove Clubhouse 2\2015\ReefPoint_22828_SpkAlarmInspection_121615.doc Inspection, Testing, and Maintenance Cover Sheet Page 1 of 1 NFPA 25 as amended by CCR, Title 19 Proaerty Information: Name: Crystal Cove Clubhouse Occupancy/Use: A-3 Address: 22828 Reef Pointe Construction Type 111 City: Newport Beach No. Stories: 1 Zip: Contact: Barbara Lakin Telephone: 949-376-4551 Ext.- 230 Contractor Information: Year Constructed: 2005 Name: Fire Safety First Address: 1170 E. Fruit Street City: Santa Ana State: California ZIP: 92701 Contact: Brandon Bridgford Telephone: (714) 836-4800 ext: CA License: C16-599761 Job #: Performed By: Brandon Bridgford (Print) 4 No. of System Risers Copy sent to: ❑ Owner Date: _ ❑ Fire/AHJ Date: _ ❑ Contractor Date: _ NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2002 Edition as amended by California Code of Regulations, Title 19, §901 to §906. 2) Inspection Items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms Included With This Report NFPA 25 Number of Forms N/A FAIL * PASS Chapter ® Automatic Sprinkler System 5 4 X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form. State Fire Marshal AES 1 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 ( System Riser ID: Pavillion #1 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Type Of System: F Cq ® Wet Pipe°� ❑ Dry Pipe ❑ Preaction ❑ Deluge REM Main Drain Test Results: Abbreviation Key: Initial Static Pressure: 155 (PSI) I = Inspection T =Test Residual Pressure: 110 (PSI) M = Maintenance A-O = After Operation Restored Static Pressure: 155 (PSI) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 I Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually I Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 1 System Riser ID: Pavillion #1 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Type Of System: F cq ® Wet Pipe ,��° C Q ❑ Dry Pipe ❑ Preaction ❑ DelugeFiRE MPS Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 _ Date of Inspection, Testing and Maintenance: 12/16/2015 1 System Riser ID: Pavillion #1 Property Information: Type Of System: �A F Name: Crystal Cove Clubhouse ® Wet Pipe ��o Z/po Address: 22828 Reef Point ❑ Dry Pipe ca m� ❑ Preaction Q ❑ Deluge 9��FiRE MP�Sz City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #1 Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Of CACL�p� FARE State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 1 System Riser ID: Pavillion #2 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Main Drain Test Results: Initial Static Pressure: 155 (PSI) Residual Pressure: 110 (PSI) Restored Static Pressure: 155 (PSI) Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Abbreviation Key: I = Inspection T =Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 - 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2X 5.2.4.3 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #2 Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 I 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.E 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #2 Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25. Chapter 5 as amended by CCR. Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 1 System Riser ID: Pavillion #2 Property Information: Type Of System: F c,� Name: Crystal Cove Clubhouse ® Wet Pipe o 0,�2 Address: 22828 Reef Point ❑ Dry Pipe v ❑ Preaction u� Q ❑ Deluge City: Newport Beach State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Main Drain Test Results: Initial Static Pressure: 155 (PSI) Residual Pressure: 110 (PSI) Restored Static Pressure: 155 (PSI) System Riser ID: Pool Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Abbreviation Key: I = Inspection. T =Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 I Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 I Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and. Maintenance: 12/16/2015 1 System Riser ID: Pool Property Information: Type Of System: Name: Crystal Cove Clubhouse ® Wet Pipe �O� acr�0 Address: 22828 Reef Point ❑ Dry Pipe y i 9 ❑ Preaction uA ❑ Deluge City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 FNFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 1 System Riser ID: Pool Property Information: Type Of System: Name: Crystal Cove Clubhouse ® Wet Pipe F Cq �o lop ❑ Dry Pipe W 7 Address: 22828 Reef Point ❑ Preaction u� ., ❑ Deluge 9�F '��RE MPS City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pool Type Of System: ® Wet Pipe°�o��, ❑ Dry Pipe ❑ Preaction ❑ Deluge 9 va Q 9��'�iRE Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the item number of the Activity listed above: ❑ See Continuation page(s) (Indicate the number of Continuation Pages) ® PASS ❑ FAIL Signature Fnaa4w vlawnd Date 12/16/2015 State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 1 System Riser ID: Clubhouse Property Information: Type Of System: Name: Crystal Cove Clubhouse ® Wet Pipe°f cA�i,�o� Address: 22828 Reef Point ❑ Dry Pipe ❑ Preaction\ ❑ Deluge /RE N1P City: Newport Beach Main Drain Test Results: Initial Static Pressure: 155 (PSI) Residual Pressure: 110 (PSI) Restored Static Pressure: 155 (PSI) Abbreviation Key: I = Inspection T =Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 I Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Clubhouse Type Of System: F ca ® Wet Pipe ,��° �''�c P ❑ Dry Pipe � ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 1 System Riser ID: Clubhouse Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Type Of System: f CA oc ® Wet Pipe ❑ Dry Pipe co ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Clubhouse Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge State Fire Marshal AES 2 March 21, 2006 ..••... I CUSCCi Fire Protection Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 v7 Cosco Wo 1601-1735 Property Information: Name. NEWPORT MEDICAL PARKING Address:1441 AVOCADO- 360 SAN MIGUEL City: NEWPORT BEACH CA Zip: 92660 Contact: ROB GRAVES-- MANNY GILES Phone: 949-279-1257 Contractor Information: Name: COSCO FIRE PROTECTION Address: 1075 W LAMBERT ROAD BLDG D City: BREA State: CA 92821 Phone: 714-989-1800 CA License# C-10/C-16-577621 Job # 1601-1735 Occupancy/Use: Utility-Misc. ogti,� Construction Type: 1-A No. Stories: 1 Year Constructed: 1978--1985�,gE M Monitoring Company: Central Station Phone Number: N/A Time system off-line: 5:00am Time system on-line: 12:00pm Performed by: ROBERT HARRIS (Print) Note: Contractor information may be pre-printed 1441(2) 360 (1) Number of System Risers Copy sent to: Owner Date Fire AHJ Contractor 02/16/2016 NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2002 Edition as amended by California Code of Regulations, Title 19,901 to 906. 2) Inspection Items may be performed by the Owner in accordance with California Code of Regulations Title 19 901.1(a) Forms included with the report NFPA 26 Chapter Number of Forms N/A FAIL* PASS R]Automatic Sprinkler System 5 uarterl ❑ ❑ Standpipe and Hose Systems 6 R ❑ ❑ ❑ Private Water Supply System 7 R ❑ 1 ❑ ❑ Fire Pump 8 0 ❑ ❑ ❑ Water Storage Tank 9 ❑ ❑ ❑ Water Spray System 10 ❑� ❑ ❑ [:1 Foam Water Sprinkler System 11 2 ❑ I ❑ *See "Deficiencies and Comments" section at end of each respective form> cosco *••- Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco WO 1601-1735 Date Inspection, Testing, Maintenance: 02/16/2016 Date Last Five Year Inspection: 05/09/2015 ❑ Unknown Property Information: Name: NEWPORT MEDICAL PARKING Address: 1441 AVOCADO- 360 SAN MIGUEL City: NEWPORT BEACH CA Zip: 92660 System Riser ID:1441(2) 360 (1) =requency: Quarterly type of System: 0 Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Page 1 of 41 AES 2 Main Drain Test Results: Abbreviation Key: Initial Static Pressure: N/A (psi) I = Inspection Residual Pressure: N/A (psi) T = Test M = Maintenance Restored Static Pressure: N/A (psi) A-O = After Operation Recovery Time: N/A (sec) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Fail N/A Pass Reference 1.1 I Daily PREACTION/DELUGE VALVES - 12.4.3.1 ❑ Q ❑ Weekly ENCLOSURE TEMPERATURE 1.2 1 Daily DRY PIPE VALVES - ENCLOSURE 12.4.4.1.1 ❑ ❑ Weekly TEMPERATURE 1.3 1 Quarterly GAUGES ( DRY, PREACTION, DELUGE ❑ � ElSYSTEMS) 5.243 1.4 1 Quarterly CONTROL VALVES 12.3.2.1 ❑ ❑ 1.5 1 Quarterly ALARM - DEVICES 5.2.6 ❑ ❑ ❑� 1.6 1 Quarterly GAUGES (WET PIPE SYSTEMS) 5.2.4.1 ❑ ❑ 1.7 1 Quarterly HYDRAULIC NAMEPLATE 5.2.7 ❑ ❑ 0 1.8 1 Quarterly PIPE AND FITTINGS 5.2.2 ❑ ❑ EZ 1.9 1 Quarterly SPRINKLERS 5.2.1 ❑ ❑ 0 1.10 1 Quarterly SPARE SPRINKLERS 5.2.1.3 ❑ ❑ R 1.11 1 Quarterly FIRE DEPARTMENT CONNECTIONS 12.7.1 ❑ ❑ R 1.12 1 Quarterly ALARM VALVES - EXTERIOR INSPECTION 12.4.1.1 ❑ ❑ R 1.13 1 Quarterly PREACTION/DELUGE VALVES - EXTERIOR 12.4.3.1.6 ❑ W ❑ INSPECTION 1.14 1 Quarterly PRESSURE REDUCING VALVES 12.5.1.1 ❑ 0 ❑ 1.15 1 Quarterly DRY PIPE VALVES - EXTERIOR 12.4.4.1.4 ❑ ❑Q ❑ INSPECTION 1.16 I Quarterly BACKFLOW PREVENTERS 12.6.1 ❑ ❑ 0 1.17 I Annually BUILDINGS 5.2.5 ❑ 0 ❑ .. rr••s.. � �/0 �.7�Li «• Fire Protection. Inspection, Testing, Maintenance Fire Sprinkler Systems NFPA 25, Chapter 5 as amended by CCR, Title 19 WO 1601-1735 of Inspection, Testing, Maintenance: 2/16/2016 Name: Information: NEWPORT MEDICAL PARKING Address: 1441 AVOCADO- 360 SAN MIGUEL City: NEWPORT BEACH CA 92660 System Riser ID:1441(2) 360 (1) -requency: Quarterly Type of System: 0 Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Page 2 of 4 AES 2 Item Activity Frequency Description NFPA25 Reference Fail NIA Pass 1.18 1 Annually HANGERS 5.2.3 ❑ ❑ 0 1.19 1 Annually SEISMIC BRACES 5.2.3 ❑ ❑ 21 1.20 1 5 year HANGERS (Accessible Concealed Spaces) 5.2.3.3 ❑ 0 ❑ 1.21 1 5 year SEISMIC BRACES (Accessible Concealed Spaces) 5.2.3.3 ❑ 0 ❑ 1.22 1 5 year y PIPE AND FITTINGS (Accessible Concealed Spaces) 5.2.2.3 ❑ .r El 1.23 1 5 year SPRINKLERS (Accessible Concealed Spaces) 5.2.1.1.4 ❑ 0 ❑ 1.24 1 5 year ALARM VALVES - INTERIOR INSPECTION 12.4.1.2 ❑ W ❑ 1.25 1 5 year ALARM VALVES - STRAINERS, FILTERS, ORIFICES 12.4.1.2 ❑ 0 ❑ 1.26 1 5 year CHECK VALVES - INTERIOR INSPECTION 12.4.2.1 ❑ ❑ 1.27 1 5 year PREACTION/DELUGE VALVES - INTERIOR INSPECTION 12.4.3.1.7 ❑ ❑ ❑ 1.28 1 5 year PREACTION/DELUGE VALVES - STRAINERS, FILTERS, ORIFICES 12.4.3.1.8 ❑ 0 ❑ 1.29 1 5 year DRY PIPE VALVES - INTERIOR INSPECTION 12.4.4.1.5 ❑ 0 ❑ 1.30 1 5 year DRY PIPE VALVES - STRAINERS, FILTERS, ORIFICES 12.4.4.1.6 ❑ 0 ❑ 2.1 T Annually ALARM DEVICES (90 SEC) 5.3.3-12.2.7 ❑ ❑ 0 2.2 T Annually MAIN DRAIN TEST (ENTER DATA ON PAGE 1) 12.2.6 12.2.6.1 12.3.3.4 ❑ 0 ❑ 2.3 T Annually ANTIFREEZE TEST 5.3.4 ❑ 0 ❑ 2.4 T Annually CONTROL VALVE - POSITION 12.3.3.1 ❑ ❑ 0 2.5 T Annually CONTROL VALVE - OPERATION 12.3.3.1 ❑ ❑ 0 2.6 T Annually SUPERVISORY 12.3.3.5 ❑ ❑ 0 2.7 T Annually PREACTION VALVE - PRIMING WATER 12.4.3.2.1 ❑ [21 ❑ 2.8 T Annually PREACTION VALVE - LOW AIR PRESSURE ALARM 12.4.3.2.10 El 0 ❑ 2.9 T Annually PREACTION - FULL FLOW TRIP TEST 12.4.3.2.2 ❑ 21 ❑ cosco = «« Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems NFPA 25, Chapter 5 as amended by CCR, Title 19 WO 1601-1735 Date Inspection, Testing, Maintenance: 2/16/2016 Property Information: Name: NEWPORT MEDICAL PARKING Address: 1441 AVOCADO- 360 SAN MIGUEL City: NEWPORT BEACH CA 92660 System Riser ID: 1441(2) 360 (1) =requency: Quarterly Type of System: 0 Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Page 3 of AES 2 Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually DRY PIPE VALVE - PRIMING WATER 12.4.4.2.1 ❑ ❑J ❑ 2.11 T Annually DRY PIPE VALVE - LOW AIR PREASSURE 12-.4.4.2.6 ❑ 2 ❑ 2.12 T Annually DRY PIPE VALVE - QUICK -OPENING DEVICE 12.4.4.2.4 ❑ ❑ 2.13 T Annually DRY PIPE VALVE - TRIP TEST 12.4.4.2.2 ❑ 0 ❑ 2.14 T Annually BACKFLOW PREVENTER ASSEMBLIES 12.6.2 ❑ ❑ 2.15 T 3 year DRY PIPE VALVE - FULL FLOW TRIP TEST 12.4.4.2.2.2 ❑ 2 ❑ 2.16 T 5 year GAUGES 5.3.2 ❑ ❑ 2.17 T 5 year PRESSURE REDUCING VALVES 12.5.1.2 ❑ ❑ 2.18 T 5 year y FIRE DEPARTMENT CONNECTION BACKFLUSH 1274 ❑ ❑ 2.19 T 5 year SPRINKLERS - EXTRA HIGH TEMPERATURE 5.3.1.1.1.3 ❑ ❑ Ely 2.20 T 5 year SPRINKLERS - CORROSIVE ENVIRONMENT OR CORROSIVE WATER 5.3.1.1.2 ❑ 2 ❑ 2.21 T 10 year SPRINKLER - DRY 5.3.1.1.1.5 ❑ f,_/1 ❑ 2.22 T 20 year SPRINKLERS - FAST RESPONSE 5.3.1.1.1.2 ❑ ❑J ❑ 2.23 T 50 year SPRINKLERS 5.3.1.1.1 ❑ ❑J ❑ 2.24 T 75 year SPRINKLERS 75 YEARS IN SERVICE 5.3.1.1.1.4 ❑ 0 ❑ 2.25 T SPRINKLERS MANUFACTURED PRIOR TO 1920 - REPLACE 5.3.1.1.1.1 ❑ 123 ❑ 3.1 M Annually CONTROL VALVES 12.3.4 ❑ ❑ ❑J 3.2 M Annually PREACTION/DELUGE VALVES 12.4.3.3.2 ❑ 2 ❑ 3.3 M Annually DRY PIPE VALVES/QUICK-OPENING DEVICES 12.4.4.3.2 ❑ ❑ ❑ 3.4 M Annually DRY PIPE VALVE - LOW POINT DRAINS 12.4.4.3.3 ❑ 2 ❑ 3.5 M 5 year OBSTRUCTION INVESTIGATION Chapter 13 ❑ 9 11 ...ww•.. CtJSi❑C�► • • �• • • • Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems Page 4 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco WO 1601-1735 AES 2 Date Inspection, Testing, Maintenance: 2/16/2016 Property Information: Name: NEWPORT MEDICAL PARKING Address: 1441 AVOCADO- 360 SAN MIGUEL City: NEWPORT BEACH CA Zip: 92660 System Riser ID:1441(2) 360 (1) Frequency: Quarterly a�� CA��o Type of System: 21 Wet Pipe ❑ Dry Pipe Mpg ❑ Preaction ❑ Deluge Item Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above: Comments: EXERCISED ALL CONTROL VALVES TO ACTIVATE TAMPER —SWITCH. AND TRIPPED WATER —FLOW DEVICE'S ON ALL FIRE SPRINKLER SYSTEMS. LUBED VALVES, ALL SIGNALS CAME INTO F.A.C.P. SYSTEMS BACK IN SERVICE AND BACK ON LINE. ALL 3 PARKING SYSTEMS HAVE ALARM CHECK VALVES. Q PASS ❑ FAIL ❑ See continuation Page(s) 0 (Indicate the number of continuation pages) LIABILITY RELEASE STATEMENT: The Owner and/or its designated representative acknowledge that the Owner has full responsibility for the operating condition of the fire protection system(s) including its component parts at the time of this inspection. This inspection/test report is governed by terms and conditions of Cosco Fire Protection Inspection signed agreement. Without in any way limiting such terms and conditions, the Owner acknowledges that the Contractor does not have any obligation to correct any deficiencies Contractor has identified in report and Owner shall have full responsibility for corrections of any such deficiencies. As an additional service, however, the Owner and/or its designated representative may enter into a separate, written repair or maintenance contract with Contractor for the correction of such deficiencies. During our work in your building, our representatives may have noticed items on your fire protection system that may need further investigation. These items are not part of the normal NFPA Standards inspection, testing or maintenance functions, but we are providing you with notice of these concerns as a courtesy. This does not constitute or represent that we have performed a full analysis of fire protection system(s) in this building and there may be other items of concern that we have not identified because this type of analysis is beyond the scope of what we were hired to do in accordance with NFPA Standards. Customer Name Inspector Name ROBERT HARRIS Customer Signature Not Available ❑ Inspector Signature Date Date 2/16/2016 ........ cosco I Fire Protection •iy�*�i Inspection, Testing, Maintenance Fire Sprinkler Systems AES 9 NFPA 25, Chapter 5 as amended by CCR, Title 19 Continuation Form for Deficiencies and Comments Cosco WO 1601-1735 Page Date Inspection, Testing, Maintenance: 2/16/2016 Property Information: Name: NEWPORT MEDICAL PARKING Address: 1441 AVOCADO- 360 SAN MIGUEL City: NEWPORT BEACH CA Zip: 92660 Frequency: Quarterly Type of System: a�oF cqo Sprinkler (Chapter 5) y m� Standpipe (Chapter 6) q Syst. Riser ID: 1441(2) 360 (1) X Private Fire Main (Chapter 7) Mp Fire Pump (Chapter 8) Fire Pump No. or ID: Water Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: 1441(2) 360 (1) Foam -Water System (Chapter 11) System Riser ID: 1441(2) 360 (1) Item IDeficiencies and Comments Item number must correspond to the Item number of the Activity listed above: LIABILITY RELEASE STATEMENT: The Owner and/or its designated representative acknowledge that the Owner has full responsibility for the operating condition of the fire protection system(s) including its component parts at the time of this inspection. This inspection/test report is governed -by terms and conditions of Cosco Fire Protection Inspection signed agreement. Without in any way limiting such terms and conditions, the Owner acknowledges that the Contractor does not have any obligation to correct any deficiencies Contractor has identified in report and Owner shall have full responsibility for corrections of any such deficiencies. As an additional service, however, the Owner and/or its designated representative may enter into a separate, written repair or maintenance contract with Contractor for the correction of such deficiencies. During our work in your building, our representatives may have noticed items on your fire protection system that may need further investigation. These items are not part of the normal NFPA Standards inspection, testing or maintenance functions, but we are providing you with notice of these concerns as a courtesy. This does not constitute or represent that we have performed a full analysis of fire protection system(s) in this building and there may be other items of concern that we have not identified because this type of analysis is beyond the scope of what we were hired to do in accordance with NFPA Standards. Customer Name Inspector Name ROBERT HARRIS Customer Signature Inspector Signature Date Date 2/16/2016 i r•:::::• � CC7SC0 -••• Tire Protection Commenfs and, Recommendations _ co5cowo1s01=1735.+. Although these comments are not the results of any engineering review, the following improvements are recommended. Tech Note: System Descriptions: LIABILITY RELEASE STATEMENT: The Owner and/or its designated representative acknowledge that the Owner has full responsibility for the operating condition of the fire protection system(s) including its component parts at the time of this inspection. This inspection/test report is governed by terms and conditions of Cosco Fire Protection Inspection signed agreement. Without in any way limiting such terms and conditions, the Owner acknowledges that the Contractor does not have any obligation to correct any deficiencies Contractor has identified in report and Owner shall have full responsibility for corrections of any such deficiencies. As an additional service, however, the Owner and/or its designated representative may enter into a separate, written repair or maintenance contract with Contractor for the correction of such deficiencies. During our work in your building, our representatives may have noticed items on your fire protection system that may need further investigation. These items are not part of the normal NFPA Standards inspection, testing or maintenance functions, but we are providing you with notice of these concerns as a courtesy. This does not constitute or represent that we have performed a full analysis of fire protection system(s) in this building and there may be other items of concern that we have not identified because this type of analysis is beyond the scope of what we were hired to do in accordance with NFPA Standards. Customer Name Inspector Name ROBERT HARRIS Customer Signature Inspector Signature ;f V? 44 Date Date 2/16/2016 h 'J. rife 5A1P"1L- Name: Lido HOa Occupancy/Use:_` Address: 601 Lido Park ©r. Construction Type: rypelVTA city. Newport Beach, CA. No. Stories: 3 ZIP: 92663 Year Constructed: Contact: (VOE Mr'` Telephone: (949) 675-6101 Name: The Alarm And Sprinkler Co Inc Copy sent to: Address: P.O. BOX 10034 M Owner Date: 02/10/16 City: Santa Ana ❑ Fire AHJ -Date: State: CA, 92711 ❑ Contractor :Date. Telephone: (866) 496-4456 NOTES: 1) For specific inspection, testing, and maintenance 978587. CA License#: - requirementsaandzinformation;hsee NFPA325, 2041 4a's; Edition'as ar�gnded=tiy�Cahfomia,Cotle of Reg'ulatioris, Title 19; §9ii1 to §906. Job#: 461.810F• ., ._:.> A `2) irixpe� nitems may tie perforrned by thenowner in Performed by: Yvo (949)-675-6101 accordance with California Code of Re ulations; Title 19, , , ,9 §904.1(a)....- _..., Forrns Included with this Report (� Automatic Sprinkler System Chapter 5 Withbek of Forms 1 ea 5yr NIA ❑ Fail* Pass ❑ Standpipe and Hose System 6 0 U Private Water Supply System 7 O�w . .. ❑ Fire Pump 8 0 ❑ Water Storage Tank 9 0 ❑ ❑ Water Spray System 10 0 ❑ Foam Water Sprinkler System 11 0 ❑ Water Mist System 12 0. " „ ❑- �• ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) i S, , . ,,. ❑ Yes ❑ No AES 1 September 3, 2013 INSPECT110N, TESTING AND MAINTENANCE IncludesQuarterly and Annual Inspections, Tests, and I = Inspection T = Test M = Maintenance IIIE Maintenance items P = Pass F = Fail A =Not (ppllcabte 1.1 I Control Valves — Identification Sign 13.3.1 02/10/16 P 1.2 1 Control Valves — Inspection 13.3.2 02/10/16 P 1.3 1 Waterflow Alarm Devices 5.2.5 02/10/16 P 1.4 I Supervisory Devices 5.2.5 02/10/16 NA 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 02/10/16 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 02/10/16 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 02/10/16 60 psi P 1.8 ! Enter +lklater 9:.:rply Pre: s-a ,,.—o Abcve Mszar Chock Z.2.4.1 02//0116 •60 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 02/10/16 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 02/10/16 NA 1.11 1 Heat Tape 5.2.7 02/10/16 NA 1.12 1 Spare Sprinklers 5.2.1.4 02/10/16 P 1.13 1 Fire Department Connections 13.7 02/10/16 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 02/10/16 P I Pressure Reducing Valves 13.5.1.1 02/10/1.6 NA E1.15 1.16 1 Backflow Preventers 13.6.1 02/10/16 NA Form AES 2.2 Sept. 3, 2013 INSPECTION,ANNUAL i MAINTENANCE Include ALL Quarterly 1 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 02/10/16 7N/A13.5.5.1 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 02/10/16 1.19 1 Buildings (Freeze Protection) 4.1.1.1 02/10/16 Owner's Responsibility N/A. 1.20 1 Sprinklers 5.2.1 02/10/16 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 02/10/16 P 1.22 1 Pipe and Fittings 5.2.2 02/10/16 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 02/10/16 P 1.24 1 Hangers 5.2.3 02/10/16 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 02/10/16 P 1.26 1 Seismic Braces 5.2.3 02/10/16 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 02/10/16 P 1.28 1 Unsprinklered Areas CFC 901.4 02/10/16 ©Yes ®No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 02/10/16 If REQUIRED, Enter'F' until results are returned from -Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) 02/10/16 N/A 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 02/10/16 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this fonn) 13.2.5 13.3.3.4 02/10/16 P 2.5 T Control Valve - Position 13.3.3.2 02/10/16 P 2.6 T Control Valve — Operation 13.3.3.1 02/10/16 P 2.7 T Supervisory Devices 13.3.3.5 02/10/16 N/A 2.8 T Backflow Preventer Assemblies 13.6.2 02/10/16 P 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 02/10/16 N/A 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 02/10/16 N/A 2.11 T Pressure Gauges - Calibration 5.3.2 02/10/16 P 2.12 T Small Hose Connections* 13.5.6.2. 002/10/16 P * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 D = Deficiencv C = Comment ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: [] See Correction Form AIRS 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this torn. Print Name Airthjony Taylpr• Signature Date 02/10/16 S 2.2 5� ~'r s Sept. 3, 2013 A Form E f 416" 66 BICKEL GROUP ARCHITECTURE May 2, 2016 Mr. Fritz Howser FHC 6306 W. Coast Hwy - Newport Beach, Ca 92660 Re: 6306 W. Coast Hwy — Office Building Fire Sprinkler Requirements Project No.: 16410 Dear Fritz: I have reviewed the conditions of the building at the above referenced location. The following are my findings and conclusions regarding the need for a smoke/fire detection -and alarm system. Building size: 860sf Building type: V-B Occupancy type: B (per CBC 304) Basic Allowable area: 9,000sf (per CBC Table 503) Per California Building Code, 2013 edition, chapter 907.2.2, manual fire alarm systems shall be installed in Group B occupancies where one of the following conditions exists: 1. The combined Group B occupant load of all floors is 500 or more. 2. The Group B occupant load is more than 100 persons above or below the lowest level of exit discharge. 3. The Group B fire area contains a Group B ambulatory health care, facility. 4. Group B occupancies containing educational facilities. The address above does not have any of these conditions, therefore a manual fire alarm system is not required. In addition, per 901.6.2, fire alarm systems are only required to be monitored by an approved supervising station when fire alarm systems are required by 907.2. Again, per above, this is not a requirement this case. Let me know if you have any further questions or comments. 9 James S. Bickel, Jr. — AIA, LEED AP President C-20925 3600 BIRCH STREET. SUITE 120 NEWPORT BENCH. CA 92660 1949.757.0411(P) 1949.757,0 511 (F) WWW:BiCKELGRP.COM MUSIC lill, Iij III 'I I .1 . •C� ,•I+:. REV- ,',,:', tr T; `r'. �..�, :,� :`., �; ,� ... R15er"`Ata�Y�itii�.rairr'. fiamBtsr: - e.'t Diarfst�r•: 'Initia:Static: •' Pressu're',?_ Residua(;'- •'Rressiire, Finliaiieft Building,..•'�i 6 55 40 50 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: M- I InspectiT=Test M=Maintenance P=Pass F=Faft N/A=NotAPPNcable v IteM m' - •.•�� ..:: - v +dJ - �be$�Ari/��•tion •::�; C p :S"•... `[�EFP,4 26 CA' :ed..- � 'i{: :' - •a y �°�_ 'Date.-.;. rl+�h. — ;t Y .r`j; � ,.ern• .�, yS• � yi,. � �y. n 'Nfd' .x .,. fin•.. 1.1 1 Control Valves — Identification Sign y 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5 2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 55 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 50 psi P 1.9 1 Pressure Readings Acceptable 5.2,4,1 P 1.1 0 I General Information Sign not re uired for s stem rlor to 2007 Edition NFPA 13) 5,2,8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1,4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13A.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2,2 Sept. 3, 2013 Inspection T =Test M=Maintenance P=Pass F=Fall N/A=NotApplfcabie "'..7'f1''ed. te^°+:!l3La:"., slrtm +• c, _.. s: 'Descri tto s= r -fi_ t:Dt ;<;r'-°•,.:om`m.enfs.Qw.,F:; ,Nt, _ ::��". }' '{: .� - 'z [� :`�i� rcr.,-."C�Blel•GI7�$: ,;;• �:'.'.i�'�};. j:•: •r:•i. .':a; 'r'- �c�:?,..w. Sr 1.17 I 18mall Hose Connections - Hose Valve* 5.1.6,r13.5,2 N/A 1.18 1 PRV — Fire Sprinkler Systems 1.19 I Buildings (Freeze Protection) 1,20 1 Sprinklers ' 1.21 1 Sprinklers -Accessible Concealed Space 1.22 1 Pipe and Fittings 1.23 1 Pipe and Fittings - Accessible Concealed Space 1.24 I lHangers 1.25 1 Hangers - Accessible Concealed Space 1.26 1 Seismic Braces 1.27 1 Seismic Braces - Accessible Concealed Space 1.28 I Unsprinklered Areas 2.1 T Field Service Test Required Send Report to Fire Code Official 2.2 T Recalled Sprinklers If not present = Pass; if present = Fall 2.3 T Water Flow Alarm Devices 90 secs max, Enter time 2.4 T Main Drain Test (Enter data on Page 1 of this form) 2.5 T Control Valve - Position 2.6 T Control Valve — Operation 2.7 T Supervisory Devices 2.8 T Backflow Preventer Assemblies 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 2.10 T PRV — Fire Sprinkler Systems 2.11 T Pressure Gauges - Calibration 2.12 T Small Hose Connections* * Small hose connections are hose valves and optional hose 13.5.1.1 r'F' until N/A 4.1.1.1 Owner's Responsibility N/A 5.2.1 P 5.2.1.1.6 P 5.2.2 P 5.2.2.3 P 5.2.3 P 5.2.3.3 P 5.2.3 P 5.2.3.3 P CFC 901.4 Yes No If REQUIREb E t 5.3.1 n e results are returned from Lab Title 19 P 904.1(c) 5.3.3 13.2.6 60 sec. P 13.2.5 P 13.3.3.4 13.3.3.2 P 13.3.3.1 P 13.3.3.5 P 13.6.2 To be Completed by Others NA 13.5.2.3 NA 13.5.3.3 13.5.1.3 NA 5.3.2 P 13.5.6.2.2 NA i by the fire sprinkler system. They do not include Class 1, II, or III Form AES 2.2 Sept. 3, 2013 fiff, W-M I =Inspection T =Test MMaintenance P Pass F Felf AVA Not Applicable 1 g 4 -417 PAIZ� "Mm'o m 1. - - - -e We'r n JR . 3.1 MI lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3ush P 3.3 M FDC - Backfi 14.3.2.4 Internal Pipe Inspection - See Deficiencies and 14.2 Yes RNo 3.4 M Comments Section for Results. Obstruction Investigation Required. if "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results - . - -- 4.5.3 2 Yes 3.6 t M ISystem Returned to Service UNo _P D = Deficiency C = Comment (Indicate type) repla&ed - El Check here if additional Deflclendes and Comments are listed on Form AES 9 Number attached: D see Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully Inspected, tested, and maintained on this date by the company indicated above, In accordance with CCR, Title 19, Sections 901 to 906 and that the equipment Is fully operable except as noted in the "Deficiencies and Comments" section -of this form, Print Name Sergio Arreola_.,,,,=,, Signature Date 12109/15 -1 Form AES 2.2 Sept. 3,2013 t' POO ` %id: yr P .i :i ;t =:, ;D7'ameter .T i i :I itial5at' fisisiiia!•? Finl':Sta R `ssiare' Pressure t1 i ! 3' , : Pres5U .. ; -.6 t: t' ::a`fifi is `:r,: , =d:'.- yy.': ; L ga ton•,: ; . ;. )J- .Y+ JY i : 0N]. 'ti_... �`�'� ?`S;',-Y:G e1 •.fLi- Building 7 65 45 50 P C1 This building has more than 5 risers, See additional AES 2.9 form attached Number of AES 2.9 forms attached: rye,,:• �`s''ri-, �,.t ,.`y5gy.' ",'�+j , . 4h e •� "� r P`5.`�,s W SON�hl. $ M". I= Inspection T Test M= Maintenance P=Pass F=Fall NIA =Not Appllcable ::5.C,};s�'7 '� .s.+ • !a ._- .§: �.z�1 IRK<PA 2 F'��'`-:ti•i.3Nj.:I�- .5. C f�. 'ai`'. [ :F+e �. +f�,od•�..u-<'-..i 'ty,.i4:•;" .� }•;a;•'Fr - `,i•=.;;r.f� v...•.µi1j+4�;y'S C''Qr �' �.i.; .-"I" E: .._t_Jpr.i�._gt .i'r=�`F"S'%,:t-Si_'', .,.�,;- r�S.i." pi. ,k.-'.0.E'iy, '.��,•, .;,��}yy•'��R�,�,.?(•.ti..�_ri,S Fi.�t��,�;.:�:t�,' -:�,;*, "i,t•�yir•_ ^y-. �9�;:• 't.��"•;.Y:.�`:f.�.. ;.'Xse'_::p'.•: •'�.: ,.'. g 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 lControl Valves — Inspection 13.3.2 P 1.3 i Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign 5.2 6 P (For hydraullcally designed systems) 1.7 1 Enter Water Supply Pressure Below Riser Check 5,2.4.1 65 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4,1 50 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign 5.2.8 NA not re aired for system prior to 2007 Edition NFPA 13) 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1,14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.16 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow, Preventers 13.6.1 NA Form AES 2.2 Sept. 3,-2013 "Inspect�lon T —Test M=Maintenance P=Pass F=Fail N/A=NotAppiicable`rid ti: 5. Ci l.. .'i1 %E:.S � ��pL�'' i �t:i '-.t J i.•9sy 1.17 1 Small Hose Connections -Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV - Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 I Pipe and Fittings 5.2.2 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5,2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 OYes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 6.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; 1f present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.E 60 sec. P 2.4 T Main Drain Test (Enter data on Page 4 of this form) 13.2.5 13.3.3.4 P 2.6 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve - Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves - Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV - Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2,2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 I =Inspection T Test M=Maintenancce P-Pass F=Fall N/A=Not Applicable crl tiori' i, �� t. '`�S''t48_ZI�` IVFP!•��'1rence •�1:. ;.:�':4?• 'bate: ��g:xi =y `Cornifiehfs,}��,1}Ilya- > .:}F=•/Ci,i�; '`I,it 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backfiush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14.2 Yes RNo 3.4 M Comments Section for Results. 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 P Deflolencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 M Nos P A = Def lency C = Comment Indicate type) •- { � ' Hl.a! � 3,i�}� and.Coiriirtenfs ;:•c.; fiy?� k d"ry ; rls:'. •.;N 'a::'r v' : � aY..', t �� :�,x ;�+; :': .. t. c 1, "4 J:ti3 .'!.?iulplilelt,.i$l�vlgS'`81ida �KaeFea/p_- Fhk hereKadditional Deficiencies end Comments are fisted on Form AES 9 Number attached: Correction Form AES 10 for corrected deficiencies. Number attached: ! hereby certify that the fire protection equipment listed above has been fully Inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 909 to 906 and that the equipment is fully operable except as noted In the "Deficiencies and Comments" section of this form. I Print Name I Sergio Arreola _ I Signature I r� ` Date 12/09/15 1 Form AES 2.2 Sept. 3, 2013 ap +Yf }�'. ',_�: �,��;. , e'e aY.x,,"�� C �•� :; � A v � ,g, 4 s. (,oc�ti•..:,. :'•a, �`• J �`� � ° FDi eD. . - '�' ::� •Y't'�". �r G am e`� ..: iil_t + �:,c„y r❑ ?" Fdssuief` : , i es VON •:,'P:i`es �e'',a •.y�P. � 1. «'`?; .;•n" � .N�[� . } . •5..'V' Building 8 60 50 60 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I= Inspection T Test M— Maintenance P=Pass F=Fall NIA =Not ApplIcabte • •.(`te ,'�i: [TI. "� a,:'- �::,.� � _.rn- .. r�, o •ri' •,%" [ e+ r:: i<;,;;.. :'s'":_v�� ° ,sue:»�°; ;,�.r.;�. :De"scrl Pion: »,t''#v.mt• -_�� p. h _r,.,•.�'•r.'� ':a.., •3 '� � . s. ;; • - - r` � - 4^ yr tiy;, '"NF.�TA° 25 0:�•;-. ed..d , tteferen�e . ��H"yyyy° 'cn7i -y ' :;�' e. a Fbr%4S,rs;S .•�:� ' ,�, �'., ..� �,:::•, -r . C mtxt • is Qa - '' �„�'+ty+?: Y� . a, r. ;; f>,��:•• " G �' a •.,� .t�:� 1.1 [ Control Valves — Identification Sign 13.3.1 P 1.2 [ Control Valves — Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1,4 1 Supervisory Devices 5.2.5 P 1,5 1 Gauges (Wet Pipe Systems) 5,2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water -Supply Pressure Below Riser Check 6.2.4.1 60 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5,2.4.1 60 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign not required for system ptior to 2007 Edition NFPA 13 5.2,8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13,7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13,6.1 NA Form AES 2.2 Sept. 3, 2013 g' Mimi I =Inspection T =Test M Maintenance P=Pass F=Fall NIA=NWAPP1108ble 'A - , "A X OW:M6Wk � aiRnW 1.17 1 Small Hose Connections - Hose Valve* NIA 1.18 1 PRV — Fire Sprinkler Systems N/A 1.19 1 IBuildings (Freeze Protection) Owner's Responsibility NIA 1.20 1 Sprinklers 5.2.1 1 P 1.21 1 Sprinklers - Accessible Concealed Space 6.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5,2,2.3 P 1.24 1 Hangers 5.2.3 P 1,25 [ Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 ISeismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 jUnsprinklered Areas CFC 901.4 E]Yes No 2.1 --- T Field Service Test Required Send Report to Fire Code Off1cfal 5.3.1 If REQUIRED,, Enter'F'unffl results are returned from Lab 22 T Recalled Sprinklers If not present=; Pass; 1f present = Fa11 Title 19 904.1 (c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13,2.6 60 see. P 2.4 T Main Drain Test (Enter data on Page I of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2,9 T Small Hose Connections* w1PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T --jPRV — Fire Sprinkler Systems 13.5.1,3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 1 T I Small Hose Connections* 1 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system, They do not include Class i, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 U V, Et' -MFmal", I Inspection T =Test MTMaintenance P=Pass FmFall N/A=NotAppllcable item.. c r:: d:�:"Fr : �'''�t t. FPA ;26 �.r • �'.�i 't J �'.9'i.''s .'i::•.': i!. ':yi . `,t•r, Cbmmerits OnT. -i :� :•c:.: ;4' •.:,.. _ rr..'•,:Izefe ri�e._::s== �,� :.�.s ,i . 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14 RNo Yes 3.4 M Comments Section for Results. 3,5 M Obstruction Investigation Required. If "Yes", see 14.3 P Deficiencies and Comments Section for Results s 3.6 M System Returned to Service 4.5.3 9No P — D - Def lency C - Comment Indicate typo) Item _. •:. �,,;�. o- � ..`, ��:• 1;1} C kt.+42• y;•,: ..ay ai,. t 1. i}e. `�-'1.'�',.{*•};J c.: Y�; �y7 ti-@it';.ii �:��..= � .�: Hw �el"lC1�i1G183 a?f?Ci:�'..011illi.�'�.�'.. �.�_ ,•. �: r �r:,_'•..-.: : t;. y:. , sd- fedlat' •et!'e, illprne f°•dovice aicf �rt fh i#ac Y aYe/ ofi:k:s..` a;.;: '.}'= 1 12/09/15 C FDC: Red paint is faded. FDC should be repainted 2 12/09/15 C Replaced CAPS 3 12/09/15 C Lube Inlet gasket and rubber [� Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. I Print Name I Sergio Arreola I Signature I s -- Date 12/09/15 i Form AES 2.2 Sept. 3, 2013 { C®SCC3 5 � = Fire Protection Inspection, Testing, and Maintenance Cover Shee-00�_ NFPA 25 as amended by CCR, Title 19 v7 Cosco Wo 1505-0293 Property Information: Name: NEWPORT MEDICAL PARKING Occupancy/Use: Utility-Misc. Q��01F Oatico� Address: 360 SAN MIGUEL Construction Type: 1A c No. Stories: 1 9 City: NEWPORT BEACH CA Year Constructed: 1985 �` F/RE MP Zip: 92660 Contact: ROB GRAVES Monitoring Company: ENG POSTED Phone Number: N/A Phone: 949-279-1257 Time system off-line: 5:00am Time system on-line: 2:00pm Contractor Information: 1 WET SYST Number of System Risers Name: COSCO FIRE PROTECTION Copy sent to: Address: 1075 W LAMBERT ROAD BLDG D Owner Date Fire AHJ City: BREA Contractor 05/09/2015 State: CA NOTES: 1) For specific inspection, testing, and maintenance Phone: 714-989-1800 requirements and information, see NFPA 26, 2002 Edition as amended by California. Code of Regulations, Title 19, 901 to 906. CA License# C-10/C-16-577621 2) Inspection Items may be performed by the.Owner in accordance with California Code of Regulations Job # 1505-0293 Title 19 901.1(a) Performed by: ROBERT HARRIS (Print) Note: Contractor information may be pre-printed Forms included with the report NFPA Chapte5 Number of Forms N/A FAIL* PASS 91Automatic Sprinkler System 5 5 Year ❑ ❑ Standpipe and Hose Systems 6 ❑ ❑ ❑ Private Water Supply System 7 P11 ❑ ❑ ❑ Fire Pump 8 n ❑ ❑ ❑ Water Storage Tank 9 R ❑ ❑ ❑ Water Spray System 10 n ❑ ❑ ❑ Foam Water Sprinkler System 11 R I ❑ ❑ *See "Deficiencies and Comments" section at end of each respective form> cost .,1 Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems Page 1 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco WO 1505-0293 AES 2 Date Inspection, Testing, Maintenance: 05/09/2015 Date Last Five Year Inspection: 02/01/2010 ❑ Unknown System Riser ID:1 WET SYST Frequency:5 Year Property Information: Type of system: of CAt��O Name: NEWPORT MEDICAL PARKING 0 Wet Pipe yQ 9Z Address: 360 SAN MIGUEL ❑ Dry Pipe City: NEWPORT BEACH CA ❑ Preaction Zip: 92660 ❑ Deluge Main Drain Test Results: Abbreviation Key: Initial Static Pressure: 60 PUMP OFF (psi) I = Inspection Residual Pressure: 50 PUMP OFF (psi) T = Test M = Maintenance Restored Static Pressure: 60 PUMP OFF (psi) A-0 = After Operation Recovery Time: 1 (sec) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Fail N/A Pass Reference 1.1 1 Daily PREACTION/DELUGE VALVES - 12.4.3.1 ❑ 0 ❑ Weekly ENCLOSURE TEMPERATURE 1.2 1 Daily DRY PIPE VALVES - ENCLOSURE 12.4.4.1.1 ❑ ❑./ ❑ Weekly TEMPERATURE 1.3 1 Quarterly GAUGES ( DRY, PREACTION, DELUGE ❑ ❑ SYSTEMS) 5.2.4.3 1.4 1 Quarterly CONTROL VALVES 12.3.2.1 ❑ ❑ ❑J 1.5 1 Quarterly ALARM - DEVICES 5.2.6 ❑ ❑ 1.6 1 Quarterly GAUGES (WET PIPE SYSTEMS) 5.2.4.1 ❑ ❑ Q 1.7 1 Quarterly HYDRAULIC NAMEPLATE 5.2.E ❑ ❑ 0 1.8 1 Quarterly PIPE AND FITTINGS 5.2.2 ❑ ❑ R 1.9 1 Quarterly SPRINKLERS 5.2.1 ❑ ❑ Q 1.10 1 Quarterly SPARE SPRINKLERS 5.2.1.3 ❑ ❑ Q 1.11 1 Quarterly FIRE DEPARTMENT CONNECTIONS 12.7.1 ❑ ❑ 1.12 1 Quarterly ALARM VALVES - EXTERIOR INSPECTION 12.4.1.1 ❑ ❑ Q 1.13 1 Quarterly PREACTION/DELUGE VALVES - EXTERIOR 12.4.3.1.6 ❑ ❑J ❑ INSPECTION 1.14 1 Quarterly PRESSURE REDUCING VALVES 12.5.1.1 ❑ Q ❑ 1.15 1 Quarterly DRY PIPE VALVES - EXTERIOR 12.4.4.1.4 ❑ ❑J ❑ INSPECTION 1.16 1 Quarterly BACKFLOW PREVENTERS 12.6.1 ❑ ❑ Q 1.17 1 Annually BUILDINGS 5.2.5 ❑ R 0 as!!a.• ` ` osco ®•- Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems NFPA 25, Chapter 5 as amended by CCR, Title 19 WO 1505-0293 Date of Inspection, Testing, Maintenance: 5/9/2015 Property Information: Name: NEWPORT MEDICAL PARKING Address: 360 SAN MIGUEL City: NEWPORT BEACH CA 92660 System Riser ID:1 WET SYST Frequency:5 Year Type of System: W Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Page 2 of AES 2 Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually HANGERS 5.2.3 ❑ ❑ R1 1.19 1 Annually SEISMIC BRACES 5.2.3 ❑ ❑ R1 1.20 1 5 year HANGERS (Accessible Concealed Spaces) 5.2.3.3 ❑ ❑ 1.21 1 5 year SEISMIC BRACES (Accessible Concealed Spaces) 5.2.3.3 ❑ ❑ 0 1.22 1 5 year PIPE AND FITTINGS (Accessible Concealed Spaces) 5.2.2.3 ❑ ❑ 1.23 1 5 year SPRINKLERS (Accessible Concealed Spaces) 5.2.1.1.4 ❑ ❑ 1.24 1 5 year ALARM VALVES - INTERIOR INSPECTION 12.4.1.2 ❑ ❑ 1.25 1 5 year ALARM VALVES - STRAINERS, FILTERS, ORIFICES 12.4.1.2 ❑ ❑ 0 1.26 1 5 year CHECK VALVES - INTERIOR INSPECTION 12.4.2.1 ❑ ❑ n 1.27 1 5 year PREACTION/DELUGE VALVES - INTERIOR INSPECTION 12.4.3.1.7 El ❑ ❑ 1.28 1 5 year PREACTION/DELUGE VALVES - STRAINERS, FILTERS, ORIFICES 12.4.3.1.8 ❑ ❑ 1.29 1 5 year DRY PIPE VALVES - INTERIOR INSPECTION 12.4.4.1.5 El ❑ 1.30 1 5 year y DRY PIPE VALVES - STRAINERS, FILTERS, ORIFICES 12.4.4.1.6 El ❑ 2.1 T Annually ALARM DEVICES (90 SEC) 5.3.3-12.2.7 ❑ ❑ Ri 2.2 T Annually MAIN DRAIN TEST (ENTER DATA ON PAGE 1) 12.2.6 12.2.6.1 12.3.3.4 ❑ ❑ R1 2.3 T Annually ANTIFREEZE TEST 5.3.4 ❑ Q ❑ 2.4 T Annually CONTROL VALVE - POSITION 12.3.3.1 ❑ ❑ R1 2.5 T Annually CONTROL VALVE - OPERATION 12.3.3.1 ❑ ❑ Q 2.6 T Annually SUPERVISORY 12.3.3.5 ❑ ❑ R1 2.7 T Annually PREACTION VALVE - PRIMING WATER 12.4.3.2.1 ❑ W ❑ 2.8 T Annually PREACTION VALVE - LOW AIR PRESSURE ALARM 12.4.3.2.10 ❑ n ❑ 2.9 T Annually PREACTION - FULL FLOW TRIP TEST 12.4.3.2.2 ❑ Q ❑ .wAAw.. � ClJ�.CQ =.wAAw.• -wAAw. Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems Page 3 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco WO 1505-0293 AES 2 Date Inspection, Testing, Maintenance: 5/9/2015 System Riser ID: 1 WET SYST Frequency:5 Year Property Information: Type of System: R Wet Pipe Name: NEWPORT MEDICAL PARKING El Dry Pipe Address: 360 SAN MIGUEL ❑ Preaction City: NEWPORT BEACH CA ❑ Deluge Zio: 92660 Item Activity Frequency Description NFPA25 Reference Fail N/A Pass 2.10 T Annually DRY PIPE VALVE - PRIMING WATER 12.4.4.2.1 ❑ ❑ 2.11 T Annually DRY PIPE VALVE - LOW AIR PREASSURE 12.4.4.2.6 ❑ f --/I ❑ 2.12 T Annually DRY PIPE VALVE - QUICK -OPENING DEVICE 12.4.4.2.4 ❑ R ❑ 2.13 T Annually DRY PIPE VALVE - TRIP TEST 12.4.4.2.2 ❑ 0 ❑ 2.14 T Annually BACKFLOW PREVENTER ASSEMBLIES 12.6.2 ❑ ❑ Q 2.15 T 3 year DRY PIPE VALVE - FULL FLOW TRIP TEST 12.4.4.2.2.2 ❑ 0 ❑ 2.16 T 5 year GAUGES 5.3.2 ❑ ❑ R 2.17 T 5 year PRESSURE REDUCING VALVES 12.5.1.2 ❑ Sa ❑ 2.18 T 5 year y FIRE DEPARTMENT CONNECTION BACKFLUSH 12.7.4 El R 2.19 T 5 year SPRINKLERS - EXTRA HIGH TEMPERATURE 5.3.1.1.1.3 ❑ Q ❑ 2.20 T 5 year SPRINKLERS - CORROSIVE ENVIRONMENT OR CORROSIVE WATER 5.3.1.1.2 ❑ 0 ❑ 2.21 T 10 year SPRINKLER - DRY 5.3.1.1.1.5 ❑ 2 ❑ 2.22 T 20 year SPRINKLERS - FAST RESPONSE 5.3.1.1.1.2 ❑ ❑ 2.23 T 50 year SPRINKLERS 5.3.1.1.1 ❑ ❑ 2.24 T 75 year SPRINKLERS 75 YEARS IN SERVICE 5.3.1.1.1.4 ❑ Q ❑ 2.25 T SPRINKLERS MANUFACTURED PRIOR TO 1920 - REPLACE 5.3.1.1.1.1 ❑ 0 ❑ 3.1 M Annually CONTROL VALVES 12.3.4 ❑ ❑ 3.2 M Annually PREACTION/DELUGE VALVES 12.4.3.3.2 ❑ 0 ❑ 3.3 M Annually DRY PIPE VALVES/QUICK-OPENING DEVICES 12.4.4.3.2 ❑ R ❑ 3.4 M Annually DRY PIPE VALVE - LOW POINT DRAINS 12.4.4.3.3 ❑ ❑ 3.5 M 5 year OBSTRUCTION INVESTIGATION Chapter 13 ❑ ❑ I 0 Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems Page 4 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco WO 1505-0293 AES•2 Date Inspection, Testing, Maintenance: 5/9/2015 Property Information: Name: NEWPORT MEDICAL PARKING Address: 360 SAN MIGUEL City: NEWPORT BEACH CA Zip: 92660 System Riser ID:1 WET SYST Frequency:5 Year of- CA(�AO Type of System: 9x Fq-1 Wet Pipe ❑ Dry Pipe�RE Mph ❑ Preaction ❑ Deluge Item Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above: Comments: FIRE SPRINKLER SYSTEM IS WELL MAINTAINED AND IN GOOD WORKING ORDER. MINOR REPAIRS PERFORMED BY COSCO FIRE PROTECTION. Q PASS ❑ FAIL ❑ See continuation Page(s) E:= (Indicate the number of continuation pages) LIABILITY RELEASE STATEMENT: The Owner and/or its designated representative acknowledge that the Owner has full responsibility for the operating condition of the fire protection system(s) including its component parts at the time of this inspection. This inspection/test report is governed by terms and conditions of Cosco Fire Protection Inspection signed agreement. Without in any way limiting such terms and conditions, the Owner acknowledges that the Contractor does not have any obligation to correct any deficiencies Contractor has identified in report and Owner shall have full responsibility for corrections -of any such deficiencies. As an additional service, however, the Owner and/or its designated representative may enter into a separate, written repair or maintenance contract with Contractor for the correction of such deficiencies. During our work in your building, our representatives may have noticed items on your fire protection system that may need further investigation. These items are not part of the normal NFPA Standards inspection, testing or maintenance functions,'but we are providing you with notice of these concerns as a courtesy. This does not constitute or represent that we have performed a full analysis of fire protection system(s) in this building and there may be other items of concern that we have not identified because this type of analysis is beyond the scope of what we were hired to do in accordance with NFPA Standards. Customer Name Inspector Name ROBERT HARRIS Inspector Signature I -mot' L� Customer Signature Not Available ❑ Date Date 5/9/2015 ICosco Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems AES 9 NFPA 25, Chapter 5 as amended by CCR, Title 19 Continuation Form for Deficiencies and Comments Cosco WO 1505-0293 Page Date Inspection, Testing, Maintenance: 5/9/2015 Property Information: Name: NEWPORT MEDICAL PARKING Address: 360 SAN MIGUEL City: NEWPORT BEACH CA Zip: 92660 Frequency:5 Year Type of System: a�o� cA4,�o Sprinkler (Chapter 5) y 9y Standpipe (Chapter 6) r Syst. Riser ID: 1 WET SYST Q X Private Fire Main (Chapter 7) Mph Fire Pump (Chapter 8) Fire Pump No. or ID: Water Storage Tank (Chapter 9) Water Spray System (Chapter 10) System Riser ID: 1 WET SYST Foam -Water System (Chapter 11) System Riser ID: 1 WET SYST Item IDeficiencies and Comments Item number must correspond to the Item number of the Activity listed above: LIABILITY RELEASE STATEMENT: The Owner and/or its designated representative acknowledge that the Owner has full responsibility for the operating condition of the fire protection system(s) including its component parts at the time of this inspection. This inspection/test report is governed by terms and conditions of Cosco Fire Protection Inspection signed agreement. Without in any way limiting such terms and conditions, the Owner acknowledges that the Contractor does not have any obligation to correct any deficiencies Contractor has identified in report and Owner shall have full responsibility for corrections of any such deficiencies. As an additional service, however, the Owner and/or its designated representative may enter into a separate, written repair or maintenance contract with Contractor for the correction of such deficiencies. During our work in your building, our representatives may have noticed items on your fire protection system that may need further investigation. These items are not part of the normal NFPA Standards inspection, testing or maintenance functions, but we are providing you with notice of these concerns as a courtesy. This does not constitute or represent that we have performed a full analysis of fire protection system(s) in this building and there may be other items of concern that we have not identified because this type of analysis is beyond the scope of what we were hired to do in accordance with NFPA Standards. Customer Name Inspector Name ROBERT HARRIS Customer Signature Inspector Signature Date Date 5/9/2015 -•-- Fire Protection `Comments,and°'Rec-ornmeinda'taons coswo,t5o5-o2g3., j Although these comments are not the results of any engineering review, the following improvements are recommended: Tech Note: System Descriptions: LIABILITY RELEASE STATEMENT: The Owner and/or its designated representative acknowledge that the Owner has full responsibility for the operating condition of the fire protection system(s) including its component parts at the time of this inspection. This inspection/test report is governed by terms and conditions of Cosco Fire Protection Inspection signed agreement. Without in any way limiting such terms and conditions, the Owner acknowledges that the Contractor does not have any obligation to correct any deficiencies Contractor has identified in report and Owner shall have full responsibility for corrections of any such deficiencies. As an additional service, however, the Owner and/or its designated representative may enter into a separate, written repair or maintenance contract with Contractorfor the correction of such deficiencies. During our work in your building, our representatives may have noticed items on your fire protection system that may need further investigation. These items are not part of the normal NFPA Standards inspection, testing or maintenance functions, but we are providing you with notice of these concerns as a courtesy. This does not constitute or represent that we have performed a full analysis of fire protection system(s) in this building and there may be other items of concern that we have not identified because this type of analysis is beyond the scope of what we were hired to do in accordance with-NFPA Standards. Customer Name Inspector Name ROBERT HARRIS Customer Signature Inspector Signature Date Date 9 2015 .� )16 �- 4? &Z.,f- 11 vto t ; D�C- # �q7gq Page 1 of 4 Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: Name: VMA Mariners Mile LLC Occupancy / Use: Ocean Dock Address: 2505-2507 W. Coast Hwy Construction Type: Wood/Concrete .Sy City: Newport Beach No. Stories: N/A ;qlr Zip: 92663 Year Constructed: r� FIRr�MR Contact: Aries Telephone: (949) 631-6276 Contractor Information: F Number of System Hose Stations Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln Owner Date 1/4/2016 City: Orange a Fire AHJ Date 1/4/2016 State: California 12865-2606 ❑ Contractor Date Telephone: 714-974-9025 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and information, see NFPA 25, 2002 Edition as amended by Job # California Code of Regulations, Title 19 §901 Performed by: Craig Knox (Technicians) to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms included with this report FPA 26 ter Cha Number of Forms N/A FAIL* PASS ❑ Automatic Sprinkler System 5 X Standpipe and Hose Systems 6 1 X ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form State Fire Marshal AES3 Page 2hf 4 �, Inspection, Testing and Maintenance Standpipe System NFPA 26, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 9/16/2014 System Riser ID: NIA Property Information: Type of System:, FRI Manual Wet ❑ Manual Dry Name: VMA Mariners Mile LLC Address: 2605-2607 W. Coast Hwy ❑ Automatic Wet ❑ Automatic Dry ON ❑ Semiautomatic Dry Class of System: ��E ❑ Class I ❑X Class II City: Newport Beach ❑ Class III Combination Sprinkler/Standpipe ❑ Yes X No Main Drain Test Results: Abbreviation Key: Initial Static Pressure: N/A (psi) I =Inspection T =Test Residual Pressure: N/A (psi) M =Maintenance A-O =After Operation Restored Static Pressure: N/A (psi) MI =Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Quarterly Control Valve 12.3.2.1 X 1.2 1 Quarterly Pressure Regulating Device 12.5.2.1 12.5.3.1 X 1.3 1 Quarterly Backflow Preventers 12.6.1 X 1.4 1 Semiannually Piping 6.2.1 X 1.5 1 Semiannually Hose Connections Chapter 12 X 1.6 1 Semiannually Cabinet NFPA 1962 X 1.7 1 Semiannually Hose NFPA 1962 X 1.8 1 Semiannually Hose Storage Device NFPA 1962 X 2.1 T Annually Alarm Device (90 Sec.) 12.2.7 X 2.2 T Annually Hose Nozzle NFPA 1962 X 2.3 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.3.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Backflow Preventer Assemblies 12.6.2 X State Fire Marshal AES3 Page 3 of 4 Inspection, Testing and Maintenance Standpipe System NFPA 26, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 9/15/2014 System Riser ID: N/A Property Information: Type of System: Q Manual Wet ooA4z ElManual Dry ❑Automatic Wet n ❑ Automatic Dry Name: VMA Mariners Mile LLC Address: 250 *07 W. Coast Hwy ❑ Semiautomatic Dry Class of System: ❑ Class I FRI Class II ❑ Class III City: Newport Beach Combination Sprinkler/Standpipe ❑ Yes 0 No Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.8 T Annually Pressure Reducing Valve — Partial Flow Test 12.5.2.3 12.5.3.3 X 2.9 T 5/3 Years Hose — Hydrostatic Test NFPA 1962 X 2.10 T 5 Years Hose Storage Device NFPA 1962 X 2.11 T 5 Years Pressure Control Valve 12.5.2.2 12.5.3.2 X 2.12 T 5 Years Pneumatic & Hydrostatic Test 6.3.2 X 2.13 T 5 Years Flow Test 6.3.1 X 2.14 T 5 Years Pressure Reducing Valve — Full Flow 12.5.2.2 12.5.3.2 X 2.15 T 5 Years Fire Department Connection Backflush 12.7.4 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Hose Connections Table 6.2.2 X 3.3 M Annually Valves (All Types) Chapter 12 X State Fire Marshal AES3 Page 4 sof 4 . __ Inspection, Testing and Maintenance Standpipe System NFPA 25, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 9/15/2014 System Riser ID: N/A Property Information: Name: VMA Mariners Mile LLC Address: 2606-2507 W. Coast Hwy City: Newport Beach Type of System: X❑ Manual Wet 40 c �� ❑ Manual Dry � ❑ Automatic Wet co ❑ Automatic Dry ❑ Semiautomatic Dry Class of System: ARE M ❑ Class I ❑X Class II ❑ Class III Combination Sprinkler/Standpipe ❑ Yes FAR] No Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: Hose #1: OK 1.8 1 — Door does not close and the latch does not catch Hose #2: OK Hose #3: OK Hose #4: OK 2.13 Flow Results 2.13 #1 — 35 GPM @ 42 PSI 2.13 #2 — 70 GPM @ 33 PSI 2.13 #3 —106 GPM @ Full Flow Above repairs completed on 12/31/2016 by Craig & Shawn of Orange County Fire Protection System Certified (Five Year) pre -dated 9/2014 by Orange County Fire Protection See Continuation Page(s) (Indicate the number of continuation pages) X PASS ❑ FAIL Signature: ---"""-- Date: 1/4/2016 Jesse Maldonado State Fire Marshal AES3 Q��,► ti lt� �Il( i�tU t�'t� NNW Page 1 of 4 Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: Name: VMA Mariners Mile LLC Occupancy / Use: Ocean Dock ©f�CA4,,�O Address: 2505-2507 W. Coast Hwy Construction Type: Wood/Concrete City: Newport Beach No. Stories: N/A Zip: 92663 Year Constructed: Unknown 'Qj�� MZ�t` �!RE MPS Contact: Ad Telephone: (949) 631-6276 Contractor Information: ❑4 Number of System Hose S 9 0 Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln X Owner Date 1/4/2016 City: Orange X Fire AHJ Date 1/4/2016 State: California 92865-2606 ❑ Contractor Date Telephone: 714-974-9025 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and_ information, see NFPA 25, 2002 Edition as amended by Job # California Code of Regulations, Title 19 §901 Performed by: Shawn (Technicians) to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms included with this report NFPA 25 Chapter Number of Forms NIA FAIL* PASS ❑ Automatic Sprinkler System 5 ❑X Standpipe and Hose Systems 6 1 X ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form State Fire Marshal AES3 Page 2 of 4 Inspection, Testing and Maintenance Standpipe System NFPA 26, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 10/7/2015 System Riser ID: NIA Property Information: Type of System: ❑ Manual D X manual et C,44/ p Dry ❑ Automatic Wet v ❑ Automatic Dry Name: VMA Mariners Mile LLC Address: 2505-2607 W. Coast Hwy ❑ Semiautomatic Dry Class of System: �Re MpQ' ❑ Class I ❑X Class II City: Newport Beach ❑ Class III Combination Sprinkler/Standpipe ❑ Yes 0 No Main Drain Test Results: Abbreviation Key: Initial Static Pressure: N/A (psi) I =Inspection T =Test Residual Pressure: N/A (psi) M =Maintenance - A-O =After Operation Restored Static Pressure: N/A (psi) MI =Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail NIA Pass 1.1 1 Quarterly Control Valve 12.3.2.1 X 1.2 1 Quarterly Pressure Regulating Device 12.5.2.1 12.5.3.1 X 1.3 1 Quarterly Backflow Preventers 12.6.1 X 1.4 1 Semiannually Piping 6.2.1 X 1.5 1 Semiannually Hose Connections Chapter 12 X 1.6 1 Semiannually Cabinet NFPA 1962 X 1.7 1 Semiannually Hose NFPA 1962 X 1.8 1 Semiannually Hose Storage Device NFPA 1962 X 2.1 T Annually Alarm Device (90 Sec.) 12.2.7 X 2.2 T Annually Hose Nozzle NFPA 1962 X 2.3 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.3.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Backflow Preventer Assemblies 12.6.2 X State Fire Marshal AES3 w Page 3 of 4 Inspection, Testing and Maintenance Standpipe System NFPA 25, Chapter 6 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 10/7/20115 System Riser ID: NIA Property Information: Type of System: At ❑X Manual Wet of Cr,�. Name: VMA Mariners Mile LLC �`� o ❑ Manual Dry ❑ Automatic Wet �( . Address: 2506-2507 W. Coast Hwy ❑ Automatic Dry`. ❑ Semiautomatic Dry Class of System: ARE MPS' City: Newport Beach ❑ Class I ❑X Class II ❑ Class III Combination Sprinkler/Standpipe ❑ Yes X No Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.8 T Annually Pressure Reducing Valve — Partial Flow Test 12.5.2.3 12.5.3.3 X 2.9 T 5/3 Years Hose — Hydrostatic Test NFPA 1962 X 2.10 T 5 Years Hose Storage Device NFPA 1962 X 2.11 T 5 Years Pressure Control Valve 12.5.2.2 12.5.3.2 X 2.12 T 5 Years Pneumatic & Hydrostatic Test 6.3.2 X 2.13 T 5 Years Flow Test 6.3.1 X 2.14 T 5 Years Pressure Reducing Valve — Full Flow 12.553.2 2 . 123. X 2.15 T 5 Years Fire Department Connection Backflush 12.7.4 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Hose Connections Table 6.2.2 X 3.3 M Annually Valves (All Types) Chapter 12, X State Fire Marshal AES3 Page 4 of 4 Inspection, Testing and Maintenance Standpipe System NFPA 25. Chanter 6 as amended by CCR. Title 19 Date of Inspection, Testing, Maintenance: 10/7/2015 Property Information: Name: VMA Mariners Mile LLC Address: 2505-2507 W. Coast Hwy City: Newport Beach System Riser ID: N/A Type of System: 0 Manual Wet of� ❑ Manual Dry ❑ Automatic Wet y ❑ Automatic Dry u, ❑ Semiautomatic Dry'.,, Class of System: �RE M. ❑ Class I ❑X Class II ❑ Class III Combination Sprinkler/Standpipe ❑ Yes X No Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: Hose #1: OK 1.8 1 — Door does not close and the latch does not catch Hose #2: OK Hose #3: OK Hose #4: OK Above repairs completed on 12/31/2016 by Craig & Shawn of Orange County Fire Protection System Certified (Annual) dated 10/2015 by Orange County Fire Protection See Continuation Page(s) (Indicate the number of continuation pages) X PASS FAIL Signature: Date: 1/4/2016 Jesse Maldonado 0M, Page 1 of 4 Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: Name:yMA Mariners Mile ILL Occupancy / Use: Ocean Dock Of CAz Address: 2429-2439 W. Coast Hwy Construction Type: Wood/Concrete . �.T'f City: Newport Beach No. Stories: N/A Zip: 92663 Year Constructed: Contact: Ari Telephone: (949) 631-6276 Contractor Information: F47] Number of System Hose Stations Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln o Owner Date 1/4/2016 City: Orange a Fire AHJ Date 1/4/2016 State: California 92866-2605 ❑ Contractor Date Telephone: 71(4-974-9025 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and information, see NFPA 25, 2002 Edition as amended by Job # California Code of Regulations, Title 19 §901 Performed by: I Craig Knox (Technicians) to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). - Forms included with this report NFPA 25 Chapter Number of Forms NIA FAIL* PASS ❑ Automatic Sprinkler System 5 ❑X Standpipe and Hose Systems 6 1 X ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form State Fire Marshal AES3 Page 2 of 4 Inspection, Testing and Maintenance Standpipe System NFPA 25, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 9/15/2014 System Riser ID: N/A Property Information: Type of System: ❑X Manual Wet ofP&I ❑ Manual Dry Name: VMA Mariners Mile LLC Address: 2429-2439 W. Coast Hwy ❑ Automatic Wet ❑ Automatic Dry cr,� ❑ Semiautomatic Dry q Class of System: ❑ Class I R Class II City: Newport Beach ❑ Class III Combination Sprinkler/Standpipe ❑ Yes X No Main Drain Test Results: Abbreviation Key: Initial Static Pressure: NIA (psi) I =Inspection T =Test Residual Pressure: N/A (psi) M =Maintenance A-O =After Operation Restored Static Pressure: N/A (psi) MI =Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Quarterly Control Valve 12.3.2.1 X 1.2 1 Quarterly Pressure Regulating Device 12.5.2.1 12.5.3.1 X 1.3 1 Quarterly Backflow Preventers 12.6.1 X 1.4 1 Semiannually Piping 6.2.1 X 1.5 1 Semiannually Hose Connections Chapter 12 X 1.6 1 Semiannually Cabinet NFPA 1962 X 1.7 1 Semiannually Hose NFPA 1962 X 1.8 1 Semiannually Hose Storage Device NFPA 1962 X 2.1 T Annually Alarm Device (90 Sec.) 12.2.7 X 2.2 T Annually Hose Nozzle NFPA 1962 X 2.3 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.3.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Backflow Preventer Assemblies 12.6.2 X State Fire Marshal AES3 Page 3 of 4 Inspection, Testing and Maintenance Standpipe System NFPA 25, Chapter 6 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 9/15/2014 System Riser ID: NIA Property Information: Type of System: Name: VMA Mariners Mile LLC ❑X Manual Wet o tir ❑ Manual Dry Address: 2429-2439 W. Coast Hwy ❑ Automatic Wet CO y ❑ Automatic Dry ❑ Semiautomatic Dry Class of System: City: Newport Beach ❑Class I ❑X Class II ❑ Class III Combination SprinklerlStandpipe ❑ Yes 0 No Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.8 T Annually Pressure Reducing Valve — Partial Flow Test 12.5.2.3 12.5.3.3 X 2.9 T 5/3 Years Hose — Hydrostatic Test NFPA 1962 X 2.10 T 5 Years Hose Storage Device NFPA 1962 X 2.11 T 5 Years Pressure Control Valve 12.5.2.2 12.5.3.2 X 2.12 T 5 Years Pneumatic & Hydrostatic Test 6.3.2 X 2.13 T 5 Years Flow Test 6.3.1 X 2.14 T 5 Years Pressure Reducing Valve — Full Flow 12.5.2.2 12.5.3.2 X 2.15 T 5 Years Fire Department Connection Backflush 12.7.4 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Hose Connections Table 6.2.2 X 3.3 M Annually Valves (All Types) Chapter 12 X State Fire Marshal AES3 Page 4 of 4 Inspection, Testing and Maintenance Standpipe System NFPA 26, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 9/15/2014 System Riser ID: NIA Property Information: Name: VMA Mariners Mile LLC Address: 2429-2439 W. Coast Hwy City: Newport Beach Type of System: ❑X Manual Wet of 964 ❑ Manual Dry��' ❑ Automatic Wet CO ❑ Automatic Dry ❑ Semiautomatic Dry Class of System: sae M ❑ Class I ❑X Class II ❑ Class III Combination Sprinkler/Standpipe ❑ Yes ❑X No Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: 3.2 1 — Provide 2'/2" brass cap FDC 3.1 2 — Replace packing and bolts on OS&Y Hose #5: 3.2 1 — Provide rubber for nozzle on hose #5 Hose #6: 3.2 1 — Wire brush corrosion off threads of copper 1 '/2" going to 1 '/2' valve then reinstall Hose #7: 1.8 1 — Door for hose station #7 lock does not latch shut. It is old and warped. Adjust it by installing a small alum piece. Hose #8: 1.8 Note: Step for boat mounted on dock in front of Hose Station making the door blocked by the steps. Customer must relocate stairs. (See pics Craig) Above repairs completed on 12/31/2016 by Craig & Shawn of Orange County Fire Protection System Certified (Five Year) pre -dated 9/2014 by Orange County Fire Protection See Continuation Page(s) (Indicate the number of continuation pages) X PASS ❑ FAIL Signature: - Date: 1/4/2016 Jesse Maldonado I State Fire Marshal AES3 cc fr w.� It� S kii 011.44, 6-,r-. j9e'0,),q'79:'� Page 1 of 4 Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: ��j �`1 Name: VMA Mariners Mile LLC Occupancy /Use: Ocean Dock Address: �2429-2439 W. Coast Hwy Construction Type: Wood/Concrete �C ZE- City: Newport Beach No. Stories: NIA++,, Zip: 92663 Year Constructed: Unknown ARE tVIP� Contact: Ari Telephone: (949) 631-6276 --� Contractor Information: ❑4 Number of System Hose Stations Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln a Owner Date 1 1/4/2016 City: Orange a Fire AHJ Date 1/4/2016 State: California 12865-2605 ❑ Contractor Date Telephone: 714-974-9025 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and information, see NFPA 25-, 2002 Edition as amended by Job # California Code of Regulations, Title 19 §901 Performed by: Shawn (Technicians) to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms included with this report NFPA 25 Chapter Number of Forms N/A FAIL* PASS ❑ Automatic Sprinkler System 5 ❑X Standpipe and Hose Systems 6 1 X ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form State Fire Marshal AES3 Page 2 o1r4 Ar.,,, Inspection, Testing and Maintenance Standpipe System NFPA 25, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 10.7-20167 System Riser ID: N/A Property Information: Type of System:, Name: VMA Mariners Mile LLC manual ❑ Manual Dry Address: 2429-2439 W. Coast Hwy ❑ Automatic Wet ❑ Automatic Dry ❑ Semiautomatic Dry Class of System: �Re MpQ' ❑ Class I ❑X Class II City: Newport Beach ❑ Class III Combination Sprinkler/Standpipe ❑ Yes 0 No Main Drain Test Results: Abbreviation Key: Initial Static Pressure: NIA (psi) I =Inspection T =Test Residual Pressure: NIA (psi) M =Maintenance A-O =After Operation Restored Static Pressure: N/A (psi) MI =Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Quarterly Control Valve 12.3.2.1 X 1.2 1 Quarterly Pressure Regulating Device 12.5.2.1 12.5.3.1 X 1.3 1 Quarterly Backflow Preventers 12.6.1 X 1.4 1 Semiannually Piping 6.2.1 X 1.5 1 Semiannually Hose Connections Chapter 12 X 1.6 1 Semiannually Cabinet NFPA 1962 X 1.7 1 Semiannually Hose NFPA 1962 X 1.8 1 Semiannually Hose Storage Device NFPA 1962 X 2.1 T Annually Alarm Device (90 Sec.) 12.2.7 X 2.2 T Annually Hose Nozzle NFPA 1962 X 2.3 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.3.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Backflow Preventer Assemblies 12.6.2 X State Fire Marshal AES3 A 1.. lt6 Page 3 of 4 Inspection, Testing and Maintenance Standpipe System NFPA 25, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 10-7-2015 System Riser ID: NIA Property Information: Name: VMA Mariners Mile LLC Address: 2429-2439 W. Coast Hwy City: Newport Beach Type of System: X❑ Manual Wet CA4 ❑ Manual Dry �©F ❑ Automatic Wet ❑ Automatic Dry,\ ❑ Semiautomatic Dry Class of System: e M ❑ Class I ❑X Class II ❑ Class III Combination Sprinkler/Standpipe ❑ Yes NO No Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.8 T Annually Pressure Reducing Valve — Partial Flow Test 12.5.2.3 12.5.3.3 X 2.9 T 5/3 Years Hose — Hydrostatic Test NFPA 1962 X 2.10 T 5 Years Hose Storage Device NFPA 1962 X 2.11 T 5 Years Pressure Control Valve 12.5.2.2 12.5.3.2 X 2.12 T 5 Years Pneumatic & Hydrostatic Test 6.3.2 X 2.13 T 5 Years Flow Test 6.3.1 X 2.14 T 5 Years Pressure Reducing Valve — Full Flow 12.5. 12.5.3.2 .2 X 2.15 T 5 Years Fire Department Connection Backflush 12.7.4 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Hose Connections Table 6.2.2 X 3.3 M Annually Valves (All Types) Chapter 12 X State Fire Marshal AES3 Page 4 a. 4 Inspection, Testing and Maintenance Standpipe System NFPA 26, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 10_7_2015❑ System Riser ID: N/A Property Information: Name: VMA Mariners Mile LLC Address: 2429-2439 W. Coast Hwy City: Newport Beach Type of System: 0 Manual Wet Hof CAC/ ❑ Manual Dry ❑ Automatic Wet ❑ Automatic Dry v3, ❑ Semiautomatic Dry Class of System: ��e. ❑ Class I ❑X Class II ❑ Class III Combination Sprinkler/Standpipe ❑ Yes X❑ No Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: 3.2 1 — Provide 2'/2" brass plug for the FDC 3.1 1 — Provide lock and cable for mini OS&Y valve for the system side Hose #5: 3.2 1 — Provide rubber for nozzle on hose #5 Hose #6: 3.2 1 — Wire brush corrosion off threads of copper 1 Y2' going to 1 Y2" valve then reinstall Hose #7: OK Hose #8: 1.8 Note: Step for boat mounted on dock in front of Hose Station making the door blocked by the steps. Customer must relocate stairs. (See pics Craig) Above repairs completed on 12/31/2015 by Craig & Shawn of Orange County Fire Protection System Certified (Annual) dated 10/2016 by Orange County Fire Protection See Continuation Page(s) (Indicate the number of continuation pages) X PASS ❑ FAIL Signature: _ Date: 1/4/2016 Jesse Maldonado State Fire Marshal AES3 I L,f? Ac%z j Page 1 of 4 Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: Name: Dick's Dock LLC 1 Occupancy / Use: Dock System - Address: 2735 W. PCH Construction Type: Wood AQ• .p City: Newport Beach No. Stories: NIA Zip: 92663 p Year Constructed: Unknown �R M Contact: Mike Nash Telephone: (714) 501-3494 Contractor Information: Number of System Hose Stations Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln a Owner Date 1/26/2016 City: Orange I —XI Fire AHJ . Date 1/26/2016 State: California 92865-2605 ❑ Contractor Date Telephone: 714-974-9026 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and information, see NFPA 25, 2002 Edition as amended by Job # California Code of Regulations, Title 19 §901 Performed by: Shawn &Tim to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms included with this report NFPA 25 Chapter Number of Forms N/A FAIL* PASS ❑ - Automatic Sprinkler System 5 ❑X Standpipe and Hose Systems 6 1 X ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form State Fire Marshal AES3 Page 2,of 4 _, Inspection, Testing and Maintenance Standpipe System NFPA 25, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 1/19/2016 System Riser ID: NIA Property Information: Type of System: [-X-1 Manual Name: Dick's Dock LLC �—�►�`',�o ❑ Manual Dry ❑ Automatic Wet ❑ Automatic Dry Address: 2735 W. PCH ❑ Semiautomatic Dry 9 N p� � Class of System: ❑ Class I ❑X Class II City: Newport Beach ❑ Class III Combination Sprinkler/Standpipe ❑ Yes 0 No Main Drain Test Results: Abbreviation Key: Initial Static Pressure: N/A (psi) I =Inspection T =Test Residual Pressure: NIA (psi) M =Maintenance A-O =After Operation Restored Static Pressure: N/A (psi) MI =Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Quarterly Control Valve 12.3.2.1 X 1.2 1 Quarterly Pressure Regulating Device 12.5.2.1 12.5.3.1 X 1.3 1 Quarterly Backflow Preventers 12.6.1 X 1.4 1 Semiannually Piping 6.2.1 X 1.5 1 Semiannually Hose Connections Chapter 12 X 1.6 1 Semiannually Cabinet NFPA 1962 X 1.7 1 Semiannually Hose NFPA 1962 X 1.8 1 Semiannually Hose Storage Device NFPA 1962 X 2.1 T Annually Alarm Device (90 Sec.) 12.2.7 - - X 2.2 T Annually Hose Nozzle NFPA 1962 X 2.3 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.3.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Backflow Preventer Assemblies 12.6.2 X State Fire Marshal AES3 Page 3 of 4 Inspection, Testing and Maintenance Standpipe System NFPA 25, Chapter 6 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 1/19/2016 System Riser ID: N/A Property Information: Type of System: ❑X Manual Wet Name: Dick's Dock LLC`� ❑ Manual Dry o ❑Automatic Wet CO" Address: 2735 W. PCH ❑ Automatic Dry ❑ Semiautomatic Dry'°, .� Class of System: City: Newport Beach ❑ Class I ❑X Class II ❑ Class III Combination Sprinkler/Standpipe ❑ Yes 0 No Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.8 T Annually Pressure Reducing Valve — Partial Flow Test 12.5.2.3 12.5.3.3 X 2.9 T 5/3 Years Hose — Hydrostatic Test NFPA 1962 X 2.10 T 5 Years Hose Storage Device NFPA 1962 X 2.11 T 5 Years Pressure Control Valve 12.5.2.2 12.5.3.2 X 2.12 T 5 Years Pneumatic & Hydrostatic Test 6.3.2 X 2.13 T 5 Years Flow Test 6.3.1 X 2.14 T 5 Years Pressure Reducing Valve — Full Flow 12.5.2.2 12.5.3.2 X 2.15 T 5 Years Fire Department Connection Backflush 12.7.4 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Hose Connections Table 6.2.2 X 3.3 M Annually Valves (All Types) Chapter 12 X State Fire Marshal AES3 Page Of 4 Inspection, Testing and Maintenance Standpipe System NFPA 26, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 1/19/2016 System Riser ID: N/A Property Information: Type of System: X Manual Wet o� cA'�;�a ❑ Manual Dry Name: Dick's Dock LLC Address: ❑ Automatic Wet s� 2735 W. PCH ❑ Automatic Dry u, ❑ Semiautomatic Dry Class of System: ❑ Class I City: Newport Beach ❑X Class 11 ❑ Class III Combination Sprinkler/Standpipe ❑ Yes 0 No Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: Hose was due for hydro and replaced during the inspection System certified (Five Year) dated 1-2016 by Oranne County Fire Protection See Continuation Page(s) (Indic a number of continuation pages) X PASS ❑ FAIL Signature: Date: 1/26/2016 Jesse Maldonado State Fire Marshal AES3 Fire Alarm and Life Safety System Inspection Certificate For Rhodes Development Building #2 1401 Avocado Ave !�� Newport Beach, CA 92660 Tested to NFPA 72 Standards This Inspection was performed in accordance with applicable NFPA Standards. The subsequent pages of this report provide performance measurements, listed ranges of acceptable results, and complete documentation of the inspection. Whenever discrepancies exist between acceptable performance standards and actual test results, notes and/or recommended solutions have been proposed or provided for immediate review and approval. Inspection Date Feb 16, 2016 Building: Rhodes Development Building #2 Company: Advanced Alarm, Inc. Contact: Carrie Duffy Contact: Rejean Royer Title: Office Manager Title: Project Mgr Executive Summary Generated by: BuildingReports.com Bii�il. - ding Infoimation . Building: Rhodes Development Building #2 Contact: Carrie Duffy Address: 1401 Avocado Ave Phone: 949-644-0603 Address: Fax: City/State/Zip: Newport Beach, CA 92660 Mobile: Country: United States of America Email: CDuffy@rhodesdev.net Inspection Performed B y Company: Advanced Alarm, Inc. Inspector: Rejean Royer Address: 13128 Telegraph Rd. #H Phone: (562)944-2356 Address: Fax: (562)944-271 5 City/State/Zip: Sante Fe Springs, CA 90670 Mobile: (951)515-1458 Country: United States of America Email: rejean@weprotectall.com System. Control Unit Manufacturer: FCI Inspection Date: 02/16/2016 IDC Style: Model Number: 7200 Install Date: 04/18/2014 SLC Style: Software Version: 1.2 Version Date: 04/18/2014 NAC Style: Location: 1 st Main Electrical Room Current Protection: Breaker Monitoring - Company: Mace Central Station Services Phone: 800-228-0580 Account #: Central Station: 51:gnal Verification Type: Digital Communicator Mfg: Fire-Lite Model #: MS- 5210UD Test Time/Date: 2/16/16 8:04:14 AM Restore Time Advanced Alarm, Inc. 1 02/21/2016 Inspection Sum- mare . Category Total -Items Serviced' - - Passed- .Failed Other: t . % - % % % Auxiliary Sound Test Initiating Control 1 9 90 54 0.65% 5.84% 58.44% 35.06% 1 0 90 54 100.00% 0% 100.00% 100.00% 1 0 90 54 100.00% 0% 100.00% 100.00% 0 0 0 0 0% 0% 0% 0% Totals - 154 _ 100% 145 94.16% ,' _ 145 100:00% : ,. - - 0' 0% Certification Company: Advanced Alarm, Inc. Inspector: Rejean Royer Signed: Building: Rhodes Development Building #2 Contact: Carrie Duffy Signed: Rejean Royer Cerfification.Type Number_ Advanced Alarm, Inc. 2 02/21/2016 Inspection & Testing Generated by: BuildingReports.com Building: Rhodes Development Building #2 Control Panel: I - FCI 7-200 The Inspection & Testing section lists all of the items inspected in your building. Items are grouped by Passed or Failed/Other. Items are listed by Category. Each item includes the services performed, and the time & date at which testing occurred. I_ Device Tvoe l .Location (Service _ _(_ _ Time' I ' Date Auxiliary Fan Shutdown 1 st Fire Alarm Control Unit Control Annunciator 1 st Lobby Battery 1 st Electrical Room Battery 1 st Electrical Room Communicator Battery 1 st Electrical Room Power Supply Battery 2nd Electrical Room Battery 2nd Electrical Room Battery 3rd Electrical Room Battery 4th Electrical Room Battery 4th Electrical Room Battery 5th Electrical Room Battery 7th Electrical Room Battery 8th Electrical Room Battery 9th Water Heater Room Communicator 1 st Fire Alarm Control Unit Control Panel 1 st Main Electrical Room Phone Jack 2nd Elevator Lobby Phone Jack 2nd North Stairwell Phone Jack 2nd South Stairwell Phone)ack 3rd Elevator Lobby Phone Jack 3rd North Stairwell Phone Jack 3rd South Stairwell Phone Jack 4th Elevator Lobby Phone Jack 4th North Stairwell Phone Jack 4th South Stairwell Phone Jack 5th Elevator Lobby Phone Jack 5th North Stairwell Phone Jack 5th South Stairwell Phone Jack 6th Elevator Lobby Phone Jack 6th North Stairwell Phone Jack 6th South Stairwell Phone Jack 7th Elevator Lobby Phone Jack 7th North Stairwell Phone)ack 7th South Stairwell Phone Jack 8th Elevator Lobby Phone Jack 8th North Stairwell Phone Jack 8th South Stairwell Tested _ 8:04:09 AM 02/16/2016 Tested 8:00:28 AM 02/16/2016 Tested 8:04:41 AM 02/16/2016 Tested 8:04:25 AM 02/16/2016 Tested 8:04:53 AM 02/16/2016 Tested 7:52:16AM 02/16/2016 Tested 7:52:33AM 02/16/2016 Tested 7:44:05 AM 02/16/2016 Tested 7:38:26AM 02/16/2016 Tested 8:06:36 AM 02/16/2016 Tested 7:34:51 AM 02/16/2016 Tested 7:21:33 AM 02/16/2016 Tested 7:16:39 AM 02/16/2016 Tested 8:09:04 AM 02/16/2016 Tested 8:04:14 AM 02/16/2016 Tested 8:31:30 AM 02/16/2016 Tested 8:59:22 AM 02/16/2016 Tested 8:58:21 AM 02/16/2016 Tested 8:59:50 AM 02/16/2016 Tested 8:57:06AM 02/16/2016 Tested 8:58:01 AM 02/16/2016 Tested 8:56:24AM 02/16[2016 Tested 8:54:44 AM 02/16/2016 Tested 8:54:02 AM 02/16/2016 Tested 8:54:59 AM 02/16/2016 Tested 8:53:03 AM 02/16/2016 Tested 8:53:41 AM 02/16/2016 Tested 8:52:36AM 02/16/2016 Tested 8:51:30 AM 02/16/2016 Tested 8:50:16AM 02/16/2016 Tested 8:52:07 AM 02/16/2016 Tested 8:48:25 AM 02/16/2016 Tested 8:49:44AM 02/16/2016 Tested 8:47:45 AM 02/16/2016 Tested 8:39:00 AM 02/16/2016 Tested 8:42:27AM 02/16/2016 Tested 8:38:38AM 02/16/2016 Advanced Alarm, Inc. 3 02/21/2016 FROM Phone Jack 9th Elevator Lobby Tested 8:40:40 AM 02/16/2016 Phone Jack 9th North Stairwell Tested 8:42:05 AM 02/16/201-6 Phone Jack 9th South Stairwell Tested 7:08:10 AM 02/16/2016 Phone Jack 9th South Stairwell Tested 7:08:28 AM 02/16/2016 Phone Jack 9th South Stairwell Tested 8:41 :19 AM 02/16/2016 Phone Jack Elevator Car 1 Tested 9:00:26 AM 02/16/2016 Phone Jack Elevator Car 2 Tested 9:07:47 AM 02/16/2016 Phone Jack Elevator Car 3 Tested 9:00:16 AM 02/1-6/2016 Phone Station 1 st Lobby Tested 8:36:07 AM 02/16/2016 Power Supply 1 st Electrical Room Tested 8:04:44 AM 02/16/2016 Power Supply 2nd Electrical Room Tested 7:51:56AM 02/16/2016 Power Supply 2nd Electrical Room Tested 7:52:24 AM 02/16/2016 Power Supply 3rd Electrical Room Tested 7:43:42 AM 02/16/2016 Power Supply 4th Electrical Room Tested 7:38:17 AM 02/16/2016 Power Supply 7th Electrical Room Tested 7:21:30 AM 02/16/2016 Power Supply 7th Electrical Room Tested 7:34:46 AM 02/16/2016 Power Supply 8th Electrical Room Tested 7:16:35 AM 02/16/2016 Power Supply 9th Water Heater Room Tested _ T _ �8:08:57 AM 02/16/2016 Initiating Pull Station 1 st Exit Suite 101 Tested 8:29:01 AM 02/16/2016 Pull Station 1 st Exit Suite 103 Tested 8:25:23 AM 02/16/2016 Pull Station 1st Lobby Tested 6:53:36AM 02/16/2016 Pull Station 1 st Lobby Entrance Tested 6:53:51 AM 02/16/2016 Pull Station 2nd Elevator Lobby Tested 7:51:07 AM 02/16/201-6 Pull Station 2nd North Stairwell Tested 7:57:13 AM 02/16/2016 Pull Station 2nd South Stairwell Tested 7:54:21 AM 02/16/201.6 Pull Station 3rd Corridor Tested 7:46:03 AM 02/16/2016 Pull Station 4th Elevator Lobby Tested 7:37:35 AM 02/16/2016 Pull Station 4th North Stairwell Tested 7:40:33 AM 02/16/2016 Pull Station 5th Elevator Lobby Tested 7:31:45 AM 02/16/2016 Pull Station 5th North Stairwell Tested 7:33:54 AM 02/16/2016 Pull Station 6th Elevator Lobby Tested 7:29:30 AM 02/16/2016 Pull Station 6th North Stairwell Tested 7:28:27AM 02/16/2016 Pull Station 7th Elevator Lobby Tested 7:17:34 AM 02/16/2016 Pull Station 7th North Stairwell Tested 7:24:50AM .02/16/2016 Pull Station 8th Elevator Lobby Tested 7:15:31 AM 02/16/2016 Pull Station 8th North Stairwell Tested 7:14:27AM 02/16/2016 Pull Station 9th AC Roof Tested 8:10:56AM 02/16/2016 Pull Station 9th Center Stairwell Tested 7:06:01 AM 02/16/2016 Pull Station 9th North Stairwell Tested 7:03:52 AM 02/16/2016 Pull Station 9th Roof Roof Access Tested 7:00:39 AM 02/16/2016 Pull Station 9th South Stairwell Tested 7:08:31 AM 02/16/2016 Pull Station 3th Elevator Lobby Tested 7:42:55 AM 02/16/2016 Pull Station 3th North Stairwell Tested 7:48:09AM 02/16/2016 Smoke Detector 1 st Elevator Lobby Tested/Cleaned 8:04:01 AM 02/16/2016 Smoke Detector 1st Lobby Tested/Cleaned 7:21:38AM 02/16/2016 Smoke Detector 1 st Lobby Tested/Cleaned 8:04:03 AM 02/16/2016 Smoke Detector 1 st Lobby Near Annunciator Tested/Cleaned 8:04:07 AM 02/16/2016 Smoke Detector 1 st Main Electrical Room Tested/Cleaned 8:03:58 AM 02/16/2016 Smoke Detector 2nd Corridor Tested/Cleaned 7:54:46AM 02/16/2016 Advanced Alarm, Inc. 4 02/21/2016 :Device T e. Wtadbn- Service Tune Date: Passed Smoke Detector 2nd Corridor Tested/Cleaned 7:55:12 AM 02/16/2016 Smoke Detector 2nd Corridor Tested/Cleaned 7:55:40AM 02/16/2016 Smoke Detector 2nd Corridor Tested/Cleaned 7:56:04AM 02/16/2016 Smoke Detector 2nd Corridor Tested/Cleaned 7:56:38AM 02/16/2016 Smoke Detector 2nd Corridor Tested/Cleaned 7:57:00AM 02/16/2016 Smoke Detector 2nd Electrical Room Tested/Cleaned 7:52:59AM 02/16/2016 Smoke Detector 2nd Elevator Lobby Tested/Cleaned 7:50:52 AM 02/16/2016 Smoke Detector 3rd Corridor Tested/Cleaned 7:45:46AM 02/16/2016 Smoke Detector 3rd Corridor Tested/Cleaned 7:46:29AM 02/16/2016 Smoke Detector 3rd Corridor Tested/Cleaned 7:46:50 AM 02/16/2016 Smoke Detector 3rd Corridor Tested/Cleaned 7:47:04AM 02/16/2016 Smoke Detector 3rd Corridor Tested/Cleaned 7:47:29 AM 02/16/2016 Smoke Detector 3rd Corridor Tested/Cleaned 7:47:53 AM 02/16/2016 Smoke Detector 3rd Electrical Room Tested/Cleaned 7:43:47AM 02/16/2016 Smoke Detector 3rd Electrical Room Above Ceiling Tested/Cleaned 7:43:35 AM 02/16/2016 Smoke Detector 3rd Elevator Lobby Tested/Cleaned 7:48:58 AM 02/16/2016 Smoke Detector 4th Corridor Tested/Cleaned 7:39:16AM 02/16/2016 Smoke Detector 4th Corridor Tested/Cleaned 7:39:30AM 02/16/2016 Smoke Detector 4th Corridor Tested/Cleaned 7:39:52 AM 02/16/2016 Smoke Detector 4th Corridor Tested/Cleaned 7:40:19AM 02/16/2016 Smoke Detector 4th Electrical Room Tested/Cleaned 7:38:14AM 02/16/2016 Smoke Detector 4th Electrical Room Above Ceiling Tested/Cleaned 7:38:12 AM 02/16/2016 Smoke Detector 4th Elevator Lobby Tested/Cleaned 7:37:21 AM 02/16/2016 Smoke Detector 5th Corridor Tested/Cleaned 7:32:35 AM 02/16/2016 Smoke Detector 5th Corridor Tested/Cleaned 7:32:52 AM 02/16/2016 Smoke Detector 5th Corridor Tested/Cleaned 7:33:15 AM 02/16/2016 Smoke Detector Sth Corridor Tested/Cleaned 7:33:32AM 02/16/2016 Smoke Detector 5th Electrical Room Tested/Cleaned 7:34:59AM 02/16/2016 Smoke Detector 5th Electrical Room Above Ceiling Tested/Cleaned 7:35:40AM 02/16/2016 Smoke Detector 5th Elevator Lobby Tested/Cleaned 7:31:55 AM 02/16/2016 Smoke Detector 6th Corridor Tested/Cleaned 7:26:55 AM 02/16/2016 Smoke Detector 6th Corridor Tested/Cleaned 7:27:17AM 02/16/2016 Smoke Detector 6th Corridor Tested/Cleaned 7:27:36AM 02/16/2016 Smoke Detector 6th Corridor Tested/Cleaned 7:28:06AM 02/16/2016 Smoke Detector 6th Electrical Room Tested/Cleaned 7:30:09AM 02/16/2016 Smoke Detector 6th Electrical Room Above Ceiling Tested/Cleaned 7:30:03 AM 02/16/2016 Smoke Detector 6th Elevator Lobby Tested/Cleaned 7:29:13 AM 02/16/2016 Smoke Detector 7th Corridor Tested/Cleaned 7:24:14AM 02/16/2016 Smoke Detector 7th Corridor Tested/Cleaned 7:24:22AM 02/16/2016 Smoke Detector 7th Corridor Tested/Cleaned 7:24:33 AM 02/16/2016 Smoke Detector 7th Corridor Tested/Cleaned 7:24:47AM 02/16/2016 Smoke Detector 7th Electrical Room Above Ceiling Tested/Cleaned 7:22:50 AM 02/16/2016 Smoke Detector 7th Elevator Lobby Tested/Cleaned 7:17:50AM 02/16/2016 Smoke Detector 8th Corridor Tested/Cleaned 7:1222 AM 02/16/2016 Smoke Detector 8th Corridor Tested/Cleaned 7:12:45 AM 02/16/2016 Smoke Detector 8th Corridor Tested/Cleaned 7:13:15 AM 02/16/2016 Smoke Detector 8th Corridor Tested/Cleaned 7:13:36AM 02/16/2016 Smoke Detector 8th Electrical Room Tested/Cleaned 7:16:07AM 02/16/2016 Smoke Detector 8th Elevator Lobby Tested/Cleaned 7:14:58 AM 02/16/2016 Smoke Detector 9th Corridor Tested/Cleaned 7:03:25 AM 02/16/2016 Advanced Alarm, Inc. 5 02/21/2016 Device T e - Location Service- Time Date -Passed. Smoke Detector 9th Corridor Tested/Cleaned 7:04:23 AM 02/16/2016 Smoke Detector 9th Corridor Tested/Cleaned 7:05:09AM 02/16/2016 Smoke Detector 9th Corridor Tested/Cleaned 7:05:33AM 02/16/2016 Smoke Detector 9th Corridor Tested/Cleaned 7:06:37AM 02/16/2016 Smoke Detector 9th Corridor Tested/Cleaned 7:06:59AM 02/16/2016 Smoke Detector 9th Corridor Tested/Cleaned 7:07:22 AM 02/16/2016 Smoke Detector 9th Elevator Machine Room Tested/Cleaned 7:10:33 AM 02/16/2016 Smoke Detector 9th Fan Room Tested/Cleaned 8:10:34 AM 02/16/2016 Smoke Detector 9th Water Heater Room Tested/Cleaned 8:09:33 AM 02/16/2016 Advanced Alarm, Inc. 6 02/21/2016 Service Summary Generated by: BuildingReports.com Building: Rhodes Development Building .#2 The Service Summary section provides an overview of the services performed in this report. Device T e- . Service. uanti - Passed Annunciator Tested 1 Battery Tested 12 Communicator Tested 1 Control Panel Tested 1 Fan Shutdown Tested 1 Phone Jack Tested 29 Phone Station Tested 1 Power Supply Tested 9 Pull Station Tested 25 Smoke Detector Tested/Cleaned 65 Total 145 Advanced Alarm, Inc. 7 02/21/2016 Auxiliary Functions Testing Generated by: BuildingReports.com Bulding.:.Rhodes Development Building #2 Coritrol,Panel: 1 - FCI 7200 The Auxiliary Functions Testing section lists each of the ancillary items, systems, and emergency equipment that are controlled by the system control unit. Items are grouped by Passed or FailedlOther. The items are listed by device type, and a check box is provided to indicate if the test conducted was simulated. T e Location Comment., ScanlD Simulated Passed Fan Shutdown Supply 1 st Fire Alarm Control Unit Passed �_ __ 31468473 Smoke Detector Elevator Recall 1 st Elevator Lobby Passed '31468298 Elevator Recall 2nd Elevator Lobby Passed 31468118 Elevator Recall 3rd Elevator Lobby Passed 31468108 Elevator Recall 4th Elevator Lobby Passed 31468100 Elevator Recall 5th Elevator Lobby Passed 31468056 ❑ Elevator Recall 6th Elevator Lobby Passed 31468499 Elevator Recall 7th Elevator Lobby Passed 31468027 Elevator Recall 8th Elevator Lobby Passed 31468006 Elevator Recall 9th Elevator Machine Room Passed 31468492 Advanced Alarm, Inc. 8 02/21/2016 Sound and Visual Testing Generated by: BuildingReports.com _Building;;Rhodes'Developt ent Building.#2-- The Sound and Visual Testing section lists various points throughout your building where audible and visual alarm notification devices were tested. Any bar-coded audible and visual devices will appear in the Inspection and Testing section of this report. Items in this section are grouped by Passed or Failed/Other. Where specific decibel readings were recorded, they will appear under the ambient and alarm columns. The Voice column indicates whether the Sound Test Point passed the Voice Intelligibility requirements. The STI or Sound Transmission Index is shown if recorded. Ambient:: Alarm. 9- Intelligibility Sound Voi'ce STI 0 Location Comment 4 dB � dB . Test Untested, Sound Test Points 1 st Bells/Strobes - 4`0 0001 2nd Bells/Strobes 11 0002 3rd Bells/Strobes El 0003 4th Bells/Strobes 11 0004 5th Bells/Strobes i] 0005 6th Bells/Strobes i] 0006 7th Bells/Strobes ❑ 0007 8th Bells/Strobes 11 000'8 9th Bells/Strobes 0009 Advanced Alarm, Inc. 9 02/21/2016 Smoke Management Testing Generated by: BuildingReports.com Building; Rhodes Development Building #2 Control Panel: 1 - FCY . 7200, The Smoke Management Testing section details the test and inspection of device items that are involved in controlling the spread of smoke in a building. Items are grouped by Passed or Failed/Other. Cj -Location - Descri tion � Comment ScaniD Simulated Passed, . -Fan..Shutdown 1 st Fire Alarm Control Unit Supply Passed 31468473 Advanced Alarm, Inc. 10 02/21/2016 Inventory & Warranty Report Generated by: BuildingReports.com Building: Rhodes Development Building #2 Control Panel: 1 FCI 7200 The Inventory & Warranty Report lists each of the devices and items that are included in your Inspection Report. A complete inventory count by device type and category is provided. Items installed within the last 90 days, within the last year, and devices installed for two years or more are grouped together for easy reference. Device or item ? Cate o -, _ % of Invento uanti Pull Station Initiating 16.23% 25 Smoke Detector Initiating 42.21% 65 Phone Jack Control 18.83% 29 Power Supply Control 5.84% 9 Battery Control 7.79% 12 Annunciator Control 0.65% 1 Fan Shutdown Auxiliary 0.65% 1 Communicator Control 0.65% 1 Control Panel Control 0.65% 1 Phone Station Control 0.65% 1 Type • .. Q Model # &scri tion -_ _ Install bate'__.,' _ .. In_Service -1 Year -to 2 Years, ; - Edwards Pull Station 1 04/18/2014 Pull Station 1 270-SPO Dual Action 04/18/2014 Pull Station 23 270-SPO Single Action 04/18/2014 -FCi _ Annunciator 1 KDM LCD 04/18/2014 Control Panel 1 7200 04/18/2014 Fan Shutdown 1 QRU Supply 04/18/2014 Smoke Detector 65 ASD-I Ionization _ 04/18/2Q14� Fire—Lite y _ Communicator I MS-5210UD Digital Communicator 04/18/2014 Power Supply 8 FCPS _ 04/18/2014 Mirtone Phone Jack 29 04/18/2014 Phone Station 1 QST-211 04/18/2014 .Silent Knight Power Supply 1 5495 _ 04/18/2014 n� _ _Yuasa Battery 1 NP7-12 T m 04/18/2014 Battery 1 Sealed Lead Acid Y 04/01 /2014 In Service.'-,3 Years to 5Tears:' Battery 4 Sealed Lead Acid 02/01 /2013 Battery 1 CS3 EVX12520 Sealed Lead Acid 02/01 /2013 Advanced Alarm, Inc. 11 02/21/2016 Battery 1 Sealed Lead Acid 11 /30/2012 Battery 1 Sealed Lead Acid 10/01 /2012 In Service, S Years to 10 Years, Battery 2 Sealed Lead Acid 11 /01 /2010 Battery 1 Sealed Lead Acid 02/01 /2010 Advanced Alarm, Inc. 12 02/21/2016 Zone Address Report Generated by: BuildingReports.com Building: Rhodes Development Building #2 Control Panel: 1 - FCI 7200 The Zone Address Report lists all of the devices and items that have an individual address, or are grouped together under a common zone. The device type, location, and description are included for your reference. Address ; Device T . e Location. I TVpe.. I ScanlD. Ll Mot Pull Station 1 st Lobby Entrance Single Action 31468000 Ll M02 Pull Station 1 st Lobby Single Action 31467999 Ll M03 Pull Station 1 st Exit Suite 101 Single Action 31468474 Ll M05 Pull Station 1 st Exit Suite 103 Single Action 31468507 Ll MI Pull Station 2nd South Stairwell Single Action 31468127 Ll MI Pull Station 2nd Elevator Lobby Single Action 31468086 Ll M12 Pull Station 2nd North Stairwell Single Action 31468082 L7 M16 Pull Station 3th Elevator Lobby Single Action 31468093 Ll M16 Pull Station 3th North Stairwell Single Action 31468089 Ll M20 Pull Station 4th Elevator Lobby Single Action 31467965 L1 M21 Pull Station 4th North Stairwell Single Action 31468096 u M24 Pull Station 5th Elevator Lobby Single Action 31467974 U M25 Pull Station 5th North Stairwell Single Action 31467970 Ll M26 Power Supply 1 st Electrical Room 31468002 L1 M26 Power Supply 2nd Electrical Room 31468119 Ll M26 Power Supply 2nd Electrical Room 31468120 LI M28 Power Supply 4th Electrical Room 31468101 Ll M30 Power Supply 3rd Electrical Room 31468109 US01 Smoke Detector 1st Main Electrical Room Ionization 31468299 L1S02 Smoke Detector 1 st Lobby Ionization 31468297 LI S03 Smoke Detector 1 st Elevator Lobby Ionization 31468298 LISO4 Smoke Detector 2nd Corridor Ionization 31468125 L1S05 Smoke Detector 2nd Corridor Ionization 31468126 LIS06 Smoke Detector 2nd Corridor Ionization 31468124 LIS07 Smoke Detector 2nd Elevator Lobby Ionization 31468118 L1S08 Smoke Detector 2nd Electrical Room Ionization 31468506 L1S09 Smoke Detector 2nd Corridor Ionization 31468128 US70 Smoke Detector 2nd Corridor Ionization 31468129 LIS11 Smoke Detector 2nd Corridor Ionization 31468130 L1 S13 Pull Station 3rd Corridor 314681 14 L1S13 Smoke Detector 3rd Corridor Ionization 31468112 US14 Smoke Detector 3rd Corridor Ionization 31468113 LIS15 Smoke Detector 3rd Elevator Lobby Ionization 31468108 LIS16 Smoke Detector 3rd Electrical Room Ionization 31468503 LIS17 Smoke Detector 3rd Electrical Room Above Ceiling Ionization 31468505 L1S18 Smoke Detector 3rd Corridor Ionization 31468111 US19 Smoke Detector 3rd Corridor Ionization 31468115 L1S20 Smoke Detector 3rd Corridor Ionization 31468116 LIS21 Smoke Detector 3rd Corridor Ionization 31468117 LIS22 Smoke Detector 4th Corridor Ionization 31468105 L1 S22 Smoke Detector 4th Corridor Ionization 31468104 L1S23 Smoke Detector 4th Elevator Lobby Ionization 31468100 Advanced Alarm, Inc. 13 02/21/2016 L1S24 Smoke Detector 4th Electrical Room Ionization 31468103 LIS25 Smoke Detector 4th Electrical Room Above Ceiling Ionization 31468502 LIS27 Smoke Detector 4th Corridor Ionization 31468106 LIS28 Smoke Detector 4th Corridor Ionization 31468107 L1S29 Smoke Detector 5th Corridor Ionization 31468061 Ll S30 Smoke Detector 5th Elevator Lobby Ionization 31468056 Ll S31 Smoke Detector 5th Electrical Room Ionization 31468500 LIS32 Smoke Detector 5th Electrical Room Above Ceiling Ionization 31468501 US33 Smoke Detector 5th Corridor Ionization 31468064 L1S34 Smoke Detector 5th Corridor Ionization 31468063 Ll S35 Smoke Detector 5th Corridor Ionization 31468062 Ll S36 Smoke Detector 1 st Lobby Near Annunciator Ionization 31468493 L2M06 Pull Station 7th Elevator Lobby Single Action 31468025 L2Mo7 Pull Station 6th North Stairwell Single Action 31467976 L2M07 Power Supply 7th Electrical Room 31468028 L2M07 Pull Station 7th North Stairwell Single Action 31467986 L2M10 Pull Station 9th South Stairwell Single Action 31467991 L2M11 Pull Station 9th Center Stairwell Single Action 31467992 L2M12 Pull Station 9th Roof Roof Access Single Action 31468017 L2M13 Pull Station 9th AC Roof Dual Action 31468471 L2M14 Pull Station 9th North Stairwell Single Action 31467990 L2M16 Pull Station 8th Elevator Lobby Single Action 31467996 L2M16 Pull Station 8th North Stairwell Single Action 31467994 L2M24 Pull Station 6th Elevator Lobby Single Action 31468038 L2M31 Power Supply 7th Electrical Room 31468059 L2S01 Smoke Detector 6th Corridor Ionization 31468052 L2S02 Smoke Detector 6th Elevator Lobby Ionization 31468499 L2So3 Smoke Detector 6th Electrical Room Ionization 31468050 L2So4 Smoke Detector 6th Electrical Room Above Ceiling Ionization 31468498 L2So5 Smoke Detector 6th Corridor Ionization 31468053 L2S06 Smoke Detector 6th Corridor Ionization 31468054 L2So7 Smoke Detector 6th Corridor Ionization 31468055 L2So9 Smoke Detector 7th Corridor Ionization 31467987 L2S10 Smoke Detector 7th Elevator Lobby Ionization 31468027 US] 1 Smoke Detector 1 st Lobby Ionization 31468496 L2S12 Smoke Detector 7th Electrical Room Above Ceiling Ionization 31468497 L2S13 Smoke Detector 7th Corridor Ionization 31468031 US] 4 Smoke Detector 7th Corridor Ionization 31468032 US1 5 Smoke Detector 7th Corridor Ionization 31467985 L2S16 Smoke Detector 9th Corridor Ionization 31468013 L2S17 Smoke Detector 9th Corridor Ionization 31468015 L2S18 Smoke Detector 9th Elevator Machine Room Ionization 31468492 L2S19 Smoke Detector 9th Water Heater Room Ionization 31468020 L2S20 Smoke Detector 9th Fan Room Ionization 31468495 L2S21 Smoke Detector 9th Corridor Ionization 31468021 L2S22 Smoke Detector 9th Corridor Ionization 31467988 L2S23 Smoke Detector 8th Corridor Ionization 31468010 L2S24 Smoke Detector 8th Elevator Lobby Ionization 31468006 L2S25 Smoke Detector 8th Corridor Ionization 31468011 L2S27 Smoke Detector 8th Electrical Room Ionization 31468494 L2528 Smoke Detector 8th Corridor Ionization 31468012 L2S29 Smoke Detector 8th Corridor Ionization 31467993 L2S30 Smoke Detector 9th Corridor Ionization 31467989 Advanced Alarm, Inc. 14 02/21/2016 L2S31 Smoke Detector 9th Corridor L2S32 Smoke Detector 9th Corridor L2S33 Power Supply 8th Electrical Room L2S34 Power Supply 9th Water Heater Ri Ionization 31468014 Ionization 31468016 31468007 Advanced Alarm, Inc. 15 02/21/2016 o�G �VSq I R ea--r- Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended. Praperfy:lnfo.�tiiattonij. is m _-rY~a`.+_,b»•"w�e.eusvre4• Y`. _ - ' w3�+ - Name: Monarch Building Association Occupancy/Use: Address: 424 32nd Street Construction Type: F CA( City: Newport Beach 2 No. Stories: j, ZIP: 2663 Year Constructed: 2004 v Charles Seager E MR Contact: Telephone: (714) 751-7858 ,77 .3 .�:r `JP�;� ..�-•en.:^'.. • yq•Xsm:au:.baW.w«..d�`'"�. 'sti' "—`,.+`,�.,`-+-•. 1 a ;N6ya .yuthr. i a . •GOT7 771tCaGt.r:IrrfOrlY7 y',st. - 'w: ' � -.... .a,� '�'' • :t.s.A.ia+arimi3:wfeS:.tu+:�at"s?.:wa,.�u`z.,:a.,,a`%.L3&.�.1Y,m3ai�....+dta:.su' Name: Orange County Fire Protection Copy sent to: 137 W. Bristol Lane Address: ❑✓ Owner Date: 04/11/16 Orange ❑✓ Fire AHJ Date: 04/11/16 City: CA ❑ Contractor Date: State: NOTES: (714) 974-9025 Telephone: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 326604 CA License#: Edition as amended by California; Code of Regulations, Title 19, §901 to §906. Job #: 2) Inspection items may be performed by the owner -in Craig accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) eclr•bortforeacti systeryi inspe`ctedfiarid dn�er:ttie,';:ntimti�'r, ►f`forrils:,used" orinspectian,;r:'.' . t - Checkpoxes:(Fail or.Rasa� ta:indioatestatus°Qf inspected 6yetekn at end ofanapectlon t' ReportForms Included with this Chapter m Automatic Sprinkler System 5 1 ❑ ❑ ❑✓ ❑ Standpipe and Hose System 6 0 ❑ ❑ ❑ ❑ Private Water Supply System 7 0 ❑ ❑ ❑ ❑ Fire Pump 8 0 ❑ ❑ ❑ ❑ Water Storage Tank 9 0 ❑ ❑ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ❑ No *Ses ":Defeiericies;and=;Gpmi tints":section .at: grid of eacii`.respecti�e fomr AES 1 September 3, 2013 J gg� , Main ;Drain ; :Di `iriete r' -lriifiahStatpc.; '-Residual Pressure Pres$ur�:. -Final Static Pressure p� F Riser,'. ;' ,' -° ` . •, ::: ; ' = `Lgcatiori' t'• '.x Riser p3amet®re; 1 Outside of building 6" 1 1/2" 60 50 60 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = NotAppllcab%e Item' •� - F•y ,�' p - ;xVt`fe "ed�;N: 'erica: ` �� 'Date`' C mrn nta;O o e y,° �';:�� .4` P F /A" ; r.. 1.1 I Control Valves — Identification Sign 13.3.1 02/18/16 P 1.2 1 Control Valves — Inspection 13.3.2 02/18/16 P 1.3 1 Waterflow Alarm Devices 5.2.5 02/18/16 P 1.4 1 Supervisory Devices 5.2.5 02/18/16 P 1.5 1 I Gauges (Wet Pipe Systems) 5.2.4.1 02/18/16 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 02/18/16 NA 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 02/18/16 psi NA 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 02/18/16 psi NA 1.9 1 Pressure Readings Acceptable 5.2.4.1 02/18/16 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13 5.2.8 02/18/16 NA 1.11 1 Heat Tape 5.2.7 02/18/16 NA 1.12 1 Spare Sprinklers 5.2.1.4 02/18/16 P 1.13 1 Fire Department Connections 13.7 02/18/16 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 02/18/16 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 02/18/16 NA 1.16 I Backflow Preventers 13.6.1 02/18/16 NA Form AES 2.2 Sept. 3, 2013 w Include ALL Quarterly I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable �tet#l' pascrldtl'tiri.'' "FPA.2lS,G bc1; Retbreiice� DEttA Cbtiytrientd Ohl'.. ' : � RIF 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 02/18/16 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 02/18/16 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 02/18/16 Owner's Responsibility N/A 1.20 1 Sprinklers 511 02%1"8/16 "- P 1.21 1 Sprinklers -Accessible Concealed Space 5.2.1.1.6 02/18/16 P 1.22 I Pipe and Fittings 5.2.2 02/18/16 P 1.23 1 Pipe and Fittings -Accessible Concealed Space 5.2.2.3 02/18/16 P 1.24 1 Hangers 5.2.3 02/18/16 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 02/18/16 P 1.26 I iSeismic Braces 5.2.3 02/18/16 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 02/18/16 P 1.28 1 Unsprinklered Areas CFC 901.4 02/18/16 QYes m No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 02/18/16 If REQUIRED, Enter'F' until results are returned from Lab NA 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) 02/18/16 P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 02/18/16 45 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 02/18/16 P 2.5 T Control Valve - Position 13.3.3.2 02/18/16 P 2.6 T Control Valve — Operation 13.3.3.1 02/18/16 P 2.7 T Supervisory Devices 13.3.3.5 02/18/16 P 2.8 T Backflow Preventer Assemblies 13.6.2 02/18/16 NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 02/18/16 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 02/18/16 NA 2.11 T Pressure Gauges - Calibration 5.3.2 02/18/16 NA 2.12 T Small Hose Connections* 13.5.6.2.2 02/18/16 NA *Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 V" I Inspection T =Test M = Maintenance P = Pass F = Fail NIA = Not Applicable P"A"P tIdA NFPA,16 CA, ed'.1,,1- Comrrterits,•Ori F NW I 3.1 M Check Valves - Internal inspection 13.4.2 02/18/16 N/A 3.2 M Control Valves 13.3.4 02/18/16 P 3.3 M FDC - Backflush 14.3.2.414.3.2.3 02/18/16 P Internal Pipe Inspection - See Deficiencies and 14.2� 02/18/16 N/A 3.4 M Comments Section for Results. No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 02/18/16 N/A�j Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 02/18/16 Q Nos P D = Def ciency C = Comment (Indicate type) -bd ava, a. ppitsth re ardor'' or,repla W", ayloes n a wpra 0 Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 1:1 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jesse Maldonado Signature Date 04/11/16 Form AES 2.2 Sept. 3, 2013 j ~ptll�W& - � q9- N .�� NFPA25 as amended. 77, Pro' -e'=lnfortriaiion7,w t. p rty. Name: Newport Hills Community Association Occupancy/Use: Address: 1900 Port Carlow Place Construction Type: Ot: CA(��p� City: Newport Beach No. Stories: 1 ro z 9 ZIP: 92660 Year Constructed: Q Jessie Briggs & Jill E M� Contact. Telephone: (949) 721-1929 r o ste ` Rls r� t'o ^` Numb ` f: rz� s YI O-r n� 0 Go tr ior. of .m ._ . :` I•Y<_. r � .•,t �^"s ' =:»'i �w�mw��fw�'+.« `A.i..�.m.'e'•••ipVr . d {..!4'g yg`rat d�'� 1 �.e{-�� ice'-��.�e. .E £.w�.si.15a fj eri �h.'��1 v''r •Yit.. nur'iv.�.s Name: Orange County Fire Protection Copy sent to: Address: 137 W. Bristol Lane ✓❑Owner Date: 04/11/16 Orange ❑✓ Fire AHJ Date: 04/11/16 City: CA ❑ Contractor Date: State: 714 974-9025 NOTES: () Telephone: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA,25,.2011.. CA License*326604 Edition as.amerided by, •,California,Code'ofRegulations;, Title 19, §901 to §906. Job #: 2) Inspection items may be performed by the owner in Performed by: Greg Coats accordance with California Code of Regulations, Title 19, §904.1(a) "°=i r�. Check boxfox each'systein�i�ispecfe�,�n'tl;:ein,"te the�n4�mberof.fori>as,ussii forrlrisp�ectlari '- Check boxes;{Fait gC;Passj, to;indic.ate%status;of,lnstiected`system ati end of;lnapectton. , , ReportForms Included with this .Forms Chapter m Automatic Sprinkler System 5 1 ❑ ❑ ❑✓ ❑ Standpipe and Hose System 6 0 ❑ ❑ ❑ ❑ Private Water Supply System 7 0 ❑ ❑ ❑ ❑ Fire Pump 8 0 ❑ ❑ ❑ ❑ Water Storage Tank 9 0 ❑ ❑ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes m No *See D ieioie icies;and' amni grits", section=atryend`:vfeacFa:tespectiye.far AES 1 September 3, 2013 Riser' ` Rrser` Main'D"rain.' ,:Location ,r +p' Diameter: •Diameter; In$Ial"Static �Residual't-' Pressure,:: Pressure . EinalStatic : Pressure .' ;P� F� NSA: 1 Shotgun riser inside building near OS&Y 4" 2" 67 55 67 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: O'e'! i IBM :1 *I. MON 10 Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not APPlicable tem. `r DescriV"tion •: p;I is •,. -t' :ed:: .,Reference ; Date: Comments Only P F N!A' ,, 1.1 1 Control Valves — Identification Sign 13.3.1 03/21/16 P 1.2 1 Control Valves — Inspection 13.3.2 03/21/16 P 1.3 1 Waterflow Alarm Devices 5.2.5 03/21/16 P 1.4 1 Supervisory Devices 5.2.5 03/21/16 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 03/21/16 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 03/21/16 NA 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 03/21/16 psi NA 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 03/21/16 psi- NA 1.9 1 Pressure Readings Acceptable 5.2.4.1 03/21/16 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 93 5.2.8 03/21/16 NA 1.11 1 Heat Tape 5.2.7 03/21/16 NA 1.12 1 Spare Sprinklers 5.2.1.4 03/21/16 P 1.13 1 Fire Department Connections 13.7 03/21/16 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 03/21/16 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 03/21/16 NA 1.16 1 Backflow Preventers 13.6.1 03/21/16 NA Form AES 2.2 Sept. 3, 2013 ANNUAL INSPECTION, TESTING, AND MMNTENAWCt"` Iticitide ALL, Quarterly ,• I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable IEenri. D,bacelption NFPA 219:CA;ed'. Referenbe " bate' Coiiathsrits' Daly' : ", F�;P;N'I' 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 03/21/16 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 03/21/16 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 03/21/16 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 03/21/16 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 03/21/16 P 1.22 1 Pipe and Fittings 5.2.2 03/21/16 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 03/21/16 P 1.24 1 Hangers 5.2.3 03/21/16 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 03/21/16 P 1.26 1 Seismic Braces 5.2.3 03/21/16 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 03/21/16 P 1.28 1 Unsprinklered Areas CFC 901.4 03/21/16 QYes m No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 03/21/16 If REQUIRED, Enter'F' until are returned from Lab NA 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) 03/21/16 P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.E 03/21/16 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 03/21/16 P 2.5 T Control Valve - Position 13.3.3.2 03/21/16 P 2.6 T Control Valve — Operation 13.3.3.1 03/21/16 P 2.7 T Supervisory Devices 13.3.3.5 03/21/16 P 2.8 T Backflow Preventer Assemblies 13.6.2 03/21/16 NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 03/21/16 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 03/21/16 NA 2.11 T Pressure Gauges - Calibration 5.3.2 03/21/16 NA 2.12 T Small Hose Connections* 13.5.6.2.2 03/21/16 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 at I= Inspection T = Test M = Maintenance P = Pass F=Fail N/A =N0tApplicable 'NFPA-16:CA id- Dates ' , fii�on"pIPn CommieIY 7 Reference: 77 3.1 M Check Valves - Internal inspection 13.4.2 03/21/16 N/A 3.2 M Control Valves 13.3.4 03/21116 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 03/21/16 P Internal Pipe Inspection - See Deficiencies and 14.2' 03/21/16--- _HNos YesN_ /A 3.4 M Comments Section for Results. 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 03/21/16 N/A Deficiencies and Comments Section for Results 3.6 IM System Returned to Service 4.5.3 03/21/16 O Nos D = Deficiency C = Comment Indicate type) 7771 _m RjS* 1: ° 'hi,6 � -an -pie.t at wore.iOPair j*61aded '011,eaulpffient _wkcos od-dr X System Certified (Five Year) dated 3-2016 by Orange County Fire Protection ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the -equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jesse M 211102_2�2 Signature Date 04/11/16 Form AES 2.2 Sept. 3, 2013 L, i.F -Fire Safety- First1. May 6, 2016 Fire Prevention Department NEWPORT BEACH FIRE DEPARTMENT 3300 Newport Blvd. Newport Beach, CA 92663 RE:' Title 19, 5-Year AES Certification 1000 Dove, Newport Beach Attention: Fire Prevention Department 1170 E. Fruit Street, Santa Ana, CA 92701 (714) 836 — 4800 1 (714) 836 — 4120 fax Fire Safety First has recently completed the Title 19, 5-Year Certification at the above mentioned property. We have completed all repairs noted on the preliminary deficiency reports and have back -flushed all fire department connections per the California Health and Safety Code, Title 19. Enclosed are copies of the Certification Report for your files. If you have any questions please call our Fire Sprinkler Maintenance Department at (714) 836-4800 ext 120. Sincerely, ;va samyan Phil Salazar, Project FIRE SAFETY FIRST C10/16/36- 599761 �c Name ffr&Saf Oty, F lrs' Copy Sent to: Address 11 ` E ,,-ftuit.str6e't owner Date: 5/4/16 City Santa, Ar�o,';, Fire AHJ Date: 5/4/16 State, Zip CX,'92701, Contractor Date: Telephone Notes: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 Edition as amended by California Code of Regulations, Title 19, Section 901 to 906. 2) Inspection items may be performed by the owner in Accordance with California Code of Regulations, Title 19, Section 904.1(a). CA License # Job # Performed by rr. -d f ft o'n, -c os", ofgat --sys emqnsp.6C kan, -:i4h isuse �fdrinspedb-'-` Pas UiW h dectl 0 '4t -:;q- e e 't �:dffflsp Forms included with this Report NFPA 25 Number of N/A Fail* Pass Chapter Forms 171 Automatic Sprinkler System 5 El 0 ❑ Standpipe and Hose System 6 El El El El Private Water Supply System 7 El ❑ El E] Fire Pump 8 El 0 El E] Water Storage Tank 9 El El 1-1 E] water spray System 10 El 0 E] Foam Water Sprinkler System 11 El El El E] Water Mist System 12 f El 0 El ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ❑ No q9 MI m --� -h-re Form AES 1 September 3, 2013 Riser Information Main Drain Test (Annual) -Main: Id:-, t 'tAt Stkl F %te'& P t N L t6 t r4 la 'et P M jqes_ sMr WRY, M, ( rf'2 2floor jator.pseffoptippn 9 '8�!--f I'dor janitbt;dOse fib.con r p, pr, 8 4P M This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 Forms Attached: 5-Year INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Hnspection T=Test M=Maintenance P=Pass F=Fail NIA=Not Applicable 61. e 4 N FPA';2, -Aff 0 AA1 en 1.1 1 Control Valves - Identification Signs 13.3.1 11'§ 1.2 1 Control Valves- Inspection 13.3.2 1.3 1 Waterflow Alarm Devices 5.2.5 844 _Z5 1.4 1 Supervisory Devices 5.2.6 3:. 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 Enter Water Supply Pressure Below Riser 5.2.4.1 N"A 1.6 I psi " Check Enter Water Supply Pressure Above Riser 1.7 1 5.2.4.1 100 psi Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 1.9 1 Hydraulic Design Information 5.2.6 (For hydraulically designed systems) General Information Sign 1.10 I (not required for systems prior to 2007 Edition of NFPA 5.2.8 1-6- - " -3P 25) 1.11 1 Heat Tape 5.2.7 3, 1.12 1 Spare Sprinklers 5.2.1.4 -3 14=16 1.13 1 Fire Department Connections 13.7 D: 1.14 1 Alarm Valves - Exterior Inspection 13.4.1 �N I e Reducing Valves Pressure 13.5.1.1 1.16 1 Backflow Preventers 13.6.1 Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Wnspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable n' FP e: M _'Optl8i A tj,,' 5.1.6, 1.17 1 Small Hose Connections— Hose Valve 13.5.2, 'A 13.5.5.1 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.6 1.22 1 Pipe and Fittings 5.2.2 6 Pipe and Fittings —Accessible Concealed 1.23 1 5.2.2.3 40, Space 1.24 1 Hangers 5.2.3 4 1 4 1 Hangers —Accessible Concealed Space 5.2.3.3 41.25 1.26 1 Seismic Braces 5.2.3 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 1.28 1 Unsprinklered Areas CFC 901.4 El Yes Z No 2.1 T Field Service Test Required 5.3.1 If REQUIRED,'ente r T' until Send report to Fire Code Official results are returned from lab. 2.2 T Recalled Sprinklers Title 19 P, If not present= Pass, lfpresent =Fail 904.1(c) 2.3 T Waterflow Alarm Devices 5.3.3 13.2.6 35 secs. 2.4 T Main Drain Test 13.2.5 (Enter data on Page 1 of this form) 13.3.3.4 2.5 T Control Valve — Position 13.3.3.2 2.6 T Control Valve- Operation 13.3.3.1 2.7 T Supervisory Devices 13.3.3.5 r 2.8 T Backflow Preventer Assemblies 13.6.2 /k: 2.9 T Small Hose Connections 13.5.2.3 w/PRV Hose Valves - Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 N" A' 2.11 T Pressure Gauges —Calibration 5.3.2 1344 j" "Tr 2.12 T Small Hose Connections 13.5.6.2.2 Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class 1, 11, or Ill Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items 1= Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable --1� — e te, e r ,K:. ^a Y �Desc:'' �i `t ,A i"oii" '�a •"j �n y•. �.Co` is y�j m�meia to r► o n '4wh �� n f�reirW' `[ate`. �_ � � is ee 3.1 M Check Valve —Internal Inspection 13.4.2 3.2 M Control Valves 13.3.4 r'3'=14',6'` :•<. pt:.:: 3.3 M — FDC Backflush 14.3.2.3 14.3.2.4 ; 4t 3.4 M Internal Pipe Inspection —See Deficiencies and 14.2 ` (� Yes p Comments Section for Results ..3`-"1,4„16-' No _ 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 Deficiencies and Comments Section for Results ® Yes 3.6 M System Returned to Service 4.5.3-1'4:5' < r No D = Deficiency C = Comment (Indicate type) I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Rhil s I`azar= Print Name a ate,' Signature <z^; S , Form AES 2.2 September 3, 2013 4 " Page 1 of 5 Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 1.9 Property Information: Name: Pacific Medical Occupancy / Use: I Commercial Address: 4601 Birch St. Construction Type: wood, stucco City: Newport Beach No. Stories: 92660 Year Constructed: 2011 Zip: Contact: Tomas & Maggie Telephone: (949) 221-0128 Contractor Information: F, I Number of System Risers Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln Owner Date 211112016 City: Orange Fire AHJ Date 2/11/2016 State: California 92865-2605 ❑ Contractor Date Telephone: 714-974-9026 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and information, see NFPA 25, 2002 Edition as amended by Job # California Code of Regulations, Title 19 §901 Performed by: George & Tim to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms included with this report NFPA 25 Cha ter Number of Forms N/A FAIL* PASS ❑X Automatic Sprinkler System 5 1 X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form State Fire Marshal AES2 Z Of 5 "4 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 2/10/2016 System Riser ID: Property Information: Name: Pacific Medical Address: 4601 Birch St. City: Newport Beach Type of System: CA 1A Of �X Wet Pipe aQ Dry Pipe Preaction ,_ _ ✓ �Rt_ MP Deluge Main Drain Test Results: (See attached sheet for multiple risers) Initial Static Pressure: 95 (psi) Residual Pressure: 80 (psi) Restored Static Pressure: 100 (psi) Abbreviation Key: I = Inspection T = Test " " M-' = Maintenance A-O = After- Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valve — Enclosure tem erature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure temperature 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES2 Paae 3 of 5 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 2/10/2016 Property Information: System Riser ID: Type of System: X Wet Pipe Dry Pipe Preaction RE M' - Deluge NFPA 25 Fail N/A Pass Reference,. Name: Pacific Medical Address: 4501 Birch St. City: Newport Beach Item Activity Frequency Description 1.18 1 Annually Hangers 5.2.3 X 1.19 I Annually Seismic Braces - 5.2:3 _ X 1.20 I 5 Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 I 5 Years Seismic Braces (Accessible concealed spaces 5.2.3.3 X 1.22 I 5 Years Pipe and Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 I 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 I 5 Years Alarm Valves — (Interior Inspection) 12.4.1.2 X 1.25 I 5 Years Alarm Valves — Strainers, filters, orifices 12.4.1.2 X 1.26 I 5 Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 I 5 Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5 Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5 Years Dry Pipe Valves — Strainers, filters, orifices 12.4.4.1.6 X 2.1 T AnnuallyAlarm Devices (90 Sec) - ' 5.3:3- 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve — Position 12.3.3.1 X 2.5 T Annually Control Valve — Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES2 Paoe 4 of 5 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 26, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 2/10/2016 Property Information: System Riser ID: Type of System: ❑X Wet Pipe o f C64 � Dry Pipe Preaction�p�� Deluge Name: Address: Pacific Medical 4501 Birch St. City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4..2.6 X 2.12 T Annually Dry Pipe Valve — Quick -Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assembly 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure Reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinklers manufactured prior to 1920 - Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valve — Low Point Drains '\ 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES2 Paae 5 of 5 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 2/10/2016 Property Information: System Riser ID: ❑� Type of System: 0cAti�, X Wet Pipe " � l - ' .• �. Dry Pipe v . ❑Address: ❑ Preaction�' Deluge ❑ Name: Pacific Medical 4501 Birch St. City: Newport Beach Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: System certified (Five Year) dated 2-2016 by Orange County Fire Protection ❑ See Continuation Pages(s) (Indicate the number of continuation pages) X❑ PASS ❑ FAIL Signature: Date: 1 2/11/2016 Jesse Maldonado State Fire Marshal AES2 Co,ntra'ctor Itafonmati'o,ri N`dmber. o#'SystdM `R9s&s " Name Fire°Safety, First Copy Sent to: Address 1.1.70 E,,Frlait Str,•ee"t z, ❑ Owner Date: City Santa Ana•. ® Fire AHJ Date: 5/17/2016 State, Zip CA, 92701 ElContractor Date: Telephone _ .. `(714). 8'36-'4806 ' ' ` Notes: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 Edition as amended by California Code of Regulations, Title 19, Section 901 to 906. 2) inspection items may be performed by the owner in accordance with California Code of Regulations, Title 19, Section 904.1(a). CA License # C16=5997:61~ : Job # Performed by Check box,for:each system in's•pe"d 'd'S'nd"e'nter bans usdd,f0r'inSOectien°. wr ... Gheck,boxes (Fj l;or;Pas' 'A-6,',ih,'.JC `e,"s"tatus''of"inspecfe°d fhe end' of�i'nspeetion', IncludedForms with this Report Chapter Forms ® Automatic Sprinkler System 5 1y ❑ ® ❑ ❑ Standpipe and Hose System 6 ❑ ❑ ❑ ❑ Private Water Supply System 7 ❑ ❑ ❑ ❑ Fire Pump 8 ❑ ❑ ❑ ❑ Water Storage Tank 9 ❑ ❑ ❑ ❑ Water Spray System 10 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 ❑ ❑ ❑ ❑ Water Mist System 12 ❑ ❑ ❑ ® Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes ❑ No See. "Defic encies'a'nil"Comenents"Fse+�tion� at oach xesp'ectjvef-f orm,,i a 5�', Lbit46 ML es 5 r V-�� -� I Form AES 1 September 3, 2013 Riser N'o. Riser Information ;' Loca, vpn, 'Riser Diameter" Main D"rain , Dtamete'r Main Drain In 186f' static: Pressure Test i Risi, dwal . ;Pressure It " Stat(t ires��a,i� P,, �F, JA 1' 'Breezeway beside Newport -Stationers 8„ 2 '80, 70; 80- P 0 This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 Forms Attached: 5-Year INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly andAnnual Inspections, Tests, and Maintenance Items Mnspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Descript-ion - .. NFPA,25. CA,Edition Reference . ;Date Com,metas On11y . �.. F N%A, 1.1 1 Control Valves — Identification Signs 13.3.1 3%2%1;6 . ,:' P 1.2 1 Control Valves- Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P' 1.4 1 Supervisory Devices 5.2.6 P' 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 F 1.6 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi N/A. 1.7 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi N/A 1.8 1 Pressure Readings Acceptable 5.2.4.1 P 1.9 1 Hydraulic Design Information (For hydraulically designed systems) 5.2.6 1.10 1 General Information Sign (not required for systems prior to 2007 Edition of NFPA 25 5.2.8 _N/A 1.11 1 Heat Tape 5.2.7 N/A 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 j P' 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 T N/A 1.15 1 Pressure Reducing Valves 13.5.1.1 N/A 1.16 I Backflow Preventers 13.6.1 N/A Form AES 2.2 September 3, 2013 ANNUAL f AND a a IncludesQuarterly Annual i and Maintenance Items 1=lnspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable ItelTi: pescriptionn' M°' 'CAE-dit'ion, 'Reference Date`, Cotnme,nts.On"Iy " `N/A 1.17 1 Small Hose Connections — Hose Valve 13.5.2, 13.5.5.1 3/2f 1,6 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N%A- 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility 1.20 1 Sprinklers 5.2.1 F. 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.E F 1.22 1 Pipe and Fittings 5.2.2 . P 1.23 I Pipe and Fittings —Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 1.25 1 Hangers —Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P, 1.27 1 Seismic Braces -Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ; " ®Yes ❑ No 2.1 T Field Service Test Required Send report to Fire Code Official 5.3.1 If REQUIRED, enter'F'until res ul[s are returned from lab. 2 2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Waterflow Alarm Devices 5.3.3 13.2.6 60 secs. 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 " P 2.5 T Control Valve — Position 13.3.3.2 -P 2.6 T Control Valve- Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 P 2.9 T Small Hose Connections * w/PRV Hose Valves - Partial Flow Test 13.5.2.3 13.5.3.3 _ :N/A 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 N%A 2.11 T Pressure Gauges — Calibration 5.3.2 N/A 2.12 T Small Hose Connections * 13.5.6.2.2 P * Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class I, 11, or III Form AES 2.2 September 3, 2013 ANNUAL AND MAINTENANCE Tests, Maintenance Items includes ALL Quarterly and Annual Inspections, I = Inspection T = Test M = Maintenance and P = Pass F = Fail N/A = Not Applicable Item- T %CA.Editioh Date, Commentsarily'-.1.1 w °"Refe"rencb ,N;�i�i 3.1 M Check Valve — Internal Inspection 13.4.2 3/2/16 N/A: 3.2 M Control Valves 13.3.4 N/A. 14.3.2.3 3.3 M FDC —Backflush 14.3.2.4 w Internal Pipe Inspection —See Deficiencies and Yes 3.4 M Comments Section for Results 14.2 ®No Obstruction Investigation Required. If "Yes", see 14.3 3.5 M Deficiencies and Comments Section for Results ", Yes 3.6 M System Returned to Service I 4.5.3 '1 1111' 7771E] No D = Deficiency C = Comment (Indicate type) Deficiencies Comments Item Date Riser D C indicate all equipment devices andparts that were repaired or replaced 1.5 3/2/16 ®,': ] ` Teswrreplace risergauge, 3.3 -3/2/16 ® 0 -- ',Backflush;FDC-Connection at completion ofrepairs _ 3/2/16 ❑ 0 . -1640,;Newp0rtStatioiters 1.21 3/,2/16 ® f:] Ab'ovesuspended.ceiling,against.leftwall=Replace=(2).corrod`ed sprinklers ; __. . 3%2/16 Gelsoii�s Marfaet , .... . 1.20 3/2/16 : ®:;•Q, . AboVe Pee't's,coffee,.next:to ligfitingfixtu're-'Replace (1)Ypaintedasprinkler 1.20 3/2/16 -';�. )ksIe,11B,.attor ner,ofwood'ceiling•—,Replace.(1)'.paintedSprinkle rhead. 1.20- 3/2/16 ®..� Deli,kitche'n,;prep.area,.overs nk= Replace (1) corroded sprinkler 1,20 3/2/16 ,'_ '0.`'Deli-kitchen;,prep-area;oversink—Replace(:1)incorrect.typespr.'inkler. 1.20 3/2/16_ ® (�`: Produce -cooler. --Replace (1)-outdated drypendentsprinkler 1.20° 3/2/1`6' :®" [� ' "`Deli:freezer-=Replace;1,) corroded.dry pendent Sprinkler 3/2/16 Q ®- B.titclier prep.area='Replace,(1)-missing,skirt - - '3 2/16 Q ` ®, Butcher;locker area -Replace (1):_mis5ing,escutcheona-kirt Check Here if additional Deficiencies and Comments are listed on Form AES 9 ❑ See Correction Form AES 10 for corrected deficiencies Number attached: 1 I Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jon -Said Signature` " -Date„5%17/20`16 . Form AES 2.2 k I `..� September 3, 2013 Automatic Sprinkler System stem Riser ID 1 Standpipe & Hose System Istem Riser ID Private Water Supply Systen Water Storage Tank Water Spray System em Riser ID Foam Water System ern Riser ID D = Deficiency C = Comment (Indicate type) item i �.ncies Comments allequipmentparindicate, were......repaired: ,replaced 1:28 - . ' 3/2/16 ; i . ❑ ®, W.ine,'a're•'a-lnstall (2) sprinklers �n decorative w,goda,ceiling:(existingsprinklers:are'too:,far off'wa11) " 3/ it Bakery ,,near•prep,a'rea7-;- nstallr(1)rvspripkler,(existingspr`irikler:is-to'ofarofFwallj 1.28 3/2/16 - 0 ®; ;Deli-.walk-Igcooler- Replace,(2) sprinklers'with�dry-pendentsprinklers,(urihea"ted area); ., . P t 'Dairy Coc, -.Replace (3) sprinkleers with d"ry;'pendeats,pe nklers` 1.28 13/2/16 ,0 ,:®,':`Frozen;storage—Replace,(3)spr"inklers,withdrypendentsprihklers.(unheated•area) . 1:28. 3/2/16 Shelving;oJerf"rozeristorage=l'ristalf(4-,5)spnnklers'('wood-shelfcreates obstruction`toSpray .- pattern) .. 1:28 3/2/16 ;I; : - cooler=Replace (3) sprinklers,with dry..pendent,"sprinklers,- 1.2& 3/.2/,16 ; []: `,'•® ' Seafood cooler=.Replace (8);sprinklers w.ith;.dry peridents,pr.'in'klers'(Uhheated'area) 1.28 3/_-/16 Q , ® Cold'prepcooler—Replace,(4)sprinklersWith drypendentsprinklers(unheated'area) 1.28 3/2/16 Produce, prep,& storage;�above employee lockers —'Install (1)'sprinkler.(existirigsprinkler-is:too-,far , off wall) 1.28 -3/2/16`, lJ'npro e.d(e'd trailer storage;2off loading -dock;- Recomrriend`'to,properly protect uriprotected`area " .per NFPA 13. Contact NBFD�for-requireM" e'r ts; 1:28 3/2/16 Unprotected;outdoor trash area, in southeast'corner- Recommend to=properly protect unp'rotected`area.per`NFPA 13. COntact,NBFD:for-re uirements. ri Form AES 9 September 3, 2013 I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jon, Saiia, Signature :=v Dafe.5/17/2016 Form AES 9 September 3, 2013 k ��'-^^.�(''� ��++ /^� Cosco Fire Protection .�®�... ` �sVJcO Fire Protection Cosco WO: 1603-0372 www.coscofire.com Corrective•California•. of • • of • Repairs Performed Inspection, Testing, and Maintenance Property Information of CSIAy Contractor or Licensed owner Information Building Name GELSONS 18 ' 9� Name COSCO-FTWPROTECTION .I Address 5521 ALTON PARKWAY, ;� Address aj`1075 W:LAIVIBERTRD BLDG..D jFflNE Ml�� city 'SREA. St. #CA Zip, City IRVINE License # ¢ 577420'., „ Phone 714 989=1800 Contact Person RICHARD KHOURY ❑ SFM Job# Phone 818.577=3340 CSLB C10/16V Misc. 5 YR..REPAIRS'FOUND •BY OTHERS D = Deficiency 2.1' C = Comment (Indicate Type) Date Date DeficienciesItem • • . Corrected Indicate all equipment,devices and parts that were repaired or replaced 2.2' 5/24/-16 REPLACED(2).C?UTDATED'DRY,SPWI—NK'ER:HEADS IN: BAKERY COOLER FREEZER 2.2 ' 5/24/16 REPLACED(T)•OUTDATEDDRY'SPRINKIiBRHEAD.IN'OURK-ITCHEN REPLACED ;(3,),I)RY PEIVDANT-HEADS IN MEAT PREP, AREA COOLER.AND` FREEZER 2.1 5/24/16 WUEOR` THEFOLLOIG DR'PNDNT.EASHAVEN`SPNTQT2.2 TESTING., -ONCE RESULTS ARE OBTAINED THEY WILL SENT TO CUSTOiVIER (1) OUR KITCHEN COOLER; "(i') PRODUCE AREA PREP COOLER AND: (1) WAREHOUSE FREEZER 2.1 2.2 5/24/16 REPLACED (1) LOAD -SP,RIN-K'LER;HEAD'ATSE'AFOOD COUNTER **NOTE: ' WITH A LIFT' WE WERBN'T'ABLE TO'LOCATED'-THE PAINTED -HEADS ,IN HALLWAY STORAGE BEHIND ,BEER`COOLER; SALES -P OOR SPECIAI:TY ; MEATS &CHEESES; ABOVE "AISLE',8,,OVERISIGN; ABOVE REGISTER,6 I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable. Building Representative Technician; 8 hawn,4136 to Signature _ :Date :Signature' _ Wun, Raymi From: Sent: To: Subject: Attachments: Follow Up Flag: Flag Status: Hello Raymi, Pamela Baker <pbaker@coscofire.com> Thursday, June 09, 2016 2:13 PM Wun, Raymi FW: Harbor View Center - Gelson's Market - 5-Year Fire Sprinkler Report (by others) and AES Correction Report by Cosco Fire Protection chid-01@newportbeachca.gov_20160519_101030_00008a2b001b.pdf AES_CORRECTION_REPORT.1605-0372-16.pdf Follow up Completed Attt Ch ed you will find the 5 yr. Sprinkler Report (performed by others) and Cosco Fire Protection AES Correction nRe ort. 'have advised the customer to forward our form to Property Mgmt. Once we get the results of the tested sprinkler // heads do you want to be notified? Again as per our conversation we didn't correct the code compliance issues as those defects would be changing the original design of the building. We correct the defects in order for certification of the 5 yr. sprinkler inspection. Should you have any questions or concerns please feel free to contact me. Thank you, Pamela Baker COSCO Fire Protection, Inc. e Life Safety Sale ccoLmt Representative 1075'W Bert Rd. Bldg. D Brea, CA 9282 714 989-1800 Ext. 112 289-1801 Fax From: Richard Khoury [mailto:rkhoury@gelsons.com] Sent: Friday, May 20, 2016 9:20 AM To: Pamela Baker Cc: Richard Khoury; Fred White Subject: Fwd: Harbor View Center - Gelson's Market - 5-Year Fire Sprinkler AES Report Pam, See below from the Newport fire department. Please get back to me. Thank you, Richard Khoury Director of Facilities Maintenance Gelson's Super Markets Cell: (818) 577-3340 Sent from my I Phone Wun, Raymi From: Pamela Baker <pbaker@coscofire.com> Sent: Tuesday, May 31, 2016 11:36 AM To: Wun, Raymi Subject: Gelsons Store 6 Newport Beach Drawing Attachments: Store 6 Fire Protection-Floor-Plaw.ladF------ l Hello Raymi. As per oGr conversation regarding the 5 yr. defects found by others. This is the only drawing that Gelson's could 'nd. It's sta�ed 1995, but there is no signoff from the Fire Dept. Again as per our conversation I have provided Gelson's with a repair proposal to only repair the defects that were f Iand by another company. All of the code compliance issues will not be repaired as they are existing as per original desi and shouldn't prevent the 5 yr. from being certified. Should you have any questions or need any more information from please contact me. Thank you, Pamela Baker OSCO Fire Protection, Inc. Firc ife Safety Sales A unit Representative 1075 W. Lain e --R Bldg. D Brea, CA 92821 714 989-1800 Ext. 112621 714 989-1S01 Fax From: Richard Khoury [ma iIto: rkhoury(@gelsons.com] Sent: Friday, May 27, 2016 12:54 PM To: Pamela Baker Subject: Store 6 Hi Pam, This is all I could find. See attached. Thank you, Richard Khoury Director of Facilities Maintenance Gelson's Markets Office: (818) 906-5713 Cell: (818) 577-3340 1 Wun, Raymi From: Sent: To: Subject: Attachments: Follow Up Flag: Due By: Flag Status: Good-no-r—ning Raymi, Pamela Baker <pbaker@coscofire.com> Friday, May 20, 2016 9:45 AM Wun, Raymi FW: Harbor View Center - Gelson's Market - 5-Year Fire Sprinkler AES Report chid-01@newportbeachca.gov_20160519_101030_00008a2b00lb.pdf, ATT00001.htm Follow Up Friday, May 20, 2016 10:11 AM Flagcled----' -f�5 My contact at Gelson's forward me your email. So all the items on page 2 (code compliance issues) need tole repaired too, before they can pass the 5 yr.? Please let me know as I'm a bit confused. \ Thank you, Pamela Baker COSCO Fire Protection, Inc. Fire Life Safety Sales Account Representative 4 7Q 5 W. Lambert Rd. Bldg. D Brea. A 92821 714 989-18Ct8-izsX-11262J 714 989-1801 Fax From: Richard Khoury Finailto:rkhoury(a)gelsons.com] Sent: Friday, May 20, 2016 9:20 AM To: Pamela Baker Cc: Richard Khoury; Fred White Subject: Fwd: Harbor View Center - Gelson's Market - 5-Year Fire Sprinkler AES Report Pam, See below from the Newport fire department. Please get back to me. Thank you, Richard Khoury Director of Facilities Maintenance Gelson's Super Markets Cell: (818) 577-3340 Sent from my I Phone Begin forwarded message: 1 Begin forwarded message: From: "Fred White" <FWhiteOgelsons.com> To: "Richard Khoury" <rkhoury gelsons.com> Subject: FW: Harbor View Center - Gelson's Market - 5-Year Fire Sprinkler AES Report FYI From: Wun, Raymi[mailto:RWun(a)newportbeachca.gov] Sent: Thursday, May 19, 2016 10:05 AM To: 'Jon Saia' Cc: Fred White Subject: RE: Harbor View Center - Gelson's Market - 5-Year Fire Sprinkler AES Report -f-Z-- Jon Saia, I am in receipt of the AES Failed 5 year certificate you sent via email. After reviewing the deficiencies noted in the AES report dated 5/17/16, 1 conducted a site visit to the Gelson's Market located at 1660 San Miguel Dr. in Newport Beach, California. During my visit, I was accompanied by Fred White, Store Director. Below are my findings: • All painted & corroded heads shall be replaced. • Areas within a walk in cooler (less than 40 degrees) require a freeze protection (dry pendent sprinkler). However, I was unable to verify the type of sprinkler that is currently installed in those areas. o If the existing fire sprinkler does not address freeze protection then a dry pipe or preaction system is required. o Most companies install a dry pendant sprinkler within those areas to satisfy the code requirement. o In Newport Beach, If there are 3 heads or more that need to be replaced, you shall have a properly licensed company submit 3 set of plans to the Newport Beach Building Counter for Fire Department review, approval and inspection of the proposed scope of work. Where it was noted the fire sprinklers are too far off the wall (Wine & Bakery prep area), I see a sprinkler in the soffit that would give coverage to that area. No changes needed. Where it was noted the wood shelf creates an obstruction. I agree. o The wood shelf would need to be less than 4 feet deep or o Have a properly licensed company provide properly spaced fire sprinklers under the wood shelf. Attached is the AES report that I received. I have highlighted the deficiencies that will need to be addressed. Thank you for the information. Please contact me if you have any questions regarding this matter. Raymi K. Wun Life Safety Specialist Newport Beach Fire Department 100 Civic Center Drive, California 92660 (949) 644-3110 From: )on Saia fmailtojsaia@firesafetyfirst.com] Sent: Tuesday, May 17, 2016 5:14 PM To: Wun, Raymi� Subject: Harbor View Center - Gelson's Market - 5-Year Fire Sprinkler AES Report Inspector Wun, Thank you for returning my call earlier. Please find the attached AES report, regarding the Gelson's Market at Harbor View Center. If you could clarify for us how Newport Beach Fire Dept would like us to handle these building modifications, it would be much appreciated. The new AES forms are asking for these items to be noted on the certification report per CFC 901.4. We see some of these unheated areas hitting 33' and refer back to NFPA 13 — 8.16.4.1 Protection of Piping Against Freezing: 8.16.4.1.1 Where any portion of a system is subject to freezing and the temperatures cannot be reliably maintained at or above 40°F, the system shall be installed as a dry pipe or preaction system. 8.16.4.1.1.1 The requirements of 8.16.4.1.1 shall not apply where alternate methods of freeze protection are provided in accordance with one of the methods described in 8.16.4.1.2 through 8.1 6.4.1.4.1 8.16.4.1.2 Unheated areas shall be permitted to be protected by anti -freeze systems or by other systems specifically listed for the purpose. Regarding the installation of sprinklers, we will defer to you, as they fall under the same notation of building modifications per CFC 901.4. Thank you for your consideration and help, Jon Saia Fire Safety First • Sprinkler Department 1170 E Fruit Street • Santa Ana, CA 92701 Office-L714) 836-4800 • Direct: (714) 263-2838 Wun, Raymi From: Wun, Raymi Sent: Thursday, May 19, 201610:05 AM �.- To: 'Jon Saia' Cc: 'fwhite@gelsons.com' Subject: RE: Harbor View Center - Gelson's Market - 5-Year Fire Sprinkler AES Report Attachments: chld-01@newportbeachca.gszti20.lZO-5-1-9=.1<0103X0�0008a2b001b.pdf Jon Saia, / \ I am in receipt of the AES F�jlecf 5 year certificate you sent via email. After reviewing the deficiencies �oted in the AES report dated 5/17/16, 1 eonducted a site visit to the Gelson's Market located at 1660 San Miguel Dr. in, Newport Beach, California. During myvisit, I was accompanied by Fred White, Store Director. Below are my findings: • All pal t�& corroded heads shall be replaced. • Areas within a walk in cooler (less than 40 degrees) require a freeze protection (dry penden sprinkler). ,6wever, I was unable to verify the type of sprinkler that is currently installed in those areas o If the existing fire sprinkler does not address freeze protection then a dry pipe or pre ction system is required. o Most companies install a dry pendant sprinkler within those areas to satisfy the code tle quirement. o In Newport Beach, If there are 3 heads or more that need to be replaced, you shall ha a properly licensed company submit 3 set of plans to the Newport Beach Building Counter for 1`4e Department review, approval and inspection of the proposed scope of work. • Where it was noted the fire sprinklers are too far off the wall (Wine & Bakery prep area), I sL a sprinkler in the soffit that would give coverage to that area. No changes needed. • Where it was noted the wood shelf creates an obstruction. I agree. o The wood shelf would need to be less than 4 feet deep or o Have a properly licensed company provide properly spaced fire sprinklers/nderewood shelf. A,tached is the AES report that I received. I have highlighted the deficiencies that wv rneed to be addressed. Thank you fo the information. Please contact me if you have any questions regarding this atter. Rayfrni K. Wun Life Safety Sp ciadist Newport Beach Fire "a-r-tment______--- 100 Civic Center Drive, California 92660 (949) 644-3110 From: Jon Saia fmailto:jsaia(aOfiresafetyfirst.com] Sent: Tuesday, May 17, 2016 5:14 PM To: Wun, Raymi GELS®N'S THE ,,�fy MARKET F / Acelebration ^everya,sle: Subject: Harbor View Center - Gelson's Market - 5-Year Fire Sprinkler AES Report FRED WHITE Store Director 1660 San Miguel Drive Newport Beach, CA 92660-7124 p: (949) 644-8660 p: (818) 906-5798 f: (949) 759-1621 fwhite@gelsons.com www.gelsons.com 1 Inspector Wun, Thank you for returning my call earlier. Please find the attached AES report, regarding the Gelson's Market at Harbor View Center. If you could clarify for us how Newport Beach Fire Dept would like us to handle these building modifications, it would be much appreciated. The new AES forms are asking for these items to be noted on the certification report per CFC 901.4. We see some of these unheated areas hitting 330 and refer back to NFPA 13 — 8.16.4.1 Protection of Piping Against Freezing: 8.16.4.1.1 Where any portion of a system is subject to freezing and the temperatures cannot be reliably maintained at or above 40°F, the system shall be installed as a dry pipe or preaction system. 8.16.4.1.1.1 The requirements of 8.16.4.1.1 shall not apply where alternate methods of freeze protection are provided in accordance with one of the methods described in 8.16.4.1.2 through 8.16.4.1.4.1 8.16.4.1.2 Unheated areas shall be permitted to be protected by anti -freeze systems or by other systems specifically listed for the purpose. Regarding the installation of sprinklers, we will defer to you, as they fall under the same notation of building modifications per CFC 901.4. Thank you for your consideration and help, Jon Saia Fire Safety First • Sprinkler Department 1170 E Fruit Street • Santa Ana, CA 92701 Office: (714) 836-4800 • Direct: (714) 263-2838 Wun, Raymi From: Jon Saia <jsaia@firesafetyfirst.com> Sent: Tuesday, May 17, 2016 5:14 PM To: Wun, Raymi Subject: Harbor View Center - Gelson's Market=-5=Y`ear Fire rinkler AES Report Attachments: SanMiguel_1640x1660_AES Reports - Failed.pdf Inspector Wun; Thankeiew r returning my call earlier. Please find the attached AES report, regarding the Gelson Market at HarbCenter. If you could clarify for us'how Newport Beach Fire Dept would like us to hand these bui ing modifications, it would be much appreciated. The new AES forms are asking for these item to be n ted on the certification report per CFC 901.4. We see some of these unh?ated areas hitting 330 a d refer ,back to NFPA 13 - 8.16.4.1 Protection of Piping Against Freezing: 8.16.4.1.1 Where any portion of a system is subject to freezing and the temperatures cannot be reli bly maintained at or above 40°F, the system shall be installed as a dry pipe or preaction system. 8.16.4.1.1.1 The requirements of 8.16.4.1.1 shall not apply where alternate methods of freeze pro ction are provided in accordance with one of the methods described in 8.16.4.1.2 through 8.16.4.1.4.1 8.16.4.1.2 Unheated areas shall be permitted to be protected by anti -freeze systems or by other ystems specifically listed for the purpose. Regarding the installation of sprinklers, we will defer to you, as they fall under the same n ation of building `modifications per CFC 901.4. you for your consideration and help, Jon Saia Fire Safety First - 1170 E Fruit Street • Santa Ana, CA 92701 Office: (714) 836-4800 • Direct: (714) 263-2838 660 4,q-),j - _ 3 r _"`, i �- __.__... _ w .�+ � e 'STATE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST See instructions on reverse. AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM Department of Social Services (916) 651-7901 2/24/2016 Adult and Senior Care EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Bethany Hunter 306005215 1A ¢erSIVED ak CODES COMMUNITY 1. ORIGINAL A. FIRE CLEARANCE 1. LICENSING I Community Care Licensing Division RENEWAL B. LIFE SAFETY AGENCY Centralized Applications Unit 3. CAPACITY CHANGE NAME AND 744 P Street MS 8-3-91 MAR 0 3 zQ 16 ADDRESS Sacramento, CA 95814 4. OWNERSHIP CHANGE Fax (910) 651-7916 5. ADDRESS CHANGE DEVELOPMENT �� s. NAME CHANGE OA- Af1jwp0Vk1 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 9 88 7 0 97 FACILITY NAME LICENSE CATEGORY Crown Cove RCFE STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 3901 East Coast llighway ' 1 CITY RESTRAINT Corona del Mar, CA 92625 N/A FACILITY CONTACT PERSONS NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Jared Mikos (949)760-2800 24/7 SPECIAL CONDITIONS TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCElD 1ALCODE del Mar CODES 1. FIRE CLEARANCE GRANTED City of Corona FIRE Fire Department Station N•5 AUTHORITY 4i0Marigold Avenue 2. FIRE CLEARANCE DENIED NAME AND ADDRESS Corona del Mar, CA 92625 A. EXITS Phone (949) 644-3104 S. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS qL/q.iv J,1-A!�rD 3D0,S,j • F. SPECIAL HAZARD G. OTHER INSPECTION DATE INSPECTOR'S SIGNATURE (Typed or Printed) EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS FAC i L, t 'r -/ U PV YL," 0 0S RE VE A toki k-) C-b S -"A-0 7 ?1 2C C. L C A-vz Am) C C C-i RA- 0T-t:-N�� 0 1,3 a--�0 0 "? , 1� �� 15 �� Lu c- -r o 1. t C��J � � f' T lYlf!?Clclm'ly Af. L GC++ii Y JANI I OR ti LAUtrL7;i y._. i CON ACTi'vf 1tt� —.� Cn'Z- . CROWN COVE i' �ARKE iiNG --�s lli fi7i ' Y� CROWN COVL4 IAIR 'JLAN \ UV4 -LC� UNIT 17 NIT , F. t, err UNIT RE! fiIJ Uhiii ;.L - -JAN i 61 'ONY . u qrr a Uh fi 4� T; 37 { Q7i{ UN T 4d r UNIT bt t2 }ii _ t �p�;;tIOQR CROWN COVE ocff„w I zo3 i CROW CO A'f's1C AREA GO LL,5 G5t C? C STAIR PLAT 9 O 1,-�L21 �Lva�l . l In CROWN COVE v5t� STAIR Fire Safety First December 16, 2015 Barbara Lakin CRYSTAL COVE CLUBHOUSE c/o Keystone Pacific 16845 Von Karman, Suite 200 Irvine, CA 92606 Re: Title 19, 5-Year, Reports and Repair Quotation Crystal Cove Community Association Dear Barbara: 0 I would like to thank you for giving Fire Safety First the opportunity to complete the Title 19, 5-Year Certification of the fire sprinkler system(s). The final testing and repairs have now been completed and a certification tag has been affixed to the standpipe. Enclosed is a copy of the Title 19 Certification Report. Please keep this report in a secure place with your building safety documentation for a minimum of 5 Years. You will likely be asked to present the report to the fire department and your insurance company. If you should have any questions please feel free to call me at (714) 836-4800, ext. 139. Sincerely, Brandon Bridgford FIRE SAFETY FIRST C 10/C 16/C36-599761 JAWPDOCS\Sprinkler Department\Sprinkler\00_Keystone Pacific\Crystal Cove Clubhouse 2\2015\ReefPoint 22828_SYrCertLtr 121615.doc Inspection, Testing, and Maintenance Cover Sheet Page 1 of 1 NFPA 25 as amended by CCR, Title 19 Property Information: Name: Crystal Cove Clubhouse Occupancy/Use: A-3 f CA,./p Address: 22828 Reef Pointe Construction Type ILI- �o v City: Newport Beach No. Stories: 1 e MPS Zip: Year C str ted: 2005 Contact: Barbara Lakin Telephone: 949-376-4551 Ext.- 230/" Contractor Information: 4 No. of System ' rs Name: Fire Safety First Copy sent to: ❑ Owner Date: Address: 1170 E. Fruit Street ❑ Fire/AHJ Date: City: Santa Ana ❑ Contractor Date: State: California ZIP: 92701 Contact: Brandon Bridgford NOTES: 1) For specific inspection, testing, and Telephone: (714) 836-4800 ext: maintenance requirements and information, see NFPA 25, 2002 Edition as amended by California CA License: C16-599761 Code of Regulations, Title 19, §901 to §906. Job #: 2) Inspection Items may be performed by the Owner in accordance with California Code of Performed By: Brandon Bridgford (Print) Regulations Title 19 §904.1(a). Forms Included With This Report NFPA 25 Chapter Number of Forms N/A FAIL * PASS ® Automatic Sprinkler System 5 4 X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form. State Fire Marshal AES 1 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 1 System Riser ID: Pavillion #1 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Main Drain Test Results: Initial Static Pressure: 155 (PSI) Residual Pressure: 110 (PSI) Restored Static Pressure: 155 (PSI) Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Abbreviation Key: I = Inspection T =Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1' X 1.10 1 Quarterly Spare Sprinklers 5.2.1%3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually I Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #1 Type Of System: 9At/ ® Wet Pipe OF Fo�2 ❑ Dry Pipe co 9 ❑ Preaction c� Q ❑ Deluge ARE' MP Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3A X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #1 Type Of System: F c,a °� ® Wet Pipe Q ❑ Dry Pipe ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #1 Type Of System: Of SAL/,, ® Wet Pipe op2� ❑ Dry Pipe F ❑ Preaction u� q�F,� ❑ Deluge /RE MP� State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 I System Riser ID: Pavillion #2 Property Information: Type Of System: OF CAt/p Name: Crystal Cove Clubhouse ® Wet Pipe t 0 ❑ Dry Pipe Address: 22828 Reef Point ❑ Preaction ❑ Deluge ��Fq- /RE MP A City: Newport Beach Main Drain Test Results: Abbreviation Key: Initial Static Pressure: 155 (PSI) I = Inspection T =Test Residual Pressure: 110 (PSI) M = Maintenance A-O = After Operation Restored Static Pressure: 155 (PSI) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 12 1 Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 I Quarterly Control Valves 12.3.2.1 X 1.5 I Quarterly Alarm Devices 5.2.6 X 1.6 I Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 I Quarterly Hydraulic Nameplate 5.2.7 X 1.8 I Quarterly Pipe and Fittings 5.2.2 X 1.9 I Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 I Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 I Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 I Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 I Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 I Quarterly Backflow Preventers 12.6.1 X 1.17 I Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #2 Type Of System: o F Gq tr,�Q�2' ® Wet Pipe - Q ❑ Dry Pipe ❑ Preaction ct� q��FiR� ❑ Deluge MPS Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 6.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #2 Type Of System: of CALF ® Wet Pipe ❑ Dry Pipe � t ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25, Chapter 5 as amended by_CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #2 Type Of System: `'� F Cq ® Wet Pipe ° �C. ❑ Dry Pipe CID ❑ Preaction ❑ Deluge�F ARE MPS State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 I System Riser ID: Pool Property Information: Type Of System: F CA Name: Crystal Cove Clubhouse ® Wet Pipe Q o [i,�o� Address: 22828 Reef Point ❑ Dry Pipe co 7 ❑ Preaction 4 ❑ Deluge ��F/Re City: Newport Beach Main Drain Test Results: Initial Static Pressure: 155 (PSI) Residual Pressure: 110 (PSI) Restored Static Pressure: 155 (PSI) Abbreviation Key: I = Inspection T =Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item ActivityFrequency q uency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2X 5.2.4.3 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually I Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pool Type of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Description NFPA 25 Reference Fail N/A Pass Item Activity Frequency Hangers 5.2.3 X 1.18 1 Annually Seismic Bracing 5.2.3 X 1.19 1 Annually Hangers (Accessible concealed spaces) 5.2.3.3 X 1.20 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.21 I 5-Years 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.23 I 5 .Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.24 I 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.25 I 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.26 I 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.27 I 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.28 I 5-Years 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 1.30 1 5-Years Alarm Devices (90 seconds) 5.3.3 12 2.7 X 2.1 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.2 T Annually Antifreeze Test 5.3.4 X 2.3 T Annually Control Valve - Position 12.3.3.1 X 2.4 T Annually Control Valve - Operation 12.3.3.1 X 2.5 T Annually 2.6 T Annually Supervisory 12.3.3.5 X Preaction Valve — Priming Water 12.4.3.2.1 X 2.7 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.8 T Annually 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 1 System Riser ID: Pool Property Information: Type Of System: F Cq Name: Crystal Cove Clubhouse ® Wet Pipe � Address: 22828 Reef Point El Dry Pipe ❑ Preaction �� u ❑ Deluge FFioM .o.� City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Main Drain Test Results: Initial Static Pressure: 155 (PSI) Residual Pressure: 110 (PSI) Restored Static Pressure: 155 (PSI) System Riser ID: Clubhouse Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Abbreviation Key: I = Inspection T =Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1. 77 1 Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Clubhouse Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 1.2.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually TPreaction Valve — Full Flow Trip Test 12.4.3.2.2 T X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Clubhouse Type Of System: °�- Cq ® Wet Pipe �1 1 ❑ Dry Pipe c ❑ Preaction u ❑ Deluge OFF e MPS` Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Clubhouse Type Of System: cqWet Piperr" GoDry Pipe1�'L ❑ Preaction �Z��p ❑ Deluge State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System 'Page 4 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 12/16/2015 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach State Fire Marshal AES 2 System Riser ID: Pool Type Of System: F Cq ® Wet Pipe �`� �'" ' C ❑ Dry Pipe ❑ Preaction y ❑ Deluge qF � /RE MP�c March 21, 2006 Fire FIRE SPRINKLER & STANDPIPE INSPECTION REPORT Safety ❑ Monthly ❑ Quarterly First ❑ Annual ® 5-Year Building #: Clubhouse, Pool, Project Name: Crystal Cove Canyon Club Pay. #l, Pay. #2 Address: 22828 Reef Point Drive City/State/Zip: Newport Coast, CA Riser #: 1-4 FAutomatic Fire Dry Pipe ❑ ❑ Combination Fire ❑ Standpipe Class ❑ Preaction System s Sprinkler System Sprinkler System Sprinkler System ❑ Wet ❑ Dry ❑ Deluge System YES NO N/A N/[ Are all FDC connections in satisfactory condition? (No leaks, check valves tight, threads not damaged, caps in Fire ® ❑ ❑ ❑ 1' place, couplings swivel freely, gaskets in place and undamaged) Department Z ❑ ❑ ❑ 2. Is the FDC painted red and correctly identified? Connection Z ❑ ❑ ❑ 3. Is there 36" access and clearance around the FDC & are outlets 18" to 48" above the adjacent grade? Z ❑ ❑ ❑ 1. Are all sprinkler system control valves open? Z ❑ ❑ ❑ 2 Are all other control valves open? (Main, Sectionals and Standpipe Controls) Control Z ❑ ❑ ❑ 3. Are all control valves in good condition, operate freely, locked open and/or supervised? Valves Z ❑ ❑ ❑ 4. Are all control valves unobstructed, accessible and properly identified? Z ❑ ❑ ❑ 5. Is sight glass in good condition and are "open/shut" indicators properly aligned in sight glass? Z ❑ ❑ ❑ 1. Are pipe hangers and earthquake sway bracing adequately secured? Piping Z ❑ ❑ ❑ 2. Is piping and fittings in good condition, not corroded, damaged or leaking? Z ❑ ❑ ❑ 1. Are all pressure gauges in good condition and showing normal supply pressures? Z ❑ ❑ ❑ 2. Is there 36" access and clearance around fire sprinkler riser? Riser Z ❑ ❑ ❑ 3. Is the Fire Sprinkler Alarm Bell working properly, free from leaks and correctly identified? Z ❑ ❑ ❑ 4. Is the spare head box correctly stocked with extra sprinkler heads and wrenches? Z ❑ ❑ ❑ 5 Is the main drain test satisfactory? Z ❑ ❑ ❑ 1. Are all sprinkler heads in good condition? No evidence of leaks, un-obstructed & free of corrosion and paint? Sprinklers Z ❑ ❑ ❑ 2. Are all cover -plates, escutcheons and/or skirts in place and in good condition? Z ❑ ❑ ❑ 3. Is all stock and storage maintained at least 18" below sprinkler heads? ❑ ❑ Z ❑ 1. Are hoses in good condition, lined, within current test date, and gaskets in place? l %2" Fire ❑ ❑ ® ❑ 2 Are correct nozzles provided, in good condition and gaskets in place? Hose ❑ ❑ Z ❑ 3. Are cabinets and stations in good condition with the hoses properly racked? Stations ❑ ❑ Z ❑ 4 Is there 36" access and clearance around fire hose stations? ❑ ❑ Z ❑ 5. Are all fire hose valves, piping, hangers and brackets in good condition and free from leaks? 2 ``/W' Outlet ❑ ❑ Z ❑ 1. Are all valve outlets in good condition, free of leaks, with caps, gaskets and hand -wheels in place? Valves ❑ ❑ Z ❑ 2. Are valves closed, unobstructed, and is piping, hangers and brackets in good condition? ❑ ❑ Z ❑ 1. Are all hydrant stems, threads, caps and paint in satisfactory condition? ❑ ❑ Z ❑ 2. Were hydrants flushed & all outlets on each hydrant fully opened & closed to insure smooth operation? Private ❑ ❑ ® ❑ 3. Are hydrants painted the proper color per local jurisdiction requirements? Fire ❑ ❑ Z ❑ 4. Are all hydrant roadway/shut-off valve covers visible, undamaged & painted red? Hydrants ❑ ❑ Z ❑ 5 Are blue dot reflectors visible and in good condition? ❑ ❑ Z ❑ 6. Is there 36" access and clearance around all fire hydrants and are outlets 14" to 24" above grade? ❑ ❑ Z ❑ 7. Are all necessary crash posts painted and in good condition? YES I Com onent in good condition I NO I Com onent needs repair or replacement N/A No.Com orient,ih Place N/1 ; -Not Inspected at.this time Riser PSI Readings Main Drain Test Results (Annual Only) ❑ Common Area Inspection only El See Deficiency Report dated for all "NO" answers. Riser Supply System Static Residual Restored Club - 155 155 110 155 House NOTES: Pool 159 159 140 159 Building PV #1 - 158 158 140 158 PV #2 - 158 158 140 158 Inspection & Testing Performed By. B. Bridgford, K. Saia Inspection Date: 12/16/20t5 J:\WPDOCS\Sprinkler Department\Sprinkler\00_Keystone Pacific\Crystal Cove Clubhouse 2\2015\ReefPoint_22828_SpkCheckoff 121615.docx Safety Fire Alarm Inspection and Test Fircf � 'CUSTOMER�NAME . :PEST:.D'A.TE'.`::': _ _T,ESTINGnINTERVAL' _ 1 Keystone Pacific 12/1612016 ❑ Monthly ❑ Quarterly ❑ Semi -An ® Annual _ - .^JOB•SITE;NAME;'.. '`_ _ 'T �,-t::._c.-_..,: a."•.. is-. ...•. ,.. a.s ... s.. ._ .._..., .__ ., _ `" '=° '" `•CONTAGT NAMES:;; - ..• ._,.,. ,., .., •, _....• .... a_.. u ..:.�.:. Crystal Cove Community Association — Club House Barbara Lakin 22828 Reef Point Dr., Newport Coast, CA 92657 (949) 833-0919 CONTROL:P,ANEL.=•r MODEL. LOCATION.OFFIREAL--A WcON,TROLiPANEL,;,;'.•;"°;: MISC€INFORMATION MA'' F. - n Radionics 7412G Barbara Lakin's Office ";'CIRCUIT'BREAKER LOCATION-": :'-:`:=: ".- >- `; :;` - ' PANEL` # '- .;' = : -; BREAKER',#"-- L'"OCKED'CIRC,UIT„' :;DEDICATEDCIRCCIIT. Banquet Hall Electrical Room SL 15 ❑ Yes ® No ® Yes ❑ No " T LL. •; , BATTERY INS A :• . = ._.. •, :.�: ,-.>_� . VOLTAGE_i c' ;-'13A7TERYI QUAN7ITY;SIZE;;&TYPE_`, ` _ • ,_•_ .. •,,:s:..;.:.-•. ...::" •. _.".7..•. ..... -._... .... ., <-_._. 04/2009 With Charger:..;•..a_:",-•_. 13.8 Voltage After Test: N/A ❑ 12.2 4 12V x 7AH Without Charger: 12.5 Note #: GENERAL, ... ; {' ,_ .. .;,_ ., ::, ZONE TROUBLE:' =,. A!C'•LOS$ -`,' , ; - ,.: ;. 4'GRO UND-FAULT' - EMERG:>GENERATOR TROUBLE TROUBLE' _ _ Normal: ® Normal: ® Normal: ® Normal: ® Normal: ElN/A CONDITIONS . Note #: Note #: Note #: Note #: Note #: ;';;MONITORING COMPANY-, ;:`.' " .`> : u'::„PHONE,': : %: _'.•`::-:ACCOUNT `;, °", NMC % Fire Safety First (800) 259-0047 L30-1414 (949) 376-4937 1 (949) 376-4903 DEVICE Bldg ❑ Pool House Cab. 1 Cab. 2 Club Hse Fit. Rm. Lib' Ct. Yd. Stor. Rm.1 Stor. Rm.2 Office Notes Area ® Floor ❑ Manual Pull Stations 5 1 1 1 1 1 Thermal Detectors Photo Detectors 2 1 1 Ion Detectors Duct Detectors Plenum Detectors Elevator Recall Special Detectors Water Flow 4 1 1 1 1 Water Flow Switch Size 2'Y2' 1" 1" 2'/" Water Flow Times 45 Sec 42 Sec 48 Sec 38 Sec Tamper Supervision 2 PIV/BFP 1 Bells 4 1 1 1 1 Strobes Horns Horns/Strobes 8 1 1 1 1 1 2 1 Speakers/Strobes Speakers Sounders Aux. Power Supply Amplifiers Fire Phones Pre/Action System Halon FM200 System Annunciator 1 1 Completed By: B. Bridgford, K. Saia ( Date: 12/16/2015 # 1538903 Fire Safety First-1170 E. Fruit Street, Santa Ana, CA 92701- (714)836-4800- J.\WPDOCS\Sprinkler Department\Sprinkler\00_Keystone Pacific\Crystal Cove Clubhouse 2\2015\ReetPoint 22828_SpkAlannInspection 121615.doc FU'@ Page 1 of 1 Safety FIRE PROTECTION INSPECTION First `t DEFICIENCY REPORT Customer: Crystal Cove Clubhouse Date: December 16, 2015 Location: 22828 Reef Point, Newport Coast Type: 5 Year (4th Quarter) ITEM # EXPLANATION OF DEFICIENCIES * I No deficiencies found at this inspection FIRE SAFETY FIRST • 1170 E. FRUIT ST. * SANTA ANA • CA • 92701 • (714) 836-4800 • (714) 836-4120 FAX J:\WPDOCS\Sprinkler Department\Sprinkler\00_Keystone Pacific\Crystal Cove Clubhouse 2\2015\ReefPoint_22828_Spk5YrDef 121615.doc CITY OF NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT LIFE SAFETY SERVICES 100 Civic Center Drive l P.O. Box 1768 { Newport Beach, CA 92658-8915 www.newportbeachca.gov l (949) 644-3200 j FAX (949) 644-3250 Application for DEPART ME I TEMPORARY PERMIT TO OPERATE LII1. SAFETY SER"V S THIS I",IRE PAP . �b HAS CANDLES & OPEN FLAMES j ,�� IN ASSEMBLY AREAS layi • W 1�iQt-- ,. 9. , Business Name; Applicant Name: AAddress. ddress:,. Contact Name: Email: l Email: Contact Phone: Y.3 02, Contact one: Event Name: 1�l Event Address: `k Event Date: Event Time: �j . j No of Attendees: p Candles & open Flames in Assembly Areas Quanta of candies ► Arrangements to be secured together as one unit, trim wicks to reduce flame height and ensure approved conditions are followed. g546.00 - Candies (includes first time and special event} p Special Conditions of Permit Apply, **(See conditions below and attached photograph) invoice No: FS500 Revenue Account: 01040402-521210 [2330-50541 Undl 613012016 Rates changed per new Master Pee Schedule adopted by Resoiutton NO.2015.76 on September 2Y, 201& Note: Effective Temporary Pennits to Operate Candles and Open Flames in Assembly Areas are not -transferable. if business.is sold, or ff quanWes or processes change, a new permit is required. Apecial Condidons: ** All wicks must be cut low. Water level 3 inches from top of all vase f containers All vases I containers must be secured on flat,surfaces with double back tape or glue F:�as,�s«wca�«,�r� � d�oaw�- ss,.aw+ iw.n� to�atxa ral Scanned by CamScanner q4- ALL WICKS MUST BE CUT LOW • WATER LEVEL MUST BE 3" FROM TOP OF CONTAINER • CONTAINERS MUST BE SECURED ON FLAT SURFACE WITH DOUBLE -SIDED TAPE OR GLUE/MUSEUM WAX ,,IEINPORT BEACH FIRE OEPAMMENT LIFE SAFETY VED SERVICES APPRON THIS FIRE PE IT OAS :f B DATE: ' 03" Oh t R• t e APPLICATION FOR TEMPORARY PERMIT TO OPERATE FIRE DEPARTMENT Newport Beach Fire Department Life Safety Services 100 Civic Center Drive, Newport Beach, CA 92660 (949) 644-3106 Fax (949) 644.3120 Perm vis Business Name: Applicant Name: C Phone: Address: 6_Cb_-4 ` Email: Email: G Contact Name: Contact Name: Val 0 C O Event Name: Event Address: q Oct Event Date: Event Time: j�/1/1 No of Attendees: 12 Q -- ) DO SPECIAL EVENT PERMIT INFORMATION applies(A site plan is required for all permits, except candle permits. Fee . each individual.. ❑ Tents and Membrane Structures Size of tent(s) In excess of 400 sq ft with sides or 700 sq ft without sides Site plan required to include the following: ► Square Footage of canopy, tent or membrane structure ► Number of Tent Walls No. Location of Exits (include size, type, etc.) ► Location of Fire Extinguishers (minimum 2-A: 10- B:C) with current service tag ► "No Smoking" signs ► Diagram for interior including location of chairs, tables, merchandise ► Occupant load for event. Use 15 square feet per person for events with tables and chairs. Use seven square feet per person for events without tables and chairs. An approved occupant load will be listed as a requirement of permit when issued. ❑ Liquefied Petroleum Gas (LP -gas) Size of tanks) Quantity of tanks ► Site plan required showing location of cooking or heating equipment and structures No. Weeds, grass, brush, trash, and other combustible materials shall be kept a minimum of 10 feet from LP -gas tanks ❑ Liquid or Gas -Fueled Vehicles or Equipment in Assembly Buildings Quantity of vehicles ► Diagram required of interior including location of chairs, tables, vehicles and location of exits. Xcandles & Open Flames in Assembly Areas Quantity of candles 7 D ► Arrangements to be secured together as one unit, trim wicks to reduce flame height and ensure conditions are followed. ❑ Other (specifySPECIAL EVENT FEES 46.00 - Candles (includes first time and special event) ❑ $142.00 - Per Individual Permit as marked above, (inspection fee included if during weekday normal business hours). ❑ $159.00 — Inspection during contiguous normal business hours (1 hour minimum): Ins ection durin non -continuous normal business hours, weekend or holida , 2 hour minimum FIRE ADMINISTRATION ONLY ❑ Special Conditions of Permit Apply, **(See Attached) Invoice No: FS5400 Customer No: Rates changed per new Master Fee Schedule adopted by Resolution No. 2015-76 on September 22, 2015. Note: Effective Fire Permits are not transferable. If business sold, or if quantities or processes change, a new Permit is required. F: LLifeSafetyServiceslForms/Application for Temp Permit - Special Event (09-22-15) '°iddf7� �'ly"Y,H"'+';,;:.<: +': £ aa'"�,� �,p•y:r!t� ». .,� r, r,.�; •. 'i°r�„"�.,dsa RS Cc- o S#_".a lb S- { lac 'fit Inc. i^ ;�'r,fi� •...:e„y: T � - ,. FEE}". `'3? �"�4r• h,;,<T' ..ec• -.. -, ^"�_ w �� s'�r`' i ga+.-.• LEA/ L N t tOM1(I aOP+OEAXWVA,5ES/CONTAINERS " t `p er µWATER yALLVASES/GCINTf/A MUST E SEC +RED UN E4A1' �NINERS •..�:� SURFACE �'wx:�r-,,,� WITHDOUBLE ��AC��,PEyC?RG", 11'E NEWPORT BEACH COMMUNITY DEVELOPMENT DEPARTMENT Payment Receipt Date Temporary Candle Permit Fee Payment Method Account # Received By a14Z L -�— 0105043-521210 &--'rim. FIRE PROTECTION EQUIPMENT PERFORMANCE CERTIFICATION CITY OF NEWPORT BEACH FIRE DEPARTMENT HRS. 3 RESPONSIBLE PARTY INITIAL TEST ® RETEST ❑ PAGE 1 OF 7 TO: (Name) TITLE: FIRM OR D.B.A.: JERWY MCMILLAN REGIONAL FACILITY MANAGER NEIMAN MARCUS — FASHION ISLAND MAILING ADDRESS: (Street) (City) (State) (Zip) PHONE: 601 NEWPORT CENTER DRIVE NEWPORT BEACH CA 92660 (949) 467-3313 TEST SITE ADDRESS: (Street) (City) (State) (Zip) TEST SITE PHONE: 601 NEWPORT CENTER DRIVE NEWPORT BEACH CA 92660 (949) 467-3313 OCCUPANCY TYPE NUMBER OF STORIES YEAR BUILT CONSTRUCTION TYPE: SQUARE FOOTAGE: COMMERCIAL 3 + 1 SUBS TYPE-II 40,000 + INITIAL TEST DATE(S) OF TESTING PHONE: 10/05/15 f, -- ® a f ® 818 249 - 2539 ADDRESS OF TESTING AGENCY: (Street),(City) (State) (Zip) 2505 FOOTHILL BLVD,.'SUITE .B , ,-LA.,CRESCENTA-. CA - - '912-14: EQUIPMENT TESTED.AND DESCRIPTION""' .,'.CERTIFIED,' 1 FIRE ALARM SYSTEM . YES 2 CENTRAL STATION MONITORING YES_M' NOQ, NOTEWORTHY CHARACTERISTICS, PROCEDURES PERFORMED, AND DEFECTS FOUND IN EQUIPMENT TESTED IF NONE, SO NOTE PLEASE SEE ATTACHED PAPERWORK ® ADDITIONAL INFORMATION ON ATTACHED SHEET I hereby certify that the fire protection equipment listed above has been fully tested in accordance with the State of California's Fire Code and that the results are accurately listed above. To the best of my knowledge the equipment is fully operable except as noted. TESTER'SNAME(Printed)•&-NAME _ TESTER'S'SIGNAT.URE , FIRE-DEPARTMENT:WITNESS: (5ighafut6.&Atsighmehty " ARBI AOHAYANI, - R4285 NOT WITNESSED REPAIR AND RETEST: If defects are found in equipment tested, correction on such defects shall commence FORTHWITH and shall be completed as soon as possible, but in every case within 30 days of initial test. At the completion of repair, the system or device shall be re -tested as necessary to determine that it is fully operable: RETEST IF NEEDED DATE OF RETEST: TESTING AGENCY: PHONE: ADDRESS OF TESTING AGENCY: EQUIPMENT RE -TESTED AND DESCRIPTION: I hereby certify that all necessary maintenance and repairs have been made to the equipment listed above in compliance with the State of California Fire Code and the equipment is fully operable. TESTER'S NAME & CERT. # TESTER'S SIGNATURE FIRE DEPARTMENT WITNESS: (Signature & assignment) ACKNOWLEDGMENTS F- 40.R-4 IS TO BE RETURNED-WITHIN'7 D'AYS T0; FIRE DEP..ARTMENT;NOTIFICATION._(2 FULL WORKING DAYS NOTICE)- CITY.OF NEWPORT BEACH FIRE, PREVENTION' NEWPOR'T, BEACHI_FIRE PREVENTION' _ (INSPECTOR), (ASSIGNMENT)- (NAME) (ASSIGNMENT) (DATE)- F CITY -OF BEVERLY HILLS FIRE DEPARTMENT FIRE PROTECTION EQUIPMENT PERFORMANCE CERTIFICATION TESTING AGENCY:. TEST SITE ADDRESS: 601 NEWPORT CENTER DRIVE, NEWPORT BEACH, CA 92660 FIRM OR D.B.A.: NEIMAN MARCUS -FASHION ISLAND DATE OF TEST: 10/05/15 ? EQUIPMENT TESTED: FIRE ALARM & CENTRAL STATION MONITORING SYSTEMS F111 ' /' • This building is a three-story Department Store with one sub -level basement. For the purpose of this report, the floor arrangement for this building will be as follows: Roof, 3, 2, 1 and B. FIRE ALARM SYSTEM The Fire Alarm Control Panel in this building is a FIRE-LITE MODEL MS9200 panel which is located on the 1" floor inside the Electrical Room. Fire alarm initiating devices consist of duct detectors, heat detectors, area smoke detectors, elevator recall smoke detectors, manual pull stations and sprinkler riser water flow switches. The means of audibility in this building are strobe/horns and strobes. FIRE ALARM SYSTEM TEST PROCEDURES A) The test was conducted in accordance with NFPA-72 Fire Codes and Procedures. B) All devices were tested for activation, original sequence of operation, and all auxiliary functions if applicable. C) All notification devices were tested for proper operation, audibility and/or visibility. D) Both notifying and initiating devices were tested for supervision on the basis of one device per floor/zone. TESTERS NAME & CERTIFICATE # 'EXPIRATION. DATE TESTERS=SIGNAT.URE ARBI AGHAYANI - R4285 04/30/16 # NAME AND ADDRESS OF TESTING AGENCY N.I.C. PROTECTION INC. 2505 FOOTHILL BLVD; SUITE B, LA.CRES.CENTA, CA 91214t, PAGE 2 OF 7 CITY OF BEVERLY HILLS. FIRE DEPARTMENT FIRE PROTECTION EQUIPMENT PERFORMANCE CERTIFICATION i TESTING AGENCY: TEST SITE ADDRESS: 601 NEHPORT CENTER DRIVE, NEUPORT BEACH, CA 92660 FIRIM OR D.B.A.: NEIMAN MARCUS —FASHION ISLAND DATE OF TEST: 10/05/15 EQUIPIMENT TESTED: FIRE ALARM & CENTRAL STATION MONITORINO SYSTEMS - FIRE ALARM SYSTEM SEQUENCE OF OPERATION TYPE OF ACTIVATE ANNUNCIATE ,RECALL. A/C DEVICE AUDIO 'FAAP .ELEVATOR SHUT -DOWN DUCT' YES YES NO YES DETECTOR 9REA,SMOKE YES YES NO YES DETECTORS ' -MAN. PULE_ YES YES NO YES STATION FLOW YES YES NO YES SWITCH - HEAT YES YES NO YES DETECTOR ELEV. LOBBY YES YES YES YES SMOKE DET. FIRE ALARM SUPERVISION VERIFICATION VERIFICATION OF: RESULT, COlVIlVIBNTS ' Alarm Panel Ground Fault OK Initiating device supervision OK Each type of device per floor Notification device supervision OK One Device Per Zone / Per Floor Additional Power Supplies / Booster panels OK Checked for ground / data supervision TESTERS NAME & CERTIFICATE # ARBI AGHAYANI — R4285 EXPIRATION DATE - NAME AND ADDRESS OF TESTING AGENCY e''�� N.I.C. PROTECTION INC. 2505 FOOTHILL BLVD, SUITE B,, LA CRESCENTA, CA: 91, PAGE 3 OF 7 CITY OF BEVERLY HILLS FIRE. DEPARTMENT', FIRE PROTECTION EQUIPMENT PERFORMANCE CERTIFICATION TESTING AGENCY: TEST SITE ADDRESS: 601 NEWPORT CENTER DRIVE, NEWPORT BEACH, CA 92660 FIRM Olt D.B.A.: NEIMAN MARCUS —FASHION ISLAND DATE OF TEST: 1"5115 - EQUIPMENT TESTED: FIRE ALARM & CENTRAL STATION MONITORING SYSTEMS - . . _.. ._..M._....�-.._ �.a..— -.._......_.__ram FIRE ALARM LIST OF DEVICES Device Location Type , ; Annunciate Cortectly Activate..: Alarm . Recalls Elevator Report's to- = Central Station 3rd FLOOR CUSTOMER SERVICE DD YES YES NO YES 3` FLOOR A LTER. DD YES YES NO YES 3rd FLOOR A LTER. DD YES YES NO YES 37 FLOOR A LTER. DD YES YES NO YES 3` FLOOR A LTER. DD YES YES NO YES 3` FLOOR A LTER. DD YES YES NO YES 3` FLOOR RTU 2 HALL DD YES YES NO YES 37FLOOR RTU 3 SUPPLY DD YES YES NO YES 3` FLOOR CRYSTAL DD YES YES NO YES 37FLOOR AIR HANDLER 2 DD YES YES NO YES 3` FLOOR SFD GIFT GALLERY DD YES YES NO YES 3rd FLOOR SFD MENS' STOCK DD YES YES NO YES 7FLOOR AIR HANDLER 1 DD YES YES YES YES 37FLOOR ALTER DD YES YES NO YES 7FLOOR AIR SUPPLY DD YES YES NO YES 3'd FLOOR R-4 T/S YES - - YES 37FLOOR ELEVATOR LOBBY WEST SD YES YES YES YES 3` FLOOR CUSTOMER SERVICE DD YES YES NO YES 3` FLOOR PASSENGER ELEVATOR LOBBY SD YES YES YES YES 7FLOOR T/S YES - - YES 3rd FLOOR T/S YES - - YES 3` FLOOR F/S YES YES NO YES 3rd FLOOR F/S YES YES NO YES 3` FLOOR RESTAURANT MAG. DOOR SD YES YES NO YES 2 NO FLOOR ALTER. DD YES YES NO YES 2 FLOOR ALTERATION DD YES YES NO YES 2 FLOOR ALTERATION DD YES YES NO YES 2 FLOOR MEN'S RESTROOM DD YES YES YES YES 2 FLOOR WOMEN'S RESTROOM DD YES YES NO YES 2ND FLOOR ERSON SHOP DD YES YES NO YES 2 FLOOR OS&Y T/S YES - - YES 2 ND FLOOR STOCK ROOM DD YES I YES T NO YES TESTERS NAME & CERTIFICATE # ARBI AGHAYANI — R4285 04/30/16 DATE NAME AND ADDRESS OF TESTING AGENCY N.I.C. PROTECTION INC. 2505 FOOTHILL .BLVD;.SUITE B. LA CRESCENTA,- CA 91214! PAGE 4 OF 7 CITY OF BEVERLY HILLS -FIRE DEPARTMENT - FIRE PROTECTION EQUIPMENT PERFORMANCE CERTIFICATION TESTING AGENCY: o]K® o lP3n®t04A:rL®3M aMC TEST SITE ADDRESS: 601 NEWPORT CENTER DRIVE, NEWPORT BEACH, CA 92660 FIRM OR D.B.A.: NEIMAN MARCUS -FASHION ISLAND DATE OF TEST: 10165115 EQUIPMENT TESTED: FIRE ALARM & CENTRAL STATION, ,MONITORING' SYSTEMS. Device Location Type Annunciate- Correctly - Activate . Alarm Reealls -Elevator . Reports to - - Central Station,' 2 NLI FLOOR ELEVATOR ROOM W. DD YES YES NO YES 2 FLOOR PASS. ELEVATOR LOBBY SD YES YES YES YES 2 FLOOR CORRIDOR MAG. DOOR SD YES YES NO YES 2 FLOOR ELEVATOR SD YES YES YES YES 2 FLOOR CORRIDOR SD YES YES NO YES 2 FLOOR DESIGN ROOM SD YES YES NO YES 2 N11 FLOOR APPAREL SD YES YES NO YES 2 FLOOR PASS. ELEVATOR LOBBY DD YES YES NO YES 2 FLOOR FREIGHT ELELVATOR DD YES YES NO YES 2 FLOOR PASS. ELEVATOR LOBBY DD YES YES NO YES 2 FLOOR DD YES YES NO YES 2 FLOOR BY GUARD MPS YES YES NO YES 2 NIJ FLOOR OS&Y T/S YES - - YES 2 FLOOR OS&Y FREIGHT T/S YES - - YES 2 FLOOR WEST HALL OS&Y T/S YES - - YES 1 FLOOR ELEVATOR ROOM SD YES YES YES YES 1 FLOOR HANDBAGS STOCKROOM DD YES YES NO YES 1 FLOOR HANDBAGS STOCKROOM DD YES YES NO YES I FLOOR ELEC. ROOM / FACP ROOM SD YES YES YES YES 1 FLOOR PASSENGER ELEVATOR H/D YES YES NO YES 1 FLOOR ELEVATOR LOBBY SD YES YES YES YES 1 FLOOR ELEVATOR MACHINE ROOM SD YES YES YES YES 1 FLOOR ELEVATOR LOBBY SD YES YES YES YES 1 FLOOR LADIES SHOES SD YES YES NO YES 1 FLOOR W. ELEVATOR ROOM DD YES YES NO YES 1ST FLOOR LLP DD YES YES NO YES 1 FLOOR LLP DD YES YES NO YES 1 FLOOR F/S YES YES NO YES I FLOOR OS&Y T/S YES - - YES 1 FLOOR FREIGHT T/S YES - - YES 1 FLOOR OS&Y T/S YES - - YES 1 FLOOR SHOE STOCK T/S YES - - YES TESTERS NAME & CERTIFICATE ## ARBI AGHAYAM'- R4285 EXPIRATION DATE 04/30/16 .,r NAME AND ADDRESS OF TESTING AGENCY Cry P; N.I.C. PROTECTION INC. 2505 FOOTHILL BLVD,,SUITE B, LA CRESCENTA, CA 91214� PAGE 5 OF 7-- CITY OF BEVERLY HILLS FIRE DEPARTMENT FIRE PROTECTION EQUIPMENT' PERFORMANCE CERTIFICATION TESTING AGENCY: TEST SITE ADDRESS: 601 NEWPORT CENTER DRIVE, NEWPORT BEACH, CA 92660 FIRIM OR D.B.A.: NEIA4ANM9RCUS—FASHION ISLAND DATE OF TEST: 10105115 } EQUIPMENT TESTED: FIRE ALARM & CENTRAL STATION -MONITORING SYSTEIIZS, f Device Location Type Annnnciaie'_ Correctly Activate Alarm - Recalls Elevator, Report"§lo Central Station _ 1 FLOOR STOCKROOM 160 T/S YES - - YES B LEVEL OFFICE DD YES YES NO YES B LEVEL FREIGHT ELEVATOR H/D YES YES NO YES B LEVEL FREIGHT ELEVATOR DD YES YES NO YES B LEVEL MA ELEVATOR SD YES YES YES YES B LEVEL ELEVATOR LOBBY SD YES YES YES YES B LEVEL R-1 F/S YES YES NO YES B LEVEL R-1 T/S YES - - YES B LEVEL R-1 T/S YES - - YES FIRE ALARM SYSTEM LIST OF DEFECTS NO DEFECTS FOUND FIRE ALARM NOTEWORTHY CHARACTERISTICS A) With each alarm activation, the ls` floor West Electrical Room smoke detector indicated a trouble signal on the Fire Alarm Control Panel. TESTERS NAME & CERTIFICATE # ARBI AGHAYANI - R4285 NAME AND ADDRESS OF TESTING AGENCY N.I.C. PROTECTION INC. EXPIRATION DATE TESTERS'SIGNATURE,, 3 04/30/16 .- 2505 FOOTHILL BLVD, SUITE B; LA CRES.CENTA,,CA 91214�) CITY OF BEVERLY HILLS FIRE DEPARTTMENT - FIRE PROTECTION EQUIPMENT PERFORMANCE -CERTIFICATION. f TESTING AGENCY: N.Z.C. protection IriC TEST SITE ADDRESS: 601 NEWPORT CENTER DRIVE, NEWPORT BEACH, CA 92660 FIRM OR D.B.A.: NEIMAN MARCUS -FASHION ISLAND DATE OF TEST:, 1"5/15 s EQUIPMENT TESTED: FIRE ALARM &CENTRAL STATIONMQX[TORING SYSTEMS' CENTRAL STATION MONITORING SYSTEM The fire alarm system in this building is being monitored by a central station. The system was tested to report all alarms and troubles to the central station with proper indication of type and time of activation. After completion of the test, the central station dispatch office matched the activations during the test and in all cases the activation signals had been received. CENTRAL STATION MONITORING TEST PROCEDURES A) The test was conducted in accordance with NFPA-72 Fire Codes and Procedures. B) Verified that the Central Station received trouble/supervisory signal within two (2) minutes. C) Verified that the Central Station received alarm signal within 90 seconds. D) Verified that the Central Station received phone line interruption within four (4) minutes. CENTRAL STATION MONITORING LIST OF DEFECTS NO DEFECTS FOUND TESTERS NAME &-CERTIFICATE # 'EXPIRATION. DATE ARBI AGHAYANI - R4285 04/30/16 TESTERS SIGNATURE NAME AND ADDRESS OF TESTING AGENCY N.I.C. PROTECTION INC. 2505 FOOTHILL BLVD,.SUITE B, L-A CRESCENTA, CA.9 PAGE 7 OF 7 Fire Safety First March 24, 2016 Jerry McMillan Erik Alarid Neiman Marcus Attn: Engineering 601 Newport Center Drive Newport Beach, CA 92660 RE: Title 19, 5-Year Certification 601 Newport Center Drive, Newport Beach Dear Jerry and Erik, 1170 E. Fruit Street, Santa Ana, CA 92701 (714) 836 — 4800 1 (714) 836 — 4120 fax I would like to thank you for giving Fire Safety First the opportunity to complete the Title 19, 5-Year Certification of your fire sprinkler system(s). The final testing and repairs have now been completed and a certification tag has been affixed to the risers and standpipes of each system. Enclosed is a copy of the Title 19 Certification Report. Please keep this report in a secure place with your building safety documentation for a minimum of 5 Years. You will likely be asked to present the report to the fire department and your insurance company. If you should have any questions, please feel free to call me at (714) 614.3780 or email me at bbridgford@firesafetyfirst.com. Sincerely, -1YO1,1;t4e Brandon Bridgford, Project Manager FIRE SAFETYFIRST C 10/16/36-599761 JAWPDOCS\Sprinkler Department\Sprinkler\Neiman Marcus\Newport Beach\5-Year 2015\NeimanMarcus T19Complete_CertLtr 032416.doc Inspection, Testing, and Maintenance Cover Sheet Page 1 of 1 NFPA 25 as amended by CCR, Title 19 Property Information: Name: Neiman Marcus Newport Beach Occupancy/Use: B of cAt/,moo Address: 601 Newport Center Dr. Construction Type: III ;� 9 City: Newport Beach No. Stories: 4 Zip: 92660 Year Constructed: E MA�� Contact: Jerry McMillan Telephone: 949-467-3313 Contractor Information: 1 No. of System Risers Copy sent to: Name: Fire Safety First ® Owner Date: 3/17/16 Address: 1170 E. Fruit Street ® Fire/AHJ Date: 3/17/16 City: Santa Ana ❑ Contractor Date: State: California ZIP: 92701 NOTES: Contact: Brandon Bridgford 1) For specific inspection, testing, and Telephone: (714) 836-4800 ext: 139 maintenance requirements and information, see NFPA 26, 2002 Edition as amended by California CA License: C16-599761 Code of Regulations, Title 19, §901 to §906. Job #: 2) Inspection Items may be performed by the Owner in accordance with California Code of Performed By: Brandon Bridgford Regulations Title 19 §904.1(a). (Print) Forms Included With This Report NFPA26 Chapter Number of Forms N/A FAIL * PASS ® Automatic Sprinkler System 5 4 X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form. State Fire Marshal AES 1 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: Basement Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Main Drain Test Results: Abbreviation Key: Initial Static Pressure: 100 (PSI) I = Inspection T =Test Residual Pressure: 88 (PSI) M = Maintenance A-O = After Operation Restored Static Pressure: 100 (PSI) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 I Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 I Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: Basement Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Of q Z MPQ� Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 279 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 J Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: Basement Type Of System: Cp °¢ ��Fc ® Wet Pipe ❑ Dry Pipe Co ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: Basement Type Of System: OF Cq4/ ® Wet Pipe �� '�C ❑ Dry Pipe ❑ Preaction c, ❑ Deluge State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 J NFPA 26. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 1 System Riser ID: 1st Floor Property Information: Type Of System: F CAtz Name: Neiman Marcus Newport Beach ® Wet Pipe �°o�,� Q Address: 601 Newport Center Dr. ❑ Dry Pipe v ❑ Preaction ❑ Deluge City: Newport Beach Main Drain Test Results: Abbreviation Key: Initial Static Pressure: 105 (PSI) I = Inspection T =Test Residual Pressure: 90 (PSI) M = Maintenance A-O = After Operation Restored Static Pressure: 105 (PSI) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2X 5.2.4.3 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 1st Floor Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X . 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 1st Floor Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 1st Floor Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 2"d Floor Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Main Drain Test Results: Abbreviation Key: Initial Static Pressure: 105 (PSI) I = Inspection T =Test Residual Pressure: 90 (PSI) M = Maintenance A-O = After Operation Restored Static Pressure: 105 (PSI) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 1 Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2X 5.2.4.3 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 2"d Floor Type Of System: Of Cq ® Wet Pipe A:*l c ❑ Dry Pipe y/ ❑ Preaction r ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 2"a Floor Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1.2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25. Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 2"d Floor Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the item number of the Activity listed above: All repairs completed per 5 year deficiency report dated October 14, 2015 Sales floor has non-sprinklered pockets around perimeter of sales floor above clothing displays. ❑ See Continuation page(s) (Indicate the number of Continuation Pages) ® PASS ❑ FAIL Signature Date 3/17/16 State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4 NFPA 26, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 3rd Floor Type Of System: N OF CAt ® Wet Pipe ❑ Dry Pipe c ❑ Preaction ElDeluge qF . /RE MPS Main Drain Test Results: Abbreviation Key: Initial Static Pressure: 100 (PSI) I = Inspection T =Test Residual Pressure: 90 (PSI) M = Maintenance A-O = After Operation Restored Static Pressure: 102 (PSI) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Daily Weekly Preaction/Deluge Valves -Enclosure Temperature 12.4.3.1 X 1.2 I Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.42 5.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 1 Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 X 1.7 1 Quarterly Hydraulic Nameplate 5.2.7 X 1.8 1 Quarterly Pipe and Fittings 5.2.2 X 1.9 1 Quarterly Sprinklers 5.2.1 X 1.10 1 Quarterly Spare Sprinklers 5.2.1.3 X 1.11 1 Quarterly Fire Department Connections 12.7.1 X 1.12 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1 X 1.13 1 Quarterly Preaction/Deluge Valves — Exterior Inspection 12.4.3.1.6 X 1.14 1 Quarterly Pressure Reducing Valves 12.5.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Backflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 31d Floor Type Of System: F cA ® Wet Pipe ° �r'�c Q ❑ Dry Pipe ❑ Preaction cr�� g�' c ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 1 Annually Hangers 5.2.3 X 1.19 1 Annually Seismic Bracing 5.2.3 X 1.20 1 5-Years Hangers (Accessible concealed spaces) 5.2.3.3 X 1.21 1 5-Years Seismic Braces (Accessible concealed spaces) 5.2.3.3 X 1.22 1 5-Years Pipe & Fittings (Accessible concealed spaces) 5.2.2.3 X 1.23 1 5-Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 X 1.24 1 5-Years Alarm Valves — Interior Inspection 12.4.1.2 X 1.25 1 5-Years Alarm Valves -Strainers, filters, orifices 12.4.1.2 X 1.26 1 5-Years Check Valves — Interior Inspection 12.4.2.1 X 1.27 1 5-Years Preaction/Deluge Valves — Interior Inspection 12.4.3.1.7 X 1.28 1 5-Years Preaction/Deluge Valves — Strainers, filters, orifices 12.4.3.1.8 X 1.29 1 5-Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5 X 1.30 1 5-Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6 X 2.1 T Annually Alarm Devices (90 seconds) 5.3.3 12.2.7 X 2.2 T Annually Main Drain Test (Enter data on page 1) 12.2.6 12.2.6.1 12.3.3.4 X 2.3 T Annually Antifreeze Test 5.3.4 X 2.4 T Annually Control Valve - Position 12.3.3.1 X 2.5 T Annually Control Valve - Operation 12.3.3.1 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1 X 2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10 X 2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 3rd Floor Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1 X 2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6 X 2.12 T Annually Dry Pipe Valve — Quick Opening Device 12.4.4.2.4 X 2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2 X 2.14 T Annually Backflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2 X 2.16 T 5 Years Gauges 5.3.2 X 2.17 T 5 Years Pressure reducing Valve 12.5.1.2 X 2.18 T 5 Years Fire Department Connection Backflush 12.7.4 X 2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3 X 2.20 T 5 Years Sprinklers — Corrosive environment or corrosive water 5.3.1.1-2 X 2.21 T 10 Years Sprinklers — Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers — Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinklers 5.3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4 X 2.25 T Sprinkler manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3.4 X 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.4.3.2 X 3.4 M Annually Dry Pipe Valves — Low Point Drains 12.4.4.3.3 X 3.5 M 5 Years Obstruction Investigation Chapter 13 X State Fire Marshal AES 2 March 21, 2006 Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25. Chapter 5 as amended by CCR. Title 19 Date of Inspection, Testing and Maintenance: 10/14/15 Property Information: Name: Neiman Marcus Newport Beach Address: 601 Newport Center Dr. City: Newport Beach System Riser ID: 3rd Floor Type Of System: F Cq o��c ® Wet Pipe ❑ Dry Pipe Co f ❑ Preaction 9� t ❑ Deluge E MPS State Fire Marshal AES 2 March 21, 2006 ,DocuSign'Envelope ID: 3F7D85B6-18DB-43D8-97C6-372D4BA76AA0 FIRE PROTECTION EQUIPMENT TEST REPORT _-- orcnnl.ICIQ1 r DADIry INITIAI TPST r l - - RPTI=CT 10 HOURS 9 PAGE 1 - of 1 NAME (LAST, FIRST, MI) TITLE: FIRM OR D.B.A. SOSSAMAN, ROB CHIEF ENGINEER EQUITY OFFICE PROPERTIES MAILING ADDRESS: (STREET) 19700 FAIRCHILD (CITY) IRVINE (STATE) (ZIP) CA 92612 PHONE: 949 954-5742 TEST SITE ADDRESS: (STREET) (CITY) (STATE) (ZIP) TEST SITE PHONE: 4041 MACARTHUR BOULEVARD NEWPORT BEACH CA 92660 949 337-3966 OCCUPANCY TYPE: NUMBER OF STORIES: YEAR BUILT: CONSTRUCTION TYPE: SQUARE FOOTAGE: B 1 5 1976 1 TYPE II 124,41 Iltll 11M 1 Gv 1 - DATE(S) TESTING AGENCY PHONE: APRIL 8, 2016 .Sy'S�ce`/lf'S (800) 266-1392 Where Reliability Counts ADDRESS OF TESTING AGENCY: (STREET) (CITY) (STATE) (ZIP) 800 WEST DORAN STREET, SUITE 200 GLENDALE CALIFORNIA 91203 EQUIPMENT TESTED: TEST RESULTS TEST RESULTS 1 ANNUAL TEST OF THE FIRE ALARM PASSED ®FAILED❑ 4 PASSED ❑FAILED[] SYSTEM 2 PASSED ❑FAILED❑ 5 PASSED.❑ FAILED❑ 3 PASSED ❑FAILED❑ 6 PASSED ❑FAILED❑ All Of The Deficiencies Originally Identified And Associated With The Fire Alarm System During The Annual Test Dated April 8, 2016 Were Repaired And Verified To Be Corrected Per Re -Test Dated May 12, 2016 No System Deficiencies Remain. 8 LICENSE # TESTER'S SIGNATURE FIRE DEPART (Signature &Assignment) N/A ,DocuSign'Envelope ID: D3170E47-0264-486C-B236-5C9EFB584742 FIRE PROTECTION EQUIPMENT TEST REPORT Drconkrcrcr c DADTv IMITIAI TPRT 10 RETEST M HOURS 6 PAGE 1 of 7 NAME (LAST, FIRST, MI) TITLE: FIRM OR D.B.A. SOSSAMAN, ROB CHIEF ENGINEER EQUITY OFFICE PROPERTIES MAILING ADDRESS: (STREET) (CITY) (STATE) (ZIP) 19700 FAIRCHILD IRVINE CA 92612 PHONE: 949 954-5742 TEST SITE ADDRESS: (STREET) (CITY) (STATE) (ZIP) 4041 MACARTHUR BOULEVARD NEWPORT BEACH CA 92660 TEST SITE PHONE: 949 337-3966 OCCUPANCY TYPE: NUMBER OF STORIES: YEAR BUILT: CONSTRUCTION TYPE: SQUARE FOOTAGE: B 5 1976 TYPE II 124,940 INITIAL TEST DATE(S) TESTING AGENCY PHONE: (800) 266-1392 APRIL 8, 2016 s�c@/ilsi Wizen Reliability Counts ADDRESS OF TESTING AGENCY: (STREET) (CITY) (STATE) (ZIP) 800 WEST DORAN STREET, SUITE 200 GLENDALE CALIFORNIA 91203 EQUIPMENT TESTED: TEST RESULTS TEST RESULTS 1 ANNUAL TEST OF THE FIRE ALARM PASSED ❑FAILED® 4 PASSED ❑FAILED0 SYSTEM 2 ANNUAL TEST OF THE CENTRAL STATION PASSED OFAILEDO 5 PASSED ❑FAILEDE3 MONITORING SYSTEM 3 ANNUAL TEST OF THE MAGNETICALLY PASSED ❑FAILED® 6 PASSED [DFAILEDO HELD OPEN SWINGING FIRE DOORS NOTEWORTHY CHARACTERISTICS, SYSTEM DESCRIPTION, PROCEDURES PERFORMED, AND DEFECTS FOUND IN EQUIPMENT TESTED (IF NONE, SO NOTE): 1. BUILDING DESCRIPTION 4041 MacArthur Boulevard is a five story office building, fully protected by a combined sprinkler standpipe system. The floors are designated as 1, 2, 3, 4, 5, and Roof. There are 5 Stairways for the building: - Stair 1 serves floors 1 through 5. - Stair 2 serves floors 1 through 2. - Stair 3 serves floors 1 through 5. - Stair 4 serves floors 1 through 4. - Stair 5 serves floors 4 through 5. There are two banks of three elevators in the building serving floors 1 through 5. One bank is comprised of two passenger elevators, while the remaining bank contains the service elevator, all serving floors 1 through 5. A Notifier AFP-200 Fire Alarm Control Panel is located in the 1" floor electrical room. The status of the fire alarm system is monitored at a remote 24 hour attended location via a Silent Knight 5104B communicator panel located in the l6t floor electrical room. ® ADDITIONAL INFORMATION ON ATTACHED SHEET(S) TESTER'S NAME & LICENSE # TESTER'S SIGNATURE FIRE DEPARTMENT WITNESS (signature &Assignment) ARIN GRIGORIAN C10, C16; 413747 Docu31gnnedby` �VIVj. N/A (�Vl OVIYi.Vt. RETEST IF NEEDED C6683F46D11C446 DATE OF RETEST TESTING AGENCY PHONE ADDRESS OF TESTING AGENCY: (STREET) (CITY) (STATE) (ZIP) EQUIPMENT TESTED AND DESCRIPTION: TESTER'S NAME & CERTIFICATE # EXPIRATION DATE TESTER'S SIGNATURE FIRE DEPARTMENT WITNESS (signature &assignment) ,DocuSi&'Envelope ID: D3170E47-0264-486C-B236-5C9EFB584742 FIRE PROTECTION EQUIPMENT TEST REPORT THIS PAGE BY ITSELF IS NOT A COMPLETE DOCUMENT PAGE 2 OF 7 DATE (S) I TEST SITE ADDRESS: (STREET) (CITY) (STATE) (ZIP) FIRM OR D.B.A.: APRIL 8, 2016 1 4041 MACARTHUR BLVD. NEWPORT BEACH CA 92660 EQUITY OFFICE PROPERTIES EQUIPMENT TESTED: ANNUAL TESTS OF THE FIRE ALARM, CENTRAL STATION MONITORING, & MAGNETICALLY HELD OPEN SWINGING FIRE DOOR SYSTEMS. NOTEWORTHY CHARACTERISTICS, SYSTEM DESCRIPTION, PROCEDURES PERFORMED, AND DEFECTS FOUND IN EQUIPMENT TESTED (IF NONE, SO NOTE): 2. FIRE ALARM SYSTEM DESCRIPTION A Notifier AFP-200 Fire Alarm Control panel is located in the 1Bt floor electrical room. Fire alarm control auxiliary functions include elevator recall, damper control, and automatic closing fire assemblies with actuating or hold open devices (magnetically held open fire doors). A remote Fire Alarm Annunciation Panel is located in the ls` floor lobby. The Fire alarm system initiating devices consist of manual pull stations, area smoke detectors, sprinkler system control valve tamper detectors, and water flow switches. Horns, Strobes, and Combination Horn/ Strobes installed throughout the building provide fire alarm notification. 2(a) FIRE ALARM SYSTEM PROCEDURES PERFORMED - Verified that the Fire Alarm Control Panel is clear of alarm, supervisory and trouble conditions before the start of the test, or that the condition is known. - Verified power supply batteries free of physical damage, leaks, loose connections, corrosion, and that battery replacement date is less than 5 years from the date of manufacturer. - Tested control panels for correct identification and location indicated for alarms, supervisory; and trouble signals and that signals at remote annunciator panel consist with fire alarm panel. - Verified activation of fire alarm notification appliances and fire safety functions occur within 10 seconds of Fire Alarm initiating device activation. - Tested fire alarm initiating and notification circuits for open circuit supervision and ground fault detection. - Tested the Fire Alarm Control Panel for the subsequent alarm feature. - Tested all control panel functions: panel silence, lamp test, signal silence, etc. - Tested all fire alarm system initiating devices. - Tested all fire alarm system notification appliances. 2(b) FIRE ALARM SYSTEM NOTEWORTHY CHARACTERISTICS - 1" floor — The elevator lobby smoke detector does not recall the elevators. Alternate recall does not seem to be provided. - The Elevators reset with the Fire Alarm Control Panel. 2(c) FIRE ALARM SYSTEM TEST RESULTS 1. 51h floor — In Suite 510 smoke detector reports to the Fire Alarm Control Panel as "Suite 500", device number D38. TESTER'S NAME& LICENSE # TESTER'S SIGNATURE: FIRE DEPARTMENT WITNESS: (SIGNATURE aassicNrnENr) D. Signed by: N/A ARIN GRIGORIAN C10, C16; 413747oo, ADDRESS OF TESTING AGENCY: (STREET) CBSB3F46D11C44B.. (CITY) (STATE) (ZIP) 800 WEST DORAN STREET, SUITE 200 GLENDALE CALIFORNIA 91203 101 , ,DocuS!gn'Envelope ID: D317OE47-0264-486C-B236-5C9EFB584742 FIRE PROTECTION EQUIPMENT TEST REPORT THIS PAGE BY ITSELF IS NOT A COMPLETE DOCUMENT PAGE 3 OF 7 DATE (S) TEST SITE ADDRESS: (STREET) (CITY) (STATE) (ZIP) FIRM OR D.B.A.: APRIL 8, 2016 1 4041 MACARTHUR BLVD. NEWPORT BEACH CA 92660 1 EQUITY OFFICE PROPERTIES EQUIPMENT TESTED: ANNUAL TESTS OF THE FIRE ALARM, CENTRAL STATION MONITORING, & MAGNETICALLY HELD OPEN SWINGING FIRE DOOR SYSTEMS. IOTEWORTHY CHARACTERISTICS, SYSTEM DESCRIPTION, PROCEDURES PERFORMED, AND DEFECTS FOUND IN EQUIPMENT TESTED (IF NONE, SO NOTE): 2. 3rd floor — In Suite 300 smoke detector failed to report to the Fire Alarm Annunciation Panel on the V floor in the lobby, device number D23. 3. V floor — The Fire Alarm Control Panel has two 12-Volt/7.2-Amphr batteries that failed an artificial load test, dated 05/2012. 4. All of the magnetically held open swinging fire doors release with activation of the fire alarm system; however the magnetized hold open devices re -energize when the silence function of the Fire Alarm Control Panel is used. 5. Prior to test the Fire Alarm Control Panel had a 2°d floor open circuit trouble which remained at the conclusion of the test, device number M70. NO OTHER SYSTEM DEFECTS FOUND 2(d) FIRE ALARM SYSTEM ADDITIONAL INFORMATION .FIRE`,ALARM SYSTEM°POWER SUPPLY PANELS ,PANEL TYPE -FLOOR. LOC'A'fl0'N ,. : GATT :QTY VOLTS AMPS „BAIT ,DATE - COMMENTS Booster 5 Electrical Room 2 12 8.0 10/14 Booster 4 Electrical Room 2 12 8.0 11/14 Booster 3 Electrical Room 2 12 8.0 02/14 Booster 2 South Electrical Room 2 12 8.0 12/13 Booster 2 North Electrical Room 2 12 8.0 11/14 Booster 1 Electrical Room 2 12 8.0 11/14 Notifier FACP 1 Electrical Room 2 12 7.2 05/12 Batteries failed Load test SK 5104E Monitor 1 Electrical Room 1 12 8.0 11/14 `717 FIRE ALARK'SYSTEM ,INITIATING':DEVICES: D.EVIGE " #..." ;.:-":TYP"E DEVICE ;FLOOR :. LOC"ATIIO.N NOTES D15 SD 5 Passenger Elevator Lobby Elevator Recall D16 SD 5 South Electrical Room D17 SD 5 Service Elevator Lobby D18 SD 5 Stair #5 D38 SD 5 Suite 510 Reports to the FACP as "Suite 500" D39 SD 5 Suite 500 D40 SD 5 Suite 500 M27 WF 5 South Electrical Room 38 Seconds M28 Tamper 5 South Electrical Room 1 Turn M29 MPS 5 Stairway 1 TESTER'S NAME& LICENSE # TESTER'S SIGNATURE: FIRE DEPARTMENT WITNESS: (sIGNATURE&ASSIGNMENT) ARIN GRIGORIAN C10, C16; 413747 D. uSigned by: N/A ADDRESS OF TESTING AGENCY: (STREET) CBMFOD11C44B. (CITY) (STATE) (ZIP) 800 WEST DORAN STREET, SUITE 200 GLENDALE CALIFORNIA 91203 DocuSign'Envelope ID: D3170E47-0264-486C-B236-5C9EFB584742 FIRE PROTECTION EQUIPMENT TEST REPORT THIS PAGE BY ITSELF IS NOT A COMPLETE DOCUMENT PAGE 4 OF 7 DATE (S) APRIL 8, 2016 TEST SITE ADDRESS: (STREET) (CITY) (STATE) (ZIP) 1 4041 MACARTHUR BLVD. NEWPORT BEACH CA 92660 FIRM OR D.B.A.: EQUITY OFFICE PROPERTIES EQUIPMENT TESTED: ANNUAL TESTS OF THE FIRE ALARM, CENTRAL STATION MONITORING, & MAGNETICALLY HELD OPEN SWINGING FIRE DOOR SYSTEMS. NOTEWORTHY CHARACTERISTICS, SYSTEM DESCRIPTION, PROCEDURES PERFORMED, AND DEFECTS FOUND IN EQUIPMENT TESTED IF NONE, SO NOTE): FIRE ALARM ;SYSTEM INITIATING bEV10E$, DEVICE .: ,DEVICE' TYPE_•:FLOO:R _, LO'CATION:' NOTES - , M30 MPS 5 Stairway 3 M31 MPS 5 Stairway 5 D12 SD 4 Passenger Elevator Lobby Elevator Recall D13 SD 4 South Electrical Room D14 SD 4 Service Elevator Lobby Elevator Recall D41 SD 4 Suite 401 D42 SD 4 Suite 401 M21 WF 4 Water Flow 23 Seconds M22 Tamper 4 South Electrical Room 1 1/4 Turns M23 MPS 4 1 Stairway 1 M24 MPS 4 Stairway 3 M25 MPS 4 Stairway 4 M26 MPS 4 Stairway 5 D09 SD 3 Passenger Elevator Lobby Elevator Recall D10 SD 3 South Electrical Room D11 SD 3 Service Elevator Lobby Elevator Recall D23 SD 3 Suite 300 Failed to report on the Fire Alarm Annunciation Panel. D38 SD 3 Suite 300 M15 WF 3 Water Flow 33 Seconds M16 Tamper 3 South Electrical Room 3/4 Turn M17 MPS 3 Stairway 1 M18 MPS 3 Stairway 5 M19 MPS 3 Stairway 4 M20 MPS 3 Stairway 3 D05 SD 2 Passenger Elevator Lobby Elevator Recall D06 SD 2 South Electrical Room D07 SD 2 Service Elevator Lobby Elevator Recall D08 SD 2 North Electrical Room M09 WF 2 Water Flow 41 Seconds M10 Tamper 2 South Electrical Room 1 1/2 Turns M11 MPS 2 Stairway 1 M12 MPS 2 Stairway 3 M13 MPS 2 Stairway 2 M14 MPS 2 Stairway 4 D01 SD 1 Passenger Elevator Not For Elevator Recall D02 SD 1 South Electrical Room D03 SD 1 Service Elevator Lobby Not For Elevator Recall D04 SD 1 North Electrical Room TESTER'S NAME& LICENSE # TESTER'S SIIGNA SIGNATURE: FIRE DEPARTMENT WITNESS: (SIGNATURE &ASSIGNMENT) ARIN GRIGORIAN C10, C16; 413747 —WcY N/A ADDRESS OF TESTING AGENCY: (STREET) CB8B3F4fiDiiC44B... (CITY) (STATE) (ZIP) 800 WEST DORAN STREET, SUITE 200 GLENDALE CALIFORNIA 91203 ,DocuSidn Envelope ID: D3170E47-0264-486C-B236-5C9EFB584742 FIRE PROTECTION EQUIPMENT TEST REPORT THIS PAGE BY ITSELF IS NOT A COMPLETE DOCUMENT PAGE 5 OF 7 DATE (S) APRIL 8, 2016 TEST SITE ADDRESS: (STREET) (CITY) (STATE) (ZIP) 1 4041 MACARTHUR BLVD. NEWPORT BEACH CA 92660 FIRM OR D.B.A.: 1 EQUITY OFFICE PROPERTIES EQUIPMENT TESTED: ANNUAL TESTS OF THE FIRE ALARM, CENTRAL STATION MONITORING, & MAGNETICALLY HELD OPEN SWINGING FIRE DOOR SYSTEMS. NOTEWORTHY CHARACTERISTICS, SYSTEM DESCRIPTION, PROCEDURES PERFORMED, AND DEFECTS FOUND IN EQUIPMENT TESTED IF NONE; SO NOTE : FIRE ALARM SYSTEM INITIATIN, G DEVICES . DEVICE DEVICE TYPE FLOOR''a ., '_. - LOCATION :N,O,TES` M01 WF 1 Water Flow 38 Seconds M02 Tamper 1 South Electrical Room 1 1/4 Turns M03 MPS 1 South Entrance M04 MPS 1 Stairway 3 M05 MPS 1 Stairway 2 M06 MPS 1 North Entrance M07 MPS 1 Stairway 4 M08 MPS 1 Service Elevator M32 Tamper 1 Main OS&Y Room 120 1 1/4 Turns M33 WF 1 Main Water Flow 38 Seconds M34 Tamper 1 Main Backflow (Closest To Building) 1 Turn M34 Tamper 1 Main Backflow 1 1/2 Turns TESTER'S NAME& LICENSE # TESTER'S SIGNATURE: FIRE DEPARTMENT WITNESS: -(SIGNATURE aassicNrNn ARIN GRIGORIAN C10, C16; 413747 ."Vl" ��aby. N/A ADDRESS OF TESTING AGENCY: (STREET) CB883F46017Caae.. (CITY) (STATE) (ZIP) 800 WEST DORAN STREET, SUITE 200 GLENDALE CALIFORNIA 91203 JDocuSign Envelope ID: D3170E47-0264-486C-B236-5C9EFB584742 FIRE PROTECTION EQUIPMENT TEST REPORT THIS PAGE BY ITSELF IS NOT A COMPLETE DOCUMENT PAGE 6 OF 7 DATE (S) I TEST SITE ADDRESS: (STREET) (CITY) (STATE) (ZIP) FIRM OR D.B.A.: APRIL 8, 2016 4041 MACARTHUR BLVD. NEWPORT BEACH CA 92660 I EQUITY OFFICE PROPERTIES EQUIPMENT TESTED: ANNUAL TESTS OF THE FIRE ALARM, CENTRAL STATION MONITORING, & MAGNETICALLY HELD OPEN SWINGING FIRE DOOR SYSTEMS. IOTEWORTHY CHARACTERISTICS, SYSTEM DESCRIPTION, PROCEDURES PERFORMED, AND DEFECTS FOUND IN EQUIPMENT TESTED (IF NONE, SO NOTE). 3. CENTRAL STATION MONITORING SYSTEM DESCRIPTION The status of the fire alarm control panel is monitored off site by a central station monitoring company via a Silent Knight 5104B communicator panel located in the 1" floor electrical room. 3(a) CENTRAL STATION MONITORING SYSTEM PROCEDURES PERFORMED - Notified the central station monitoring company and building occupants prior to conducting tests. - Determined that the transmitter panel is operating properly and all lamps/lights are undamaged and operational. - Verified power supply batteries free of physical damage, leaks, loose connections, corrosion, and that battery replacement date is less than 5 years from the date of manufacturer. - Determined that the system has two approved methods of transmitting the signal to the Central Station monitoring company. - Actuated fire alarm devices, supervisory devices, and transmitters for proper operation and supervision. - Notified the central station monitoring company at the conclusion of the test and determined that the central station properly supervised and received test signals. _.: CENTRAL STATION' MON)TORING: ' TELEPHONE NUMBER; 866 283-42fi7 ,.,, ',' .' '-: ,.: _ W-OU,NT,'NUMBER: 2960=1110 DES•CR/PT1ON'OF-S7GNALS',SEN•T:.'A,'ND;RECEIVED BYCENTRi4G S,T,4:TION ,TIME, LOCATION•EtC. , ZONE- DES'CRIPTIO.N,. TIME INITIATED, - : TIME:RECEII/ED , .AL. TR -SUP,: '_ ;,,, ,COMMENTS 2 Fire General Alarm 20:05:38 20:06:00 X 3 Fire System Trouble 20:10:47 20:11:16 X - Phone Line 1 20:08:13 20:08:36 X - Phone Line 1 20:22:24 20:22:49 X - Low Batt e 20:44:51 20:45:24 X NO SYSTEM DEFECTS FOUND TESTER'S NAME& LICENSE # TESTER'S SIGNATURE: FIRE DEPARTMENT WITNESS: (SIGNATURE&ASSIGNMENT) DocuSigned by: N/A ARIN GRIGORIAN C10, C16; 413747 • ADDRESS OF TESTING AGENCY: (STREET) CWBVODIZA4B . (CITY) (STATE) (ZIP) 800 WEST DORAN STREET, SUITE 200 GLENDALE CALIFORNIA 91203 jDocuftrf Envelope ID: D3170E47-0264-486C-B236-5C9EFB584742 FIRE PROTECTION EQUIPMENT TEST REPORT THIS PAGE BY ITSELF IS NOT A COMPLETE DOCUMENT PAGE 7 OF 7 DATE (S) TEST SITE ADDRESS: (STREET) (CITY) (STATE) (ZIP) FIRM OR D.B.A.: APRIL 8, 2016 1 4041 MACARTHUR BLVD. NEWPORT BEACH CA 92660 EQUITY OFFICE PROPERTIES EQUIPMENT TESTED: ANNUAL TESTS OF THE FIRE ALARM, CENTRAL STATION MONITORING, & MAGNETICALLY HELD OPEN SWINGING FIRE DOOR SYSTEMS. NOTEWORTHY CHARACTERISTICS, SYSTEM DESCRIPTION, PROCEDURES PERFORMED, AND DEFECTS FOUND IN EQUIPMENT TESTED (IF NONE, SO NOTE): 4. MAGNETICALLY HELD OPEN SWINGING FIRE DOORS SYSTEM DESCRIPTION The building is equipped with magnetically held open swinging fire doors installed in selective locations. All automatic closing assemblies are designed to release and properly close and latch with activation of the fire alarm system, or related initiating device. 4(a) MAGNETICALLY HELD OPEN SWINGING FIRE DOORS PROCEDURES PERFORMED - Verified the fire door(s) have no damage that affects the fire rating. - Verified that the coordinator is in good working condition and all magnets and accessories are in good repair. - Verified that the magnetically held open fire door(s) released with activation of the fire alarm system. - Verified that the coordinator prevents the active leaf from closing before the inactive leaf. - Verified the doors closed completely and latch securely. 4(b) MAGNETICALLY HELD OPEN SWINGING FIRE DOOR TEST RESULTS 1. 4'h floor — Passenger elevator lobby magnetically held open double swinging fire doors leading to the corridor fail to latch. NO OTHER SYSTEM DEFECTS FOUND TESTER'S NAME& LICENSE # TESTER'S SaIGNAYTURE: FIRE DEPARTMENT WITNESS: (sicNATURe&AssIGNmENn ARIN GRIGORIAN C10, C16; 413747 N/A ADDRESS OF TESTING AGENCY: (STREET) CBBMFOD77C44B.. (CITY) (STATE) (ZIP) 800 WEST DORAN STREET, SUITE 200 GLENDALE CALIFORNIA 91203 V-k Morris, Nadine From: Sent: To: Subject: Good afternoon Rob, Morris, Nadine Thursday, May 19, 2016 2:34 PM 'Rob Sossaman' RE: 4041 MacArthur Boulevard Signoff I contacted TRL to discuss the strobe sync issue. It seems that floors that have not been remodeled may not sync. This is considered an existing previously approved fire alarm system. So if a tenant space does not see the corridor, the existing condition can remain. if the corridor is remodeled, two or more devices in a field of view will be required to sync. Or if a tenant space is remodeled and their space may be visible to the corridor due to a glass entry/front, the sync issue will need to be corrected. At this time all alarm issues have been resolved. There is no further action required on your part. Thank you, Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net From: Rob Sossaman [mailto:Rob Sossaman@equityoffice.com] Sent: Tuesday, May 17, 2016 2:11 PM To: Morris, Nadine Subject: RE: 4041 MacArthur Boulevard Signoff These were noted on my original fire alarm test and resolved as a repair and retest. From: Morris, Nadine[mailto:NMorris(a)newportbeachca.gov] Sent: Tuesday, May 17, 2016 2:09 PM To: Rob Sossaman Subject: RE: 4041 MacArthur Boulevard Signoff Good afternoon Rob, Thank you for the annual fire alarm maintenance testing report. I have updated our records. The area of concern that remains is the synchronization of strobes when there are more than two visible notification appliances in a field of view. The lack of synchronization was noticed in the 2Id floor corridor, this may be the case on other floors too. Please advise how this issue will be addressed. Thank you, Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net CERTIFICATION -r PJJBLIC RADIO -SYSTEM COVERAGE BUILDING PERMIT NO: X2014-3757 CERTIFICATION TESTING DATE: BUILDING ADDRESS: Tw-,,V �-,- FCC -Certified Technician to provide checkmark for one of the following: _(Amplycation System Provided) I certify that installation of the necessary amplification system and its associated components have been installed per plans and specifications. (Note: amplification system requires OCCOMM clearance, see bottom of page) (Ampliifcation System No litre,,L I certify that installation of the 2 inch conduit or greater pathway, from the lowest.fioor to the roof, has been installel per plans and specifications. i4o-r i\1-cMIC> I further certify that radio coverage testing has been conducted and radio coverage has been found to meet the minimum requirements of the City of Newport Beach Guideline D.05 for check one) �L Both DAQ and Signal Strength DAQ only (FCC Certified Technician Name) (Si ature) '?4(' • iS t - -7 S qzl (FCC License Number) (Phone Number) (Technician's Company game) (pate) ----------------------------------- .,--------------------------------------------------------. _•__ OCCOMM Clearance Non-interference check and alarm programming verificafion. (Only required when amplification system provided) Received: One copy of As -built plans per City of Newport Beach Public Radio System Coverage Testing and Acceptance Procedure (or copy of original approved plans if design was not deferred). (OCCOMM Representative Name) (Signature) --------�--------- --, (iNTERNAi. USE Inspector to check the appropriate Lines tad cofiect testing report and as -bunts as needed; penru�tspeciaiistta update permit record, file form, testing report, and as -bunts for records retention) Testing Report Received _ Deferred Decision: Amplification System provided, set of as-builts collected. (800.1) X Amplification System not required. (800.2) F•U DZ%fe61&NcesiFo AQ9rtificAnlPublicSafe tyRadlerSoemCoverage CUC Along 'thi-0 Lihe V V UNITED 3TA` ES gF AMERICA ` FEDERAL COMMUNICATIONS COMMISSION General Radiotelephone Operator License SCHM17T, MIKE W 26371 PALwA m98 FOOTHILL RANCH, CA 92610 FCC Registration Number (F'RN): OOI8662957 Special Conditions / Endorsements Ship Radar Endorsement. This license Confers authority to operate licensed radio 5tado is in the Aviation, Marine and International Fixed - Public -Radio Services, only: This licetisi: drays not confer any authority to operate broadcast stations. It is not assignable or transferable. Refer to CFR Title 47 Section 133(c)(5). Grata Date Effective bate print Mite Eipir'4004 mate 04-03-2009 04-03-2009 04-04-2009 File Dumber Serial Number Date of Birth 0003796060 P000026659 02=10-1970• THIS LICENSE IS NOT TRANVERABLE (Lic�see's Signature) FCC 605-FRC- May Zt?o7 Cut Along This Line Cur- Along This Line Serial Number Grant I)at'e Expiration Date P00002665� N-03-2009 Date of Birth FCC Registration Number (l' RN) 02-10-i970 001W2957 SCHM TT, MIKE w 23371 PALOIiiA #198 FOOTHILL RANCH. CA'Y'610 Gen" Radiotelephone Operator License FCC 605- MC -May 2tM77 Gieeirsee; ftis,i"sZrjtcyradio ctut3us; izatott:'irt siv�s suitthl� ,�t3r;�'tfttr,}i�ctll�t'aritl fo'rfrrt7itirt�:. Carefulty cut.•ilte dpervrs rrts iiY�`rig °tli�• Irie3 ris."iridl�aitrrl artrf sign �trtrtt:diclteiti upptz rce,e4rr. P' gy ar~e • e;r-: hell id .tttrtil:signeif. The �ramrtlfssivn sugg.;;'sts thur;tit�'°�a�lef size}'eYsiiln b <ammated (vr arzvtfir..r si�illrrr dQCttrrenr(�rvt6�G'tivFr ptcicess)'afterstgatirtg. ;The .Cvrr»#sslon ,lias fib4 rd, °u 4r L'e1'titin: cireurrFsfitticer,.lrrser d �rffii�is:sitlaje�r'ty rlisplucerszettt. a �M FN. n file Number matoitc lwfi'44*i -bate 00037mo 04-04.2009 04-03-2009 THIS LICENSE IS NOT TRA1.Y81Fi MASLE I Special Conditions I Endorsements: Ship Radar Endorsement. This liconse eonfers.authority to s operate licensed radio siationsin the A-vintlon. Marine and International Fixed Public Radio Services only, -This license doss not cont'er any authority to operate broadcast stations. It is not assignable or transfexabie. Refer ca. CFI271lie 47 l Section 13.7(c)(5). l y l (Lltxiista';;.Signsiur�) t FEDERALC0_.M' UNiCATloNgg0mhtI5SION: ,�• Cut Along Thia Line 'at a I(; x: N c' 0 NEWPORT BEACH FIRE DEPARTMENT 100 CIVIC CENTER DRIVE, P.O. BOX 1768, NEWPORT BEACH, CA 92660 PHONE: (949) 644-3104 FAX: (949) 644-3120 WEB: www.nbfd.net SCOTT L. POSTER Fire Chief May, 16, 2016 Liz Miller, Office Manager True Recovery 20351 SW Acacia St, 2"d Floor Newport Beach, CA 92660 Subject: Fire Clearance 20351 SW Acacia St, 2"d Floor Newport Beach, CA 92660 Dear Liz: The above subject location was inspected on May 16, 2016, for compliance with local fire code requirements. At that time no violations of the California Fire Code were found. A fire clearance has been granted. If you have any questions, I can be reached at (949) 644-3105 or nmorris nbfd.net. Thank you. Sincerely, Nadine Morris Life Safety Specialist COMMUNITY DEVELOPMENT DEPARTMENT PLANNING DIVISION 100 Civic Center Drive, P.O. Box 1768, Newport Beach, CA 92658-8915 (949) 644-3200 Fax: (949) 644-3229 www.newportbeachca. gov ZONING CLEARANCE LETTER January 5, 2016 RE: True Recovery Administrative and Counseling Office 20351 Acacia St, Newport Beach, CA 92660 439-391-26 Dear Ms. Sapetto: The above referenced property is located within the Santa Ana Heights Specific Plan Zoning District (SP-7) with a SP Land Use of Business Park (BP) and is designated as General Commercial Office (CO-G) within the Land Use Element of the General Plan. The SP-7 BP Zoning District allows for professional office uses, including psychological and psychiatric services. Per the description of use you have provided in the attached document, the outpatient program including group counseling (maximum 15 clients at any time), one-on-one counseling and the related office use has been determined to be consistent with the CO-G land use designation and is a permitted use in the SP-7 BP Zoning District. The SP-7 BP regulations require a minor use permit for new professional office uses; however, the previous use of these suites was a professional office and therefore a minor use permit is not required. However, the following changes in the operation as provided in the attachment would constitute a change in use and possibly an intensification of parking demand, including but not limited to: an increase in the number of groups, an increase in the size of the groups, conducting group meetings open to the public, or conducting medical activities on -site, etc. This would require separate review and possibly require an application for approval of a use permit. Should you have any further questions, please contact me at 949-644-3209 or imurilloCa)newr)ortbeachca.aov. Sincerely, Kimberly Brandt, AICP, Community Development Director By: Ja' e Murillo, Senior Planner Enclosures: Description of outpatient program use for 20351 SW Acacia St SAPETTO REAL ESTATE SOLUTIONS, INC. December 10, 2015 Mr. Jaime Murillo Senior Planner City of Newport Beach 100 Civic Center Drive Newport Beach, CA 92660 RE: Zoning Confirmation for True Recovery at 20351 SW Acacia Street, Newport Beach Dear Jaime: This is a follow up to our meeting with you and Kim Brandt on November 4, 2015 regarding the proposed location of an alcohol and drug addiction treatment facility's administrative and group counseling functions in the second floor of the two-story existing building located at 20351 SW Acacia Street in Newport Beach. The proposed facility operator is True Recovery and the operator is also the building owner. The second floor is currently vacant and the first floor has one tenant, an insurance agent. The building is 19,321sf with 8,019sf on the first floor with a 1,838sg garage area and 9,464sf on the second floor. The exterior parking area has 59 stalls plus 2 handicapped stalls for a total of 61 stalls. The property is located in the Santa Ana Heights Specific Plan Area and has a Zoning designation of Business Park of which Professional Office is a permitted use. True Recovery is an alcohol and drug addiction treatment center for individuals and families afflicted with alcoholism and drug addiction. True Recovery proposes to locate administrative offices, individual and group counseling functions to the second floor of the building. Administrative hours would be from 9:00am to 5:00pm Monday through Friday. Group Therapy sessions would be conducted between 9:00am and 9:00pm Monday through Friday. Sapetto Real Estate Solutions, Inc • 18662 MacArthur Blvd, Suite 200, Irvine, California 92612 • (949) 252-0841 www.SapettoRealEstate.com Mr. Jaime Murillo, City of Newport Beach December 10, 2015 Page 2 Of the 9,464sf second floor area (see Exhibit A), the Administrative functions would consist of 4,144 sf of administrative area for up to 13 employees, including reception, managers and administrative personnel. The area would consist of a reception area, administrative offices, conference room and cubicles for administrative staff. An additional 1,066sf of counselor offices for 6 counselors would also be considered administrative area. The counselors would use their offices for administrative purposes and would conduct therapy sessions in the group counseling rooms. In regards to the group counseling sessions, approximately 15 clients would be on - site at a time. There are a total of 3 group therapy rooms and group therapy sessions would have 4-5 persons in a session. Sessions are generally for a period of 1 hour at a time and a client would have 2-3 group therapy sessions a day. When the clients were not in group sessions, breakroom and lounge area provided totaling 1,763 sf. In addition, an outdoor smoking area would be designated for client breaks. No smoking would be permitted outside of this area or on public sidewalks. Further, clients would not be allowed to gather in the ground floor parking area except to get on or off the shuttle vans. Clients would not be permitted to walk to or from the building. In regards to parking (see Exhibit B), the site has a total of 61 parking stalls, 2 are handicapped accessible. 33 stalls have been set aside for the first floor area providing for a rate of 1 stall per 250sf per code for professional office uses. For the second floor, a total of 27 stalls would be provided to allow for 19 stalls for the up to 19 employees (13 administrative and 6 counselors), 2 stalls for the transport vans bringing clients to and from the facility and 1 space for family members who may visit to meet with a counselor on an appointment only basis, leaving 6 stalls available. As previously noted clients are not permitted to operate vehicles or walk to the facility and are transported in vans between sober living homes and the facility. The location of the proposed administrative office and group counseling operations at 201351 SW Acacia Street is consistent with the Professional Office designation of the Santa Heights Specific Plan. Given that the building owner is also the owner of True Recovery, the operations of the facility would be run consistent with a use in a professional office area. Access to the site is at the easterly side via a driveway off of SW Acacia Street. The north and south sides of the property have extensive Mr. Jaime Murillo, City of Newport Beach December 10, 2015 Page 3 landscaping, separating and shielding views from adjacent properties. The entrance to the facility and part of the parking lot are located on the northerly side of the building. The westerly side of the property has a parking area and is adjacent to the back end of the driving range of the Newport Beach Golf Course. The site is surrounded by other Office and medical/dental uses and a Newport Beach Fire Station is located southerly of the site off of Acacia Street. The nearest residential areas are a significant distance from the property as residences are located easterly of Birch which is the connector street east of Acacia, also in the Santa Ana Heights area. Other residential would be located to the south and west of the Newport Beach Golf Course driving range and Irvine Avenue.The proposed use is compatible with the surrounding land uses. We would appreciate your review of the information provided for this zoning confirmation request. Please contact me at psapetto(Dsapettorealestate.com or Andrea Maloney at 949-683-3271 or amaloneygsapettorealestae.com if you have any questions. Sincerely, i Pamela Sapetto Principal Cc: Kim Brandt, City of Newport Beach I - - ------------ Mum : I= vrnr w 1� —camm dam. R!'ST7lOOM RG3'nlOOM 6RLAKRDOM — _ GONRRCNC� DISC' K (I ROOM GIEL (/ ® Q Q601G r iuuin� Moan I 1 7 f LJLJwi GOUNSGLOR ;Rxerr ow 0 :7r�- J --- � � L066Y j 1 1 GONrLRdNGO ROOM t I I / // IIGSTfOpM \) L, ///�/, i PROPOSED 2ND FLOOR PLAN SME W - 20551 5H AGAGIA 5T., NEWPORT BEAGH, GA LEGEND ADMINI5TRATION- 4,144 5F GOUN5ELOR5 - 1,066 5F GROUP THERAPY - 859 5F 0 BREAKROOMME5TROOM5- 1,163 5F 0 steinerstudio GIRGULATION - 1,140 5F 0 architectureand interior design 19 PARKING SPACES FOR 19 EMPLOYEES, 2 PARKING SPACES FOR VANS,1 VISITOR SPACE -" --1 1ST FLOOR TENANT 8,019 SF 33 PARKING SPACES 1 ST FLOOR GARAGE 1,838 SF TOTAL 61 SPACES PROVIDED• 19,321 SF 65 SPACES REQUIRED (LEAKING 6 EXTRA SPACLSI' < 0 SITE PLAN SCALE: NTS N . THIS NUMBER DOES NOT INCLUDE 5 PARKING SPACES IN THE GARAGE. StelnerStudio -Wtectwe and mtedarlle,J n f� Inspection, -A .-• by r -.,:: ". r' ation'� _ R o �1 fo m -Pr n p �Y� <t . d•r re Name: Hills Boat Services Inc. Occupancy/Use: Address: 814 E. Bay Ave. Construction Type: OF eaC,,�o �z City: Newport Beach No. Stories: co > ZIP: 92661 Year Constructed: Carson/Marlene E M� Contact: Telephone: (949) 675-0740 t t s ,' •�Q`" ..f^d, .F• G"V' `^:i�1. Y,: °r ':3i�.^•_'. �. '4'S,,i (a.".„t''t•'4 a,j r,- y':Ctr`a7:710 `}'� r. , a$XELL—. 4. tE.n rm�.�w.i:�..: s�aa ,a2't' "�,�IL:iGrt:ximauEr- ^--`•u3.' 1,1.a�.. - Meanrn•i, d'xG'.;�ia.`: Name: Orange County Fire Protection Copy sent to: 137 W. Bristol Lane M Owner Date: 05/19/16 Address: Orange ❑ Fire AHJ Date: City: CA ❑ Contractor Date: State: Telephone: (714) 974-9025 NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 201,1, 326604 CA License#: Edition as'amended by California -Code -of -Regulations, Title 19, §901 to §906. Job #: 2) Inspection items may be performed by the owner in Performed by: Josh accordance with California Code of Regulations, Title 19, §904.1(a) ,5 ;'Check, b&'fo',•:eacli s'stein;iris "acted end anterAheinamb6kof;fomis,used;fof Inap,o*,0 n.;.' � ' ,h %all or''Pass :xo°Srw'dtCa estaluaol;ins ecfe�`,"tarri'ata d;of:in'spe0ttotl., f IncludedForms .. Chapter ❑ Automatic Sprinkler System 5 0 ❑ ❑ ❑ m Standpipe and Hose System 6 0 ❑ ❑ 0 ❑ Private Water Supply System 7 0 ❑ ❑ ❑ r' El Fire Pump 8 0 ❑ ❑ ❑ ❑ Water Storage Tank 9 0 ❑ ❑ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ❑ No *$ee;'Gipefieie : e es. an' Corrimti sectors a read"'of each' rEspec�td��or�,{' -' '; ' ' _'<:' is a.Cn _ .5- f}�'. :�; �'F� •I.x t.t' of AES 1 September 3, 2013 ❑ Manual Wet ❑ Automatic Dry Class 1 ❑ Manual Dry ❑ Semi -Automatic Dry 0 Class II F-1 Automatic Wet (-1 Combined Sprinkler/Standpipe ❑ Class III s • ;; . Dlaiinete�- Drainv.:Initia1 D'laMete� Y � Sta'tie :'Re;idual' ressure ressure ° fnal'Static Pressures P','',F; N/A,;. No: ,"> :Location- >: ;t ;y, ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached ♦- A a' ee e I = Inspection T = Test M = Maintenance P = Pass F = Fail NIA =NotAPPlicable `NFPA .gym. Y�.lf_ �ts. .% s 'E'Y' ' ri P .Fy Date: Coinmen 0 I � sDescii t�ori'c '�.�:r:' Y 1.1 1 Control Valves — Identification Sign 13.3.1 05/12/16 N/A 1.2 1 Control Valves — Inspection 13.3.2 05/12/16 N/A 1.3 1 Waterflow Alarm Devices 5.2.5 05/12/16 N/A 1.4 1 Supervisory Alarm Devices 5.2.5 05/12/16 N/A 1.5 1 Pressure Gauges 6.2.1 05/12/16 N/A Pass = Normal Pressures 6.2.2 1.6 1 Water Supply Pressure Below Dry pipe 6.2.1 05/12/16 psi N/A or Preaction Valve 6.2.2 Water Supply Pressure Above Dry pipe 6.2.1 05/12/16 psi N/A 1.7 1 or Preaction Valve 6.2.2 1.8 1 Pressure at Top of Sandpipe Riser 6.2.1 6.2.2, 13.2.7 05/12/16 psi N/A 1.9 I it/Nitrogen Pressure 6.2.1 6.2.2, 13.2.7 05/12/16 psi N/A 1.10 1 Pressure at Discharge of Fire pPmp or Pressure Tank 6.2.1 6.2.2, 13.2.7 05/12/16 psi N/A 1.11 1 Pressure Readings Acceptable 6.2.2 13.2.7 05/12/16 N/A 1.12 1 Hydraulic Design Information Sign 6.2.3 05/12/16 N/A (For hydraulically designed systems) 1.13 I Heat Tape 5.2.7 05/12/16 N/A Form AES 3.1 Sept. 3, 2013 Inspection, Testing nd , nce Includes5-Year A rInspections,,rMaintenance Items I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A =Not Applicable Item Desc�iptloh' 26',CA•sdi gate,. CoFhittehts Ohl�i,,. h;F;Ni�h,; itet�ierice . 1.14 1 Standpipe Hose Valves 13.5.6.1 05/12/16 P 1.15 1 Pressure Reducing Hose Valves 13.5.2.1 05/12/16 N/A 1.16 1 Pressure Reducing Valves 13.5.1.1 05/12/16 N/A 1.17 1 Fire Department Connections. 13.7 05/12/16 N/A 1.18 1 Backflow Preventers 13.6.1 05/12/16 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 05/12/16 Owner's Responsibility N/A 1.20 I Pipe and Fittings 6.2.1 Table 6.1.2 05/12/16 N/A 1.21 I Hangers 6.2.1 05/12/16 N/A 1.22 I Seismic Braces 6.2.1 05/12/16 NIA 1.23 1 Hose Connection 6.2.1 Table 6.1.2 05/12/16 P 1.24 1 Cabinet 6.2.1 Table 6.1.2 05/12/16 P 1.25 1 Hose 6.2.1 Table 6.1.2 05/12/16 P 1.26 1 Hose Storage Device 6.2.1 Table 6.1.2 05/12/16 P 1.27 1 Hose Nozzle 6.2.1 Table 6.1.2 05/12/16 P 2.1 T Control Valve - Position 6.2.1 13.3.3.1 05/12/16 N/A 2.2 T Control Valve - Operation 6.2.1 13.3.3.2 05/12/16 N/A 2.3 T Supervisory Devices 13.3.3.5 05/12/16 NIA 2.4 T Waterflow Alarm Devices 5.3.3 05/12/16 sec. N/A 90 sec max. Enter time 13.2.6 2.5 T Main Drain Test 13.2.5 05/12/16 N/A (Enter data on Page 1 of this form) 13.3.3.4 2.6 T Standpipe Flow Test 6.3.1 05/12/16 Provide results in table on N/A 1st a e. 2.7 T Standpipe Hydrostatic Test 6.3.2 05/12/16 N/A 2.8 T Hose Rack Assembly Flow Test 13.5.3.2 05/12/16 N/A 2.9 T Backflow Preventer Assemblies 13.6.2 05/12/16 N/A 2.10 T Pressure Reducing Hose Valves 13.5.2.2 05/12/16 N/A 2.11 T Pressure Reducing Valves 13.5.3.2 05/12/16 N/A 2.12 T Pressure Gauges 6.3.4 05/12/16 N/A Form AES 3.1 Sept. 3, 2013 I I Inspection T =Test M = Maintenance P=Pass F=Fail NIA =Not Applicable 3.3 M Internal Pipe Inspection: See Deficiencies and 14.2 05/12/16 N/A Comments Section for Results 3.4 M Obstruction Investigation required. If "Yes", see 14.3 05/12/16 M Yes' ONo N/A Deficiencies and Comments Section for Results 1 Flow Rate at Remote Hose Valve No. Standpipe Risers Total Flow Rate Required Pressure at Remote Hose Valve Outlet Flow Rate Supplied at FDC Flow Rate Supplied at Pump 1pressure Supplied at FDC Pressure Supplied at Pump D Deficiency C Comment (indicate type) Item D Fire Hose is 1 1/2" outlet, 75' hose, manufactured 4/2016 D = Deff lency C = Comment Indicate type) Itoni Da>t0: Riser D .., Ci flCl �►cl.4s end do*t►t�►f s cont) Inclic�te'IiN:ogalp'rpdHf,_tievicg,dir��patts•tha't.werid.tepelrtbddfrepleced' I i Check here if additional Deficiencies and Comments are listed on Form AES9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company Indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jesse aid a Signature Date 05/19/16 Form AES 3.1 Sept. 3, 2013 Inspection,•Aby CCR, Title 1.9 Property information: ., Name: East & West Tower Occupancy/Use: B Address: 4000 MacArthur Blvd Construction Type: Type I -A p( City: Newport Beach No. Stories: 10 & Basement & Penthouse C* a ZIP: 92660 Year Constructed: 9F/AE Mp�Q Contact: Tim Bermudez Telephone: 949-955-9160 Copy sent to: Name: ® Owner Date: 5/18/16 Address ❑ Fire AHJ Date: City: "►--✓- Systems, Inc. ® Contractor Date: 5/18/16 State: 1354 S. Parkside Place NOTES: Ontario, CA 91761 1) For specific inspection, testing, and maintenance Telephone: Phone: 877-331-2084 requirements and information, see NFPA 25, 2011 edition as amended by California Code of Regulations, CA License#: 905493 Title 19, §901 to §906. Job #: 27456/27457 2) Inspection items may be performed by the owner in accordance with California Code of Regulations, Title 19, Performed by: Jeff Ruesga §904.1(a) Check bxfoestmctedientr h;sep er; inspection~ Gh'ecic, numbet offorrrs `used #oo bokes' (Fail_ or Pass);%<indiirate>statu's of inspected system at en&6f ,inspection: IncludedForms .. Chapter ❑ Automatic Sprinkler System 5 ® ❑ ❑ ❑ Standpipe and Hose System 6 ® ❑ ❑ ® Private Water Supply System 7 1 ❑ ❑ ® Fire Pump 8 1 ❑ ❑ ❑ Water Storage Tank 9 ® ❑ ❑ ❑ Water Spray System 10 ® ❑ ❑ ❑ Foam Water Sprinkler System 11 ® ❑ ❑ ❑ Water Mist System 12 ® ❑ ❑ ❑ Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ® No See. "Deficiencies'agd:Comrrient5" seet�oriateiid:of�ea`ch Pespective:form,�, ;. '„ = - Form AES 2.2 Sept. 3, 2013 4(_'V+ HCz System tne. HC SALES REP Karen Lara CUSTOMER ADDRESS Ontario - San Diego — Irvine — Fresno — Sacramento - Hayward Telephone: (877) 331-2084 FIRE HYDRANT TEST REPORT 4000 MacArthur LLC 4000 MacArthur Blvd. JOB # 27457 TECHNICIAN Jeff CONTACT Mariano PHONE 619 972-4850 EXT Newport Beach E-MAIL Z Annual ❑ 5-Year ❑ Other DATE: 5/18/16 YES NO 1. All hydrant stems and threads were inspected for damage and lubrication ® ❑ 2. All hydrant caps, gaskets and chains were inspected for damage and lubrication ® ❑ 3. All hydrant outlets were fully opened and closed to ensure smooth operation ® ❑ 4. All hydrant shut-off valves were closed and fully reopened to ensure adequate waterflow ® ❑ 5. All hydrants are accessible with outlets 14 inches to 24 inches above grade ® ❑ 6. All crash posts are in place to prevent vehicular damage ® ❑ 7. All hydrants have 36 inches of unobstructed access around all hydrants ® ❑ 8. Each hydrant is clearly identified or marked ® ❑ 9. Each hydrant is painted per local jurisdiction specifications ® ❑ See remarks for explanation of all "No" answers (GPM) Gallons per Minute (PSI) Pounds per Square Inch L9- Hydrant # / Location Flow (GPM) Static Pressure PSI Residual Pressure PSI Remarks / Discrepancies #1 1250 95 55 Missing blue dot #2 1250 95 55 Missing blue dot End of report. Technician Signature Date 5/18/16 �•�. Systems I:ic. LIC# 905493 PUMP # 1 SALES REP Karen Lara CUSTOMER 4000 MacArthur ADDRESS 4000 MacArthur Blvd. JURISDICTION OCFA FIRE DEPT PHONE ❑ Regulation 4 CIDC DIIMD INCnDMATInN- Ontario -San Diego - Irvine - Northern California -Palm Springs Tele pho ne: (877) 331-2084 / www.h cisystem s.n et FIRE PUMP PERFORMANCE TEST Page 2 0(-K,% ❑ Acceptance JOB # 27456 TECHNICIAN Jeff Ruesga F.D. WITNESS No CONTACT Mariano PHONE 619 972-4850 EXT E-MAIL C.O.F. # ® Title 19 DATE: 5/18/16 MANUFACTURER RATE GPM RATED HEAD -FT RELIEF VALVE TANK SIZE AND LOCATION (IF APPLICABLE) Worthington 500 ok 10,000 MODEL RATED PSI RATED RPM IMPELLER SIZE CITY SUPPLY PRESSURE (IF SUPPLIED DIRECTLY BY CITY) 4LRO-11 105 3550 8.5 MIN MAX (IFAVAILABLE) now= INCnDMATInN- DIESEL IF DIESEL DRIVEN, HOW MANY GALLONS OF FUEL ARE AVAILABLE (8 HOUR SUPPLY REQUIRED)? 150 GAL. ELECTRIC IF ELECTRICALLY DRIVEN, HOW MANY GALLONS OF FUEL SUPPLY THE EMERGENCY GENERATOR? rnNTRnI 1 FR INFnRMATInN- MANFACTURER AUTO START AUTOSTOP MODEL OVERRUN TIME JOCKEY PUMP (PSI) Metron 100 Churn M400-50-460 B 10 min I ON 120 1 OFF 130 oeo CnDAfiAAV`C TCCT. REQUIRED FLOW NUMBER OF OUTLETS NOZZLE ORIFICE PITOT PRESSURE ACTUAL GPM SUCTION PRESSURE DISCHARGE PRESSURE SYSTEM PRESSURE NET PRESSURE RPM Churn 0 0 0 0 33 155 150 122 3579 50% 1 flow meter 250 32 145 145 113 3563 100% 2 flow meter 500 30 135 140 105 3558 150% 2 flow meter 750 26 105 130 79 3547 A11TnMAT1C CTARTR• MANUAL STARTS! LOCATION OF TEST FLOWS/REMOTE START: Test header NUMBER OF STARTS: 3 NUMBER OF STARTS: 3 SATISFACTORY RESULTS: 1yes SATISFACTORY RESULTS: yes COMMENTS: pump passes. TECHNICIAN SIGNATURE jJeff Ruesga I Date 5/18/16 Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended. Prcperty.lnformationi Name: East & West Tower Occupancy/Use: B Address: 4000 MacArthur Blvd Construction Type: Type I -A OF CA4 City: Newport, CA No. Stories: 10 & Basement & Penthouse 2 n ZIP: 92660 Year Constructed: 9 P Contact: CD Wicks E VA Telephone: (949) 313-2200 Contractor Igformation: ' Number, of.SVstem' Risers , Copy sent to: Name: ® Owner Date: 4/29/15 Addressf1cl ❑ Fire AHJ Date: City: y gfemsr Inc. ❑ Contractor Date: 1354 S. Parkside Place NOTES: State: CA 91761 Ontario,1) For specific inspection, testing, and maintenance Telephone: Phone: 877-331-2094 requirements and information, see NFPA 25, 2011 edition as amended by California Code of Regulations, CA License#: 905493 Title 19, §901 to §906. Job #: 2) Inspection items may be performed by the owner in accordance with California Code of Regulations, Title 19, Performed by: Jeff Ruesga §904.1(a) `Check'boz #off, each system inspected and'enter the n,uniber offorms used',fgr inspection. Check,' boxes ,(Fail ox Pas's),to; indicate status of Wipected aystetnwat end; of, inspection., ., 25 IncludedForms ..rt Number of Forms Chapter ® Automatic Sprinkler System 5 1 ❑ ❑ n ❑ Standpipe and Hose System 6 ❑ ❑ ❑ ❑ Private Water Supply System 7 ❑ ❑ ❑ ❑ Fire Pump 8 ❑ ❑ ❑ ❑ Water Storage Tank 9 ❑ ❑ ❑ ❑ Water Spray System 10 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 ❑ ❑ ❑ ❑ Water Mist System 12 ❑ ❑ ❑ ❑ Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ❑ No *S'ee:"Deficiencies and. Cornments" #ction.at 0rt'd' of each respeetiVe;forni.'. AES 1 Sept. 3, 2013 Wet Pipe California Code of Regulations - Title 19 5-Year 1 3 Sprinkler System Inspection, Testing, and Maintenance of ReportFire CA4/.o0 3' Owner Inform 'on Property Information t�of Contractor or Licensed ti Building Name I East & West Tower v Address 4000 MacArthur Blvd. 9 P A&SYstoms,inc. E Mp` Phone: (M)3312084 Ontario* San Diego * Irvine * Fresno * Sacramento* Hayward City Newport Beach License # 905493 Contact Person Jose S'M ❑ SFM Job # Phone 714 317-9763 ® Misc. RiSor Drain,long Main Riser .,, 16tatioh; ' Rider Nla,'in,Drain, ; „ lnitial;Static ` Residual FinalfStat,ic Nb: Diameter' ,,'„ Diameter;;,; Pressure,.-' Pressure Pressure•--' ..: 1 West Tower 4" 1-1/4" 110 100 110 P 2 East Tower 4" 1-1/4' 110 100 110 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached 1=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not applicable Item; Description ,' NF,P,A.25 CA ed: ' Refer'gol ;Date - Cornment's'Ohly � P,,,F,,N%A, 1.1 1 Control Valves — Identification Sign 13.3.1 4/11/15 P 1.2 1 ControlValves— Inspection 13.3.2 4/11/15 P 1.3 I Waterflow Alarm Devices 5.2.5 4/11/15 P 1.4 1 Supervisory Devices 5.2.5 4/11/15 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 4/11/15 P 1.6 I Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6 4/11/15 N/A 1.7 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 4/11/15 psi N/A 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 4/11/15 psi N/A 1.9 1 Pressure Readings Acceptable 5.2.4.1 4/11/15 N/A 1.10 1 General Information Sign (Not Required for System Prior to 2007 Edition NFPA 13) 5.2.8 4/11/15 N/A 1.11 1 Heat Tape 5.2.7 4/11/15 N/A 1.12 1 Spare Sprinklers 5.2.1.4 4/11/15 P 1.13 I Fire Department Connections 13.7 4/11/15 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 4/11/15 N/A 1.15 1 Pressure Reducing Valves 13.5.1.1 4/11/15 N/A 1.16 I Backflow Preventers 13.6.1 4/11/15 j N/A Form AES 2.2 Sept. 3, 2013 ANNbAL • TESTING, AND MAINTENANCE �Inclu,• • .ns 1 = Inspection T = Test M = Maintenance P = Pass F= Fail N/A =Not Applicable Item Description :NFPA25;GA;ed., Reference 'Da#e Comments*"Only; P,F,N/A 1.17 1 Ismail Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 4/11/15 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 4/11/15 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 4/11/15 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 4/11/15 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 4/11/15 N/A 1.22 1 Pipe and Fittings 5.2.2 4/11/15 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 4/11/15 N/A 1.24 1 Hangers 5.2.3 4/11/15 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 4/11/15 P 1.26 1 Seismic Braces 5.2.3 4/11/15 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 4/11/15 P 1.28 1 Unsprinklered Areas CFC 901.4 ❑ Yes ❑ No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter `F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) 4/11/15 N/A 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 4/11/15 38 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 4/11/15 P 2.5 T Control Valve - Position 13.3.3.2 '4/11/15 P 2.6 T ControlValve—Operation 13.3.3.1 4/11/15 P 2.7 T Supervisory Devices 13.3.3.5 4/11/15 P 2.8 T Backflow Preventer Assemblies 13.6.2 4/11/15 N/A 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 4/11/15 N/A 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 4/11/15 N/A 2.11 T Pressure Gauges - Calibration 5.3.2 4/11/15 F 2.12 T mall Hose Connections 13.5.6.2.2 4/11/15 N/A * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 p MAINTENANCE .• ALL Quarterlyi inspections I = Inspection T = Test M = Maintenance P= Pass F= Fail NIA = Not Applicable Item; 'Description NFPA,25 CA ed.. ' DIte.•.' CommentsOnly r P;F,N/A. Refer.,ence 3.1 M Check Valves - Internal inspection 13.4.2 4/11/15 P 3.2 M Control Valves 13.3.4 4/11/15 p 3.3 M FDC- Backflush 4/11/15 P 14.3.2.3 3.4 M Internal Pipe Inspection - See Deficiencies and 14.2 4/11/15 El Yes p Comments Section for Results. ® No 3.5 M Obstruction Investigation Required. If "Yes", See 14.3 4/11/15 P Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 4/11/15 ®Yes ❑ No p D = Deficiency C = Comment (Indicate type) y 1.20 4/11/15 east #1 1)2"d fl. Stair #2- (1) missing aluminum Star mod. E esc. 1.20 4/11/15 east #2 2)Suite 200- (1) Central chrome semi recessed esc. In Adnan Boostany's office, and (1) In the hallway. 1.20 4/11/15 east #3 3) (1)Central chrome semi recessed esc. missing in Paris Hill's office. 1.20 4/11/15 east #4 4)1't fI. Stair #2- (2) missing chrome 401 esc. End of West Tower deficiencies. Note: west tower is under construction from 2"d f1.-10th fl. The 1st fl. Has been completed and has no discrepancies at this time. 2.11 4/11/15 The following gauges are out of date and calibration - west 5)Penthouse, 9th fI., 8th fl., 7th fl., 61h fl., and the Jockey pump discharge gauge. (6-total) Pump Room- packing on the OS&Y valve, (discharge for the fire pump), leaks Excessively. Parts for this valve are obsolete. (4"). Cla-Val for the city supply line isn't working properly and should be replaced, (4"). As of 7/9/15 all discrepancies have been completed. ❑ Check here if additional Deficiencies and Comments are listed on Form AES9. Number attached ❑ See Correction Form AES 10 for corrected deficiencies. Number attached I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jeff Ruesga Signature �Ze# Rae494 Date 4/11/15 Form AES 2.2 Sept. 3, 2013 4Y* INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY ,cot TIME RECEIVED REMOTE CSID DURATION PACES STATUS August 3, 2016 12:23:57 PM PDT 8182431042 48 1 Received 08/03/2016 12:15 8182431042 OCON INS AGCV INC PAGE 01/pi V NE, wpoRT BEACu FIR-E DEPARTMENT 3300 Newport Blvd, Newport 13caoh, CA, 92663 Office (949) 644-3106 Fax (949) 644-3 f20 VIOLATION NOTICE As a result of a fire inspection by the Newport Beach Fire Departvient, the violation(s) listed bolow were noted. ,fee reiterse side fa- violation code descriptiotls. OkDER TO COMPLY: You ttre liereby required to correct the above, conditlou(s) immediately upon race•ipl, r, Noncompliance widr the foregoing'order bei~Dre the date -Ofrtri'nspectian tnsy sender you HWE! to the penalties provided by Jaw 1101- s wch viointion(s). A reinspection dale is noted on the botlotn of this notice. Print - Responsiblc Party Sigoatcrs •- esponsiliiC Party I„4��t•t • Inspection Unit T aqp,atc ?e,r„r.J,hm 2011 Original - Busincss Yel(ow -- Fite Provetttion State Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request STD 850 JULY 18, 2016 CCL 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714) 703-2831 N. MALEK/ MCR E203 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 370 304370938 7A, SEE NOTE 10. Response Required Codes 1. Original A. Fire Clearance Department of Social Services 2. Renewal B. Life Safety Community Care Licensing 3. Capacity Change 750 The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change NOTE: PRESCHOOL = 24 TOTAL CAPACITY = 24 6. Name Change CHANGING ROOM TO ROOM 18 7. Hours: Monday - Friday Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date 07/24/2014 Capacity Medical Prev.Cap Capacity Medical Prev.Cap 18. Facility Code -16 - CCC 24 Care? 24 0 Care? 0 24 No No 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC NEWPORT ELEMENTARY PRESCHOOL 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 1327 WEST BALBOA BLVD. NONE 4. APH 12. ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under NEWPORT BEACH 92660 24 HRS. 6. SNF 14. CCF 7. ICF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special MERIN, MAYRA 949-424-8978 NONE 8. ICF/DD 16.Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Telephone # CARS ID# T-19 OCC 1. Fire Clear/Granted (9 4q) 2. Fire Clear/Denied D 1212i S & Li Ll-3 (Cif 3 0� S� 3. Fire Clear[vVithheld Inspection Date Inspector's Signature Clearance Code 6 P-A cS W_6 Explanation of Denial or Special Conditions: Denial Code Fire Agency Denial Codes 1.Exits Newport Beach Fire Department 2.Construct. 100 Civic Center Drive 3.Fire Alarm Newport Beach, CA 92660 4.Sprinklers 5.Housekeeping 6.Special Hazard 7.Other Newport Elementary 2016/17 i:C:C:C:4:c.ifi {. <-C4'<';'{ Kindergarten Playground Requesting License Room 17 Room 18 Workroom Science Room 20 s} i K 0�- Room19B �„nig Room 19 A i S i-Si-C-{-{•{-S-S ,i,;�S`;`i't'L';J<J`iT �— Bike Racks Room 21 COMPUTER 4th Grade LAB Room 23 R E i?� 0 w T R 0 0 U N cD N `r 06 M N N E —>>>>>>>>>>>. Bike Racks_ c o LIBRARY iE c U Restroom Restroom ADLT c3 RLRM N Room 5 2°d Grade Room 4 H. L {';'i' }}>}>>>}}>}>> 3rdGrade :'j•;:.:_: ••.• > } > y } y } } y } y } } } } } > } } y } y } y y y ; < { i { { < L ; < S < < < { { i < < RTI & • TEACHERS < { L > } } } > > } > > > } } } } > } > > > > > } } > Active Kids •'"'•'•'•' L Z N LOUNGE �i��tit£iiitiiiitttiiiiiti Room 6 •' . Room 15 Room 14 Room 13 Room 3 ; .$ ; `- 4thl5th Gr 5th Gr. R 1n Grade : r:: :E:' E S Room— E: R 6 Grade E Room 10 LITERACY ::�.: 2aa Grade RESOURCE T' 0 W8 j o Room 2 M 3rd Grade T' Kitchen S T P LANG PTAINESF1 NURSE MULTI -PURPOSE A S Room 9 Room 8 MUSIC Hansen ROOM G Y 6� Grade ROOM 7 OFFICE Room 1 E C Prin. OFF,MGR Mahtesian 2ndGr Rodriguez Kandel H . . . . . . . . . .............. :Bboaivct. ::::::::.: ; . • • . 1 - Station 1 NBFD Inspection Worksheet Occupancy Type E Occupancy ID # 15423 Assigned NE61C Inspection Month Repeat: July 12 Name: Newport Elementary Location: 1327 W BALBOA BLVD Description: N/A (Stand alone) Business Phone: (949)515-6965 Business EMail Address ❑ Bldg Status In Normal Use dkandel@nmusd.us ❑ Stories A-1 ❑ Fire Department Permits Required or Update/Verify Contact Name Day Time Phone After Hours Phone E Mail Contact Involvement esc Attention: Rich Rodriguez (949)515-6965 (949)939-2744 E-Mail rrodriguez@nmusd.us (Principal) Attention: Debbie Kandel (949)515-6965 (949)515-6965 E-Mail dkandel@nmusd.us (Admin Assitant) Attributes: Description Comments FACP Located in Main Hallway Closet near Fire Protection Equipment Tvpe Cert Expiration Dati Library Fire Protectia System ' Knox Box ./Sprinkler System Standpipe 07/26/201 1 At Main Entrance Comments: 7/17/2015- Received annual passing certification. R Wun Fir.,e Alarm System ✓Alarm System Full - Monitored 04/01/201 Comments: FACP located in Main Hallwav Closet near Li ✓Hood and Duct m 02/15/201, Comments: Located in the Kitchen area next to the multi -purpose room. 15423 Newport Elementary 1327 W BALBOA BLVD Closed Type Activity Description Assigned/Found Completed Status Assigned to 06/28/2016 A Fire Operations Inspection 03/31/2016 06/28/2016 Closed Station, Station 1, NE61, C F -ZZ-Other code violatio 06/28/2016 08/18/2016 Closed BROWN, Chris F -ZZ-Other code violatio 06/28/2016 08/18/2016 Closed BROWN, Chris 08/18/2016 A State Fire Clearance 08/18/2016 08/18/2016 Closed Division, Life Safety Services, LS2 F -NC-No Code Violations Found 08/18/2016 08/18/2016 Closed MORRIS, Nadine 15423 This Occupancy Inspection is : Closed T t�t-i" "von W �K 1E i (CILJOI�S-I 5 - lo-1 q 3 TW t-� �J Q wXv s i> , US Printed: 08/18/2016 14:50:33 CITY OF NEWPORT BEACH 100 Civic Center Drive Newport Beach, California 92660 949 644-3200 newportbeachca.gov/communitydevelopment August 18, 2016 Alyssa Figueroa Newport Beach Developmental Optometry Group 901 Dover Drive, Suite 100 Newport Beach, CA 92660 Subject: Fire Clearance 901 Dover Drive, Suite 100 Newport Beach, CA 92660 Dear Alyssa: The above subject location was inspected on August 18, 2016, for compliance with local fire code requirements. At that time no violations of the California Fire Code were found. A fire clearance was granted. If you have any questions, I can be reached at (949) 644-3105 or nmorris(a)nbfd.net. Thank you. Sincerely, Nadine Morris Life Safety Specialist NEWPORT BEACH FIRE DEPARTMENT 100 Civic Center Drive P.O. Box 1768, Newport Beach, CA 92660-8915 Life Safety Services Division (949) 644-3106 FIELD INSPECTION NOTICE INSPECTI DAT INSPECTOR N ME BUSINE S NAME /� �` Ctea �n / ,/t T PHONE NO BUSINESS ADDRESS aCITY 2((4 I r-,� A dl- P1� ZIP MAILING ADDRESS (If different) CITY ZIP OW R/M GER rmt) t' 7'e l TITLE Gallfiorn .. +�.. h=$ Safi }"� r.otl+E;1>CltprS: Ar#(cie'tiQns5=2551i'&.li(artilaad+ of ) u, ons'ri6e 18°1v: Arti±rt . Hazardous materials Business Emergency Plan is correct and up to date. ❑ Hazardous materials Business Emergency Plan not available onsite*for review. " ❑ Business owner/operator page is missing, incomplete, or requires updating. ❑ Hazardous material chemical page(s) not available on site for review. ❑ Hazardous material chemical page(s) require updating or new chemical(s) onsite require disclosure. ❑ Emergency plan is missing, incomplete, or requires updating. ❑ Facility map(s) is missing or requires updating. Other — explain: Original White — Life Safety Services Division Yellow— OwnerfTenant Revised: 04.18.13 Fire Safety First August 5, 2016 Fire Prevention Department NEWPORT BEACH FIRE DEPARTMENT 100 Civic Center Drive, Bay 1D Newport Beach, CA 92660 RE: Tax & Financial Group 4001 MacArthur Blvd., Newport Beach Attention: Fire Prevention Department 1170 E. Fruit Street, Santa Ana, CA 92701 (714) 836 — 4800 1 (714) 836 — 4120 fax NEWPART BEACHDEPi MINISTRATION "G 0 9 20 P, RECEIVED BY. _.._.- -• Fire Safety First has recently completed the Title 19, 5-Year Certification at the above mentioned property. We have completed all repairs noted on the preliminary deficiency reports and have back -flushed all fire department connections per the California Health and Safety Code, Title 19. Enclosed are copies of the Certification Report for your files. If you have any questions please call our Fire Sprinkler Maintenance Department at (714) 263-2831. Sincerely, Sd& Phil Salazar, Senior Project Manager FIRE SAFETY FIRST C10/16/36- 599761 - "S t Name ire� "Y,: First Copy Sent to: Address 1 76' .-Fruit Street:: Owner Date: 7/11/16 City -S OrItayAda ::,, Fire AHJ Date: 7/11/16 State, Zip CA;-:92701':---�'- Ej contractor Date: Telephone p - - - - -36 -80 114" 8 -4 Notes: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 Edition as amended by California CA License # --�'- 561' Code of Regulations, Title 19, Section 901 to 906. 2) Inspection items may be performed by the owner in accordance with California Code of Regulations, Title 19, Section 904.1(a). Job # Performed by .'BqlrFer n, ,ect S�,: sed', J spd tl &t -;pk frh' 'o r -n jo Forms Included with this Report NFPA 25 Number of N/A Fail* Pass Chapter Forms V\j Automatic Sprinkler System 5 El r El Standpipe and Hose System 6 El 0 El ❑ Private Water Supply System 7 El El El E] Fire Pump 8 El El El E] Water Storage Tank 9 El El El E] Water Spray System 10 El El El E] Foam water sprinkler System 11 El E] Water Mist System 12 El El El El Concerns that are not deficiencies (i.e. Non-Sprin-klered Areas) E-1 Yes Ej No 41 Cjje, t J, _,Pq AUG 0 9 2016 Form AES 1 September 3, 2013 "R A Riier:' JAre -'Pulffi "'j Residua -,�re' q Ss jSouth�.stair.'lln.ap' 9 , - ce Ply 4": -, Z :control29:,fl'pdt,,Janitor-doset.(,fi6or '41 -4 W 'T D This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 Forms Attached: 5-Year INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual inspections, Tests, and Maintenance Items Hnspection T=Test M=Maintenance P=pass F=Fail N/A=Not Applicable Ntt nj MY- 1.1 1 Control Valves — Identification Signs 13.3.1 1.2 1 Control Valves- Inspection 13.3.2 -,!,3 1.3 1 Waterflow Alarm Devices 5.2.5 1.4 1 Supervisory Devices 5.2.6 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 '�s 1.6 1 Enter Water Supply Pressure Below Riser 5.2.4.1 C� ",0' h psi —N Check 1.7 1 Enter Water Supply Pressure Above Riser 5.2.4.1 :3=14 16> 95 psi Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 -14=16Hydraulic , . .. . . ... 1.9 I Design Information 5.2.6 11�Wl (For hydraulically designed systems) 41 General Information Sign 4, 1.10 I (not required for systems prior to 2007 Edition ofNFPA 5.2.8 25) 1.11 1 Heat Tape 5.2.7 1.12 1 Spare Sprinklers 5.2.1.4 3=14=16 1.13 1 Fire Department Connections 13.7 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 VA, 1.15 1 Pressure Reducing Valves 13.5.1.1 1.16 1 Backflow Preventers 13.6.1 U AUG 0 9 2016 Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Mnspection T=Test WMaintenance P=Pass F"-Fail N/A=lNot Applicable 'TItlO FA,2� 5 m t�Op 1.17 I Small Hose Connections — Hose Valve 5.1.6, .5.2, 13 ,3.5.5.1 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 1.19 1 Buildings (Freeze Protection) Owners Responsibility 1.20 1 Sprinklers 5.2.1 14 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.6 1.22 1 Pipe and Fittings 5.2.2 1.23 1 Pipe and Fittings — Accessible Concealed 5.2.2.3 T Space 1.24 1 Hangers 5.2.3 1.25 1 Hangers —Accessible Concealed Space 5.2.3.3 1.26 1 Seismic Braces 5.2.3 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 wyu 1.28 1 Unsprinklered Areas CFC 901.4 El Yes 0 No 2.1 T Field Service Test Required 5.3.1 If REQUIRED, enterF'unffl Send report to Fire Code Officiol results are returned from lab. 2.2 T Recalled Sprinklers Title 19 If not present Pass; If present Fall 904.1(c) 2.3 T Waterflow Alarm Devices 5.3.3 13.2.6 1". 14 42 secs. 2.4 T Main Drain Test 13.2.5 (Enter data on Page 1 of this form) 13.3.3.4 2.5 T Control Valve — Position 13.3.3.2 3 2.6 T Control Valve- Operation 13.3.3.1 3-14 2.7 T Supervisory Devices 13.3.3.5 2.8 T Backflow Preventer Assemblies 13.6.2 = :N/A`; -11,11, J 2.9 T Small Hose Connections 13.5.2.3 Partial Flow Test w/PRV Hose Valves 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 2.11 T Pressure Gauges— Calibration 5.3.2 �:�3-*1 f 2.12 T Small Hose Connections 13.5.6.2.2 Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class 1, 11, or III AUG 0 9 201'6 Form AES 2.2 September 3, 2013 M ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable # 'n- 7 3.1 M Check Valve — Internal Inspection 13.4.2 "A-: J, 3.2 M Control Valves 13.3.4 4 6":` 3.3 M FDC — Backflush 14.3.2.3 14.3.2.4 Internal Pipe Inspection —See Deficiencies and Yes �'p 3.4 M Comments Section for Results 14.2 No M Obstruction Investigation Required. if "Yes", see 14.3 'N/ 3.5 Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 .. .... Ye! E] No D = Deficiency C = Comment (indicate type) I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments"section of this form. P Print Name Signatures. REVIEWED & APPROM 8CW POW, Fft ChW AUG 0 9 2016 Form AES 2.2 September 3, 2013 Morris, Nadine From: Boland, Jim Sent: Monday, August 15, 2016 11:52 AM To: Morris, Nadine Subject: Re: 800 MHz - 2301 San Joaquin Hills Rd Inside has good coms, basement has poor at best. Third time went through but extremely scratchy. Should work considering basement isn't a high activity location. Let me know what you think Jim Sent from my iPhone On Aug 15, 2016, at 6:44 AM, Morris, Nadine <NMorris@newportbeachca.gov> wrote: Hi Jim, Has anyone had a chance to go by the cafe? The contractor is pushing to get his final from the building dept. Thanks, Nadine From: Boland, Jim Sent: Tuesday, August 9, 2016 5:59 PM To: Morris, Nadine Subject: Re: 800 MHz - 2301 San Joaquin Hills Rd Yes, I'll get it handled and let you know. Sent from my iPhone On Aug 9, 2016, at 10:18 AM, Morris, Nadine <NMorris@newportbeachca.gov> wrote: Hi Jim, Hope all's well. @ Roger's Gardens built a new cafe building — Farmhouse. The radio coverage was tested by a contractor and frequency readings show that a Public Safety Radio System is not required. The building is small, only a kitchen and basement. Seating is all outdoors. Can someone go by and verify radio coverage? As always, thank you for your assistance. Nadine NADINE MORRIS I Life Safety Specialist (949) 644-3105 I nmorris@nbfd.net 1 CERTIFICATION — PUBLIC RADIO SYSTEM COVERAGE BUILDING PERMIT NO: X2015-1335 CERTIFICATION TESTING-DATE1 8f7f16 BUILDING ADDRESS: 2301 San Joaquin Hills Road, Newport Beach, CA FCC -Certified Technician to provide checkmark for One of the following: _(Amplification System Provided) I certify that installation of the necessary amplification system and its associated components have been installed per plans and specifications. (Note: amplification system requires OCCOMM clearance, see bottom of page) _(Amplification System Not Required) I certify that installation of the 2 inch conduit or greater pathway, from the lowest floor to the roof, has been installed per plans and specifications. I further certify that radio coverage testing has been conducted and radio coverage has been found to meet the minimum requirements of the City of Newport Beach Guideline D.05 for check one) _ _ Both DAQ and Signa ength DAQ only Ralph A Chavez (FCC Certified Technician Name) (Signature) PG00048158 (FCC License Number) HCI (Technician's Company Name) 949-599-5052 (Phone Number) 8-8-2016 (Date) OCCOMM Clearance Non-interference check and alarm programming verification. (Only required when amplification system provided) Received: One copy of As -built plans per City of Newport Beach Public Radio System Coverage Testing and Acceptance Procedure (or copy of original approved plans if design was not deferred). (OCCOMM Representative Name) (Signature) -»------------------------------------------------------------------------------------------. (INTERNAL USE: Inspector to check the appropriate lines and collect testing report and as-builts as needed; permit specialist to update permit record, file form, testing report, and as-builts for records retention) Testing Report Received _ Deferred Decision: _ Amplification System provided, set of as-builts collected. (800.1) -. Amplification System not required. (800.2) F.•IlifeSafetyServicesiFormsiCertiPcationlPublic Safety Radio System Coverage Ontario 0 Irvine 0 San Diego 0 Hayward Sacramento 0 Fresno 0 Glendale/LA Systems Inc. Telephone: (877)331-2084 Fax: (909)628-7774 The Farmhouse Cafe, 2301 San Joaquin Road, Corona Del Mar, C 800 MHz Public Safety Radio - RF TEST 11 'W4.Z' FAR USE -7 A :A ROGER'SGARDENS Building Name: The Farmhouse Cafe Building Address: 2301 San Joaquin Road, Corona Del Mar, CA HCI Contact: Mike Schmitt Phone: 949-751-7844 2 Id Contact: Ralph Chavez Phone: 949-599-5052 FCC Testing Technician: Ralph A Chavez Test Date: 8/4/2016 Ontario • Irvine • San Diego • Hayward Sacramento • Fresno • Glendale/LA Systems Inc. Telephone: (877)331-2084 Fax: (909)628-7774 PAS — Preliminary Test Date: August 4, 2016 Project: The Farmhouse Cafe Address: 2301 San Joaquin Road, Corona Del Mar, CA HCI arrived on -site on Thursday, 08/04/2016, to take preliminary radio frequency measurements (Public Safety Radio coverage) at 2301 San Joaquin Road, Corona Del Mar. The testing that was performed will give a visual measurement of radio frequency coverage of the site listed above. Measurements were taken in the basement and ground level. California Fire Code states 510.4.1 Radio Signal Strength. The building considered to have acceptable emergency responders radio coverage when signal strength measurement in 95% of all areas on each floor of the building meet the signal strength requirements in Sections 510.4.1.1 510.4.1.1 A minimum signal strength of -95dBm shall be receivable within the building RF Test Overview Preliminary measurements are preformed prior to completion of a building to gauge the likelihood that an enhancement system will be required and to mitigate impacts to construction. The test was conducted using a Signal Hound - Handheld Spectrum Analyzer set for frequency (800 MHz) South Tower and County dispatch frequency. The tests were performed using a diagonal grid pattern with a back and forth sweep. The test results were documented with the negative acceptable loss, in each grid. HCl tested basement. HCl tested the interior of the ground floor which included kitchen and outside dining area. The building at the time of the test was in its completed state. • 4 Systems Inc. Ground Level qg . S=South Tower S•821C-74� �C=County Ontario • Irvine • San Diego • Hayward Sacramento • Fresno • Glendale/LA Telephone: (877)331-2084 Fax: (909)628-7774 ■ IR ■ -11 iw J ■�� a .� S i ! r V _ Basement Level 17 71C Ontario • Irvine • San Diego • Hayward Sacramento • Fresno • Glendale/LA Telephone: (877)331-2084 Fax: (909)628-7774 Spectrum Analyzer Test South Tower — Ground Level Grid#1 Grid#2 Grid#3 Grid# 4 t s 4 lM�JMMYNW t m iq ,aq+naouw Downlink: -95dBm Downlink: -86dBm Downlink: -84dBm Downlink: -81dBm Grid#5 Grid#6 Grid#7 Grid#8 Downlink: -81dBm Grid#9 Downlink: -81dBm Grid#13 Downlink: -86dBm Downlink: -77dBm Downlink: -83dBm Grid#10 Grid#11 Grid#12 Downlink: -81dBm Downlink: -83dBm Downlink: -78dBm Grid#14 Grid#15 Grid#16 Downlink: -80dBm Downlink: -74dBm Downlink: -82dBm Downlink: -81dBm Grid#17 Grid#18 Ontario • Irvine • San Diego • Hayward Sacramento • Fresno • Glendale/LA Telephone: (877)331-2084 Fax: (909)628-7774 Grid#19 ,rid#20 Downlink: -77dBm Downlink: -82dBm Downlink: -71dBm Downlink: -79dBm Spectrum Analvzer Test South Tower — Basement level Grid#1 Grid#2 Downlink: -95dBm Downlink: -93dBm Spectrum Analyzer Test County Ground Level Grid#1 Grid#2 Grid#3 Downlink: -86dBm Grid#5 ',rid# 4 Downlink: -89dBm Downlink: -82dBm Downlink: -82dBm ',rid#6 71 ,rid#7 Grid#8 Downlink: -77dBm Downlink: -84dBm Downlink: -75dBm Downlink: -80dBm C IICI 10% Systems Inc. Grid#9 Grid#10 Ontario • Irvine • San Diego • Hayward Sacramento • Fresno • Glendale/LA Telephone: (877)331-2084 Fax: (909)628-7774 Grid#11 Grid#12 Downlink: -76dBm Downlink: -81dBm Downlink: -79dBm Downlink: -78dBm Grid#13 Grid#14 Grid#15 Grid#16 Downlink: -81dBm Downlink: -75dBm Downlink: -77dBm Downlink: -80dBm Grid#17 Grid#18 Grid#19 Grid#20 Downlink: -81dBm Downlink: -74dBm Downlink:-77dBni Downlink: -83dBm Spectrum Analyzer Test County -_Basement level Grid#1 Grid#2 AL Downlink: -94dBm Downlink: -90dBm Ontario • Irvine • San Diego • Hayward Sacramento • Fresno • Glendale/LA v� Systems Inc. Telephone: (877)331-2084 Fax: (909)628-7774 Conclusion In conclusion to the preliminary RF test performed at the Farmhouse Cafe. HCI walked through the facility with a spectrum analyzer to record and document the off air signal that is present at the Farmhouse caf6. The facility has a small basement and a kitchen and service area with an open dining area. The basement has borderline readings however have passed the -95 dBm limit. The Ground level kitchen and dining area has good coverage and are above the -95 dBm limit. At the time of the test the building was complete. Submitted by: Ralph Chavez DAS Foreman 1731 Reynolds Avenue Irvine, CA 92614 Cell: 949-599-5052 Irvine Office: 949-724-5000 Fax: 949-724-5001 E-mail: rchavez(Z�hcisystems.net Michael Schmitt Project Manager 1731 Reynolds Avenue Irvine, CA 92614 Cell: 949-751-7844 Irvine Office: 949-724-5000 Fax: 949-724-5001 E-mail: mschmitt(&_hcisystems.net Ontario 0 Irvine 0 San Diego 0 Hayward HC1 LSacramento* Fresno* Glendale/LA Vim. Systems Inc. Telephone: (877)331-2084 Fax: (909)628-7774 dsy UNI PED STAXEN Of? ANIRRICk VEDVWXL COMMUNICATIONS CON&MRON Ganoral 1121flotalaphane Operator License IMAVI:f, KARNA Ship carkbflj+ cle the dwrXimrs &'In2 M. U.- i,t indientd Th. C—A km rxv-0. &d IA. IW'11,Vr07WCdCW Ile pflftc :, xrrLt a if, &,pf-'--j- CIUVE/ RW.Ptl A 16*Pk'TfCVqLk (:A 9179-1 G-1 umud'),PM., Opirrarof LRfAik U*.Ij Thi. State Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request STD 850 JUNE 3, 2016 CCL 3. Agency Contact 4. Telephone 5. Evaluator (714) 703-2800 Fax (714) 703-2831 N. MALEK/ MCR E203 Department of Social Services 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 304371110 4A 370 10. Response Required Codes 1. Original A. Fire Clearance Department of Social Services 2. Renewal B. Life Safety Community Care Licensing 3. Capacity Change 760 The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change NOTE: PRESCHOOL = 72 TODDLER OPTION = 24 6. Name Change TOTAL CAPACITY =96 7. Hours: Monday - Friday 7:30AM - 6:OOPM Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap 96 96 Care? 0 0 Care? 0 18, Facility Code -16 - COG No No 12, Facility Name 13. # of Bldgs. 1. GACH 9. ADHC ORANGE TREE CHRISTIAN PRESCHOOL 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14, Street Address (Actual Location) 15. Restraint 1000 BISON AVE NONE 4. APH 12. ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under NEWPORT BEACH 92660 24 HRS. 6. SNF 14. CCF 7.1CF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special LUCY, LESLIE 949-458-1382 NONE 8. ICF/DD 16.Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Telephone # CFIRS ID# T-19 OCC 1. Fire Clear/Granted ( q y q) 2. Fire Clear/Denied WSJ I N G M t2ti21 S 014- 31 O 5 3 D O.SS 3. Fire ClearlWithheld Inspection Date Inspector's Signature Clearance Code Explanation of Denial or Special Conditions: Denial Code Fire Agency Denial Codes 1.Exits 2.Construct. NEWPORT BEACH FIRE PREVENTION BUREAU 3.Fire Alarm 100 CIVIC CENTER DRIVE 4.Sprinklers NEWPORT BEACH, CA 92660 5.Housekeeping 6.Special Hazard 7.Other r• f Rest, 011 room West Exit Pull Station First Aid f Smoke/Heat Detector Room 3 845 SF , � I c� 1 \L Room 2 595 SF First #1 Smoke/Heat EX, Ad Detector Fire "warm Horn FF-Restroom � -- 1 "_ .1, Gas Water Shut -oft / Shut-off .�1'Y-ice Restroom Electrical Shut -oft Exit Room 1 777 SF st , SmokelHoat A Detector I Exit - 1 J _e Fire Alarm Hallway _ Hom Pull Fire Station Extinguisher I South Exit East Exit North 121 Ar STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING FACILITY SKETCH (Floor Plan) Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard. The floor sketch must label rooms such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by staff/residents/clients/children. Door and window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x ,I±r1 �3.4: 1.3 ~i , .. >• In• y� f --). V�1 1 i.Yi l .. �i /D i , 'r�•b�� rr1- l-.. V1.i t �•"i t `-' .+rV. i +ya CW.7J rb�� °' •T!su ' i �a! . 1';rt.: •i ,:. 'tip �'l,"• : i' tF)tt) r"r'�c . C- Il�f 1 i FECu li 3�iA aT..` i1 ;i:i;nr:: hP7�< t' i i (E)ClA55ZOOv LZ tz7:LA55CA NNE', LIC 999 (3199) ll LE STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING FACILITY SKETCH (Yard) The yard sketch should show all buildings In the yard Including the home (with no detail), garage and storage building. include walks, driveways, play area, fences, gates. Show any potential hazardous area such as pools, garbage storage, animal pens, etc. Show the. overall yard size. Try to keep the sizes close to scale. Use the space below. Rises „,' i ocation ^ Riser;, Main., -Drain , Initial', statirr esid,ual Einal' Stiatic - P,,.l , N/A Di-ameter' D,iaraeter, Pressure Pres`sur �e' Pressure 1 Riser'closet behind;b'uil'di'ng 3 1% ' 48, 42 - 4:8 P l , .... ' 1 ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 Forms Attached: F 5-Year INSPECTION, TESTING, Includes ALL Annual inspections, AND MAINTENANCE Tests, and Maintenance Items Quarterly and 1=Inspection T=Test M=Maintenance P=Pass F=Fail N/A --Not Applicable lterii” p2SGGlpCIOtJr CA, Edition, Date,.' Comments'enly: NSA „°, ' Reference 1.1 1 Control Valves — Identification Signs 13.3.1 3, -2/16 ; , . P' 1.2 1 Control Valves- Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P . 1.4 1 Supervisory Devices 5.2.6 F 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Enter Water Supply Pressure Below Riser 5.2.4.1 psi ." . NA Check 1.7 I Enter Water Supply Pressure Above Riser 5.2.4.1 psi NA-' Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 P 1.9 I(For Hydraulic Design Information 5.2.6 NA hydraulically designed systems) General Information Sign 1.10 1 (not required for systems prior to 2007 Edition of NFPA 5.2.8 NA 25 1.11 1 Heat Tape 5.2.7 _ NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 "P` 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 P AUG 0 9 2016 Form AES 2.2 September 3, 2013 IncludesANNUAL INSPECTION, TESTING, AND MAINTENANCE 1=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable dte'mr Qesbriptio' h, ''NFP,.,A;25 cA`Edition iRefere"nce:. Date; „ Com,ments' 061y N"E- 1.17 I Small Hose Connections —Hose Valve 5.1.6, 13.5.2, 13.5.5.1 3%2/16 ; NA" 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N;A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.E 1.22 1 Pipe and Fittings 5.2.2 P' , 1.23 1 : Pipe and Fittings —Accessible Concealed Space 5.2.2.3 I' 1.24 1 Hangers 5.2.3 - Pw 1.25 I Hangers —Accessible Concealed Space 5.2.3.3 ". P, 1.26 1 Seismic Braces 5.2.3 P" . 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ❑ Yes ® No 2.1 T Fie Service Test Require Send report to Fire Code O iciol 5.3.1 If REQUIRED, enter'F'until results are returned from lab. ,P~ 2.2 T Recalled Sprinklers If not present = Pass; If present =Fail Title 19 904.1 c P, 2.3 T Waterflow Alarm Devices 13.2.E .2. -_ 60 secs. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 _ 'P 2.5 T Control Valve — Position 13.3.3.2 P 2.6 T Control Valve- Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P" 2.8 T Backflow Preventer Assemblies 13.6.2 P 2.9 T Small Hose Connections * w/PRV Hose Valves - Partial Flow Test 13.5.2.3 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 = NA _ 2.11 T Pressure Gauges — Calibration 5.3.2 'NA 2.12 T Small Hose Connections * 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class I, II, or III AUG 0 9 201E Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND i Quarterlyincludes ALL 1 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable Item, D'escriptio;n" C&Ed"itioa' -Date. Comments<Qr�ly Reference 3.1 M Check Valve — Internal Inspection 13.4.2 NA 3.2 M Control Valves 13.3.4 P 3.3 M FDC — Backflush 14.3.2.3 14.3.2.4 F " Internal Pipe Inspection —See Deficiencies and 14.2 ❑ Yes 3.4 M Comments Section for Results ® No = 3.5 M Obstruction Investigation Required. If "Yes"see 14.3 NA !Deficiencies and Comments Section for Results ®Yes 3.6 M System Returned to Service 4.5.3 ❑ No Deficiency C Comment•type) Deficiencies Comments Item Date Riser D C Indicate all equipment devices and parts that were repaired or replaced F1 Check Here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: see Correction Form AES 10 for corrected deficiencies Number attached: 1 hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name . Jon Saia Signature 'Date, Z/21/2Q16 " AUG 0 9 2016 Form AES 2.2 September 3, 2013 Fire A FIRE PROTECTION INSPECTION Page 1 of 1 Safety DEFICIENCY REPORT First Customer: Newport North Center % Irvine Company Retail Properties Date: March 2, 2016 Location: 1200 Bison, Newport Beach Type: 5 Year (1st Quarter) ITEM # I EXPLANATION OF DEFICIENCIES C-1, Radiant Hot Yoga 1. Men's Restroom — Lower 1 firesprinkler and replace missing escutcheon 2. Overhang in front of Radiant Hot Yoga — Replace 2painted sprinkler heads C-2, Pita Jungle 3. Men's restroom- Replace 1 missing cover plate 4. Dish Pit — Replace 1 corroded sprinkler head 5. * Kitchen — Maintain 18" clearance to all sprinkler heads Riser 6. Install 1 spare head box with extrasprinkler heads and wrenches 7. Re -mount existing spare head box to wall 8. Test or replace 1 riser gauge Fire Alarm Control Panel 9. Replace 2 outdated batteries Main Fire Line and FDC Connection 10. Backflush FDC connection at completion of repairs Items marked with an asterisk * are the responsibility of the owner, property management or tenant RIEtt poster, Fire CeDSh FIRE SAFETY FIRST • 1170 E. FRUIT STREET • SANTA ANA • CA • 92701 • (714) 836-4800 • (714) 836-4120 FAX AUG 9 9 2016 ANNUAL INSPECTION, AND MAINTENANCE IncludesALL I andAnnualInspections,and Maintenance Mnspection T=Test M=Maintenance P=Pass F=Fail _ N/A=Not Applicable ItMIT'Descr'ipfion ` '' ;`' NfPA,25 CA'Edition, .References, Date; Cornrrients;Qrily N/A,_ 1.17 1 Small Hose Connections — Hose Valve 5.1.6, 13.5.2, 13.5.5.1 3/2%16 NA- 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 NA 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.E " ;,: P ; + 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings —Accessible Concealed Space 5.2.2.3 ; t,.., P. - 1.24 I Hangers 5.2.3 R 1.25 1 Hangers — Accessible Concealed Space 5.2.3.3 P 1.2E I Seismic Braces 5.2.3 'P 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ❑ Yes ®No 2.1 T Fie Service Test Require Send report to Fire Code Official 5 3 1 If REQUIRED, enter'F'until results are retumed from lab. P 2 2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1 c . P, 2.3 T Waterflow Alarm Devices 5.3.3 13.2.E 60 secs. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 F - 2.5 T Control Valve — Position 13.3.3.2 R, 2.6 T Control Valve- Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 P 2 9 T Small Hose Connections * w/PRV Hose Valves - Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 -:NA 2.11 T Pressure Gauges — Calibration 5.3.2 NA, 2.12 T Small Hose Connections * 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class I, II, or III AUG 0 9 2016 Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly andAnnual Inspections, Tests, and Maintenance Items I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Ap 'cable Item Description - NFPA 25„ GA Edition' •Reference' Date; COf111Tlents'O'nl, Y' • . P' F' N/A 3.1 M Check Valve — Internal Inspection 13.4.2 NA, 3.2 M Control Valves 13.3.4 P 3.3 M FDC— Backflush 14.3.2.3 14.3.2.4 P 3.4 M Internal Pipe Inspection —See Deficiencies and 14.2 ❑ Yes Comments Section for Results ®No 3.5 M Obstruction Investigation Required. If "Yes"„ see 14.3 'NA • ' Deficiencies and Comments Section for Results ®Yes 3.6 M System Returned to Service 4.5.3 ❑ No D = Deficiency C = Comment (Indicate type) 5%23/16 "®- Repairs, c ' - � ' � ompleted'per Deficiency:Re,port-dated 3%2/16 � •, ' El El R ❑ ❑ ❑ ' ❑ _. . ❑ Check Here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jon Saia Signature Date 6/21/2016 � v REVIEWED & APPROVED Scott Poster, Fire Chief AUG 0 9 2016 Form AES 2.2 September 3, 2013 Fire Page 1 of 1 0 Safety FIRE PROTECTION INSPECTION Firet DEFICIENCY REPORT Customer: Newport North Center % Irvine Company Retail Properties Date: March 2, 2016 Location: 1220 Bison, Newport Beach Type: 5 Year (1st Quarter) ITEM it I EXPLANATION OF DEFICIENCIES Al, Baskin Robbins 1. Replace 1 outdated dry pendent sprinkler head A2, Elegance Family Dentist 2. No Access at this inspection 3. Storage closet — Lowersprinkler head and replace missing cover plate A3, Pilates Plus 4. Restroom- Replace 1 missing skirt A4, European Wax Center — Oka A5, Labels 5. Dressing room — Replace 1 missing escutcheon A6, Spade Skin Care 6. Restroom- Replace 1 corroded sprinkler head 7. Rooms 1 & 4 — Replace 2 corroded sprinkler heads A7, Sole Comfort 8. Back Electrical room — Install 1 firesprinkler under wood mezzanine Riser 9. Butterfly Control valve - Replace missing tamper switch cover 10. Add extrasprinkler heads and wrench to existing spare head box 11. Test or replace 1 riser gauge Common Areas 12. Outside of A2 — Replace 1painted sprinkler head 13. Overhang, above A6 — Replace 2painted sprinkler heads Main Fire Line and FDC Connection 14. Adjust 2 tamper switches 15. Backflush FDC connection at completion of repairs FIRE SAFETY FIRST • 1170 E. FRUIT STREET • SANTA ANA • C 1 • (714) 836-4800 • (714) 836-4120 FAX REVIEWED & APPROVED AuG 9 2016 Scott Poster, Fire Chief Aiser, No. Riser Information Location, .,':: ' . Riser.", ,. piaf�,eter � Main D."rain CSameter' Main Drain lriifi2l: tatiC Pr:.essure Test (Annual) Residual Pressure, . . Static Pressure... P N/A, , 1 . ' Riser,closet behind building, 3 1%: ., 49 42 49 P _ ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 Forms Attached: 5-Year INSPECTION, TESTING, AND , + QuarterlyIncludes ALL 1=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Item ;Description " NFP,A 25' cA;Eaition ` Dat'e - 1„ :-Comments Qnly, " P., 'F, N' A 1., Reference. 1.1 1 Control Valves — Identification Signs 13.3.1 3%2%16 P 1.2 1 Control Valves- Inspection 13.3.2 P ,• 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.6 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P' 1 6 I Enter Water Supply Pressure Below Riser 5.2.4.1 psi '- NA Check 1.7 I Enter Water Supply Pressure Above Riser 5.2.4.1 psi NA Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 P 1.9 I Hydraulic Design Information 5.2.6 NA. (For hydraulically designed systems) General Information Sign 1.10 I (not required for systems prior to 2007 Edition of NFPA 5.2.8 NA 25 1.11 1 Heat Tape 5.2.7 NA . 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 P AUG 0 9 2016 Form AES 2.2 September 3, 2013 l INSPECTION, ANNUAL • AND MAINTENANCE Includes ALL I and Annual Inspections,and Maintenance l=Inspection T=Test M=Maintenance P=Pass F=Fail N/A --Not Applicable )Item ,. Descriptio,nu "' - - ,' NFPA,25 &a ditio6; `References" Date .. . Comments O"n'ly 1.17 1 Small Hose Connections— Hose Valve 516, 13.5.2, 13.5.5.1 3%2/16 ; NA, 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 NA 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility 1.20 I Sprinklers 5.2.1 P _ 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.E i t _ P�; 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 . Pipe and Fittings —Accessible Concealed Space 5.2.2.3 �y -P.. 1.24 1 Hangers 5.2.3 1.25 1 Hangers —Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P' 1.27 1 Seismic Braces -Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ❑ Yes ® No 2.1 T Fie Service Test Require Send report to Fire Code Official . . 531 If REQUIRED, enter `F'until results are retumed from lab. - F 2 2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1 c P ' 2.3 T Waterflow Alarm Devices 5.3.3 13.2.6 60 secs. P 2.4 T Main Drain Test (Enter data on Pagel of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve — Position 13.3.3.2 P 2.6 T Control Valve- Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 „ P - 2.8 T Backflow Preventer Assemblies 13.6.2 P , 2 9 T Small Hose Connections * w/PRV Hose Valves - Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV— Fire Sprinkler Systems 13.5.1.3 T NA 2.11 T Pressure Gauges — Calibration 5.3.2 :NA . 2.12 T Small Hose Connections * 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class I, II, or III AUG 0 9 2016 Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, AND MAINTENANCE Includes ALL Quarterly andAnnual Inspections, I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable P'" F` Item � � Descari tion . ' Pt : ; CA,Eaitioh Reference Date Comments; Only, N/A e 3.1 M Check Valve—Internallnspection 13.4.2 NA 3.2 M Control Valves 13.3.4 P ° - 3.3 M FDC — Backf lush 14.3.2.3 14.3.2.4 P ' Internal Pipe Inspection —See Deficiencies and 14.2 i _ ❑ Yesy 3.4 M Comments Section for Results ® No 3.5 M obstruction Investigation Required. If "Yes":, see 14.3 NA Deficiencies and Comments Section for Results ® Yes 3.6 M System Returned to Service 4.5.3 ❑ No =Deficiency C = Comment•type) Deficiencies Comments Item Date Riser D C Indicate all equipment devices and parts that were repaired or replaced ■ Check Here if additionald Comments are listed on Form AES 9 Number attached: ■see Correction Form AES 10.corrected deficiencies J; Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jon Saia Signature Date 6/21/2036 u v Form AES 2.2 REVIEWED & APPROVED Scott Poster, Fire Chief AUG 0 9 2016 September 3, 2013 Fire 0 FIRE PROTECTION INSPECTION Page 1 of 1 Safety DEFICIENCY REPORT First Customer: Newport North Center % Irvine Company Retail Properties Date: March 2, 2016 Location: 1260 Bison, Newport Beach Type: 5 Year (1st Quarter) ITEM # EXPLANATION OF DEFICIENCIES D1, Starbucks - D3, Champagne's Bistro & Deli 1. 1 Kitchen — Replace (1) missing cover plate _I Riser 2. 1 Test or replace (1) riser Main Fire Line and FDC Connection 3. 1 Backflush FDC connection at completion of repairs i AUG 0 9 20 FIRE SAFETY FIRST e 1170 E. FRUIT STREET • SANTA ANA • CA e 92701 • (714) 836-4800 • (7141) 83 20 FAX REVIEWED & APPRO Scott Poster, Fire Chi No: Riser Information Locatiiin ' „ Riser : Diameter Main' _ ` rain P - D'i"arneter Main Drain Initia'1 static Pressure ,[' Test (Annual) Resi$Ut I' Pre'ssur„e Find S'atic t ,Pressure,. ; R,, F, N/A` 1 `Riser closet behind building 4 " 2 41 4i,- 47 P t, ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 Forms Attached: 5-Year INSPECTION, TESTING, Includes ALL Annual Inspections, AND MAINTENANCE Tests, and Maintenance Items Quarterly and 1=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Item, = M ,- ,r - :D,esc,rifptiori "NFPA25 6dEditioh• Date Co%n)iierits,Only','; ; P.,,F, N/A: ,Reference 1.1 1 Control Valves — Identification Signs 13.3.1 3%2%2016' P' 1.2 1 Control Valves- Inspection 13.3.2 P. 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.6 P' ` 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Enter Water Supply Pressure Below Riser 5.2.4.1 psi - NA Check 1.7 1 Enter Water Supply Pressure Above Riser 5.2.4.1 psi NA -, Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 P 1.9 I Hydraulic Design Information 5.2.6 NA For hydraulically designed systems) _ General Information Sign 1.10 1 (not required for systems prior to 2007 Edition of NFPA 5.2.8 NA, 25 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P. 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 P AUG 0 9 2016 Form AES 2.2 September 3, 2013 ANNUAL AND MAINTENANCE Includes Quarterly and Annual Inspections,and Maintenance 1=Inspection T=Test WMaintenance P=Pass F=Fail N/A=Not Applicable " Item Description . NFPA„25 ' . cA-Edition ,, x _Reference„„, ;Date „ ; ,.... —00 v rCohi'ments' Only PIT", /A 1.17 1 Small Hose Connections — Hose Valve 13.5.2, 13.5.5.1 32/2016 -, NA -_ 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 NA 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility 1.20 I Sprinklers 5.2.1 P 1.21 1 ` Sprinklers Concealed Space S p p 5.2.1.1.E ' 1 P ,P I 1.22 1 Pipe and Fittings 5.2.2 :P , 1.23 I Pipe and Fittings —Accessible Concealed Space 5.2.2.3 ..P-.. 1.24 1 Hangers 5.2.3 .P_. 1.25 1 Hangers —Accessible Concealed Space 5.2.3.3 " P 1.26 1 Seismic Braces 5.2.3 Pl 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 -P 1.28 1 Unsprinklered Areas CFC 901.4 ® Yes ❑ No 2.1 T Field Service Test Required Send report to Fire Code 0 icial 5.3.1 If REQUIRED, enteff'unfit results are refumed from lab. P 2 2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Waterflow Alarm Devices 13.2.E .2. 60 secs. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 - F 2.5 T Control Valve — Position 13.3.3.2 'P . 2.6 T Control Valve- Operation 13.3.3.1 P -- 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 P 2 9 T Small Hose Connections * w/PRV Hose Valves - Partial Flow Test 13.5.2.3 13.5.3.3 NA, 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges —Calibration 5.3.2 'A - 2.12 T Small Hose Connections * 13.5.6.2.2 - NA * Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class I,11, orill Form AES 2.2 AUG 0 9 2016 September 3, 2013 ANNUAL r MAINTENANCE Quarterlyincludes ALL I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicabl Item-Deseripfiion- - NFPA;25. ` CA Editio n :Date, Comments"On'ly P, -F; .. -N/A, R'eferenc 3.1 M Check Valve — Internal Inspection 13.4.2 3%2/2016 NA 3.2 M Control Valves 13.3.4 P , , 3.3 M FDC — Backflush 14.3.2.3 14.3.2.4 ,. P - 3.4 M Internal Pipe Inspection —See Deficiencies and 14.2 ❑Yes Comments Section for Results ® No ' 3.5 M Obstruction l,nvestigation Required. If "Yes', see 14.3 3 NA Deficiencies and Comments Section for Results , ®Yes 3.6 M System Returned to Service 4.5.3 ❑ Nd D = Deficiency C = Comment (Indicate type) Deficiencies Item Date Riser r CIndicate all equipment devices andparts that were repaired. .. •. T%21/2'0.16, ❑ '-®'.`Repairs;completed:p,erDeficiencyRep ort6ted=,3/2%16.; 1.2.8 ,, ❑ , �' Back of cfeaners,'by exit.door,=;Rerrlove plywood sforage or instali'(1) spri'nkhar'head- 0 ❑ ❑ ❑ ; ❑ Check Here if additional Deficiencies and Comments are listed on Form AES 9 ❑ See Correction Form AES 10 for corrected deficiencies Number attached: Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jon Saia Signature Date 7/21/20115 AUG 0 9 2016 Form AES 2.2 September 3, 2013 Fire A FIRE PROTECTION INSPECTION Page 1 of 2 Safety DEFICIENCY REPORT First Customer: Newport North Center % Irvine Company Retail Properties Date: March 02, 2016 Location: 1280 Bison, Newport Beach Type: 5-Year (1st Quarter) ITEM # I EXPLANATION OF DEFICIENCIES Bl, Ma 's Donuts & Bake — Oka B2 Scottrade 1. Front entrance — Lower 1 sprinkler heads to correct position and replace missing escutcheon 2. Back of front office — Replace 1 corroded sprinkler head 3. Restroom — Replace 1 corroded sprinkler head 4. Restroom — Replace 1 missing small skirt 5. Conference Room — Lower 1 sprinkler head to correct position and replace 1 missing escutcheon 6. Back office — Install 1 sprinkler head(existing head is too far off wall B3, Meri Education - Oka B4, Newport North Cleaners 7. Restroom — Replace 1 corroded sprinkler head 8. Back of cleaners, by exit door — Remove plywood storage or install 1 sprinkler head B5, Master Tailoring — Oka 116, Royal Jewelers 9. Front of suite — Replace 1 corroded sprinkler head B7, Vacant 10. Throughout — Replace 2 corroded sprinkler heads 11. No Access at this inspection Vacant key did not unlock door B8 Happy Nails 12. Throughout — Lower 3 sprinkler heads to correct position and replace 3 missing escutcheon 13. Back Rest Room — Replace 1 corroded sprinkler head 14. Entrance to back of suite — Plug and remove 1 firesprinkler within 6' of another B9, Lil Baby Sprouts — Oka B10, GNC — Oka Bll, Bowls of Heaven — Oka FIRE SAFETY FIRST • 1170 E. FRUIT STREET • SANTA ANA • CA • 92701 • (714) 836-4800 • (714) 836-4120 FAX AUG 0 9 2016 Fire Page 2 of 2 Safely FIRE PROTECTION INSPECTION First DEFICIENCY REPORT Customer: Newport North Center % Irvine Company Retail Properties Date: March 02, 2016 Location: 1280 Bison, Newport Beach Type: 5-Year (lst Quarter) ITEM # I EXPLANATION OF DEFICIENCIES B14, Petco 15. Dog groomingarea, over sinks — Replace 2 corroded sprinkler heads 16. Back of small animal aisle — Replace 1 damaged sprinkler head 17. Stock room near double swinging door — Install 2 firesprinklers(heads 9'+ off wall Riser 18. Mounts are head box to wall 19. Add existing heads to existing spare head box 20. ID Inspector's Test Valve 21. Replace 1.5" cap on main drain outlet 22. Test or replace 1 fire riser gauge Common Areas 23. Overhang outside B6 — Replace 2painted sprinkler heads 24. Overhang outside B 14 — Replace 4painted sprinkler heads Main fire line and FDC 25. Backflush FDC at completion of repairs 4, REVIEWED & APPROVED Scott Poster, Fire Chief FIRE SAFETY FIRST • 1170 E. FRUIT STREET • SANTA ANA • CA • 92701 • (714) 836-4800 • (714) 836-4120 FAX AUG 0 9 2016 C 41iVu d 7, rn Name Copy Sent to: Address 1170-E.Fraif-15 Z owner Date: 6/30/16 City Fire AHJ Date: 6/30/16 State, Zip •CA! -�Pp- E] contractor Date: Telephone �74800, Notes* For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 Edition as amended by California CA License # C, 116Q 50 7 61- Code of Regulations, Title 19, Section 901 to 906. 2) Inspection items may be performed by the owner in accordance Job # 777 with California Code of Regulations, Title 19, Section 904.1(a). Performed byT- Nf -b- bk �','�,C-h dk,,b ,� fdVe'ac, �sy t -ji :Fr6C P 6, Forms included with this Report N1FPA 25 Number of N/A Fail* Pass Chapter Forms Automatic Sprinkler System 5 E] Standpipe and Hose System 6 El El El E] Private Water Supply System 7 ❑7 El r El El E] Fire Pump 8 El El El E] Water Storage Tank 9 E] water spray System 10 s.El El 0 E] Foam Water Sprinkler System 11 El El El E] water mist System 12 El El E] concerns that are not deficiencies (i.e. Non-Sprinklered Areas) E] Yes No YAt r z, d ll -n,M, e e,. ...Ant C "V Form AES 1 JUL 112016 September 3, 2013 U0 S' ic", 0 3 7 "'1 171 This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 Forms Attached: 5-Year INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Hnspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable q N' Ytr0m, ;-;--NEPA acajdt E 1.1 I. Control Valves — Identification Signs 13.3.1 1.2 1 Control Valves- Inspection 13.3.2 J� �'T 1.3 1 Waterflow Alarm Devices 5.2.5 1.4 1 Supervisory Devices 5.2.6 D 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 "P" 1.6 1 Enter Water Supply Pressure Below Riser 5.2.4.1 psi Check 1.7 1 Enter Water Supply Pressure Above Riser 5.2.4.1 -P51 Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 n' 1.9 I Hydraulic Design Information 5.2.6 (For hydraulically designed systems) General Information Sign 1.10 1 (not required forsystems prior to 2007 Edition ofNFPA 5.2.8 25) 1.11 1 Heat Tape 5.2.7 1.12 1 Spare Sprinklers 5.2.1.4 1.13 1 Fire Department Connections 13.7 T 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 1.15 1 Pressure Reducing Valves 13.5.1.1 NA Fl-16 1 Backflow Preventers; 13.6.1 NA: JUL 112016 Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items 1=1nspection T=Test M=Maintenance P=Pass F=Fail N/A=Not-Applicable es �e QD i tt `6 y;s % n e, 5.1.6, 1.17 1 Small Hose Connections — Hose Valve 13.5.2, 13.5.5.1 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility 1.20 1 Sprinklers 5.2.1 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.6 1.22 1 Pipe and Fittings 5.2.2 1.23 1 Pipe and Fittings —Accessible Concealed 5.2.2.3 Space 1.24 1 Hangers 5.2.3 ---- ----- 1.25 1 Hangers — Accessible Concealed Space 5.2.3.3 1.26 1 Seismic Braces 5.2.3 _1:11117'" 711 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 7, v 1.28 1 Unsprinklered Areas CFC 901.4 A El Yes ®No 2.1 T Field Service Test Required 5.3.1 If REQUIRED, ente 'F'until Send report to Fire Code Official results are retumed from lab. 2.2 T Recalled Sprinklers Title 19 If not present = Pass, If present Fail 904.1(c) 2.3 T Waterflow Alarm Devices 5.3.3 13.2.6 60 secs. 2.4 T Main Drain Test 13.2.5 (Enter data on Page 1 of this form) 13.3.3.4 2.5 T Control Valve — Position 13.3.3.2 2.6 T Control Valve- Operation 13.3.3.1 J, 2.7 T Supervisory Devices 13.3.3.5 V 2.8 T Backflow Preventer Assemblies 13.6.2 P 2.9 T Small Hose Connections 13.5.2.3 w/PRV Hose Valves - Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 2.11 T Pressure Gauges — Calibration 5.3.2 -1- 2.12 T I Small Hose Connections 13.5.6.2.2 �N ,A Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class I; 11, or III JUL 112016 Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items I = Inspection T = Test M = Maintenance P = Pass is = Fail N/A = Not Applicable ... ... . . ... empuw .11 3.1 M Check Valve — Internal Inspection 13.4.2 3.2 M Control Valves 13.3.4 NA 3.3 M FDC — Backflush 14.3.2.3 P 14.3.2.4 Internal Pipe Inspection —See Deficiencies and 77777 y -Yes- 3.4 M Comments Section for Results 14.2 No Obstruction Investigation Required. If "Yes", see N,"'A 3.5 M Deficiencies and Comments Section for Results 14.3 NYes 3.6 M System Returned to Service 4.5.3 ❑ No D = Deficiency C = Comment (indicate type) I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained,on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments"section of this form. Print Name -Jdfi,'S 2 Signature 'e 0 JUL. 112016 INVEM & APPROM Swft Polder, Film Chief Form AES 2.2 September 3, 2013 Coittractor lnfoe— ation Number olf System° Risers Name Fire,Safety First Copy Sent to: Address 1170 E. Fruit Street ® Owner Date: 7/25/16 City Santa Ana ® Fire AH1 Date: 7/25/16 State, Zip CA, 92701 ' j ❑ Contractor Date: 'Telephone (714). 83-6-4800 i Notes: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 Edition as amended by California Code of Regulations, Title 19, Section 901 to 906. 2) Inspection items may be performed by the owner in accordance with California Code of Regulations, Title 19, Section 904.1(a). CA License # C16-599761 Job # Performed by Brandon Bridgford Check box for each system: inspected and,6ntOr,f9rms :used';fo ' in's°pecti'or�: on'strMS:ofnseceoi., .Cheek boxes :F,.a'il ,or -Pass ttb date --tied nseti IncludedForms with this Report Chapter Forms ® Automatic Sprinkler System 5 ti ❑ ❑ ❑ Standpipe and Hose System 6 ❑ ❑ ❑ ❑ Private Water Supply System 7 ❑ ❑ ❑ ❑ Fire Pump 8 ❑ ❑ ❑ ❑ Water Storage Tank 9 ❑ ❑ ❑ ❑ Water Spray System 10 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 ❑ ❑ ❑ ❑ Water Mist System 12 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ❑ No *See ``Deficiencies and; Co, meats" seet'ion .at each. tegp,ectiVe f>,orm'.:`; -j , F Conp. A-t- Ct N° 015 `,AUG 012016 Form AES 1 September 3, 2013 InformationRiser , Riser Location, : : Riser fvlait' Drain; Initial, static " Residual; , Final Static ; ; P, F,' N/-A'" N'o:. , „ ,. biameter - ,'.D'iarneter ° .,Pressure Pressure - :.Pressure:, 1 1-17 Veroli 2" 1.25" 99 65 95 P' - 2 1-17 Padua 2" 1.25" 99 64 94, P 3 1-17 Merano - - 2" 1.25" 82 . '64, - " $0' 4 1-17 Roma f 2" 1:2-5 90; 70 85 P 5 1-17 Tivoli <- 3 2" ; 1.25" 75 58 73 "P ® This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 Forms Attached: 1 INSPECTION, TESTING, AND MAINTENANCE Quarterly5-Year Includes ALL 1=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable :I,tem p.escription- " - - NFPA:25 cA18iti6n , —Date,: Comments Only N/A- 1.1 1 Control Valves — Identification Signs 13.3.1 10/17/15 P 1.2 1 Control Valves- Inspection 13.3.2 10/17/15 P 1.3 1 Waterflow Alarm Devices 5.2.5 10/17/15 - P 1.4 1 Supervisory Devices 5.2.6 10/17/15 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 ,10/.,17/,15 P 1.6 1 Enter Water Supply Pressure Below Riser 5.2.4.1 psi N/A ' . Check 1.7 I Enter Water Supply Pressure Above Riser 5.2.4.1 10/17/15 psi P Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 10/17/15 P- 1.9 I Hydraulic Design Information 5.2.6 NSA' For hydraulically designed systems) General Information Sign N/A 1.10 1 (not required for systems prior to 2007 Edition of NFPA 5.2.8 25 1.11 1 Heat Tape 5.2.7 :: N/A 1.12 1 Spare Sprinklers 5.2.1.4 10/17/15 P 1.13 1 Fire Department Connections 13.7 10/17/15 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 N/A 1.15 1 Pressure Reducing Valves 13.5.1.1 N/A 1.16 1 Backflow Preventers 13.6.1 N%A Form AES 2.2 AUG 912016 September 3, 2013 ANNUAL AND MAINTENANCE includesQuarterlyand AIInspections,and Maintenance 1=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Item-, ';Description cA.Edition-" Reference Date .'CommentsOnly 1.17 1 Small Hose Connections — Hose Valve 13.5.2, 13.5.5.1 N/A 1.18 1 PRV— Fire Sprinkler Systems 13.5.1.1 !N/A " 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility N/A- 1.20 1 Sprinklers 5.2.1 10/17/15 P 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.6 10/17/15. - P - 1.22 1 Pipe and Fittings 5.2.2 10/17/15 - P 1.23 1 Pipe and Fittings —Accessible Concealed Space 5.2.2.3 10/17/15_ 1.24 1 Hangers 5.2.3 N/A 1.25 1 Hangers —Accessible Concealed Space 5.2.3.3 10/17/15 P 1.26 1 Seismic Braces 5.2.3 N/A: 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 N/A, 1.28 1 Unsprinklered Areas CFC 901.4 ❑ Yes ® No 2.1 T Fie Service Test Require Send report to Fire Code Official 5 3 1 If REQUIRED, enter F'until results are returned from lab. N/A - 2 2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1 c - N/A, ` 2.3 T Waterflow Alarm Devices 5.3.313.2.6 .10/17/15. _ 30-90 secs. P 2.4 T Main Drain Test (Enter doto on Page 1 of this form) 13.2.5 13.3.3.4 1'0/17/1°5 " P' 2.5 T Control Valve — Position 13.3.3.2 10/17/15 P 2.6 T Control Valve- Operation 13.3.3.1 -10/17./15 P 2.7 T Supervisory Devices 13.3.3.5 10/17./15, P 2.8 T Backflow Preventer Assemblies 13.6.2 N/A 2. 9 T Small Hose Connections * w/PRV Hose Valves -Partial Flow Test 13.5.2.3 13.5.3.3 N/A . 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 N/A ' 2.11 T Pressure Gauges —Calibration 5.3.2 N/A 2.12 T Small Hose Connections * 13.5.6.2.2 N/A * Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class 1, 11, or III AUG 01 2016 Form AES 2.2 September 3, 2013 ANNUAL AND MAINTENANCE Quarterlyincludes ALL I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable 9,tem: Description NFPA 25 cA.Edltion - Date Comments Only P,,Fi R'e'f`erence N/A; 3.1 M Check Valve — Internal Inspection 13.4.2 N/A . 3.2 M Control Valves 13.3.4 .10/17%15. I P 3.3 M FDC — Backf lush 14.3.2.3 14.3.2.4 10/11/15 .. P' 3.4 M Internal Pipe Inspection —See Deficiencies and 14.2 ❑ Yes Comments Section for Results ❑ No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 N/A Deficiencies and Comments Section for Resultsj 3.6 M System Returned to Service 4.5.3 10/17/15. :' TED Yes No P - =Deficiency C = Comment• - type) Item Date Riser D C Deficiencies Comments Indicate all equipment devices and parts that were repaired or replaced Check Here if additional Deficiencies and Comments are listed on Form AES 9 see Correction FormAES 10 for corrected deficiencies Number attached: Numberattached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Brandon Bridgford Signature Date 7/22/16 Form AES 2.Z AUG 01 2016 September 3, 2013 • • Riser Information e 6n, - - - - Main Drain Test (Annual) ®®®®®® 1-17 " • ®®®® Savona ®®�® • O I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Brandon Bridgford Signature Date 7J22/,16 HEYIEINEDAAPPROM AUG 012016 September 3, 2013 Form AES 2.9 $MR P OK. Fft C1ief INSPECTION, TESTING, AND MAINTENANCE OF WATER —BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: System Riser ID- Name: Industrial Building Occupancy /Use: SS=1 � e of System: Address: 1620 Monrovia Ave. Construction Type: IlI A . Wet Pipe l o f Ntji ',, Dry Pipe City: Newport Beach No. Stories: 1 0 ` �✓ ZIP: 92663 Year Constructed 1966 Preaction ,'� , Y;; OCDIX& 1F NEVI gEAC Contact: Matt Montgomery FIRE DEPARTMENT AUG 0,Z2016 Telephone:949-933-6977 RECEIVED Contractor Information: Name: AUTOMATIC SPRINKLER TESTING Address: 2271 Pepperwood Ln. City: Corona State: CA Telephone: (714) 612-2001 CA License# 705005 Job # Performed by: LARRY SCHLOPY (Print) Note: Contractor information may be pre-printed 1 Number of SystMtRisers Copy sent to: ❑ Owner Date 7=20-2016 Fire AHJ Date p Contractor Date NOTES: 1) For specific inspection, testing and maintenance requirements and information, see NFPA 25, 2002 Edition as amended by California Code of Regulations, Title 19, §901 to §906. 2) Inspection Items may be performed by the Owner in accordance with California Code ofRegulations Title 19 §904.1(a) Forms included with this report NFPA 25 Chapter Number of Forms N/A FA1L* PASS Automatic Sprinkler System 5 0 Standpipe and Hose Systems 6 [� Private Water Supply System 7 Q Fire Pump 8 Water Storage Tank 9 Water Spray System 10 = Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form. w t INSPECTION, TESTING, AND MAINTENANCE OF WATER —BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 P e1of4 System Riser ID: Date of Inspection, Testing, Maintenance: 7=20-2016 of System: Property Information: j�(e ` 71 wet Pipe Of C44 Name: Industrial Building Dry Pipe Preaction �y+ Address: 1620 Monrovia Ave. Q Deluge v'` ? City: Newport Beach, _CA.92663 Main Drain Test Results: Abreviation Key: I = Inspection Initial Static Pressure: 60 (psi) T = Test M = Maintenance Residual Pressure: 52 (psi) A O = After Operation 1W = Per Manufacturer's Instructions Restored Static Pressure: 60 (psi) Item Activity Frequency Description NFPA 25 Fail N/A Pass Reference 1.1 I Daily Preaction/Deluge Valves Enclosure 12.4.3.1 Weekly temperature 1.2 I Daily Dry Pipe Valves -Enclosure 12A.4.1.1 Weekly temperature 1.3 I Quarterly Gauges (Dry, Preaction, Deluge 4.2.4-2 Systems) 5.2.4.3 1.4 I Quarterly Control Valves 12.3.2.11 1.5 I Quarterly Alarm Devices 5.2.6 1.6 I Quarterly Gauges (Wet Pipe Systems) 5.2.4.1 1.7 I Quarterly Hydraulic nameplate 5.2.7 r 1.8 I Quarterly Pipe and Fittings 5.2.2 1.9 I Quarterly Sprinklers 5.2.1 1.10 I Quarterly Spare Sprinklers 5.2.1.3 1.11 I Quarterly Fire Department Connections 12.7.1 1.12 I Quarterly Alarm Valves -Exterior Inspection 12.4.1.1 1.13 I Quarterly Preaction/Deluge Valves -Exterior 12.4.3.1.6 Inspection 1.14 I Quarterly Pressure Reducing Valves 12.5.1.1 1.15 I Quarterly Dry Pipe Valves -Exterior Inspection 12.4.4.1A 1.16 I Quarterly Backflow Preventers 12.6.1 1.17 I Annually Buildings 5.2.5 A F-s Z. Z INSPECTION, TESTING, AND MAINTENANCE OF WATER —BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 PaZe2of4 Date of Inspection, Testing, Maintenance: 7-20-2016 Property Information: Name: Industrial Building Address: 1620 Monrovia Ave. City: Newport Beach, CA 92663 System Riser ID: Type of System: Wet Pipe + 0f CAA t4 O D Pipe �' 0 Preaction t `� 0 Deluge �'--,� Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 I Annually Hangers 5.2.3 1.19 I Annually Seismic Braces 5.2.3 1.20 I 5 years Hangers (Accessible concealed spaces) 5.2.33 1.21 I 5 years Seismic Braces (Accessible concealed spaces) 5.2.3.3 1.22 I 5 years Pipe and Fittings (Accessible concealed spaces) 5.2.3.3 1.23 I 5 years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 1.24 I 5 years Alarm valves -Interior Inspection 12.4.1.2 1.25 I 5 yes Alarm Valves -Strainers, filters, orifices 12.4.1.2 ✓ 1.26 I 5 years Check Valves -Interior Inspection 12.4.2.1 1.27 I 5 years Preaction/Deluge Valves -Interior Inspection 12.4.3.1.7 ✓ 1.28 I 5 years Preaction/Deluge Valves -Strainers, filters, orifices 12.4.3.1.8 `, V 1.29 I 5 yes Dry Pipe Valves -Interior Inspection 12.4.4.1.5 V ii� 1.30 I 5 years Dry Pipe Valves -Strainers, filters, orifices 12.4.1.1.6 2.1 T Annually Alarm Devices (90 Sec) 5.3.3 12.2.7 2.2 T Annually Main Drain Test (Enter data on Page 1) 12.2.6 12.2.6.1 12.2.2.4 !, Y 2.3 T Annually Antifreeze Test 5.3.4 y( 2.4 T Annually Control Valve -Position 123.3.1 2.5 T Annually Control Valve -Operation 12.3.3.1 2.6 T Annually Supervisory 12.3.3.5 2.7 T Annually Preaction Valve -Priming Water 12.4.3.2.1 2.8 T Annually Preaction Valve -Low Air Pressure Alarm 12A.3.2.10 2.9 T Annually Preaction Valve -Full Flow Trip Test 12.4.3.2.2 4 &S -Z. z- . 't INSPECTION, TESTING, AND MAINTENANCE OF WATER —BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCX Title 19 Page 3 of Date of Inspection, Testing, Maintenance: 7-20-2016 Property Information: Name: Industrial Building Address: -1620 Monrovia Ave. City: Newport Beach. CA 92663 System Riser ID:--_ TYPIR of System: ` wet Pipe .� Dry Pipe 0 Preaction 0 Q `*',SAE MAC Deluge .� Item Activity Frequency Description NFPA 25 Reference Fail NIA Pass 2.10 T Annually Dry Valves -Priming water 12.4.4.2.1 2.11 T Annually Dry Pipe Valve -Low Air Pressure Alarm 12.4.4.2.6 2.12 T Annually Dry Pipe Valve -Quick Opening Device 12.4.4.2.4 vj 2.13 T Annually Dry Pipe Valve -Trip Test 12.4.4.2.2 2.14 T Annually Backflow Preventer Assemblies 12.6.2 2.15 T 3 years Dry Pipe Valve -Full flow Trip Test 12.4.41.2 . f 2.16 T 5 years Gauges 5.3.2 2.17 T 5 years Pressure Reducing Valve 12.5.1.2 2.18 T 5 years Fire Department Connection Backflush 12.7.4 Y 2.19 T 5 years Sprinklers Extra High temperature 5.3.1.1.1.3 2.20 T 5 years Sprinklers -Corrosive environment or corrosive water 5.3.1.1.2 ✓ 2.21 T 10 years Sprinklers Dry 5.3.1.1.1-5 2.22 T 20 years Sprinklers -Fast Response 5.3.1.1.1.2 2.23 T 50 years Sprinklers 5.3.1.1.1 2.24 T 75 years Sprinklers 75 years in service 5.3.1.1.4 t( 2.2 T Sprinklers manufactured prior to 1920- Replace 5.3.1.1.1.1 v 3.1 M Annually Control Valve -Position 12-3.4 3.2 M Annually Preaction/Deluge Valves 12.4.3.3.2 3.3 M Annually Dry Pipe Valves/Quick-Opening Devices 12.4.3.3.2 . / 3.4 M wally Dry Pipe Valve -Low Point Drains 12.4.3.3.3 3.5 M 5 years Obstruction Investigation Chapter 13 ��S -j" t- INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Page 4 of 4 Date of Inspection, Testing, Maintenance: 7-20-2016 System Riser ID:--.. _.._ . Property Information: Tvne of System: �11 FVJ Wet Pipe ep j _ E! Name: Industrial Building 1 _�tio ... o;;; El Dry Pipe Address: 1620 Monrovia Ave. Preaction1�� `"✓ -; City: Newport Beach, CA 92663 Deluge Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the item number Of the Activity listed above: 777 r is __>.,.,�,..a'�•c,�`•;`.�:F�-', . T. e f r � See Continuation Page(s) - _ _ -_ - - _ __ __(Indicate the number of continuation pages) - Pass Fail ��.�s.�. 1�-,� .. 7-20-2016 Signature Date REVS M & APPROVED Scott Poster. Fire cw AUG 0 2 2016 A1�s Z-z- MMEMD & APMMM Scott Poster, Fire Chief JUL 2 2 2016 e-z✓ Inspection, NFPA25as amended by CCR, Title 19 Name: RESIDENTIAL Occupancy/Use: R2 Address: 1 SUNDIAL Construction Type: Type V-g City: NEWPORT COAST No. Stories: 2 ZIP: 92657 Year Constructed: 2005 Contact: BRIAN STRUCK Telephone: (219) 613-6529 Name: ACTION FIRE PROTECTION Copy sent to: Address: 7602 ANTHONY AVE 0 Owner Date: 06/19/16 City: GARDEN GROVE ❑✓ Fire AHJ Date: 06/19/16 CA State: ❑ Contractor Date: Telephone: (714) 260-0101 ,NOTES: ) For specific inspection, testing, and maintenance requirements and Information, see NFPA 25, 2011 848831 C-16 CA License#: Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: 2) inspection items may be performed by the owner in Performed by: ROMAN CASTILLO accordance with California Code of Regulations, Title 19, IncludedForms -.. * Automatic Sprinkler System Chapter 6 1 ❑ ❑Ir ❑ Standpipe and Hose System 6 0 ❑ ❑ ❑ ❑ Private Water Supply System 7 0 ❑ ❑ ❑ ❑ Fire Pump 8 0 ❑ ❑ ❑ ❑ Water Storage Tank 9 0 ❑ ❑ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes m No JUL 2 2 2016 Riser Information Main Drain Test (ANNUAL) 1 GARAGE 11N 1/21N 100 60 100 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: Includes5-Year INSPECTION, TESTING AND MAINTENANCE Quarterly and Annual Inspections, I = Inspection T = Test M = Maintenance P = Pass F =Fall N/A = Nol AppUcab/e 1.1 1 Control Valves — Identification Sign 13.3.1 03/24/16 P 1.2 1 Control Valves -- Inspection 13.3.2 P 1.3 I Waterfiow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 NA 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 NA 1.7 1 Enter Water Supply Pressure Below Riser Check 6.2.4.1 psi NA 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 100 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5 2 8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 NA 1.14 I Alarm Valves — Exterior Inspection 13.4.1 NA 1.15 1 Pressure Reducing Valves 13.5.1,1 NA 1.16 1 Backflow Preventers 13.6.1 NA JUL 2 2 2016 IncludeANNUAL INSPECTION, TESTING, AND MAINTENANCE ALL Quarterly 1 = Inspection T = Test M = Maintenance P a Pass F= Fall N/A = Not.4ppllcable 1.17 I Small Hose Connections -Hose Valve* 5.1.6,13,5.2 N/A 13.5.5.1 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 NIA 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility P 1.20 1 Sprinklers 5.2.1 03/24/16 F 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P .1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 .P 1.26 f Seismic Braces 5.2.3 NIA 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 N/A 1.28 t Unsprinklered Areas CFC 901.4 UYes 10 No 2.1 T Field Service Test Required Send Report to Fire Code Official 531 .. If REQUIRED, Enter'F' until results are returned from Lab N/A 2.2 T Recalled Sprinklers If not present = Pass; If present = Fait Title 19 904.1(c) PASS 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 15 sec. PASS 2 4' T Main Drain Test (Enter data on Page 1 of this form) 13.2.6 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 NIA 2.8 T Backflow Preventer Assemblies 13.6.2 N/A 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.6.3.3 N/A 2.10 T PRV —Fire Sprinkler Systems 13.5.1.3 N/A 2.11 T Pressure Gauges - Calibration 5.3.2 NIA 2.12 T Small Hose Connections* 13.6.6.2.2 NIA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. JUL 2 2 2016 ANNUAL INSPECTION, TESTING, AND MAINTENANCE include ALL Quarterly Inspections (See AES 2.1) 1 = inspection T =Test M = Maintenance P= Pass F = Fail N/A=NotAppilcable 3.1 M Check Valves - Internal inspection 13.4.2 N/A 3.2 M Control Valves 13.3.4 P 3.3 M JFDC - Backflush 14.3.2.3 14.3.2.4 N/A 3.4 M Internal Pipe Inspection - See Deficiencies and 14 2 - N/A Comments Section for Results. Nos 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 NIA Deficiencies and Comments Section for Results s 3.6 M System Returned to Service 4.5.3 a No P ID = Deficiency C = Comment (indicate type) 1.20 3/24l16 1 X THERE ARE 8 PAINTED CONCEALED ESCUTCHEONS THAT REQUIRE TO BE REPLACED ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction_ Form AES 10 for corrected deficiencies. Number attached: 1 hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments "section of this form. Print Name ROMAN CASTILLO Signature Roman Castillo "�"e"e�.Y.e�„b� Date 03/24/16 "t1:m010A.4il;X.n•tu nm9aoman.21$mumntr-US te: Mi6AJ2411:M']0 4 7U(Y Corrective Action California Code of Regulations - Title 19 of and Repairs Performed Inspection, Testing, and Maintenance I Property Information Contractor or Licensed Owner Information Building Name BRIAN STRUCK RESIDENTIAL. Name ACTION FIRE PROTECTION Address 1 SUNDIAL Address 7602 ANTHONY AVE City GARDEN GROVE St. CA Zip 92841 City NEWPORT COAST License # 848831 Phone 714-260-0101 Contact Person BRIAN STRUCK ❑ SFM Job # Phone X CSLB C-16 Misc, Item AES Date Date Deficiencies and Comments Form # Found Corrected Indicate all equipment, devices and parts that were repaired or replaced INSTALLED 8 NEW CONCEALED• i • • 1• I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable. Roman Castillo P.O. BOX 1768 NEWPORT BEACH, CA 92658-Nib FIRE DEPARTMENT R�IV J U L 2 8 2016 Inspection,-. .-. , y CCR, Title 19 atl ii Prig a • Info o P rh/ rin - Y , Name: Lincoln Elementary School Occupancy/Use: Address: 3101 Pacific View Drive Construction Type: City: Corona Del Mar No. Stories: 1 ZIP: 92625 Year Constructed:'P Patrick Bullock ARE Contact: Telephone: (714) 424-7538 Number'of S steiri.:P sacs Name: Orange County Fire Protection Copy sent to: Address: 137 W. Bristol Lane ✓❑ Owner Date: 07/25/16 City: Orange ✓❑ Fire AHJ Date: 07/25/16 CA ❑ Contractor Date: State: (714) 974-9025 Telephone: NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 326604 CA License#: Edition as amended by California,Code of Regulations, Title 19; §909 to §906. Job #: 2) Inspection items may be performed -by the owner in Performed by: George & Tim accordance with California Code of Regulations; Title 19, §904.1(a) Ctecl� lioii.for each;system tn'ap`ec%d arid° enter�the number offomis; used ibr' Ctieck't�ozes (Fail or;f'aps� o t�idicafa atat�is ;ot (nspecfed syslie Report Chapter m Automatic Sprinkler System 5 1 ❑ ❑ ❑ ❑ Standpipe and Hose System 6 0 ❑ ❑, ❑ ❑ Private Water Supply System 7 0 ❑1 ❑ ❑ 'l Fire Pump 8 0 ❑ ❑ ❑ ❑ Water Storage Tank 9 0 ❑ ❑ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ❑ No *e8.�.`D4flCleilG(S+2111" "i✓OIYIIYl@T1" SeCtioh at �11d Of`BaC%lf@S�®0tIN8`fOftT1` REVlEWEQ A APPROVED Scott Foster, Flip Chief AES 1 September 3, 2013 .1 iser' Main' Diairi , i i. I, -P�essu`re' -pressure `1 iriit al"Stet c,` Reslilual'777 Riser closet access outside w/ check 4" 2" 60 55 ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: OEM— UI P = Pass F = Fail WA = Not Applicable = Inspection T = Test M = Maintenance ltem'- Des "I `ttonj°-.. p - ed::: Reference Date'.;" Com meots.Ohl' Y, r P F WA , , 1.1 1 Control Valves — Identification Sign 13.3.1 07/12/16 P 1.2 1 Control Valves — Inspection 13.3.2 07/12/16 P 1.3 1 Waterflow Alarm Devices 5.2.5 07/12/16 P 1.4 1 Supervisory Devices 5.2.5 07/12/16 NA 1.5 1 I Gauges (Wet Pipe Systems) 5.2.4.1 07/12/16 P 1.6 1 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 07/12/16 NA 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 07/12/16 59 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 07/12/16 60 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 07/12/16 P 1.10 1 General Information Sign not required for system prior to 2007 Edition NFPA 93 5.2.8 07/12/16 NA 1.11 1 Heat Tape 5.2.7 07/12/16 NA 1.12 1 Spare Sprinklers 5.2.1.4 07/12/16 P 1.13 1 Fire Department Connections 13.7 07/12/16 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 07/12/16 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 07/12/16 1.16 I Backflow Preventers 13.6.1 07/12/16 +NA Form AES 2.2 Sept. 3, 2013 INSPECTION,ANNUAL QuarterlyInclude ALL I = Inspection T = Test M = Maintenance P = Pass F = Fall NIA =Not Applicable Item, . Duacr"Iptibn NFPA, x!! Cd ed. tteNtence : : "Dite " ' C0Wh6r fe'0trljt ' .- PIFP lA ' .,.... , 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 07/12/16 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 07/12/16 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 07/12/16 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 07/12/16 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 07/12/16 P 1.22 I Pipe and Fittings 5.2.2 07/12/16 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 07/12/16 P 1.24 1 Hangers 5.2.3 07/12/16 P 1.25 1 Hangers -Accessible Concealed Space 5.2.3.3 07/12/16 P 1.26 I Seismic Braces 5.2.3 07/12/16 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 07/12/16 P 1.28 1 Unsprinklered Areas CFC 901.4 07/12/16 QYes m No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 07/12/16 If REQUIRED, Enter'F' until are returned from Lab NA 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) 07/12/16 P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 07/12/16 51 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 07/12/16 P 2.5 T Control Valve - Position 13.3.3.2 07/12/16 P 2.6 T Control Valve — Operation 13.3.3.1 01/12/16 P 2.7 T Supervisory Devices 13.3.3.5 07/12/16 NA 2.8 T Backflow Preventer Assemblies 13.6.2 07/12/16 NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 07/12/16 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 07/12/16 NA 2.11 T Pressure Gauges - Calibration 5.3.2 07/12/16 NA 2.12 T Small Hose Connections* 13.5.6.2.2 1 07/12/16 NA all hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III 7stSarndpipe systems. Form AES 2.2 Sept. 3, 2013 I = Inspection T = Test M = Maintenance P=Pass F=Fail N/A =NOtApplicable M,,] D"i ti pll_ WFPX26,,'9A id' * Men /A,lte, Roo hicoz,X-11: f r',e' 3.1 1 M ICheck Valves - Internal inspection 13.4.2 07/12/16 P 3.2 M Control Valves 13.3.4 07/12/16 P 3.P M FDC - Back lush 14.3.2.3 14.3.2.4 07/12/16 P Internal Pipe Inspection - See Deficiencies and 14.2 07/12/16 RNo Yes .N/A 3.4 M Comments Section for Results. 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 07/12/16 N/A Deficiencies and Comments Section for Results Z Yes 3.6 M System Returned to Service 4.5.3 07112/16 E]No P I D = Deficiency C = Comment (Indicate type) -Item 0 V-. A. and Com en" iaworVre'Cr1d .- O4z, 1.20 7/12/16 1 X 2 - Replace corroded Rasco G 165* chr 1/2" SR in library above computers in library 1.20 7/12/16 1 X 1 - Replace corroded Rasco, G 165' chr 1/2" SR room #11 by smoker detector 1.20 7/12/16 1 X I - Replace corroded Rasco G 165* chr 1/2" SR in room #9 above T bar and outlet in ceiling. 1.20 7/12/16 1 X 1 - Replace corroded Rasco G 1650 chr 1/2" SR in room #8 above T bar near projector 1.20 7/12/16 1 X 1 - Replace corroded Rasco G 165* chr 1/2" SR in room #6 above T bar 1st head 1.20 7/12/16 1 X I - Replace corroded Rasco G 165* chr 1/2" SR in hall by room #3 next to boy's restroorn 1.20 7/12/16 1 X 1 - Replace corroded Rasco G 165* chr 1/2" SR room #4 next to exit door Above Repairs completed on 7/22/2016 by George & Tim of Orange County Fire Protection System Certified (Five Year) dated 7-2016 by Orange County Fire Protection 0 Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 0 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jesse Maldonad Signature Date 07/12/16 Form AES 2.2 Sept. 3,2013, Californiai r Corrective Action •.Regulations Repairsand Property Information ,��°F ca<i�o P MP Contractor or Licensed Owner Information Building Name Lincoln Elementary School Name Orange 9 County Fire Protection Address 3101 Pacific View Drive Address 137 W. Bristol Lane 3101 Pacific View Drivel City Orange St. CA Zip 92865 City Corona Del Mar License # 326604 Phone (714) 974-9025 Contact Person Patrick Bullock M SFM E0422 Job # Phone (714) 424-7538 IN CSLB C10 & C16 Misc. Item AES --bate Date 07/22/16 Deficiencies and parts replaced 2 - Replace corroded Rasco G 1650 chr 1/2" SR in library above computers in library 1.20 2.2 07/12/16 1.20 2.2 07/12/16 07/22/16 1 - Replace corroded Rasco G 165' chr 1/2" SR room #11 by smoke detector 1.20 2.2 07/12/16 07/22/16 1 - Replace corroded Rasco G 165' chr 1/2" SR in room #9 above T bar and -outlet in ceiling. 1.20 2.2 07/12/16 07/22/16 1 - Replace corroded Rasco G 165° chr 1/2" SR in room #8 above T bar near projector 1.20 2.2 07/12/16 07/22/16 1 - Replace corroded Rasco G 165° chr 1/2" SR in room #6 above T bar 1st head 1.20 2.2 07/12/16 07/22/16 1 - Replace corroded Rasco G 165' chr 1/2" SR in hall by room #3 next to boy's restroom 1.20 2.2 07/12/16 07/22/16 1 - Replace corroded Rasco G 165° chr 1/2" SR room #4 next to exit door I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable. i-Build►ng', :Tectinician ' �' Patrick Bullock Jesse Maldonado Si natuie. ; 9 Dafe - Signafui` Date: 07/22/16 07/22/16 =& APPROVED PWK, Fire Chief Form AES 10 Sept. 3, 2013 CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING FIREWORKS PROGRAM t P.O. Box 944246, Sacramento, California 94244-2460 1 (916) 445-8373 Fax (916) 445-8458 CITY OF-NEWPORT BEACH i PYROTECHNIC OPERATOR POST DISPLAY REPORT FIRE DEPARTMENT Pursuant to California Code of Regulations, Title 19, Section 1005(a) within ten (10) working days following any public display, the licensed pyrotechnic operator in charge of the display shall JUL 2 8 2016 submit a complete, accurate and factual written report directly to the State Fire Marshal Failure to comply with these requirements may result in suspension or revocation of your license. RECEIVED 1. Craig Cauthen (714) 824-1075 , CSFM license number 2296-02 , PyrotdaVW.C_�perator, (Name and Phone Number) supervising the discharge of fireworks for this display, submit the following report per Title 19, Section 1005: 1. FIREWORKS COMPANY NAME AND PHONE NUMBER GPD# 672 Pyro Spectaculars, Inc. 909-355-8120 2. FIREWORKS COMPANY ADDRESS 3. CITY 3196 N. Locust Avenue Rialto, CA 4. DATE OF DISPLAY 5. TIME OF DISPLAY 7/4/2016 FROM ODC..- to 6. EXACT LOCATION OF DISPLAY Newport Dunes Waterfront Resort ;1131 Back Bay Drive ,Newport Beach ,CA 7. DEFECTIVE SHELLS LIST MANUFACTURER'S NAME, SIZ/�E� OF SHELL, AND MALFUNCTION. (Refer to list below for definitions to be used.) .9— 5 " Jcwl S .� /4vL5 cytie % — 106 51../- C,h A46 Frye 8. INJURY TO PERSON FROM FIREWORKS. PROVIDE INJURED PERSON's NAME AND ADDRESS Verbal noti 'cation is required within 24 hours to the State Fire Marshal in Injury or Death. ❑ Yes o 9. VIOLATIONS OF HEALTH AND SAFETY CODE OR REGULATIONS RELATING TO PUBLIC DISPLAY OF FIREWORKS. El Yes O,N 0 10. FIRES CAUSED BY FIREWORKS. INCLUDE OWNER'S NAME, ADDRESS AND A BRIEF SUMMARY OF INCIDENT. VerbalLnno fication is required within 24 hours to the State Fire Marshal if emergency action or response was required due to the fire. ❑ Yes 4a'o 11. RECOMMENDA�TIONS OR COMMENTS / &,,k . 12. LIST NAMES OF PYROTECHNIC ASSISTANTS AND STATE FIRE MARSHAL PYROTECHNIC LICENSE NUMBER IF APPLICABLE. A. B. / E. F. 13. SIGNATURE OF PYRO IC OPERATOR IN CHARGE 14. DATE - 7/4/16 Attach additionaapages if necessary. "Defective Shell" definitions: TERM DEFINITION Detonation The entire shell and lifting charge explode at the bottom of the mortar. Detonation should not be confused with a "Flower Pot" or "Mine" for the following reasons: (1) There is no shower of stars and burning materials; (2) The entire shell and lifting charge are consumed in one instantaneous explosion. Dud A pyrotechnic item that leaves the mortar and returns to earth Without producing the intended burst or effect. Flower Pot A shell (not a lifting charge) that explodes at or near the bottom of a mortar blowing a shower of stars and burning materials into the air. Low Break The shell explodes below the prescribed height. Low Burst The shell explodes below the prescribed height. Misfire A pyrotechnic item that fails to function as designed after initiation. Muzzle Burst The process of ail aerial shell breaking or bursting just as it leaves the mortar, scattering stars and burning material. �1 ..�.J� �:� s%/� 5Q� w,,a,� s , t,�,��,�.a��d sauna - 9t4�° 1� �'1^� >> --� CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION OFFICE OF THE STATE FIRE MARSHAL FIRE ENGINEERING i FIREWORKS PROGRAM P.O. Box 944246, Sacramento, California 94244-2460 �FWPORT BEACH (916) 445-8373 Fax (916) 445-8458 FIRE DEPARTMENT I j PYROTECHNIC OPERATOR POST DISPLAY REPORT pp i Pursuant to California Code of Regulations, Title 19, Section 1005(a) within ten (10) working days JUL 6 8 2016 following any public display, the licensed pyrotechnic operator in charge of the display shall submit a complete, accurate and factual written report directly to the State Fire Marshal Failure to comply with these requirements may result in suspension or revocation of your license. RECEIVED - Nils Nehrenheim (310) 344-1678 2665-02 BY: 1, , CSFM license number , Pyrotechnic pera Mr (Name and Phone Number) supervising the discharge of fireworks for this display, submit the following report per Title 19, Section 1005: 1. FIREWORKS COMPANY NAME AND PHONE NUMBER GPD# 672 Pyro Spectaculars, Inc. 909-355-8120 2. FIREWORKS COMPANY ADDRESS 3. CITY Rialto, CA 3196 N. Locust Avenue 4. DATE OF DISPLAY 5. TIME OF DISPLAY ` 1 7/4/2016 FROM to 6. EXACT LOCATION OF DISPLAY Newport Beach ; 2012 E. Bay Dr. Newport Beach ,CA 7. DEFECTIVE SHELLS LIST MANUFACTURER'S NAME, SIZE OF SHELL, AND MALFUNCTION. (Refer to list below for definitions to be used.) b Alt 8. INJURY TO PERSON FROM FIREWORKS. PROVIDE INJURED PERSON's NAME AND ADDRESS Verbal notification is required within 24 hours to the State Fire Marshal in Injury or Death. ❑ Yes No 9. VIOLATIONS OF HEALTH AND SAFETY CODE OR REGULATIONS RELATING TO PUBLIC DISPLAY OF FIREWORKS. ❑ Yes XNo 10. FIRES CAUSED BY FIREWORKS. INCLUDE OWNER'S NAME, ADDRESS AND A BRIEF SUMMARY OF INCIDENT. Verbal n tfication is required within 24 hours to the State Fire Marshal if emergency action or response was required, due to the fire. WNo ❑ Yes 11. RECOMMENDATIONS OR COMMENTS B R' e, LV 0t It\ t 12. LIST NAMES OF PYROTECHNIC ASSISTANTS AND STATE FIRE MARSHAL PYROTECHNIC LICENSE NUMBER IF APPLICABLE. A. e re vo/# t� B. .--+ id- c. ff11 r(an h �ehh �i ef-� ^�— �cJ Jo Raoje E. F' V1-4.4ATtE 13. SIGNATURE OF PYROTECHNIC OPERATOR IN CHARGE em if. 44-- 7/4/16 Attach additional pages if necessary. "Defective Shell" definitions: TERM DEFINITION Detonation The entire shell and lifting charge explode at the bottom of the mortar. Detonation should not be confused with a "Flower Pot" or "Mine" for the following reasons: (1) There is no shower of stars and burning materials; (2) The entire shell and lifting charge are consumed in one instantaneous explosion. Dud A pyrotechnic item that leaves the mortar and returns to earth Without producing the intended burst or effect. Flower Pot A shell (not a lifting charge) that explodes at or near the bottom of a mortar blowing a shower of stars and burning materials into the air. Low Break The shell explodes below the prescribed height. Low Burst The shell explodes below the prescribed height. Misfire A pyrotechnic item that fails to function as designed after initiation. Muzzle Burst The process of ail aerial shell breaking or bursting just as it leaves the mortar, scattering stars and burning material. i I I, l - i-',4 13 Jovb�j Pd- fnOI5 4 1 M V4)f S� Una y 4 '.,7aj Property Information ,�*�~�r�o Contractor or Licensed Owner Inform'1tioV— �Q' 9y Building Name cov Name Orange County Fire Protection Birch Medical Office Center 9 �Q Address 137 W. Bristol Lane Addre s 20162 SW Birch Street MPFf' City Orange St. CA Zip 92865 20162 SW Birch Street License # 326604 Phone (714) 974-9025 City Newport Beach Q SFM E0422 Job # Contact Person Candle Huang © CSLB C10 & C16 Misc. Riser N_ o: , .: ; ._ ' " oLocatioi, ' ,,,; •Riser" Diameter , 'Main'.D'rairi - .. Diametet, , `Initial Static ' Pressure , " Residual ' ' Pressure. iFina('S,tatic �P-ressure , , ,"P. F NIA, _ ' '* 1 In closet inside of suite 150 4" 2" 75 60 76 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: '•,30. '/a%M.nrry kS ,+,. .yYr h,"s,— • A 0 0 ' 0 f = Inspection T = Test M = Maintenance P = Pass F = Fall N/A =Not Applicable Item• Description„ ' ." NFPA'25eCA Reference Date- Comments Only , P,. F, N%A: 1.1 1 Control Valves — Identification Sign 13.3.1 04/01/16 P 1.2 1 Control Valves — Inspection 13.3.2 04/01/16 P 1.3 1 Water -now Alarm Devices 5.2.5 04/01/16 P 1.4 I Supervisory Devices 5.2.5 04/01/16 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 04/01/16 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 04/01/16 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 04/01/16 74 psi F 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 04/01/16 75 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 04/01/16 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 04/01/16 NA 1.11 1 Heat Tape 5.2.7 04/01/16 -NA 1.12 1 Spare Sprinklers 5.2.1.4 04/01/16 P 1.13 1 Fire Department Connections 13.7 04/01/16 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 04/01/16 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 04/01/16 NA 1.16 1 Backflow Preventers 13.6.1 04/01/16 NA Form AES 2.2 Sept. 3, 2013 = Inspection T = Test M = Maintenance P = Pass F = Fall N/A = NotApplicable Item Desc��pfon ', , ; , NFPA'2$"CA ed.` Reference, - D'ate., _ Comments,O'nl ` Y. P,F,N/A 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 04/01/16 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 04/01/16 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 04/01/16 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 04/01/16 P 1.21 I Sprinklers -Accessible Concealed Space 5.2.1.1.6 04/01/16 P 1.22 1 Pipe and Fittings 5.2.2 04/01/16 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 04/01/16 P 1.24 1 Hangers 5.2.3 04/01/16 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 04/01/16 P 1.26 1 Seismic Braces 5.2.3 04/01/16 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 04/01/16 P 1.28 I Unsprinklered Areas CFC 901.4 04/01/16 QYes ®V/,, No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 04/01/16 If REQUIRED, Enter'F' until results are returned from Lab NA 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) 04/01/16 P 2.3 T water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 04/01/16 60 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 04/01/16 F 2.5 T Control Valve - Position 13.3.3.2 04/01/16 P 2.6 T Control Valve — Operation 13.3.3.1 04/01/16 P 2.7 T Supervisory Devices 13.3.3.5 04/01/16 P 2.8 T Backflow Preventer Assemblies 13.6.2 04/01/16 NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 04/01/16 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 04/01/16 NA 2.11 T Pressure Gauges - Calibration 5.3.2 04/01/16 NA 2.12 T Small Hose Connections* 13.5.6.2.2 04/01/16 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 49 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable :Item Description• NFPA•25",CA ed:; 'Date' Comments Only, P,F,N/A• . Reference _' 3.1 M Check Valves - Internal inspection 13.4.2 04/01/16 N/A 3.2 M Control Valves 13.3.4 04/01/16 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 04/01/16 P 3.4 M Internal Pipe Inspection - See Deficiencies and 14.2 04/01/16 Yes N/A Comments Section for Results. ,,j, No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 04/01/16 N/A Deficiencies and Comments Section for Results Ye 3.6 M System Returned to Service 4.5.3 04/01/16 MNos P D = Deficiency C = Comment Indicatetype) Item Date, , R1 er ' •,'L) C Deficiencies and tornmen-ts .1ndi.cate.al(equipmerit, dev/oes and"pans that Were repaired orM 'laced 1.20 4/1/16 1 X 2 - Replace corroded Tyco 155° QR'/Z" wht concealed & lower'/z' on outside overhang entrance 1.20 4/1/16 1 X 2 - Replace corroded Tyco 155' QR Y2' wht concealed main entrance marked w/ X 1.20 4/1/16 1 X 1 - Replace corroded Tyco 155' QR chr W k=11.2 SR in front cubical by receptionist in 100 1.20 4/1/16 1 X 1 - Replace corroded Tyco 155° QR chr 3/4" k=11.2 SR in office next to whit cabinets 100 1.20 4/1/16 1 X 4 - Replace corroded Tyco 155° QR'/z" chr SR in 220A 1.20 4/1/16 1 X 1 - Replace corroded Tyco 155' QR'/2" chr SR big office are of 220A 1.20 4/1/16 1 X 1 - Replace corroded Tyco 155' QR'/z" chr SR in small office 220A 1.20 4/1/16 1 X 2 - Replace corroded Tyco 1550 QR %Z' chr SR in break room 220A 1.20 4/1116 1 X 1 - Replace corroded Tyco 155' QR chr 3/4" k=11.2 SR front of break room suite 375 1.20 4/1/16 1 X 1 - Replace corroded Tyco 155' QR chr W k=11.2 SR 1st office rt lobby in suite 300 1.20 4/1/16 1 X 1 - Replace corroded Tyco 155' QR chr 3/4" k=11.2 SR in hallway 2nd head lobby 1.20 4/1/16 1 X 1 - Replace corroded Tyco 155' QR chr W k=11.2 SR in vacant office 1.20 4/1/16 1 X 1 - Replace corroded Tyco 155' QR chr 3/4' k=11.2 SR in Douglas office glass table 1.20 4/1/16 1 1 X 4 - Replace corroded Tyco 155' QR chr W k=11.2 SR office at end of hall in suite 325 Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 1 © See Correction Form AES 10 for corrected deficiencies. Number attached: 2 I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jesse Maldonado Signature %1"d a Date 04/08/16 Form AES 2.2 Sept. 3, 2013 etyk-'rrn-vA-j-7 or---' OF �-1'i 64try,- el 1 CsS- Continuation� California ..Regulations Inspection, Testing, and Maintenance Deficiencies and Comments oF CA4�,�o Property Information �Z Contractor or Licensed Owner Information �Q tc ARE MA Building Name Birch Medical Office Center Name Orange -County Fire Protection Address 20162 SW Birch Street Address 137 W. Bristol Lane 20162 SW Birch Street City Orange St. CA Zip 92865 City Newport Beach License # 326604 Phone (714) 974-9025 Contact Person Candle Huang N SFM E0422 Job # Phone (949) 288-1828 ❑■ CSLB C10 & C16 Imisc. .7 „ , Ty,pe,of,Sys em, .. „ . Automatic Sprinkler System ❑ Water Storage Tank System Riser ID 1 ❑ Water Spray System ❑ Standpipe & Hose System System Riser ID System Riser ID ❑ Foam -Water System ❑ Private Water Supply System System Riser ID D = Deficiency *C = Comment Item Date 1.20 04/01/16 1 (Indicate type) Deficiencies and Comments Indicate all equipment, devices and patts that were repaired or replaced 3 — Replace painted Tyco wht concealed covers next to elevator near front entrance 1.20 04/01/16 1 1 — Replace silicone Tyco wht concealed cover by front door marked w/ x 1.20 04/01/16 1 ✓ 1 — Replace painted Tyco wht concealed cover in suite 150 front restroom 1.5 04/01/16 1 1 — Replace bottom gauge on riser and retest main drain 1.13 04/01/16 1 I �/ 1 — Provide plastic pug for FDC 1.13 04/01/16 1 j ✓ 1 — Paint FDC fire safety red 1.2 04/01/16 1 1 — Provide lock for sectional PIV 1.1 04/01/16 1 1 — Provide control valve sign for PIV 1.3 04/01/16 1 1 — Provide bell sign 1.3 04/01/16 1 1 — Remove birds nest from bell 1.12 04/01/16 1 1 — Provide Tyco TY3531 concealed wrench for Spare Head Box (SHB) 1.12 04/01/16 1 1 — Provide RC1 wrench for SHB 1.12 04/01/16 1 1 — Provide Tyco w-type 7 wrench for SHB 1.12 04/01/16 1 F _- 2 — Provide Tyco 155' QR 1/4" chr SSP k=11.2 for SHB 1.12 04/01/16 1 ✓ 1 — Provide Tyco SR wrench for SHB 1.12 04/01/16 1 2 — Provide Rasco Mod G4 FR 165' QR 1/" concealed head for SHB 1.12 04/01/16 1 ✓ 1 — Provide Rasco Mod G4 FIR wrench for SHB Above repairs completed on 7-25-2016 by Josh & Tim of Orange County Fire Protection System Certified (Five Year) dated 7-2016 by Orange County Fire Protection - L Form AES 9 Sept. 3, 2013 D = Deficiency C = Comment M See Correction Form AES 10 for corrected deficiencies. Number attached: 2 I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jesse Maldonado Signature Vii— Date 04/08/16 Form AES 9 Sept. 3, 2013 Inspection, -, amended by , PropeW.Informatiop; Name: Birch Medical Office Center Occupancy/Use: Address: 20162 SW Birch Street Construction Type: ,��0? CA4 ��p9 City: Newport Beach No. Stories: 2 D ZIP: 92660 Year Constructed: 2003� Contact: Candie Huang ARE MPQ` Telephone: (949) 288-1828 Contractor information: '. , " : `; ', Number of System ,Risets Name: Orange County Fire Protection Copy sent to: Address: 137 W. Bristol Lane ❑✓ Owner Date: 07/26/16 City: Orange ❑✓ Fire AHJ Date: 07/26/16 State: CA ❑ Contractor Date: (714) 974-9025 NOTES: Telephone: 1) For specific inspection, testing, and maintenance 326604 requirements and information, see NFPA 26, 2011 CA License#: Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: 2) Inspection items may be performed by the owner in Performed by: George & Tim accordance with California Code of Regulations, Title 19, §904.1(a) Clieck, boirfor°each system,.inspected,and enter ttW,'humber'cf,forms used for inspection. Check•.boxes, (Fain o"r,' Pass')'to indicate status of -inspected' system at end. of;inspection. IncludedForms .. Chapter m Automatic Sprinkler System 5 1 ❑ ❑ ❑✓ ❑ Standpipe and Hose System 6 0 ❑ ❑ m Private Water Supply System 7 1 ❑ ❑ ❑✓ ❑ Fire Pump 8 0 ❑ ❑ ❑ ❑ Water Storage Tank 9 0 ❑ ❑ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ El ❑ Water Mist System 12 0 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) Yes 0 No *See,'"Deficieinces and°Comments'' section" at;.end;gf-eae(i, respective;form: AES 1 September 3, 2013 AES 1 September 3, 2013 4 o(:� z- Corrective Action California Code of Regulations Repairsand Property Information F CA4��O Contractor or Licensed Owner Information s'y Building Name Birch Medical Office Center coov Name Orange County Fire Protection Address 20162 SW Birch Street P Address 137 W. Bristol Lane 20162 SW Birch Street ARE Mph City Orange St. CA Zip 92865 City Newport Beach License # 326604 Phone (714) 974-9025 Contact Person Candle Huang SFM E0422 Job # Phone (949) 288-1828 CSLB C10 & C16 IMisc. It 1.20 It 1.20 2.2 Date 04/01/16 )_ co rr,ec 07/25/16 Deficiencies Indicate all equipment, devices and parts that were repaired or replaced 2 - Replace corroded Tyco 155' QR'/2" wht concealed & lower'/2' on outside overhang entra 1.20 2.2 04/01/16 07/25/16 2 - Replace corroded Tyco 155' QR %2" wht concealed main entrance marked w/ X 1.20 2.2 04/01/16 07/25/16 1 - Replace corroded Tyco 155' QR chr W k=11.2 SR in front cubical by receptionist in 100 1.20 2.2 04/01/16 07/25/16 1 - Replace corroded Tyco 155° QR chr W k=11.2 SR in office next to whit cabinets 100 1.20 2.2 04/01/16 07/25/16 4 - Replace corroded Tyco 155° QR 'W' chr SR in 220A 1.20 2.2 04/01/16 07/25/16 1 - Replace corroded Tyco 155' QR %' chr SR big office are of 220A 1.20 2.2 04/01/16 07/25/16 1 - Replace corroded Tyco 155° QR'/2" chr SR in small office 220A 1.20 2.2 04/01/16 07/25/16 2 - Replace corroded Tyco 155° QR'/2" chr SR in break room 220A 1.20 2.2 04/01/16 07/25/16 1 - Replace corroded Tyco 155' QR chr 3/" k=11.2 SR front of break room suite 375 1.20 2.2 04/01/16 07/25/16 1 - Replace corroded Tyco 155' QR chr %" k=11.2 SR 1st office rt lobby in suite 300 1.20 2.2 04/01/16 07/25/16 1 - Replace corroded Tyco 155° QR chr %" W 1.2 SR in hallway 2nd head lobby 1.20 2.2 04/01/16 07/25/16 1 - Replace corroded Tyco 155° QR chr W W 1.2 SR in vacant office 1.20 2.2 04/01/16 07/25/16 1 - Replace corroded Tyco 155° QR chr W W 1.2 SR in Douglas office glass table 1.20 2.2 04/01/16 07/25/16 4 - Replace corroded Tyco 155° QR chr W k=11.2 SR office at end of hall in suite 325 I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable. Building'Representative Technician Candie Huang Jesse Maldonado Signature .- Date - Signature; _ Date 07/26/16 %Yl. 07/25/16 Form AES 10 Sept. 3, 2013 "-ZA, &�S-TLr-- Z- Corrective Action California Code of Regulations . Repairs oF CA(��p Property Information Contractor or Licensed Owner Information v �Re M Building Name Birch Medical Office Center Name Orange County Fire Protection Address 20162 SW Birch Streeter Address 137 W. Bristol Lane 20162 SW Birch Street City Orange St. CA Zip 92865 City Newport Beach License # 326604 Phone (714) 974-9025 Contact Person Candie Huang SFM E0422 Job # Phone (949) 288-1828 CSLB C10 & C16 IMisc. 017/25/16 3 — Replace painted Tyco wht concealed covers next to elevator near front entrance 1.20 9 04/01/16 1.20 9 04/01/16 07/25/16 1 — Replace silicone Tyco wht concealed cover by front door marked w/ x 1.20 9 04/01/16 07/25/16 1 — Replace painted Tyco wht concealed cover in suite 150 front restroom 1.5 9 04/01/16 07/25/16 1 — Replace bottom gauge on riser and retest main drain 1.13 9 04/01/16 07/25/16 1 — Provide plastic pug for FDC 1.13 9 04/01/16 07/25/16 1 — Paint FDC fire safety red 1.2 9 04/01/16 07/25/16 1 — Provide lock for sectional PIV 1.1 9 04/01/16 07/25/16 1 — Provide control valve sign for PIV 1.3 9 04/01/16 07/25/16 1 — Provide bell sign 1.3 9 04/01/16 07/25/16 1 — Remove birds nest from bell 1.12 9 04/01/16 07/25/16 1 — Provide Tyco TY3531 concealed wrench for Spare Head Box (SHB) 1.12 9 04/01/16 07/25/16 1 — Provide RC1 wrench for SHB 1.12 9 04/01/16 07/25/16 1 1 — Provide Tyco w-type 7 wrench for SHB 1.12 9 04/01/16 07/25/16 2 — Provide Tyco 155° QR %" chr SSP k=11.2 for SHB 1.12 9 04/01/16 07/25/16 1 — Provide Tyco SR wrench for SHB 1.12 9 1 04/01/16 07/25/16 2 — Provide Rasco Mod G4 FR 165° QR'/z" concealed head for SHB 1.12 9 04/01/16 07/25/16 1 — Provide Rasco Mod G4 FR wrench for SHB I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable. Building Representative Technician i Candie Huang Jesse Maldonado Signature Date Signature Date 07/25/16 ink_ 07/25/16 Form AES 10 Sept. 3, 2013 T� Property Information Contractor or Licensed Owner Information Name Birch Medical Office Center 92 Name Orange County Fire Protection 20162 SW Birch Street �Q Job # Newport Beach • ' lsW..� 0 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable Item - Description, ' NFPA 25 CA ed.; Reference' Date, , ' ' '' Comments Only jP;F,IN/A 3.1 M Control Valves 13.3.4 04/01/16 P 3.2 M Mainline Strainers 7.2.2.3 Table 7.2.2.3 04/01/16 N/A 3.3 M Hose Houses 7.2. 2.7 Tablee 7.2. 04/01/16 N/A 3.4 M Hydrants 7.4.2 04/01/16 P 3.5 M Monitor Nozzles 7.4.3 04/01/16 N/A 3.6 M FDC - Backflush 14.3.2.3 14.3.2.4 04/01/16 N/A 3.7 M Internal Pipe Inspection: See Deficiencies and 14.2 04/01/16 N/A Comments Section for Results 3.8 M Obstruction Investigation required. If "Yes", see 14.3 04/01/16 ❑ Yes NIA Deficiencies and Comments Section for Results No 3.9 M System Returned to Service .5.7 04/01/16 Q No P Flow Rate m Static Pressure(psi) Hose Stream Allowance (gpm) Residual Pressure (psi) Total System Demand m Flow Rate ( m) Required Pressure at Source (psi) Available Pressure at Total System Demand (psi) D = Defi iency C = Comment (Indicate type) -lfein, :Date Riser ° D C Deficiencies and°Commentsa Indicate ad, equipment devices abd parts that were repaired or.replaced -. 2.8 4/1/16 1 x Hydrant #1, Outlet size 2'/2", Static 78, Residual 55, Pitot 30, GPM 919 by front entrance 2.8 4/1/16 1 x Hydrant #2, Outlet size 2 %', Static 80, Residual 57, Pitot 33, GPM 964 street side 1.9 4/1/16 1 x 1 — Provide Blue marker for hydrant by front entrance System Certified (Five Year) dated 7-2016 by Orange County Fire Protection ❑ Check here if additional Deficiencies and Comments are listed on Form AES9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Jesse Maldonado Signature I g= iyl.jj- Date 04/08/16 Form AES 4.1 Sept. 3, 2013 = Inspection T = Test M = Maintenance P=Pass F=Fail NIA Not Applicable NFPA25,C4` "Description- ed. r Date Comments ;Only„ Referegce 1.1 1 Control Valves — Identification Sign 13.3.1 04/01/16 P 1.2 1 Control Valves — Inspection 13.3.2 04/01/16 N/A 1.3 I Hose Houses 7.2.2.7 04/01/16 N/A 1.4 1 Fire Department Connections 13.7 04/01/16 N/A 1.5 1 Pressure Reducing Valves 13.5.1.1 04/01/16 N/A 1.6 1 Backflow Preventers 13.6.1 04/01/16 N/A 1.7 1 Monitor Nozzles 7.2.2.6 04/01/16 N/A 18 1 Hydrants 7.2.2.4 04/01/16 N/A (Dry Barrel and Wall) Table 7.2.2.4 1 Hydrants 7.2.2.5 04/01/16 P (Wet Barrel) Table 7.2.2.5 1 Mainline Strainers 7.2.2.3 Table 7.2.2.3 04/01/16 N/A 0- I Piping (Exposed) 7.2.2.1 Table 7.2.2.1.2 04/01/16 P 1.12 ]2.1 I Hose 7.1.4 NFPA 1962 04/01/16 N/A T Control Valve - Positions 13.3.3.1 04/01/16 P T Control Valve - Operation 13.3.3 04/01/16 P T Monitor Nozzles 7.3.3 04/01/16 N/A 2.4 T Hydrants - Flush 7.3.2 04/01/16 P 2.5 T Supervisory Devices 13.3.3.5 04/01/16 N/A 2.6 T BackflowPreventerAssemblies 13.6.2 04/01/16 P 2.7 T Piping 7.3.1.1 04/01/16 Record results in Deficiencies N/A (Exposed and Underground Evaluation) and Comments section Record results below in 2.8 T Water Supply Evaluation 7.3.1.2 04/01/16 Table for Water Supply P (If required by 7.3.1.2) Test Evaluation 2.9 T Pressure Reducing Valve 13.5.1.2 04/01/16 N/A Full Flow Test 2.10 T Hose 7.1.4 NFPA 1962 04/01/16 1 N/A Form AES 4.1 Sept. 3, 2013 : .� � :::y � � � � >� : ... �� y :,�:� .�v�.� .. � 3 \� � � � � \� °� ..� � � y � � / «� 2dd��. ?� <... >� \....�� .� �� .� <y< ... J»».,. ..� +� «...... \ 2 . . . »«�� § f, °- . , . . . . .. : � wm � � y� � > .. . ... . . y � � � � � ; A ,Fire Safety First May 20, 2016 Fire Prevention Department NEWPORT BEACH FIRE DEPARTMENT 3300 Newport Blvd. Newport Beach, CA 92663 RE: Title 19, 5-Year Certification 1300-1380 Bison Ave, Newport Beach Attention: Fire Prevention Department 1170 E Fruit St ( Santa Ana, CA 92701 (714) 836-4800 1 (714) 836-4120 FAX - Fire Safety First has recently completed the Title 19, 5-Year Certification at The Bluffs Shopping Center in Newport Beach. We have completed all repairs noted on the preliminary deficiency reports and have back -flushed all fire department connections per the California Health and Safety Code, Title 19. Enclosed are copies of the Certification Report for your files. If you have any questions, please call our Fire Sprinkler Maintenance Department at (714) 836-4800. Sincerely, Jon Saia FIRE SAFETY FIRST C10/16/36- 599761 CAUsers\jsaia\Documents\00 Project Files\TIC Retail\Bluffs, The\5-Year 2015\Bison_1300x1380 NewportBeach5yrFDCertLtr_052016.docx t. t. Y• - Contractor I fp r"Atloxi• g`; .{�y Y _ a•; , �; , Name Fire Safiety''First -1:=,t,„ Copy Sent to: Address 1170='E.""Fruit'Street'" ®Owner Date: 5/23/2016 City Santa Aria:.. ® Fire AHJ Date: 5/23/2016 State, Zip rvCA:92701• ;;•ry °-• .•,..:: .'.: Contractor Date: Telephone ::".;:.. .:.:`..>..,. (7:14);:8.36`=4800=` Notes: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 Edition•as amended by California -;:•;;,., .:•; ' -' CA License # C1'6=59976'1. ,t:'; ;;; ° Code of Regulations, Title 19, Section 901 to'906. 2) Inspection items may be performed by the owner in accordance with California Code of Regulations, Title 19, Section 904.1(a). Job # . `.: " Performed by -> n ::t:tforrris=` ,; GhecJ "o :,fork'each-'s:'sterii'%ns ected:a. d:en er. u `47- i. r.fe s at•`=:, .os�`t°°' tie- eiid•cf;.. .�tai=� { ck: "x�s°Fa i`• `s IncludedForms with this Report Chapter Forms ® Automatic Sprinkler System 5 "wY;:S' ❑ ❑ ❑ Standpipe and Hose System 6 ❑ ❑ ❑ ❑ Private Water Supply System 7 ❑ ❑ ❑. ❑ Fire Pump 8 °- r ❑ ❑ ❑ ❑ Water Storage Tank 9 ❑ ❑ ❑ ❑ Water Spray System 10 ::::`' ❑ ❑ ❑ _:':" ❑ Foam Water Sprinkler System 11 " , ❑ ❑ ❑ ❑ Water Mist System 12 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑'Yes ®No .. .. x,• •ro;-�.o--»"<r:; i,-.a , : w J, . '."P : ,y na 3»r_ %� ; is r. ;z±ti.: - - - ,.n. - .s• - . • +'•x ' pax, - - , ee DeflcI ��c es:- cl' ° i ',. t+ Form AES 1 September 3, 2013 Riser Information Main Drain Test (Annual) KIse $6r n41 S 't icon d 2 1A1 -107', Lo P 'pyi J E] This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 Forms Attached: 5-Year INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Hnspection T=Test M=Maintenance P=Pass F=Faii N/A=Not Applicable tip.j" esc r , -� 1 '-*'—�";-.�'�,'i"' ", ", -, on - 0 'qeh ti � 2-, —,' I, -, , 1, � -Fx 1.1 1 Control Valves — identification Signs 13.3.1 1.2 1 Control Valves- Inspection 13.3.2 1.3 1 Waterflow Alarm Devices 5.2.5 F, 1.4 1 Supervisory Devices 5.2.6 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 -,V Enter Water Supply Pressure Below Riser 1.6 1 5.2.4.1 psi Check 1.7 I Enter Water Supply Pressure Above Riser 5.2.4.1 psi Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 32 1.9 1 Hydraulic Design Information 5.2.6 2, /2-3 (For hydraulically designed systems) 1.10 1 General Information Sign (not required for systems prior to 2007 Edition of NFPA 5.2.8 25) 1.11 1 Heat Tape 5.2.7 N /A 1.12 1 Spare Sprinklers 5.2.1.4 -z' A 1.13 1 Fire Department Connections 13.7 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 '-z 1.15 1 Pressure Reducing Valves 13.5.1.1 I Backflow Preventers 13.6.1 A - Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Mnspection T=Test M=Maintenance P=Pass F=0aii N/A=Not Applicable �c WPA, -A", it - 4 'e 1�. g s rip _4 rdiht* On S"O' 5.1.6, 1.17 1 Small Hose Connections - Hose Valve 13.5.2, 13.5.5.1 1.18 1 PRV -Fire Sprinkler Systems 13.5.1.1 N, 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility is 1.20 1 Sprinklers 5.2.1 '2 k�'5."j. 1.21 1 Sprinklers -Accessible Concealed Space 5.2.1.1.6 1.22 1 Pipe and Fittings 5.2.2 A 1.23 1 Pipe and Fittings -Accessible Concealed 5.2.2.3 " 2 p Space 1.24 1 Hangers 5.2.3 1.25 1 Hangers -Accessible Concealed Space 5.2.3.3 15 ..... .. 1.26 1 Seismic Braces 5.2.3 1.27 I Seismic Braces- Accessible Concealed Space 5.2.3.3 1.28 1 Unsprinklered Areas CFC 901.4 El Yes Z No 2.1 T Field Service Test Required Send report to Fire Code Official 5.3.1 ...... J� If REQUIRED, enterFuntil results are returned from lab. 2.2 T Recalled Sprinklers Title 19 :P If not present = Pass, if present Fail 904.1(c) 2.3 T Waterflow Alarm Devices 5.3.3 13.2.6 60 secs. 2.4 T Main Drain Test 13.2.5 2 < -T' 'P" (Enter data on Page I of thisform) 13.3.3.4 2.5 T Control Valve - Position 13.3.3.2 2.6 T Control Valve- Operation 13.3.3.1 Y 2.7 T Supervisory Devices 13.3.3.5 :L 2.8 T Backflow Preventer Assemblies 13.6.2 '2/ V. J. 2.9 T Small Hose Connections 13.5.2.3 w/PRV Hose Valves - Partial Flow Test 13.5.3.3 2.10 T PRV - Fire Sprinkler Systems 13.5.1.3 2.11 T Pressure Gauges - Calibration 5.3.2 N/A 2.12 T Small Hose Connections 13.5.6.2.2 Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class 1, 11, or III Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable A t. C to 3.1 M Check Valve Internal Inspection 13.4.2 ""Nk 3.2 M Control Valves 13.3.4 3.3 M FDC — Backf lush 14.3.2.3 14.3.2.4 Internal Pipe Inspection —See Deficiencies and Yes 3.4 M Comments Section for Results 14.2 . .... No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 5 Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 El No D = Deficiency C = Comment (Indicate type) MINE =��N MIME Tj 'Check Here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: IF1 See Correction Form AES 10 for corrected deficiencies I Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as note in the "Deficiencies and Comments" section of this form. Print Name -S,a. 0, ,;Y Signature _N Form AES 2.2 September 3, 2013 5-Year INSPECTION, TESTING, AND MAINTENANCE includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Hnspection T=Test M=Maintenance P=Pass F=Oail iV/A=Nqt Applicable scrip t 0). P7 T 1.1 1 Control Valves — Identification Signs 13.3.1 I's 1.2 1 Control Valves- Inspection 13.3.2 2%23J1.5 ;D 1.3 1 Waterflow Alarm Devices 5.2.5 1.4 1 Supervisory Devices 5.2.6 23 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 Enter Water Supply Pressure Below Riser 5.2.4.1 1.6 1 Check psi Enter Water Supply Pressure Above Riser 1.7 I 5.2.4.1 psi Check 7 1.8 1 Pressure Readings Acceptable 5.2.4.1 1.9 1 Hydraulic Design Information 5.2.6 (For hydraulically designed systems) 'T General Information Sign 1.10 1 (not required forsystems prior to 2007 Edition of NFPA 5.2.8 N 25) 1.11 1 Heat Tape 5.2.7 1.12 1 Spare Sprinklers 5.2.1.4 E. 1.13 1 Fire Department Connections 13.7 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 1.15 Pressure Reducing Valves 13.5.1.1 1.16 1 Ba + ksfulow Preventers c 13.6.1 Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Hnspection T=Test WMaintenance P=Pass F=F.afi-'N/A=NotAp_p1icab1e 'De -WPA.2 J b 'Y n. dr.PJo t !, '10 s p 5.1.6, 1.17 1 Small Hose Connections — Hose Valve 13.5.2, 13.5.5.1 K, 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owners Responsibility 1.20 1 Sprinklers 5.2.1 'A1� 1.21 1 Sprinklers — Accessible Concealed Space 5.2.1.1.6 "'2 1.22 1 Pipe and Fittings 5.2.2 1.23 1 Pipe and Fittings —Accessible Concealed 5.2. 23 .2 `6 Space 1.24 1 Hangers 5.2.3 1.25 1 Hangers —Accessible Concealed Space 5.2.3.3 '°'2/ 1.26 1 Seismic Braces 5.2.3 2/- 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 'V' : : - ' 1.28 1 Unsprinklered Areas CFC 901.4 ` 1, ' , I El Yes No 0 2.1 T equired Field Service Test R 5.3.1 If REQUIRED, enteff'uhtif Send report to Fire Code Official results are returned from lab. Recalled Sprinklers Title 19 r j If not present Pass; If present Fail 904.1(c) 2.3 T Waterflow Alarm Devices 5.3.3 60 secs. 13.2.6 2.4 T Main Drain Test 13.2.5 P' (Enter data on Page 1 of this for 13.3.3.4 2.5 T Control Valve — Position 13.3.3.2 2.6 T Control Valve -Operation 13.3.3.1 3�-,1,55 T P, 2.7 T Supervisory Devices 13.3.3.5 2.8 T Backflow Preventer Assemblies 13.6.2 2.9 T Small Hose Connections 13.5.2.3 w/PRV Hose Valves - Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 2.11 ssu' re Gauges —Calibration 5.3.2 2.12 T :±P mre S all Hose Connections 13.5.6.2.2 Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do n6t:include Class I, 11, or III Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items I = Inspection T = Test M = Maintenance P =Pass F =-Fail N/A- Not Applicable T �n -: 118 it ft:� jo. n A- 3.1 M Check Valve — Internal Inspection 13.4.2 3.2 M Control Valves 13.3.4 5 3.3 M FDC — Backflush 14.3.2.3 _P 14.3.2.4 Internal Pipe Inspection —See Deficiencies and ❑ Yes 3.4 M Comments Section for Results 14.2 No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 F[:] No D = Deficiency C = Comment (Indicate type) I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as note in the "Deficiencies and Comments" section of this form. Print Name tonS Signature Form AES 2.2 September 3, 2013 5-Year INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Hnspection T=Test M=Maintenance P=Pass F;!Fail N/A=Not Applicable ll 06sc 5 'F efereac A 1.1 1 Control Valves — Identification Signs 13.3.1 1.2 1 Control Valves- Inspection 13.3.2 j 1.3 1 Waterflow Alarm Devices 5.2.5 4- % P, 1.4 1 Supervisory Devices 5.2.6 t/2�11� 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 T� P Enter Water Supply Pressure Below Riser 5.2.4.1 1.6 I Check PSI 1.7 I Enter Water Supply Pressure Above Riser 5.2.4.1 psi Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 1.9 1 Hydraulic Design Information 5. 2.6 (For hydraulically designed systems) General Information Sign 1.10 1 (not required for systems prior to 2007 Edition of NFPA 5.2.8 25) 1.11 1 Heat Tape 5.2.7 T 1.12 1 Spare Sprinklers 5.2.1.4 1.13 1 Fire Department Connections 13.7 1,5, 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 A& 1.15 1 Pressure Reducing Valves 13.5.1.1 1.16 1 Backflow Preventers 13.6.1 A Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items 1=1nspection T=Test WMaintenance P=Pass F_'-Fail N/A --Not Applicable 7 N FP'25 A' t ly $90 'A r'n -e 1.17 1 Small Hose Connections — Hose Valve 5.1.6, 13.5.2, 13.5.5.1 V' 1.18 1 PRV— Fire Sprinkler Systems 1.19 1 Buildings (Freeze Protection) Owners Responsibility 1.20 1 Sprinklers 5.2.1 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.6 R 1.22 1 Pipe and Fittings 5.2.2 _,'2/1 Pipe and Fittings —Accessible Concealed 1.23 1 5.2.2.3 Space 1.24 1 Hangers 5.2. 3 1.25 1 Hangers —Accessible Concealed Space 5.2.3.3 2/23r15,-'V-,', 1.26 1 Seismic Braces 5.2.3 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 1.28 1 Unsprinklered Areas CFC 901.4 0 Yes Z No 2.1 Field Service Test Required 5.3.1 -REQUIRED, Y"until If -REQUIRED, enter Send report to Fire Code Official results are returned -from lab. 2.2 T Recalled Sprinklers Title 19 If not present Pass; If present Fail 904.1(c) 2.3 T Waterflow Alarm Devices 5.3.3 13.2.6 60 secs. 2.4 T Main Drain Test 13.2.5 (Enter data on Page 1 of this form) 13.3.3.4 2.5 T Control Valve — Position 13.3.3.2 2.6 T Control Valve- Operation 13.3.3.1 2,� 2.7 T Supervisory Devices 13.3.3.5 2.8 T Backflow Preventer Assemblies 13.6.2 V, 2.9 T Small Hose Connections 13.5.2.3 w/PRV Hose Valves - Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 2.11 T Pressure Gauges — Calibration 5.3.2 NI/ 2.12 T Small Hose Connections 13.5.6.2.2 -Vi Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class 1, 11, or III Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items 1= Inspection T =Test M = Maintenance P = Pass F = Fail N77 = Not Applicable ",f4 S0 AB j Jon, hP 3.1 M Check Valve — Internal Inspection 13.4.2 7 3.2 M Control Valves 13.3.4 t 7, B 1`5 3.3 M FDC— Backf1ush 14.3.2.3 F", 7i 14.3.2.4 Internal Pipe Inspection —See Deficiencies and LJ Yes 7777 -77 7 7- i 3.4 M Comments Section for Results 14.2 No Obstruction Investigation Required. If "Yes", see 14.3 ,'A 3.5 MN Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 _ E1 No D = Deficiency C = Comment (Indicate type) 7: 'X 74 jx Z - El K F-1 Check Here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: E] See Correction Form AES 10 for corrected deficiencies I Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equioment'Isfully operable except as note in the "Deficiencies and Comments" section of this form. : Print Name J0h 011 Signaturer. Form AES 2.2 September 3, 2013 5-Year INSPECTION, TESTING, AND MAINTENANCE includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Nnspection T=Test M=Maintenance P=Pass F=Fail N/A=Not-Applicable scrip, I a W', -mm Uatii"�' :Liz - "�Z r-7 Control Valves — Identification Signs 13-3.1 1.2 1 Control Valves- Inspection 13.3.2 1- 511 1.3 1 Waterflow Alarm Devices 5.2.5 1.4 1 Supervisory Devices 5.2.6 3' 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 Enter Water Supply Pressure Below Riser 5.2.4.1 1.6 1 Check Psi 1.7 1 Enter Water Supply Pressure Above Riser 5.2.4.1 psi 77 " �k" "N Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 2 5, 1.9 1 Hydraulic Design Information 5.2.6 (For hydraulically designed systems) 1.10 1 General Information Sign (not re q uired fo r systems p rio r to 200 7 Edition of NFPA 5.2.8 'w, 25) 1.11 1 Heat Tape 5.2.7 7 1.12 1 Spare Sprinklers 5.2.1.4 M 1.13 1 Fire Department Connections 13.7 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 1.15 1 Pressure Reducing Valves 13.5.1.1 1.16 1 Backflow Preventers 13.6.1 Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Hnspection T=Test WMaintenance P=Pass F=Fall N/A=Not Applicable k. "7: YY 4 Ny. 5.1.6, 1.17 1 Small Hose Connections— Hose Valve 13.5.2, 13.5.5.1 17 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 '7 N: 1.19 1 Buildings (Freeze Protection) 4.1.1.1 -owners Responsibility 1.20 1 Sprinklers 5.2.1 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.6 1.22 1 Pipe and Fittings 5.2.2 .2_1 1.23 I Pipe and Fittings —Accessible Concealed 5.2.2.3 '5 Space 1.24 1 Hangers 5.2.3 h 1.25 1 Hangers —Accessible Concealed Space 5.2.3.3 2/2 1.26 1 Seismic Braces 5.2.3 1.27 1 Seismic Braces -Accessible Concealed Space 5.2.3.3 22' 1.28 1 Unsprinklered Areas CFC 901.4 E]Yes" 0 No 2.1 T Field Service Test Required Send report to Fire Code Official . . 531 If REQUIRED, enteff'until results are returned from lab. 2.2 T Recalled Sprinklers if not present = Pass; If present = Fail Title 19 904.1(c) 2.3 T Waterflow Alarm Devices 5.3 3. 13.2.6 60 secs. 2.4 T Main Drain Test 13.2.5 D, T (Enter data on Page 1 of this form) 13.3.3.4 2.5 T Control Valve — Position 13.3.3.2 'p, 2.6 T Control Valve- Operation 13.3.3.1 42/2. 2.7 T Supervisory Devices 13.3.3.5 2.8 T Backflow Preventer Assemblies 13.6.2 2.9 T Small Hose Connections 13.5.2.3 w/PRV Hose Valves - Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 2.11 T Pressure Gauges — Calibration 5.3.2 2.12 T Small Hose Connections 13.5.6.2.2 Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class 1, 11, or III Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items I = Inspection T = Test M = Maintenance P = Pass F =Fail N/A = Not Applicable L W Desprip 'tidn me 71 _�,OVt z 3.1 M Check Valve —Internal Inspection 13.4.2 3.2 M Control Valves 13.3.4 3.3 M FDC — Backflush 14.3.2.3 14.3.2.4 Internal Pipe Inspection —See Deficiencies and El Yes 3.4 M Comments Section for Results 142 . Z No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 Deficiencies and Comments Section for Results 0 Yes 36 M System Returned to Service 4.5.3 - .-1 ❑ No D = Deficiency C = Comment (indicate type) I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as note in the "Deficiencies and Comments" section of this form. J,b Print Name "V Signature Form AES 2.2 September 3, 2013 5-Year INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Hnspection T=Test M=Maintenance P=Pass F=Fail N/A=Rqt Applicable yam:ateM11 'N F PA-,(2& �,,Jtd '3-, 6n, fts,',U 4ren� VA - 1.1 1 Control Valves — Identification Signs 13.3.1 : P 1.2 1 Control Valves- Inspection 13.3.2 Pf 1.3 1 Waterflow Alarm Devices 5.2.5 �: P 1.4 1 Supervisory Devices 5.2.6 Y` 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 Enter Water Supply Pressure Below Riser 5.2.4.1 1.6 I Check psi 1.7 I Enter Water Supply Pressure Above Riser 5.2.4.1 psi Check 1.8 1 Pressure Readings Acceptable 5.2.4.1 1.9 1 Hydraulic Design Information 5.2.6 (For hydraulically designed systems) 1.10 1 General Information Sign (not required forsystems prior to 2007 Edition of NFPA 5.2.8 25) 1.11 1 Heat Tape 5.2.7 2 7 1.12 1 Spare Sprinklers 1 .4 5.2.1.4 55 2 �/2t/i§ 471- 1.13 1 Fire Department Connections 3 13.7 1/2-3 s 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 1.15 1 Pressure Red u ci ng Valves 51 1 1.16 1 Backflow Preventers 13.6.1 Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items Nnspection T=Test M=Maintenance P=Pass F=Oall N/A=Not Applicable lti h", or., MR- D 'E" -_X A 5.1.6, 1.17 1 Small Hose Connections — Hose Valve 13.5.2, 13.5.5.1 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 1.19 1 Buildings (Freeze Protection) Owners Responsibility 1.20 1 Sprinklers 5.2.1 1.21 1 Sprinklers —Accessible Concealed Space 5.2.1.1.6 R 1.22 1 Pipe and Fittings 5.2.2 Pipe and Fittings — Accessible Concealed 5.2.2.3 1.23 Space 1.24 1 Hangers 5.2.3 1.25 1 Hangers —Accessible Concealed Space 5.2.3.3 5 1.26 1 Seismic Braces 5.2.3 1.27 1 Seismic Braces- Accessible Concealed Space 5.2.3.3 1.28 1 Unsprinklered Areas CFC 901.4 F]Yes ® No 2.1 T Field Service Test Required 5.3.1 If REQUIRED, einteff'undl Send report to Fire Code Official results are returned from lab. 2.2 T Recalled Sprinklers Title 19 3 If not present= Pass; Ifpresent =Fail 904.1(c) . . ..... 2.3 T Waterflow Alarm Devices 5.3.3 13.2.6 60 secs 2.4 T Main Drain Test 13.2.5 ',2/28 1 "-4 (Enter data on Page 1 of this form) 13.3.3.4 2.5 T Control Valve — Position 13.3.3.2 2.6 T Control Valve- Operation 13.3.3.1 2.7 T Supervisory Devices 13.3.3.5 3ZI 2.8 T Backflow Preventer Assemblies 13.6.2 2.9 T Small Hose Connections 13.5.2.3 w/PRV Hose Valves - Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 2.11 T Pressure Gauges — Calibration 5.3.2 2.12 T Small Hose Connections 13.5.6.2.2 Small hose connections are hose valves and optional hose supplied the fire sprinkler system. They do not include Class 1, 11, or III Form AES 2.2 September 3, 2013 ANNUAL INSPECTION, TESTING, AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance Items I= Inspection T = Test M = Maintenance P = Pass F = Fall N/A = Not Applicable J, , $_-, 7777 , 7 1, _1 _1 - 4 ��-`Dp RA Y. s,c zrip rt 3.1 M Check Valve — internal Inspection 13.4.2 3- 3.2 M Control Valves 13.3.4 L,- - 4 3.3 M FDC — Backflush 14.3.2.3 14.3.2.4 Internal Pipe Inspection —See Deficiencies and lYes 3.4 M Comments Section for Results 14.2 No 3.5 m Obstruction Investigation Required. If "Yes", see 14.3 Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 E] No D = Deficiency C = Comment (Indicate type) I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the fire equipment is fully operable except as note in the "Deficiencies and Comments" section of this form. 777, 77-7%, Print Name jon,SaJ&, 41 1'�, ,v4-`_,, "A' `11 -: - , :,- 8-1 I ate, Signature Form AES 2.2 September 3, 2013 - SYSTEM RECORD OF COMPLETION T « V 1 (P ` 0301 This form is to be completed by the system installation contractor at the time ofsystem accePtanceand approval. It shall be permitted to nrodifi, this form as needed to pl•ovide a more complete andlor cleatrecord! Insert N/A in all w7used litres. Attach additional sheets, data, or calculations as necessmy to provi'cle a complete, record. Form Completion Date: 7/22/16 Supplemental Pages. Attached: 0 1. PROPERTY INFORMATION Name of property: DJM CAPITAL PARTNERS Address: 3446 VIA OPORTO, NEWPORT BEACH, CA. 92663 Description of propertys RETAIL / RESTAURANT Name of property representative: NOE ESPINOZA Address: Phone: 949-514-1249 Fax: N/A E-mail: NESPINOZA@DJMCAPITAL.COM 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: Bay Alarm Company Address: 1590 S. Lewis St., Anaheim, CA 92805 Phone: 800-610-1000 Fax: 714-939-9759 E-mail: Service organization: Bay Alarm Company Address: 1590 S. Lewis St., Anaheim, CA 92805 Phone: 800-610-1000 Fax: 714-939-9759 E-mail: Testing organization: Bay Alarm Company Address: 1590 S. Lewis St., Anaheim, CA 92805 Phone: 800-610-1000 Fax: 714-939-9759 E-maih Effective date for test and inspection contract: Monitoring organization: Bay Alarm Company Address: 1590 S. Lewis St., Anaheim, CA 92805 Phone: 800-610-1000 Fax: 714-939-9759 E-mail: Account number: 3486470 Phone line 1: N/A Phone line 2: N/A Means of transmission: RADIO Entity to which alarms are retransmitted: BAY ALARM COMPANY Phoiie: 800-610-10110 3. DOCUMENTATION On -site location of the required record documents and site -specific software: BELOW PANEL IN FACU CLOSET 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ® New system ❑ Modification to existing system Permit number: l- 7_0 l b - 0301 NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: DMP 4.2 Software and Firmware Firmware revision number: U G IQ 4.3 Alarm Verification Number of devices subject to alarm verification: N/A Model number:, XR.150FCR ® This system does not incorporate alarm verification. Alarm verifidi tion.set t`or seconds Copyright© 2012 National Fire Protection Association. This form maybe copied for individual use other than for resale. It"may-not be copied for commerefal•sale or distribution. (p. 1 of 3) SYSTEM RECORD OF COMPLETION (confinued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120VAC Overcurrent protection: Type: BREAKER Branch circuit disconnecting means location: Control panel amps:. , 3 Amps: 20 ELECTRICAL ROOM Number: NIA 5.1.2 Secondary Power Type of secondary power: BATTERY Location, if remote from the plant: FACU PANEL Calculated capacity of secondary power to drive the system: In standby mode (hours): 24 HRS 5.2 Control Unit ® This system does not have power extender panels ❑ Power extender panels are listed on supplementary sheet A a rrQr_t Irrc enrn peTNwevc In alarm mode (minutes): 5 MIN Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line N/A N/A B 0 Device Power N/A N/A B' 0 Initiating Device NIA N/A B 0 Notification Appliance N/A N/A B' 0 Other (specify): 7. REMOTE ANNUNCIATORS N/A A WITIATIMCC nF=VlrRS Type Quantity Addressable or Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 0 N/A N/A Smoke Detectors 1 CONVENTIONAL ALARM Duct Smoke Detectors 0 N/A N/A Heat Detectors 0 N/A NIA Gas Detectors 0 NIA N/A Waterflow Switches 1 CONVENTIONAL ALARM Tamper Switches 2 CONVENTIONAL SUPERVISORY Copyright m 2012 National Fire Protection Association. This form maybe copied for individual use other than for resale. It may not be copied for commercial sale or'distribution. (p, 2 of 3) SYSTEM RECORD OF COMPLETION (continued) 9 NnTIKIrATION APPI IANCES Type Quantity Description Audible 1 SPRINKLER BELL Visible 0 Combination Audible and Visible 0 4n QVQTGM ei1MTC(')I 9=11W TIMIR Type Quantity Hold -Open Door Releasing Devices Q HVAC Shutdown 0 Fire/Smoke Dampers 0 Door Unlocking 0 Elevator Recall 0 Elevator Shunt Trip 0 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 name: NICK MOSS Date: 7/22/16 Organization: BAY ALARM COMPANY Title: INSTALLATION MANAGERPhone: _ _714=937-762$ 12.2 System Operational Test This system as specified herein has tested according to all NFPA standards cited herein. Signed: % Printed name: NICK MOSS Organization: BAY ALARM CO Title: INSTALLATION MANAGER 12.3 Acceptance Test Date and time of acceptance test: 7/15/16 10AM Installing contractor representative:Testing contractor representative: i Property representative: AHJ representative: Date: 7122/16 Phone: 714=937-7628 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. 3 4f 3) - �, .- - - 'rp_ L`�t .Q - .: ,. e. ati:'' � 1•''ir��' ^#,`� _ '. a4�; r� - •_ - 'Riser• - `�,' n l'ocation: - Riser Diameter: Main:D'rain'.' - Diameter: :InifiaL:Statici; Pressure; -..- 'idual: �� .Res ..re 'sine: �P s s Frial:Stat'ic 1?ressii�e: ^ ��' lA 1 West side in basement 2 and 1/2 1 and 1/4 90 86 90 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I = Inspection T - Test M = Maintenance p _ P =Pass F =Fail N/A Not Applicable Item w " Description' ed:= `'Refer`ence- Date; .; Comments Onl Y' 1.1 1 Control Valves - Identification Sign 13.3.1 P 1.2 1 Control Valves - Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1.4 I Supervisory Devices 5.2.5 P 1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves - Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 I Backflow Preventers 13.6.1 P Form AES 2.2 Sept. 3, 2013 ' ® .• ® r _ 1 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable - C nits Oril' .omme FFN%A { ,P - 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 rjYes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab N/A 2.2 T Recalled Sprinklers If not present = Pass, If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 sec. 20 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 P 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 N/A 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 N/A 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 1 T Small Hose Connections* 13.5.6.2.2 N/A * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 . . Sept. 3, 2013 =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Item; DescPipton,..•= j 25 .Date Comrnen{s`Qnl", , .i . Refereiic'e;;_ _ 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backfiush 14.3.2.3 14.3.2.4 P 3.4 M Internal Pipe Inspection - See Deficiencies and 14.2 RNo Yes P Comments Section for Results. 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 N/A Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 Z No P D = Deficiency C = Comment (Indicate type) , ,It `m.:- ,. - a e+• rt.. � ,, .Date:: � ^• : -: ; -;:: ;:.� =•. Rise� } < =, r_ ,.• : • ; : :D� : -+:: '; ,;,C; iciencies::and:Cominents '• D,ef , :x . ; ` _ _ -- r.. "� _ r'lndicatei"all=e"ui rimerita;devices;_and;'`aitstfiat ivere;repaired;or rep'laced�, .., :: ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Tom McMillan Date 07/08/16 Signature Tom Dgnmryspnaaeyram :� DN-m=Tom.o, cu.emaA=IwmsptlndorQgmal wm, c=US .'� DMe•261607681493U8-0TW Form AES 2.2 Sept. 3, 2013 P V SYSTEMSACGEPTADICE 13445 Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, Inspection and tests shell be made by the contractor's represematfys and witnessed by iheproperty-ownerbr their authorized agent. All defects shall be'corrected and system leh in service befdre contractors personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shali,be prepared for approving authonties, owners, and contractor, It is understood the owner's representatives signature in no way prejudices airy claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. Date �/il/2016 Propertyname Rogers Gardens/ Farmhouse Property address 2301 San Joaquin Hills Rd. Corona Del Mar, CA Accepted by approving authorities (names) Newport Beach Fire Department Address 100 Civic Center Dr. Newport Beach, CA 92660 Plans Installation conforms to accepted plans QYes ONO ❑ Equipment used is approved .n, Yes No If no, explain deviations Has person in charge of fire equipment been instructed as Yes r�No to location of control valves and care and maintenance of this new equipment? It no, explain Have copies of the following been loft on the promises? Yes Cho QYes ❑No 1. System components instructions QYes ONo LinsMtrucllons 2. Care and maintenance instructons 3. NFPA25 QYes ONO Supplies buildings2301 San Joaquin Hills Rd. Corona Del Mar, CA Year of Oritice Temperature Make Model manufacture size 'Quantity rating Tyco TYFRB 2016 1/2" 24 200°0 Tyco TYFRB 2016 1 22 2 155° Sprinklers Tyco DS-1 2016 2 155 Pipe and DYNA Flow- DYNA Thread Sch-10 Sch-40 Type of pipe Malibu Cast Iron fittings Type of fittings Maximum time to Operate Alarm Alarm device through test connection valve or Type Make Model Minutes Seconds Flow Indicator Flow switch 0 20 or valve Q.O. D: Make Model Serial no. Make . Model Serial no. N/A Time to trip Air Trip point Time water reaches} Alarm a tad op, ra Dry pipe through test connectiona.b Water rassure pressure afrpressure test ouUeta•b property operating Minutes Seconds sf psi psi Minutes Seconds Yes No test Without Q.O.D. With O.O.D. If no, explain NFPA-13 (p.1 pt 3) ® 2012 National Fire Protection Association a Measured from ❑mp In ecwr s resr cm`--, i� ..N=� � b NFPA 13 onlyrequires a 60-second limltation in specfic mlkins FIGURE 25.1 Contractor's Material and Test Cerdf sate for Aboveground Piping. 2613 Edition On. it 4, 13-246 RNSTALL.t tON OF SPkI NRLERSYSMIS Operation upheuhlatic ❑Efecn`b UHydrauffcs N/A Piping supervised ayes ON. Oetectingmedlasupervised 0Yes 13 No, Does valve operate from the manual trip, remote, or both control stations? QYes ❑ No Deluge and Is there an accessible facility, in each Circuit for testing? f no, explain ' preaction Yes Q No I valves ---- Does each circuit operate — Does h cimuipoperate Maximum time fo Make Model supervision loss alarm? valve release? operate release, Yes No Yes No Minutes' Seconds Pressure- Location Make and Residual pressure reducing and floor model Setting Stella pressure (flowing) Flow rats valve test Inlet (psi) I Outlet (psi) Inlet (pin I Otitlet'(psf) Plow (gpm) N/A Saekfiow, device Indicate means used for forward flow test of backffow device: Complete Underground Flush forward now test When means to test device was opened, was system flaw demand creafea? ( r� Yes ❑ No ❑ W4 Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13 6 bar) for 2 flours or 50 psi (3.4 bar) above staff; pressure in excess of 150 psi (10.2 bar) for2 hours. Differential dry pipe valve clappers shalt be left Test open during the test to prevent damage. All aboveground piping leakage shall be stopped. description pneumatic: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall notexceed 1'h, psi (0.1 bar) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure'drop; which shall not exceed 1'h psi (0.1 bar) in 24 hours. All piping hydrostatically tested at 2 0 0 psi (— bar) for 2 hours If no, state reason Dry piping pneumatically tested [r(Yes @No No dry piping Equipment operates properly �]c Yes El No Do you certify as the sprinkler Contractor that additives and corrosive chemicals, sodium silicate or derivatives of sodium silicate, brine, or other corrosive chemicals were not used for testing systems or stopping leaks? WYes ❑No Tests Drain I Reading of gauge located near water Residual pressure with valve in fast test suppiytest connection: 20 psi (—bar) connectidhbpen.wide. 86 psi( —,bar) Underground mains and lead-in connections to system risers flushed before oonn'ection made to sprinkler piping Verfffetl by copy of the Contractors Material andTast [�1,. Yes. ❑ No Other Explain Certificate for Underground Piping. r-y Flushed by installer of underground sprinkler piping QYas 0No Ifpowder-drivan fasteners are used in concrete, has representative sample testing bean Yes No dno,. explain. No powder driven satisfactorily completed? fasteners used Bienktesting Number used 0 Locations 0 Nurilberremoved 0 gaskets Welding piping ❑ Yes 0 No It es ... _�--_ Do you certify as the sprinkler contractor that welding procedures used compiled with ❑ Yes ❑ No N/A the minimum requirements of AWS 82.1, ASME Section IX Welding and Brazing QuaGllcafions, or other applicabie.qualification standard as required by the AHJ? Do you certify that all welding was performed by welders or welding operators QYes Q No Welding qualified in accordance Wth the minimum requirements of AWS B2.1, ASME Section 1X Welding and Brazing Qualifrcatfons, or other applicable qualification standard as required by the AHJ? Do you certify that the welding was conducted in compliance, with a documented Ely.❑ No quality control procedure to ensure that (i) all discs are retrieved; (2) that openings in piping are smooth, that slag and other welding residue are removed; (3) the internal diameters of piping are not penetrated; (4) completed welds are free from cracks. incomplete fusion, surface porosity greater than 'As in. diameter, undercut deeper than the lesser of 25% of the wall thickness or'/a in.; and (5) completed dreumferential butt weld reinforcement does not exceed %2 in.? @ 2012 National Fire Protection Association NFPA 13 (p.2 of 3) FIGURE 25.1 Cordinued `0 2013 Edition Jie t. SY5iETISACCEPTANCE 18_249 Cutouts (discs) De you certify that you have a control feature to ensure that all cutouts (discs) are retrieved? N/A ❑Yes ❑No Hydraulic data nameplate Nameplate provided Yes ❑ No It no, explain Sprinkler contractor removed all caps and straps? 12 Yes ❑ No Remarks Date left in service with all control valves open Name of sprinkler contractor Sprinkmatic A Corp. Tests witnessed by Signatures The property owner or their authorized agent (signed Title Date For sprinkler contractor (signed) Title Date Additional explanations and notes 0 2012 National Fire Protection Association NFPA 93 (p. 3 of 8j FIGURE 25.1 Condinted 2613 Edition etm �;,.• ^opydoht 2014 National Fire Protection Association(NFPAJ. ticonsed,byagreement, lorindivlduat use and single download on Febivaiy14,2014 t6 Sprinkmatic fordtisfgrmIed,ua& CfiucktiamIllon:Ne other reproduction ortrensmissron In any form permitted wlthputwrlttan pormiaslor vI NFPA. For hrqulres or to report unauthorized yso, contact itcensingQrfpa,prg.. UNDERGROUND PIPING Contractor's Material and Test Certificate for Underground'Fiping PROCEDURE Upon completion of work, Inspection and tests shalt be made by the contractor's representative and witnessed by an owners representative. Ail defects shall be corrected and systemleft in service before contractor's personnel finai(y leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared forapprovtng authorities, owners; and conhactor. It is understood the owner's representative's signature in noway prajudicesany claim against contractorfor faulty material, poor, workmanship, or failure to comply with approving authority's requirements or local ordinances. Property name Rogers Gardens/ Farmhouse Date 7/11/2016 Property address 2301 San Joaquin Hills Rd. Corona Del Mar, CA Accepted by approving authorities (names) Newport Beach Fire Department Address 100 Civic Center Dr. Newport Beach, CA 92660 Plans Installation conforms to accepted plans x Yes' U No 0 No Equipment used is approved Yes. If no, state deviations Has person in charge of fire equipment been instructed as to location of Yes No control valves and care and maintenance of this new equipment? If no, explain instructions ❑ Yes Have copies of appropriate Instructions and care and maintenance x No charts been left on premises? If no, explain Lacatlon Suppfiesbuiliings 2301 San Joaquin Hills Rd. Corona Del Mar, CA Pipe types and class CPVC CL 150 Type Joint MJ Pipe conforms to NFPA-13 standard Yes ❑ No Underground �dy Fillings conform to NFPA-13 standard Yes U No• pipes and joints. If no, explain Joints needing anchorage clamped, strapped, or blocked in Yes ❑ No accordance with NFPA-13 standard If no, explain Flushing: Flow the required rate until water is dear as Indicated by no collection of foreign material in burlap�bags at outlets gtiah ai hydrants and blow -offs. Flush at one of the flow rates as spec fled in 10.102.1.3. -at Hydrostatic All piping and attached appurtenances subjected to system working pressure shall be hydrostatically tested 200 psi (13.8 bar) or 50 psi (3.5 bar) in excess of the system working pressure, whichever is greater, and shall maintalh that pipssule a5 psi (0.35 bar) for 2 hours. Hvdrostati Testing Allowance: where additional water is added to the system to maintain the test pressures required by 10,10.2.2.1•, Teat the amount of water shall be measured and shall not exceed the limits of the •following equation (tot metric.equation, see 10.10,2.2.6): description L = testing allowance (makeup water), in gallons per hour _ SD4P S = length of pipe tested, in feet t 148,000 D = nominal diameter of the pipe, in inches P = average test pressure during the hydrostatic test, in pounds per square m4q (gauge) New underground piping flushed according to �. Yes No NFPA standard by (company) It no, explain Flushing How flushing flow was obtained Public water ❑Tank or reservoir ❑Fire pump Through what type opening ❑ Hydrant butt Open "pipe tests Lead-ins Flushed according to NFPA standard by (company) Yes No If no, explain How flushing flow was obtained Through what type opening Public water 0 Tank or reservoir Fire pump ❑ Y connection to flange (] Open pipe and spigot 02012 National Fire Protection Association •NFPA 13 (p.1 of 2) FIGURE 10.10.1 Sample of Contractor's Material and Test Certificate for LIndergr6und Piping. [24: Fgure 10.16.11 2013 Edition �wr�+r t +� R 'opyrlght 2014 National Fire Protection Association (NFPA).Licensed, by agreement, for individual usa and single download an February 14,20i4 to Spfidkmatic,tor dastg'naietl usgr CltuckKimfiton. Nc other reproduction or transmission In any torm permitted without written Permission of t•1FPA For Inquires or to report unauthorized use, comaeClicenstng@rttpaorg. 13-120 INSTALLATION or spRmi-ER sysmi S Hydrostatic All new underground piping hydrostatically tested at Joints covered test 200 Psi for 2 hours Yes N6 Total amount of leakage measured Leakage 0 2 gallons hours lest Allowable leakage 0 gallons 2 hours Forward flow Foward flow test performed in accordance with i0.10.2.52. test of baeMlow Yes ❑ No proventer Number installed Type and make 'Alf operate satisfactorily Hydrants 1 Clow Modia 2050 a Yes ❑ No Water control valves left wide open Yes No If no, state reason Control vohrga Hose threads of fire department connections and hydrants Interchangeable with Yes �, No those of fire department answering alarm Date left in service Remarks Name of installing contractor Sprinkmatic A Corp. Tests.wltnessed by signatures For property owner (signed) Tide Dais For installing contractor (signed) idle Dato. Additional explanation and notes ® 2012 National Fire Protection Association NFPA •13 (p.2 of 2) FIGURE 10.10.1 Condicued 19 2013 Edition t ,R a . 'efth5 k1DIDfA1555 No *' April 23, 2016 Brian Stuck 1 Sundial Newport Drive, CA 92707 175�,Ibo%Aev, JUN 14'2016 Attn: Brian Stuck 219-613-6529 brian@socalinvestmentpartners.com Location: 1 Sundial, Newport Coast, CA 92657 Subject: 5 Year Fire Sprinkler Test Report All deficiencies have been corrected per N.F.P.A. 13 and the local fire code. Action Fire Protection has certified the Automatic Fire Sprinkler System. FIRE DEPT. CONNECTION — OK CONTROL VALVES — OK ALARM BELLS — OK RISER, GAUGES, MAIN DRAIN TEST — OK SPRINKLER INSPECTION — OK This concludes the 2016 5-Year Fire Sprinkler report. Thank you for choosing Action Fire Protection to take care of your fire protection needs! Sincerely, Joe Rodriguez Service Department Manager - k NEWPORT BEACH FIRE DEPT ADMINISTRATION JUN 13 20, RECEIVED BY. FIRE SPRINKLER CONTRACTORS • Engineering • Installation • Repairs • Testing 7602 Anthony Avenue Garden Grove, CA 92841 (714) 260-0101 • Fax (714) 823-4623 • Lic. C-16 #848831 • www.actionfp.com Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19 -7 -7777777777�_7, -7777777� g, Prop 100 "Arldn't," Name: RESIDENTIAL Occupancy/Use: R2 1 SUNDIAL Type 1-13 or- CA4 Address: Construction Type: City: NEWPORT COAST No. Stories: 2ya ZIP: 92657 Year Constructed: 2005 BRIAN STRUCK Contact. Telephone: (219) 613-6529 "7- _7 fS, "-V R' Name: ACTION FIRE PROTECTION Copy sent to: Address: 7602 ANTHONY AVE F� Owner Date: 04/23/16 City: GARDEN GROVE � Fire AHJ Date: 04/23/16 State: CA M Contractor Date: (714) 260-0101 Telephone: NOTES: 1) For specific inspection, testing, and maintenance requirements and information,, see NFPA 25, 2011 CA License#: 848831 C-16 Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: 2) Inspection items may be performed by the owner in Performed by: ROMAN CASTILLO accordance with California Code of Regulations, Title 19, §904.1 (a) 0 Check `,fti* Pq "Ayl- P pec f 4 pq C tim'4'�'e'Ad� In i Forms Included with this Report NFPA 25 Number of Forms NIA Fail* Pass Chapter Z Automatic Sprinkler System 5 1 E] Standpipe and Hose System 6 0 El El El El Private Water Supply System 7 0 El El 1-1 n Fire Pump 8 0 ❑ Water Storage Tank 9 0 El El Water Spray System 10 0 ri Foam Water Sprinkler System 11 0 El Water Mist System 12 0 0 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes No �'IEPP Mpz*�e" LpC� Eo». :... x.. ; Riser Pi�meter;•;,e,.:d1a»iet�r .=M1lI" iii ain Dra `Initial Static; :P;t'essure, �.. "'Resiiival' a.:!?r'essure.:: linat Static , "Pres�uM 1 GARAGE 11N 1/21N 100 60 100 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: ., 5.; .:r>,^ .: iE"^� Z i% �' „yp, .L,�}"'3::�-`.4 y: `',Cr 2F; s �3 rR�1.• .Z „it 't.= i#�� 9 # 3p 4 '::rt= ,Tyre •'3; 1 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable Iterii..\ i]escrptori:; ed:; ; Reference;,, aPate.'_ CcimiSiertts'.0 1.1 1 Control Valves — Identification Sign 13.3.1 03/24/16 N/A 1.2 1 Control Valves — Inspection 13.3.2 N/A 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 NA 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 NA 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi NA 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 100 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 NA 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backfiow Preventers 13.6.1 NA I .,. :,a .,. ,.:,„�, ;.,;, .., m ,. .i ... ", ;.�Z'. ,,�, qy s �. ••m .3.� ,: ��_� > �, ,i ?tE.:.,-.. :. :: ':ti "YS't-Y4�.a-. = Inspection T = Test M = Maintenance P = Pass F= Fail N/A = Not Applicable .ate:::..... .....�.. ......... . ......... : >.. ... ;: �e3GtIjJt10[]� ...a.<........ .. . , , . ;..::. .. ; 'IVi"r�A:-25 CA eil;' fLi�te; %`Qlfltll � ' Y P 1F ILIA x : .._ 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility P 1.20 1 Sprinklers 5.2.1 04/19/16 Repair Complete P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 N/A 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 N/A 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes R1 No 2.1 T Field Service Test Required Send Report to Fire Code Official 5 3 1 If REQUIRED, Enter'P until results are returned from Lab N/A 2.2 T Recalled Sprinklers If not present = Pass; !f present = Fail Title 19 904.1(c) PASS 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 15 sec. PASS 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 N/A 2.6 T Control Valve — Operation 13.3.3.1 N/A 2.7 T Supervisory Devices 13.3.3.5 N/A 2.8 T Backflow Preventer Assemblies 13.6.2 N/A 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 N/A 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 N/A 2.11 T Pressure Gauges - Calibration 5.3.2 N/A 2.12 T Small Hose Connections* 13.5.6.2.2 N/A * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable Item. i7escri tion': p NFF?A 25 GA.ed., ".' ate . Comm�ints'O"nfy ' -• P',)F;iM/A': j~tefernce .: 3.1 M Check Valves - Internal inspection 13.4.2 N/A 3.2 M Control Valves 13.3.4 N/A 3.3 1 M JFDC - Backflush 14.3.2.3 14.3.2.4 N/A Internal Pipe Inspection - See Deficiencies and 14.2 N/A 3.4 M Comments Section for Results. No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 N/A Deficiencies and Comments Section for Results Yes. 3.6 M System Returned to Service 4.5.3 P D = Deficiency C = Comment (Indicate type) lterti: �., : I)a�e' 'Riser•..•. . #� ' G;:: Deficie 4' &66mmicies:n#s .... ., . .. .,.. .,:..:., ` tniJfc# al}=equiprnrf c/eYTses and=parts tha#°were Cejiair it rapJaced, 1.20 3/24/16 1 X THERE ARE 8 PAINTED CONCEALED ESCUTCHEONS THAT REQUIRE TO BE REPLACED 4/19/201 x All Repairs Complete ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 99, Sections 909 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name ROMAN CASTILLO Si/7nature Roman Castillo OlglWy N.—Rion QsHlby menCo,Mo Date 04/23/16 7 bola 2O16.O32411tl'353O-OTOO' 9=mmenc2AQmsn mm, c=US Wun, Raymi From: Poster, Scott Sent: Tuesday, June 14, 2016 3:48 PM To: 'brian@socalinvestmentpartners.com' Subject: 1 Sundial, Newport Coast Mr. Struck, We received a copy of a Title 19, 5-year sprinkler test at the above address. We have no record of requiring this test. There is conflicting information on the documents transmitted by Action Fire Protection as well. It is routine for our department to review and approve Title 19 fire sprinkler tests. Upon review, we are unable to approve this test as the authority having jurisdiction. If you have any questions please contact me or have your sprinkler contractor contact me. Thanks, Scott L. Poster, Chief Newport Beach Fire Department 100 Civic Center Drive Newport Beach, CA 92660-3267 (949) 644-3101 00C_ # 9_770/23 .. esting-,-and -Maintenan-ce-Cover-Sheet- NFRA25 as amended by CCR, Title 19 7 rr Name: Bayview rtments Occupancy/Use: R2 Addre 1121 Back Bay Drive s s- City: ewpo each Construction Type: Type V-A No. Stories: 3 ZIP: 92660 Year Constructed: 2004 Contact. Larry Russo Telephone: (949) 759-1238 7' 777=7==7 u e. Name: Omega Fire Protection Copy sent to: Address: 1191 Huntington Drive #354 7 owner Date: 04/21/16 City: Duarte 0 Fire AHJ Date: CA []Contractor Date: 04/21/16 State: (626) 930-9212 Telephone: NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 971828 C16 CA License#: edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: 2) Inspection items may be performed by the owner in Performed by: Rosendo Lamas accordance with California Code of Regulations, Title 19, §904.1(a) r C, j-a-h qr o O cluded with this Re _Fo_rmLs_jjn _P_Q_rt NFPA 25 C pter- Number of Forms 1 NIA Fail* Pas 0 Automatic Sprinkler System 5 ❑ Standpipe and Hose System 6 0 0 F-1 ❑ Private Water Supply System 7 1 El Fire Pump 8 0 ❑ Water storage Tank 9 0❑ ❑ED ❑ Water Spray System 10 0❑ ❑D El Foam Water Sprinkler System 11 0❑ ❑D ❑ Water Mist System 12 0 El 11 11 ❑ Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas) Yes 0 No 7-7, AES 1 September 3, 2013 • e SprinklerFire • Property Information ea' - - • •Testing, and Maintenance Orr CA 55; M • Report Contractor or Licensed Owner Information Building Name Name Omega Fire Protection Bayview Landing Apartments Address 1191 Huntington Drive #354 Address 1121 Back Bay Drive City Duarte St. CA Zip 91010 License # Phone (626) 930-9212 City Newport Beach ©❑ SFM Job # Contact Person Larry Russo © CSLB 971828 C16 Misc. 9�•3 4 i... t \.: _ Risen-- - - - - i l-Stati Pressure- si - Press re al to c ` F S Pres" iire,.=- .NC ! . - 1 Outside east by trash room1 6 2 110 80 110 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached: k' I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable .. - ri.:,t .ow _ —gyp .P - -- - - p,= = - 1.1 1 Control Valves — Identification Sign 13.3.1 04/21/16 P 1.2 1 Control Valves — Inspection 13.3.2 04/21/16 P 1.3 1 Waterflow Alarm Devices 5.2.5 04/21/16 P 1.4 1 Supervisory Devices 5.2.5 04/21/16 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 04/21/16 P 1.6 1 Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6 04/21/16 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 04/21/16 110 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 04/21/16 110 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 04/21/16 P 1.10 I General Information Sign (Not Required for System Prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 I Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 04/21/16 P 1.13 1 Fire Department Connections 13.7 04/21/16 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 I 1 Backflow Preventers 13.6.1 04/21/16 P Form AES 2.2 Sept. 3, 2013 a- c as - -a c of SprinklerFire • •Testing, and Maintenance Report Property Information , Contractor or Licensed Owner Information - 4 Building Name Bayview Landing Apartments 15; Name Omega Fire Protection Address 1121 Back Bay DriveJob # City Newport Beach s +iY',��v,'s`.. a'd'i�. •. ;.i. . .;�.,:), „rr".... >„>r;'. - F 'a" ',t -:,.. � :s7 r>'< t. b y'''Tx+'�t�' .`3: ..R:A -.�^. -.. _— ` • � • • µXv`i_ NY fi !' l4t .#r-z - - I = Ins ection T = Test M = Maintenance P=Pass F=Fail N/A=Not Applicable -_ rip :Hl: Aef - -n Oorl y - ei�ed: ce' 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 N/A 13.5.5.1 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 04/21/16 F 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 04/21/16 P 1.22 1 I Pipe and Fittings 5.2.2 04/21/16 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 04/21/16 P 1.24 1 Hangers 5.2.3 N/A 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 N/A 1.26 1 Seismic Braces 5.2.3 N/A 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 N/A 1.28 1 Unsprinklered Areas CFC 901.4 nYes El No 2.1 T Field Service Test Required 5.3.1 If REQUIRED, Enter'F' until N/A Send Report to Fire Code Official results are returned from Lab 2.2 T Recalled Sprinklers Title 19 04/21/16 P /f not present = Pass; if present = Fail 904.1(c) 2.3 T Water Flow Alarm Devices 5.3.3 04/21/16 sec. P 90 secs max. Enter time 13'.2.6 2.4 T Main Drain Test 13.2.5 04/21/16 P (Enter data on Page 1 of this form) 13.3.3.4 2.5 T Control Valve - Position 13.3.3.2 04/21/16 P 2.6 T Control Valve — Operation 13.3.3.1 04/21/16 P 2.7 T Supervisory Devices 13.3.3.5 04/21/16 P 2.8 T Backflow Preventer Assemblies 13.6.2 04/21/16 P 2.9 T Small Hose Connections* 13.5.2.3 N/A w/PRV Hose Valves — Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 N/A 2.11 T Pressure Gauges - Calibration 5.3.2 N/A 2.12 1 T Small Hose Connections* 13.5.6.2.2 N/A * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, II, or 111 standpipe systems. Form AES 2.2 Sept. 3, 2013 Property Information D, Building Name Bayview Landing Apartments W Address 1121 Back Bay Drive City Newport Beach I Contractor or Licensed Owner Information Name Omeqa Fire Protection I "`- , ,-,j}+; ;: ,,.=`r- �..b;r $. ;' k�": f0 �y •8ayRibi 2Jft - '�+.1 Y..-k'021, .;fi: J,�..,� _ --?z.-,<...�$�,,5;.-.."mot - - I = Inspection T = Test M = Maintenance P=Pass F=Fail N/A=Not Applicable -�i - to e`s r i p - ?I�FfiA - - 'Da'te _Co mment O N A, • _ = - vR fe- e ren e: .Y 3.1 M Check Valves - Internal inspection 13.4.2 N/A 3.2 M Control Valves 13.3.4 4/21116 P 3.3 M FDC - Backflush 14.3.2.3 N/A 14.3.2.4 Internal Pipe Inspection - See Deficiencies and 14.2 Ye N/A 3.4 M Comments Section for Results. Nos 3.5 M Obstruction Investigation Required. If "Yes", See 14.3 N/A Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 4/21/16 0 Nos P D = Deficiency C = Comment Indicatetype) it - = - I?TCato: aYweree�nre ts'a�r'r lndf- ui � efc �enV cc�es.e.asn.da arf"s;f'h-OM t�o a ce - 1.20 04/21/16 1 X 2nd floor north wing trash room - 2 painted QR white semi -recessed bulb 1.20 4121116 1 X Painted sprinkler heads in the following patio storage closets 144, 125, 211, 215, 307, 311, 314, 237, 328, 332, 333, 138 1.20 4/21/16 1 X Painted or corroded sprinkler heads in the following bathrooms 208 1.20 4/21/201 1 X 5 painted sprinkler heads in unit 338 1.20 4/21/16 1 X Corroded or leaking sprinkler heads in the kitchen of 221,132 1.20 4/21/16 1 X Sprinkler head covered by painters tape in unit 111 1.20 4/21/16 1 X Painted sprinkler head in the bedroom closet of 223, 312, 340 1.20 4/21/16 1 X Painted or leaking sprinkler head hall closet of 316, 318, 343, 341, 138 1.20 4/21/16 1 X Painted sprinkler heads in the kitchen and bathroom of unit 319 1.20 4/21/16 1 X Leaking sprinkler head in bedroom of unit 320 1.20 4/21/16 1 X Leaking sprinkler head hallway between units 329 and 331 1.20 4/21/16 1 X Dented sprinkler head hall of unit 341 X fdc flush will need to be conducted when repairs are made. City has to close street valves. ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Rosendo Lamas Signature Date 04/21/16 Form AES 2.2 Sept. 3, 2013 Corrective Action California 1 Code of Regulations - Title 19 of I . Repairs-. Inspection, C Contractor Licensed Owner Informati Property Information or W +`r` Building Name Bayvie ments Name Omega Fire Protection Address Address 1191 Huntington Drive #354 1121 Back Bay Drive"" City Newport Beach St. CA Zip 91010 City ewport Beach License # Phone (626) 930-9212 Contact Pe ❑ SFM Job # Phone (949) 759-1238 CSLB 971828 C16 Misc. 1.20 •� 1 s. ':Found, 04/21/16 r, t6d 06/27/16 DeficienciesItem Indicate all equipment,devices and parts that were repaired or replaced 2nd floor north wing trash room - 2 painted QR white semi -recessed bulb 1.20 1 04/21/16 06/27/16 Painted sprinkler heads in the following patio storage closets 144, 125, 211, 215, 307, 311, 314, 237, 328, 332, 333, 138 1.20 1 04/21/16 06/27/16 Painted or corroded sprinkler heads in the following bathrooms 208 1.20 1 04/21/16 06/27/16 5 painted sprinkler heads in unit 338 1.20 1 04/21/16 06/27/16 Corroded or leaking sprinkler heads in the kitchen of 221,132 1.20 1 04/21/16 06/27/16 Sprinkler head covered by painters tape in unit 111 1.20 1 04/21/16 06/27/16 Painted sprinkler head in the bedroom closet of 223, 312, 340 1.20 1 04/21/16 06/27/16 Painted or leaking sprinkler head hall closet of 316, 318, 343, 341, 138 1.20 1 04/21/16 06/27/16 Painted sprinkler heads in the kitchen and bathroom of unit 319 1.20 1 04/21/16 06/27/16 Leaking sprinkler head in bedroom of unit 320 1.20 1 04/21/16 06/27/16 Leaking sprinkler head hallway between units 329 and 331 1.20 1 04/21/16 06/27/16 Dented sprinkler head hall of unit 341 I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable. Technicai_v.;- Rosendo Lamas Si riafure; Date,' :Sigl7afure;_' .. .pate - 04/21/16 06/27/16 Form AES 10 Sept. 3, 2013 JUL 0 6 2016 e-4' 5`pT 1 y qol5w" < jr- cep�— , 6ce., _ff- lG 3&7 ... amended by . forinatian Name: S Center Occupancy/Use: Ad re 2121 East Coast Highway nstruction Type: f CAI��D City: No. Stories: a ZIP: 92625 Year Constructed: 1989 9 `i Doug Sweaney E Contact: 851-0995 F►Y Telephone: (949) .. _. :.Naiinpeir:ofS'�te Isers...' Contractor 0 .'�orrratloi� .}d. P"F,k.+• ,4.4 Name: Orange County Fire Protection Copy sent to: Address: 137 W. Bristol Lane ❑✓ Owner Date: 06/20/16 City: Orange ❑✓ Fire AHJ Date. 6 CA ❑ Contractor Date: State: Telephone: (714) 974-9025 NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA_25, 2011, 326604 CA License#: Edition as amended by California Code of. -Regulations, Title 19, §901 to §906. Job #: 2) Inspection items may be performed by the owner in Performed by: George & Josh accordance with California Code of Regulations, Title 19, §904.1(a) Chick'"bgx'figr`eacl% Systeiti'?insp°ected-and-6ntal the ;numbdr of�farril$.ius d for`lrtbpectlbn.' Cheak:boxes,(Fail.o_r:Pass)#o'IriIcate.sta'tusQf`ipspe.cteil;systenn"atend"af'IrispetCofr Forms Included with this Report Chapter m Automatic Sprinkler System 5 1 ❑ ❑ ❑ Standpipe and Hose System 6 0 ❑ ❑ Private Water Supply System 7 0 ❑ ❑ ❑ ❑ Fire Pump 8 0 ❑ ❑ ❑ "❑ Water Storage Tank 9 0 ❑ ❑ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ ❑ Water Mist System 12 0 ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ❑ No AES 1 September 3, 2013 ; . ..•. "Location',;:-, pPa eter Mai,nbria n Diameter''``• ;Inifial;Sfatic �tesid'uai t�ressure I?ressur'e':' ' Finsil3tatic_ P e' ure S-, Riser: „ • 1 Inside the 1 st level of the parking 4+' 2" 85 70 85 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: t' I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable .iltem � . .C►esaiipti �r' :;' �� '+ ments`Onl" r" P. 1.1 1 Control Valves — Identification Sign 13.3.1 05/25/16 P 1.2 1 Control Valves — Inspection 13.3.2 05/25/16 P 1.3 1 Waterflow Alarm Devices 5.2.5 05/25/16 P 1.4 1 Supervisory Devices 5.2.5 05/25/16 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 05/25/16 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 05/25/16 NA 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 05/25/16 83 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 05/25/16 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 05/25/16 P 1.10 1 General Information Sign not required for system prior to 2007 Edition NFPA 13 5.2.8 05/25/16 NA 1.11 1 Heat Tape 5.2.7 05/25/16 NA 1.12 1 Spare Sprinklers 5.2.1.4 05/25/16 P 1.13 1 Fire Department Connections 13.7 05/25/16 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 05/25/16 NA 1.15 1 Pressure Reducing Valves 13.5.1.1 05/25/16 NA 1.16 1 Backflow Preventers 13.6.1 05/25/16 NA Form AES 2.2 Sept. 3, 2013 INSPECTION,ANNUAL 1 InspectionsInclude ALL Quarterly I = Inspection T = Test M = Maintenance P = Pass F = Fafl N/A =Not Applicable Rent Gas r p, io NPPA 26 CA ad ftefersnee site ,Gom eats• 01i, .. . _ 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 05/25/16 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 05/25/16 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 05/25/16 Owner's Responsibility N/A 1.20 1 Sprinklers 5,2.1 05/25/16 P 1.21 1 Sprinklers -Accessible Concealed Space 5.2.1.1.6 05/25/16 P 1.22 I jPipe and Fittings 5.2.2 05/25/16 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 05/25/16 P 1.24 1 Hangers 5.2.3 05/25/16 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 05/25/16 P 1.26 1 18eismic Braces 5.2.3 05/25/16 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 05/25/16 P 1.28 1 Unsprinklered Areas CFC 901.4 05/25/16 Yes m No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 05/25/16 If REQUIRED, Enter'F' until results are returned from Lab NA 2.2 T Recalled Sprinklers If not present = Pass; If present = Fall Title 19 904.1(c) 05/25/16 P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 05/25/16 51 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 05/25/16 P 2.5 T Control Valve - Position 13.3.3.2 05/25/16 P 2.6 T Control Valve — Operation 13.3.3.1 05/25/16 P 2.7 T Supervisory Devices 13.3.3.5 05/25/16 P 2.8 T Backflow Preventer Assemblies 13.6.2 05/25/16 NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 05/25/16 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 05/25/16 NA 2.11 T Pressure Gauges - Calibration 5.3.2 05/25/16 NA 2.12 T Small Hose Connections* 13.5.6.2.2 05/25/16 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 i s R HMO' Jllilii dry;I; milli 1 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A =Not Applicable a., on.-, `Date . Carttmeriti'On !y P;F�N ?, Reference 3.1 M Check Valves - Internal inspection 13.4.2 05/25/16 P 3.2 M Control Valves 13.3.4 05/25/16 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 05/25/16 P 3.4 M Internal Pipe Inspection - See Deficiencies and 14.2 05/25/16 H Nos' N/A Comments Section for Results. 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 05/25/16 N/A Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 05/25/16 0 Nos P F- D = Deficiency C = Comment (Indicate type) Def/ciencies, and,C6M` M—QP'6 - bata" R1ser" :D `) m' r' l dlcate all epuipr ent` devices'and' arts,thatwerere aired{orre /a 1.20 5/25/16 1 X 5 — Replace corroded Gasco 160° br'/" SSU in parking garage 1.20 5/25/16 1 X 1 — Replace damaged Gasco 160' br %" SSP w/ 2 piece cage in parking garage 1.20 5/25/16 1 X 1 — Replace damaged Central A 165° br %" SSP in parking garage 1.20 5/25/16 1 X 1 — Provide Central H chr esch outside suite 160 1.20 5/25/16 1 X 1 — Replace corroded Tyco 155' chr'/" SR in suite 200 room right of thermostat 1.20 5/25/16 1 X 1 — Provide central chr esch in suite 200 break room 1.20 5/25/16 1 X 1 — Provide Tyco chr esch in suite 220 restroom near lobby 1.20 5/25/16 1 X 1 — Provide Central H chr each in suite 260 inside and in front of break room 1.20 5/25/16 1 X 3 — Provide beauty rings for concealed heads in patient rooms 2.7 5/25/201 1 x 1- OS&Y tamper did not receive at the panel to be fixed by fire alarm company Above repairs completed on 6/17/2016 by George & Terry of Orange County Fire Protection System Certified (Five Year) dated 6-2016 by Orange County Fire Protection ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 0 See Correction Form AES 10 for corrected deficiencies. Number attached: 1 I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name I Jesse Signature Date 05/25/16 Form AES 2.2 Sept. 3, 2013 Corrective Action California Code of Regulations - Title 19 1 of { RepairsPerformed Inspection,Testing, Property Information �Q,�w�F CA�� W 2 'E Mp Contractor or Licensed Owner Information Building Name Coast Business Center Name Orange County Fire Protection Address 2121 East Coast Highway Address 137 W. Bristol Lane 2121 East Coast Highway City Orange St. CA Zip 92865 City Corona Del Mar License # 326604 Phone (714) 974-9025 Contact Person Doug Sweaney SFM E0422 Job # Phone(949) 851-0995 [■ CSLB C10 & C16 IMisc. AES i.t& Date Deficiencies Item 1.20 Form# 2.2 Found 05/25/16 Corrected 06/17/16 Indicate all equipment devices and parts that were repaired.replaced 5 — Replace corroded Gasco 1600 br 1/" SSU in parking garage 1.20 2.2 05/25/16 06/17/16 1 — Replace damaged Gasco 160° br V SSP w/ 2 piece cage in parking garage 1.20 2.2 05/25/16 06/17/16 1 — Replace damaged Central A 165' br W SSP in parking garage 1.20 2.2 05/25/16 06/17/16 1 — Provide Central H chr esch outside suite 160 1.20 2.2 05/25/16 06/17/16 1 — Replace corroded Tyco 155' chr %" SR in suite 200 room right of thermostat 1.20 2.2 05/25/16 06/17/16 1 — Provide central chr esch in suite 200 break room 1.20 2.2 05/25/16 06/17/16 1 — Provide Tyco chr esch in suite 220 restroom near lobby 1.20 2.2 05/25/16 06/17/16 1 — Provide Central H chr each in suite 260 inside and in front of break room 1.20 2.2 05/25/16 06/17/16 3 — Provide beauty rings for concealed heads in patient rooms 2.7 2.2 05/25/16 06/17/16 1- OS&Y tamper did not receive at the panel to be fixed by fire alarm company I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable. ;Building Representative Technician.; , Doug Sweaney Jesse Maldonado Signature ' Date-:. - ..Signature Date . 06/17/16 06/17/16 Mar -PA" NDVPWPR �X��Ep� JUL 1 2016 Form AES 10 NWPW NCH, CA 92868-M6 Sept. 3, 2013 JUN� 18 ra _ Inspection,•, amended by ion�r. . r� Name: The Irvine Company Occupancy/Use: - of CA��,cU Address: 500 Newport Center Drive Construction Type: City: Newport Beach, CA No. Stories: B - 10 Wv ZIP: 92660 Year Constructed: 1968 9 P Contact: Freddy Flores E MP Telephone: 949 279-6188 V� �>Y_ A ::C + Fact r l`n or`", a 'on• r of S}ts`em Rise - 1 '��' Name: Kelly Fire Protection, Inc. Copy sent to: Address: 10141 Theseus Drive ®Owner Date: 6-21-16 City: Huntington Beach ® Fire AHJ Date: 6-21-16 State: California ❑ Contractor Date: NOTES: Telephone: (714) 704-9024 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 CA License#: C-16 878823 Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: 7280 2) Inspection items may be performed by the owner in Performed by: Michael Rusin accordance with California Code of Regulations, Title 19, §904.1(a) - -' o -ectlo Ctieck 'o`-'foc:ea'cli sstem'`n's ' ectesi=and esker the:�num a 6f f',rms us d.f ,fins rit' { Check do "es'°Fail>or Pass ':to Tndic'''test'tus 0 'I ectd, � stem'af end of:iris' ectio IncludedForms ReportNumber of Forms NIA Fail* Chapter Pass ® Automatic Sprinkler System 5 2 ❑ ❑ ❑ Standpipe and Hose System 6 0 ❑ ❑ El ❑ Private Water Supply System 7 0 ❑ ❑ ❑ ❑ Fire Pump 8 0 ❑ ❑ ❑ ❑ Water Storage Tank 9 0 ❑ ❑ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ® No it,t •�.T,.}«..y�. - .Fc' ?`lu 3 e ro eficie `ties; "nd=Cog eiits,.4sec �d'n:afi endoof.eac Y,[espqq,lv,e AES 1 September 3, 2013 - Riser' { ^ .Riser' Di66, ainetet Main:Draiii: i)arrieter Initial St af c,. Ptessute>' Residfia I Pressure""'.' Ei''aLS a c` t t :Pre"sure' Penthse North Stair Penthouse Only 2" 1-1/4" N/A FIRE PUMP P 1-9 South Stair 2-1/2" 1-1/4" N/A FIRE PUMP P Basement 6" 1 2" N/A FIRE PUMP P 6" Standpipe in both N & S Stair Standard Hose Valves ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 'r`� :pit+-Y�-^ L�,'-'" r _ tT`'`: .-�;,•�y;j� '; �.t , = Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable Item escription; ''ei�: f. ric �Date'�-' ommerits'O tP� F> N 1.1 1 Control Valves — Identification Sign 13.3.1 5-14-16 1.2 1 Control Valves — Inspection 13.3.2 5-14-16 P 1.3 1 1 Waterflow Alarm Devices 5.2.5 5-14-16 P 1.4 1 Supervisory Devices 5.2.5 5-14-16 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 5-14-16 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 -14- P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi N/A 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi N/A 1.9 1 Pressure Readings Acceptable 5.2.4.1 5-14-16 P 1.10 1 General Information Sign not required for system prior to 2007 Edition NFPA 13) 5 2 8 N/A 1.11 1 Heat Tape 5.2.7 N/A 1.12 1 Spare Sprinklers 5.2.1.4 5-14-16 P 1.13 1 Fire Department Connections 13.7 5-14-16 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 N/A 1.15 1 Pressure Reducing Valves 13.5.1.1 N/A 1.16 1 Backflow Preventers 13.6.1 5-14-16 Form AES 2.2 Sept. 3, 2013 . r ..�.. :Y . -,t"' its i'a: • .�. -_ , = Inspection T = Test M = Maintenance P = Pass F — Fail N/A — Not Applicable It ' em. >z iDes'cr� tion;.:' .: p • CA'ed: at �Co` ' ments` O'n a',. m e y RAN/A - ��" - Reference 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 NIA 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility P 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 j I Seismic Braces 5.2.3 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 Yes 12 No 2.1 T Field Service Test Required 5.3.1 If REQUIRED, Enter'P until Send Report to Fire Code Official results are returned from Lab 2.2 T Recalled Sprinklers Title 19 If not present = Pass; If present = Fail 904.1(c) N/A 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 Average 35 per flr. sec. P Main Drain Test 13.2.5 2.4 T (Enter data on Page 9 of this form) 13.3.3.4 N/A Fire Pump N/A 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 Tested by Others N/A Small Hose Connections* 13.5.2.3 2.9 T w/PRV Hose Valves — Partial Flow Test 13.5.3.3 N/A 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 N/A 2.11 T Pressure Gauges - Calibration 5.3.2 N/A 2.12 T Small Hose Connections* 13.5.6.2.2 N/A * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 1 � ! l .t4 { ?l:l i•: h �it�� Me4`.+ N U 1 �Ag.. YA yr Q 8 0 f ''L+n.iR•7'.•.: t3 ,^�,d .�• f st .^ M1eih!-i = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable .ry i L :f' Desc'r'i'tiori: ` ip-. NFPA 25';GA'e d: ` f)'ate Comm6hts:Orii Y' / { PF't�A Reference . - 3.1 M Check Valves - Internal inspection 13.4.2 5-14-16 P 3.2 M Control Valves 13.3.4 5-14-16 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 5-14-16 P 3.4 M Internal Pipe Inspection - See Deficiencies and 14.2 ; Yes Comments Section for Results. 5-14-16 No P 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 Deficiencies and Comments Section for Results N/A 0 Yes 3.6 M System Returned to Service 4.5.3 ❑ No P D = Deficiency C = Comment (Indicate type) »; >C. :.w - Deirciencies aiad°Colnments-- lridicate `alt a ui "meat: devices'and 0rts' at Were re aired.oc fe laced d P P P 3.3 5-14-16 D FDC Check Valve was buried Underground. CORRECTED 5-21-16 See AES 10 1.20 5-14-16 8 D Replace 2painted 165F upright heads in No. Stairwell of 8th fir. Not Corrected. 1.20 5-14-16 D Suite 440 - Replace 1 G-4 semi -recessed wht escutcheon of corner office. Not corrected 1.20 5-14-16 3 D 3rd Fir - Replace caulked cover plate to ceiling the in office facing NCD. Not corrected. 1.20 5-14-16 4 1 D 4th Flr. - B of A - Replace 2 missing Model H escutcheons. Not Corrected. 1.20 5-14-16 1 D 1 st Mr. - B of A - Replace 1 corroded sprinkler in Server Room 155F QR. Not corrected 1.26 5-14-16 C The following Firs. need earthquake braces installed: 10 9 8 7 6 5 4 3 2 & 1. Not corr. 1.20 5-14-16 6 C 6th Flr. Ste. 600 - Add 1 head to front office & fix glued escutcheon to tile. Not corrected. 1.20 5-14-16 B C Add 1 head to Store Room #1. Not corrected. ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ® See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Michael A. Rusmn Signature Date 5-14-16 Form AES 2.2 Sept. 3, 2013 Corrective Action California Code of Regulations - Title 19 1 of and Repairs Performed Inspection, Testing, and Maintenance Property Information �oF CA<'^0 a �1� ��Q '`7RE MPQ Contractor or Licensed Owner Information -V_—� Name Kelly Fire Protection, Inc. Address 10141 Theseus Drive City Huntington Beach, CA 92646 Building Nam �(� � Address `J Q 0 t� A City f7r License # Contact Person S ❑ SFM jJob # 10,000 Phone Ceigoo a-101—j CSLB C,- 16 Imisc. �5. 1 hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable. Building Represent five. ,'Tec<xnician " k-y-�,-J,-A Signature Dafe 5' nafule., a' Date Form AES 10 Sept. 3, 2013 Private Fire California Code of Regulations - Title 19 Quarterly and Service Main Inspection, Testing, and Maintenance Annual Report I of 2 Property Information if CA Contractor or Licensed Owner Information Building Name y i 6 C, Um Name Vi V-( P-1, Y-f, VCY-) Address 500 r4iew V-0A te-i 0 1, Address City Buw� iv%illll -Drebst- O-A Zip OW6 City IsAf\,j Vp/t �CA� CA License # Phone Contact Person ipl-KAl �jprc� El SFM lJob # '91111, 9 0 Phone bLaqajGA- 6tco CSLB C,- 16 IMisc. I= Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable Ilem-4 N F PW tell� "Dil te, btioft, e er 1.1 1 Control Valves - Identification Sign 13.3.1 1.2 1 Control Valves - Inspection 13.3.2 1.3 1 Hose Houses 7.2.2.7 1.4 1 Fire Department Connections 13.7 1.5 1 Pressure Reducing Valves 13.5.1.1 Ak- 1.6 1 Backfiow Preventers; 13.6.1 1.7 1 Supervisory Devices 13.3.3.5.1 1.8 1 1 Monitor Nozzles 7.2.2.6 &UR' NEW HU!'111,12C - I= Inspection T =Test M = Maintenance P = Pass F = Fail NIA = Not Applicable scr X26^-ZA,�1 PAY VIA,- 1.9 1 Hydrants (Dty Barrel and Wall) Table 7.2.2.4 1.10 1 Hydrants 7.2.2.5 (Wet Barrel) Table 7.2.2.5 1.11 1 Mainline Strainers 7.2.2.3 Table 7.2.2.3 1.12 1 Piping (Exposed) 7.2.2.1 A Table 7.2.2.1.2 tA) 1.13 1 Piping (Underground) 7.3.1 1.14 1 Hose NFPA 1962 2.1 T Control Valve - Position 13.3.3.1 2.2 T Control Valve - Operation 13.3.3 4-00 2.3 T Monitor Nozzles 7.3.3 2.4 T Hydrants - Flush 7.3.2 r7 C0 �\(Av-,l 2.5 T Supervisory Devices 13.3.3.5 2.6 T Backflow Preventer Assemblies 13.6.2 2.7 T Pressure Reducing Valve 13.5.1.3 (Partial Flow Test) 3.1 M Control Valves 13.3.4 3.2 M I Mainline Strainers 7.2.2.3 ri Form AES 4 Sept. 3, 2013 Private Fire California Code of Regulations - Title 19 Quarterly and 2 of 2 Service Main Inspection, Testing, and Maintenance Annual Report InformationProperty Contractor or Licensed Owner boo Address = Inspection T = Test M = Maintenance P = Pass F = Fail IVIA =NotAp livable . ro •_ t� Descri t� n'` p o ` Date; Cotriiiieiitis'Onl P' F N/Aµ - :Reference ,.; : 3.3 M Hose Mouses 7.2.2.7 Table 7.2.2.7 3.4 M Hydrants 7.4.2 �j.\►lt.�� Qycw seJ Wnwj P 3.5 M Monitor Nozzles 7.4.3 Obstruction Investigation required "Yes", Yes 3.6 M (If see Deficiencies and Comments Section 14.3 No for Results. 3.7 M System Returned to Service 4.5.3 IM El Yes15.7 No Deficiency C omment (indicate type � �."� �ItemtSafe 7 �''ti#" �} ",?`f�"f"'�F• tG.'lr� user �Yt! r� , ��` �"'4!5""^,ve71(,t•'r�i7:'%�S x"'�afi"'.�3xerrw{ r � 1 V m r .�- `D G�� ` ; �Z7II W"Declencre�actl C.ommen#sue. �� , �117ticaf�rlrjupmentdel�tcpsandpatsliatwere'repa7�ertorreplaced F-1 Check here if additional Deficiencies and Comments are listed on Form AES9 Number attached: 0 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter �!? l . r' - . ., .""q..^,^nt_«^+..„y,--*--.'t'f^'t^. . ^t-�..<....�.q....- .-m+;-»•..;�,.a--+.,.m.m+n+m 'Qu6112Gr t -1:.' Annual 4tii�4.:Anrival; Date Print Name Signature �. Form AES 4 Sept. 3, 2013 ' JUpI 2 7 2016 Inspection,... 7 .w^ _4.,ww�r , :7- ...77 ^?7r. wP",'s+^CJ'^-?w^?? - �t :+-a�^ m e..'. A•�sc-- an� Pro 'e In rt on do:.• ` rya ris u; Name: The Irvine Company Occupancy/Use: - Address: 550 Newport Center Drive Construction Type: 11-g ��pF Cq47�O City: Newport Beach, CA No. Stories: B - 10 �' v ZIP: 9266Q Year Constructed: 1968 Contact: Freddy Flores MAC Telephone: 949 279-6188 �•/�, - rt •, - �I�uiiiber •of S.'sfem� Rise` ;1''1: ;: Name: Kelly Fire Protection, Inc. Copy sent to: Address: 10141 Theseus Drive ® Owner Date: 6-21-16 City: Huntington Beach [x1 Fire AHJ Date: 6-21-16 State: California ❑ Contractor Date: NOTES: Telephone: (714) 704-9024 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 CA License#: C-16 878823 Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: 7280 2) Inspection items may be performed by the owner in Performed by: Michael Rusin accordance with California Code of Regulations, Title 19, §904.1(a) iio fo " eac .s::dfi— � iris` ;', x p h., Y,. ec 'eci andt e t �:t 'e ii rt e .o ::fo�mi; se: - - rt 4 h umb, c f u d'f..r:Irisp . .p... , -•s ': ' =`=' ` ' fC''ecli'ti'bXF-.-a'I ar?Pass o:indi ate':Mat es (. r.t c u cf-in p- cted°system at.erid of rispecfion , Forms• ' •with this Reportof qhapter Forms N/A Fail* Pass ® Automatic Sprinkler System 5 El X❑ 2 ❑ Standpipe and Hose System 6 0 ❑ Private Water Supply System 7 0 ❑ ❑ ❑ ❑ Fire Pump 8 0 ❑ ❑ Water Storage Tank 9 0 ❑ ❑ ❑ ❑ Water Spray System 10 0 ❑ ❑ El El Foam Water Sprinkler System 11 0 ❑ ❑ - ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ® No -�/1 a4"' t�'A" _ -:ib',T '•11': M..j.^.. .tL "'.'".__i ^e''i' ,. ; 'T':- .. f,r, . -- "; C +-t. F `S" �?.' S'1� xk�' %" . •''`:9, *See. seCtirn af''endrieaeli:r'es(h�eetiue orm tea: 5..-' :_ f.� tDeficlenc'es:aird'Gorrirnen`ts: N:, - ;,.:f...,•<?e AES 1 September 3, 2013 ?at YY(�.`U.`�;+s;��=: No: r' Location . ,;=x; = ;. Riser,' ` F Diamefer., � • :Maui Drain' :'Diameter"" Initial.Static :Pressure `ali � Reside Pressure t� Final Sta c QressU�e -. F+�'E • NI . ' ' Penths North Stair Penthouse OnIV 2" 1-1/4" N/A FIRE PUMP P 1-9 South Stair 2-1/2" 1-1/4" N/A FIRE PUMP P Bsmnt I Basement 6" 2" N/A FIRE PUMP P 6" Stand i e in both N & S Stair Standard Hose Valves ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: y'--�.y,-,• -. 5. 4-74 ,ig+" �+b.ay Pv?wa r • yis A = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable a'ate,-,n j. �Descri tiony• ,pr "�4� ri'• •'J ` •Comrhedts:0 P N ,. 1.1 1 Control Valves — Identification Sign 13.3.1 5-14-16 1.2 1 Control Valves — Inspection 13.3.2 5-14-16 P - 1.3 1 Waterflow Alarm Devices 5.2.5 5-14-16 3rd fir. wtr flow didn't report -F 1.4 1 Supervisory Devices 5.2.5 5-14-16 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 5-14-16 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi N/A 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi N/A 1.9 1 Pressure Readings Acceptable 5.2.4.1 5-14-16 P 1.10 1 General Information Sign not required fors stem prior to 2007 Edition NFPA 18 5 2 8 N/A 1.11 1 Heat Tape 5.2.7 N/A 1.12 1 Spare Sprinklers 5.2.1.4 5-14-16 P 1.13 1 Fire Department Connections 13.7 5-14-16 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 5-14-16 1.15 1 Pressure Reducing Valves 13.5.1.1 N/A Fl. 16 1 Backflow Preventers 13.6.1 5-14-16 Form AES 2.2 Sept. 3, 2013 >'. s��t�,�.3��;^r. "a��i�:.��',r,"°5•a>,��a;,. 63 , � . . _ � yy y ��y >i+Mt•'4:'�`,t'i",:.- Nale ..P�j•. _ _ B � i 0 ' /s'.- 5y "'��. ..�J` "W�eyK`Rr�. I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A =Not Applicable Item ;F ; de cri' i`n _s , pt o. 'NFPA 25,CA ed: :Referenc ' Date Gomments.Qnl y' 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 5-14-16 P 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 5-14-16 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.E 5-14-16 P 1.22 1 Pipe and Fittings 5.2.2 5-14-16 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 5-14-16 P 1.24 1 Hangers 5.2.3 5-14-16 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 5-14-16 P 1.26 1 Seismic Braces 5.2.3 5-14-16 IP 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 5-14-16 P 1.28 1 Unsprinklered Areas CFC 901.4 nYes No 2.1 T Field Service Test Required 5.3.1 If REQUIRED, Enter'P until Send Report to Fire Code Official results are returned from Lab NZA 2.2 T Recalled Sprinklers Title 19 If not present = Pass; if present = Fail 904.1(c) N/A 2.3 T Water Flow Alarm Devices 5.3.3 90 secs max. Enter time 13.2.6 5-14-16 Avera a 32 per fir. sec. P 2.4 T Main Drain Test 13.2.5 (Enter data on Page 1 of this form) 13.3.3.4 N/A Fire Pump N/A 2.5 T Control Valve - Position 13.3.3.2 5-14-16 P 2.6 T Control Valve — Operation 13.3.3.1 5-14-16 P 2.7 T Supervisory Devices 13.3.3.5 5-14-16 ~ P 2.8 T Backflow Preventer Assemblies 13.6.2 Tested by Others N/A 2.9 T Small Hose Connections* 13.5.2.3 w/PRV Hose Valves — Partial Flow Test 13.5.3.3 N/A N/A 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 2.11 T Pressure Gauges - Calibration 5.3.2 N/A 2.12 T Small Hose Connections* 13.5.6.2.2 N/A * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 I= Inspection T = Test M = Maintenance P = Pass F=Fail N/A =NotApplicable twin Is CA ed "Date,` onmi t-b- I i 3.1 M Check Valves - Internal inspection 13.4.2 N/A 3.2 M Control Valves 13.3.4 5-14-16 P 3.3 M FDC - Backfiush 1 14.3.2.3 14.3.2.4 5-14-16 P Internal Pipe Inspection - See Deficiencies and Yes 3.4 M Comments Section for Results. 14.2 No N/A 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 Deficiencies and Comments Section for Results N/A FXJ Yes 3.6 1 M System Returned to Service 4.5.3 5-14-16 ❑ No P I D = Deficiency C = Comment (indicate type) bai :J"Riger"X Icten"al-esjand -pquipfient, devicMahdpPrtimai**iep or 16ced' 5.2.5 5-14-16 3 X Water flow failed to report to panel. CORRECTED. See AES 10 5,23 5-14-16 see Q X These floors need EQ bracing installed: 9. 6. 5, 4. 3. 2 & 2. Not Corrected. 1.20 5-14-16 Bsmnt — X Recomm. replacing 3-155F ssu's & change to 20OF due to heat in rm. CORR.see AES 10 1.20 5-14-16 Bsmnt X Recomm. to install (1) sprinkler head to Engineer Storage Room. Not corrected. 1.20 5-14-16 2 X Re lace (1) missing Victaulic Cover Plate in small office. CORRECTED. See AES1 0 1.20 5-14-16 2 X Replace (4) painted 155F ssu's above hard lid. Not corrected 1.20 15-14-16 1 X In both Server Rooms of 550-A, the ceiling tile is missing around sprinklers. Not'corrected 1.20 5-14-16 6 X 6th FIr. Ste. 600 - Add (1) head to front office & fix glued escutcheon to tile. Not corrected. 1.20 5-14-16 B X Add (1) head to Store Room #1. Not corrected. El Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 91 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. I Print Name Min-hael A- Ruson —I I Signature XMCJ�A RU&6a, Date 5-14-16 jml< Form AES 2.2 Sept. 3, 2013 Corrective Action California Code of Regulations - Title 19 1 Of and Repairs Performed Inspection, Testing, and Maintenance Property Information �pF CA<�,�`0 Contractor or Licensed Owner Information 2 0Q E M�Qy Name Kelly Fire Protection, Inc. Address 1O141 Theseus Drive City Huntington Beach, CA 92646 Phone 'j o Lj-qp &k Building Name Address 550 O City pry License # S-1 $ Contact Person r ❑ SFM Job # ") a 8b Phone bqen A-1'1 _ -V CSLB C -j b Misc. k% ,1ZAA I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable. Building Representative Tecf►nician..; ........ Signafu�e'. Date: ;Signature Dat Form AES 10 e -1 6 Sept. 3, 2013 Private Fire California .. Quarterly Main Inspection, Testing, and Maintenance Annual ReportService Property Information IFCpCi�o Contractor or Licensed Owner Information GOO � y�Q Building Name ki(VI vie, CornAin`( Name Address 1;1 j p W c)y-+ tAv. 96, ve, Address City 1nVYv16n n &C i St. lfi Zip Ok P,6L% City twoV License # '31$$ a3 Phone C) q t7 + Contact Person SFM Job # ' a$ Q Phone 6 iS $ ICA CSLB C,-t6 Misc. P e • = Inspection T = Test M = Maintenance P = Pass F = Fail N/A =Not Applicable '_. 25 CA• ., N .1?i0.� m� '7te nnt . �Desci' 'oti:` ; ria `e` . .: e ere' riP..: 1.1 1 Control Valves - Identification Sign 13.3.1 1.2 1 Control Valves - Inspection 13.3.2 N A 1.3 1 Hose Houses 7.2.2.7 �A 1.4 1 Fire Department Connections 13.7 N 1.5 1 Pressure Reducing Valves 13.5.1.1 1.6 1 Backflow Preventers 13.6.1 hl a 1.7 I Supervisory Devices 13.3.3.5.1 A 1.8 1 I Monitor Nozzles 7.2.2.6 NlA s r r a = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Ap Ycable - - .{;r •;{': '- `�: �:�": -- �.Desc� "tong' NFPA>25 't`..j T ?". .Date , .. Cor"rirrieiits Onl '.P;F N7A , 19 1 Hydrants 7.2.2.4 (Dry Barrel and Wall) Table 7.2.2.4/%k 1 Hydrants 7.2.2.5 .1.10 (Wet Barrel) Table 7.2.2.5 1.11 1 Mainline Strainers 7.2.2.3 / is%A Table 7.2.2.3 1.12 1 Piping (Exposed) 7.2.2.1 Table 7.2.2.1.2 1.13 1 Piping (Underground) 7.3.1 N A 1.14 1 Hose NFPA 1962 N 2.1 T Control Valve - Position 13.3.3.1 5'ly�ab 2.2 T Control Valve - Operation 13.3.3 2.3 T Monitor Nozzles 7.3.3 2.4 T Hydrants - Flush 7.3.2 2.5 T Supervisory Devices 13.3.3.5 2.6 T Backflow Preventer Assemblies 13.6.2 2.7 T Pressure Reducing Valve 13.5.1.3 (Partial Flow Test) 3.1 M Control Valves 13.3.4 3.2 M Mainline Strainers 7.2.2.3 Form AES 4 Sept. 3, 2013 1 ® l ! l l = Ins ection T = Test M = Maintenance P = Pass F = Fail N/A = Not Ap licab/e Des ri tion:<:; Date. '' Gorriments=Onl P F t/A . fe 3.3 M Hose Houses 7.2.2.7 N/A Table 7.2.2.7 3.4 1 M Hydrants 7.4.2 5_14-16 �6 Sed 3.5 M Monitor Nozzles 7.4.3 �• Obstruction Investigation required ❑ Yes 3.6 M (If "Yes", see Deficiencies and Comments Section 14.3 No rl/A for Results. 4.5.3 El Yes 3.7 M System Returned to Service 15.7 ElNo LAIA D Deficiency C Comment (indicate type) �1c ei�cies axrd'dr»rrretts ' t Item , Date YaA Riser a � �� . �d�ca#e all eg pmet t ,deVtc s apd afts'that*w repaued.or to laced ---FOW w + s NEWUMTEFAFT nW i F� Check here if additional Deficiencies and . E] See Correction Form AES 10 for corrected deficiencies. Number attached: 1 hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter Qf, 1t a/; Date ��►� Print Name VVAi(�/)p�� Signature V • + tZ - Form AES 4 Sept. 3, 2013 Pape 1 of 3 Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: Name: Bay Island Occupancy / Use: Residential Address: 1 — 25 Bay Island Construction Type: Wood, Stucco City: Newport Beach No. Stories: co-t Zip: 92661 Year Constructed: 1987 ARE M� Contact: Charles Seager Telephone: (714) 751-7858 —� Contractor Information: F2 ] Number of System Hydrants Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln � Owner Date 1/20/2016 —❑ City: Orange Pq Fire AHJ Date 1/20/2016 State: California 92865-2605 ❑ Contractor Date Telephone: 714-974-9025 NOTES: 1) For specific inspection, testing, and CA License# 326604 maintenance requirements and information, see NFPA 25, 2002 Edition as amended' by Job # California Code of Regulations, Title 19 §901 Performed by: Shawn & Tim to §906. 2) Inspection items may be performed by the Owner in accordance with California Code of Regulations Title 19 §904.1(a). Forms included with this report NFPA 25 Chapter Number of Forms N/A FAIL* PASS ❑X Automatic Sprinkler System 5 1 X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 ❑ Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 *See "Deficiencies and Comments" section at end of each respective form State Fire Marshal AES2 Paae 2*of 3-"— Inspection, Testing, and Maintenance Private Fire Main Systems NFPA 26, Chapter 7 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 1-19-2016 c-4 of Property Information: Abbreviation Key: � Name: Bay Island I = Inspection 1� y Address: 1 — 25 Bay Island T = Test �Re Mpa` M = Maintenance A-O= After Operation MI = Per Manufacturer's Instruction City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 1 Quarterly Hose Houses 7.2.2.7 X 1.2 1 Quarterly Control Valves 12.3.2.1 X 1.3 1 Quarterly Pressure Regulating Devices 12.5.1.1 12.5.4.1 X 1.4 1 Quarterly Backflow Preventers 12.6.1 X 1.5 1 Semiannually Monitor Nozzles 7.2.2.6 X 1.6 1 Annually Hydrants (Dry Barrel and Wall) 7.2.2.4 X 1.7 1 Annually Hydrants (Wet Barrel) 7.2.2.5 X 1.8 1 Annually Mainline Strainers 7.2.2.3 X 1.9 1 Annually Piping (Exposed) 7.2.2.1 X 1.10 1 See 7.2.2.2 Piping (Underground) 7.2.2.2 X 2.1 T Annually Monitor Nozzles 7.3.3 X 2.2 T Annually Hydrants 7.3.2 X 2.3 T Annually Control Valve — Position 12.3.3.1 X 2.4 T Annually Control Valve — Operation 12.3.3.1 X 2.5 T Annually Backflow Preventer Assemblies 12.6.2 X 2.6 T Annually Supervisory 12.3.3.5 X 2.7 T 5 Years Piping (Exposed and Underground) Flow Test 7.3.1 X 2.8 T 5 Years Pressure Regulating Valve 12.5.1.2 12.5.4.2 X 2.9 T 5 Years Fire Department Connection Backflush 12.7.4 X 3.1 M Annually Mainline Strainers 7.4.2 X 3.2 M Annually Hose Houses 7.4.5 X State Fire Marshal AES2 �a Page 3 of 3 Inspection, Testing, and Maintenance Private Fire Main Systems NFPA 25, Chapter 5 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 1-19-2016 Property Information: Abbreviation Key: = Inspection p Name: Bay Island Address: 1 — 25 Bay Island T = Test M = Maintenance e MPg` A-O= After Operation MI = Per Manufacturer's Instruction City: Newport Beach Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 3.3 M Annually Hydrants 7.4.3 X 3.4 M Annually Monitor Nozzles 7.4.4 X 3.5 M Annually Control Valves 12.3.4 X 3.6 M Annually Valves (All Types) Chapter 12 X Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: FLOW RESULTS Hydrant #1: Outlet size 2 Y2", Static 55, Residual 42, Pitot 18, GPM 721 Hydrant #2: Outlet size 2 1/2", Static 53, Residual 39, Pitot 16, GPM 671 System Certified (Five Year) dated 1-2016 by Orange County Fire Protection Notes: 1) Both of the hydrants are off of the domestic water supply. 2) FDC feeds hydrants and domestic feed. See Continuation Pages(s) a (Indicate the number of continuation pages) X❑ PASS FAIL Signature: Date: 1 1-20-2016 sse Maldonado State Fire Marshal AES2 0 -1 -- Bepcv 3MA 2 9 zo I F/ P'SCE-1v BY'. 5 NEWPORT BEACH FIRE DEPARTMENT 100 CIVIC CENTER DRIVE, P.O. BOX 17'68, NEWPORT BEACH, CA 9266-0 PHONE: (949) 644-3104 FAX: (949) 644-3120 WEB: www.nbfd.net SCOTT L. POSTER Fire Chief August 24, 2015 Park Newport Building 4 Summary of Findings: Park Newport Community was found to be in violation of the California Fire Code for the 5 year maintenance of the Class 2 standpipe. Specifically, Building 4 was required to conduct a 5 year certificate per NFPA 25 (Maintenance of Water Based Systems). The system at this location is an automatic wet combination of standpipes consisting of a domestic supplied class I standpipe (1- 2 %" hose valve) and class II standpipe (hose cabinet). While conducting the certification, the contractor found the Fire Department Connection (FDC) was "wet" and under pressure. Once verified, a check valve was added to return the FDC back to the existing "dry" condition and the FDC caps were able to be removed. At that time, a flow test was conducted at the most remote area and the results, per NFPA 25 was a "Fail' due to the requirements for this system being; for buildings after 1970 the flow shall be 70 gpm at 35 psi. The Pitot reading for this test was 30 psi = 40 gpm at 35 psi. Since there no history or documentation of this system and the standpipe is not in accordance with NFPA 14 (Installation of Standpipe and Hose Systems), California Code of Regulations (CCR) Title 19 Section 6.3.1.7 shall apply. See below: Add Section 6.3,1.7 as follows: 6.3.1.7 Class 11 Srttnapipes not im u llod in accojAwtee with NFPA 14 shall W t ted in accordori :o with Tabte 6.3.i.7. Add Table. 6,11.7 as follows: Table 6.33.7 Tkite ofi It�st illetaan RequiiocI bloc* 41t Outlet itcauircd Ne66Utt at t)�dlat tat o 194S 20 Arm 1946 to 1939 95 gpm 12 PO 19W to 1979 245 gpin 15 ixxi lkliarp e: 1M Uniform Fim12bdc Appendix G If there are other Class II Standpipe systems within the Park Newport Community that are served by a domestic water supply and not in accordance with NFPA 14 CCR Title 19 Section 6.3.1.7 shall apply. Raymi Wun Life Safety Specialist II Newport Beach Fire Department Phone: (949)644-3110 Email: rwun@nbfd.net Wun, Raymi From: Wun, Raymi Sent: Friday, August 21, 2015 2:04 PM To: 'service@actionfp.com' , Cc: 'Doug Garrity; field@actionfp.com; tommy@actionfp.com; 'Craig Durand'; 'Jim Diaz' Subject: RE: Building #4 Standpipe Joe Rodriguez, Thank you for contacting us regarding this unique condition... Yes the Newport Beach Fire Department (NBFD) reviewed this case as an existing non -conforming system. The fire department connection (FDC) at this location has been returned to an existing dry pipe condition that supplies a wet system to include Class 1 & 2 Standpipe. Due to the fact the Class 2 standpipe, comes off a domestic supply, doesn't conform to NFPA 14 and has no history and an unknown time of installation... NBFD applied Title 19 Section 6.3.1.7. NBFD understands that only trained employees or qualified people are to use the Class 2 standpipe. Also, Park Newport communicates to their tenants to evacuate the structure during a fire emergency rather than use the Class 2 Standpipe. if you have any questions or concerns, please call (949) 644-3110. Raymi K. Wun Life Safety Specialist Newport Beach Fire Department 100 Civic Center Drive, California 92660 (949) 644-3110 From: service actionfp.com rmailto:service@actionfp.com] Sent: Friday, August 21, 2015 12:15 PM To: Wun, Raymi Cc: 'Doug Garrity; fielcl(,Oactionfp.com; tommy(5actionfp.com; 'Craig Durand' Subject: FW: Building #4 Standpipe Hi Raymi, Good Speaking with you today. A very interesting case, but I think that NBFD did an excellent job on this one. As the authority over this jurisdiction, please validate the attached email as we discussed for our files. Action Fire Protection will comply with the NBFD determinations. The attachment is the Title 19 code that is referenced. Please let me know if you have any additional questions. Best Regards, Joe Rodriguez JOERODRIGUEZ ACTION FIRE PROTECTION Service Department Manager service@actionfp.com 7602 ANTHONY AVENUE 714-26MIOL GARDEN GROVE, CA 92841 FAX: 714 923.4623 www.actionfp.com - LIC. C-16 #848831 From: Doug Garrity [mailto:dgarrity(ftb-a.com] Sent: Friday, August 21, 2015 11:17 AM To: service0actionfp.com Subject: FW: Building #4 Standpipe From: Jim Diaz Sent: Friday, August 21, 2015 10:48 AM To: Mark Rogers Cc: Tad Scales; Ken Dressel; Doug Garrity Subject: Building #4 Standpipe Mark, Great news! Kirk and I met with Raymi Wun, Fire Safety Specialist with the NBFD. Raymi conducted research and has found the attached code referencing the chart used to qualify the standpipe GPM/PSI in 1979. When using this code, Park Newport is in compliance with the standpipe test and no modification is. necessary. We will not be held to the more current (higher standard) code: Chief Kitch has agreed that by adding new fire alarms and elevator fire recall systems we have made the building safer and the old code will be honored. We still need to certify that the standpipe meets these codes, but our initial testing indicates that we will be fine. Jim Diaz Park Newport P: 949.734.2380/2381/2382 F: 949.717.7622 This email has been scanned by the Symantec Email Security.cloud service. For more information please visit htti)://www.syrnanteccloud.com § 901 BARCLAYS CALIFORNIA CODE OF REGULATIONS _f Title 19 Replace Section 6.2.1 as follows: 6.2.1 Components of standpipe and hose systems shall be visually inspected semi—annually or as specified in Table 6.1. Replace Section 6.3.1.3 as follows: 63.1.3 All systems shall be flow tested and pressure tested at the re- quirements in effect at the time of the installation. Where such re- quirements cannot be determined, the Fire Authority Having Juris- diction shall establish the test requirements, Add Section 6.3.1.3.1.1 as follows: 63.1.3.1.1 Where the standpipe is supplied by a fire department connection and a fire pump, the standpipe shall be tested using the fire pump and the fire department connection independently. Where multiple fire department connections are installed, the stand - pipe shall be tested by using each fire department connection inde- pendently. Add Section 6.3.1.3.1.2 as follows: 63.1.3.1.2 Where the standpipe is supplied by pumps which are staged in series due to the height of the building and the fire depart- ment connection is not capable of supplying standpipes in the high zone, the fire department connection shall be used to supply thelugh zone pump. Add Section 6.3.1.6 as follows: 6.3.1.6 Class I and Class III Standpipes not installed in accordance with NFPA 14 shall be tested in accordance with Table 6.3.1.6, Add Table 6.3,1.E as follows: Table 6.3.1.6 Class Type of Test Required Flow at Outlet Required Pressure at Outlet Hydrostatic Test Duration I Air I Hydrostatic N/A I Flow 100 gpm III Flow 500 gpm Add Section 6.3.1.7 as follows: 6.3.1.7 Class 11 Standpipes not installed in accordance with NFPA 14 shall be tested in accordance with Table 6.3.1.7. Add Table 6.3.1.7 as follows: Table 63.1.7 25 psi 50 psi + Static Pressure NIA but not less than 150 psi 3 Minutes Maximum friction loss not to exceed 15 psi N/A 3 Minutes 65 psi N/A 3 Minutes Add Section 6.3.1.7.1 as follows: 6.3.1.7.1 Testing of Class 11 Standpipes installed prior to 1980 which are supplied by gravity tanks or pressure tanks shall include the operation of the automatic filling device. Replace Section 8.3.4.3 as follows: Required Flow Required Pressure 8.3A.3 Tests of appropriate environmental pump room space Date of Installation at Outlet at Outlet conditions (e.g., heating, ventilation, illumination) shall be made as Prior to 1948 20 gpm 8 psi needed to ensure proper manual or automatic operation of the associated equipment, 1948 to 1959 35 gpm 12 psi Replace Table 9.1 as follows: 1960 to I979 35 gpm 15 psi Reference: 1979 Uniform Fire Code, Appendix G Table 9.1 Summary of Water Storage Tank Inspection, Testing, and Maintenance Item Activity Frequency Reference Condition of water in tank Inspection Monthly/quarterly 9.2.1 Water temperature Inspection Daily/weekly* 9.2.4 Heating system Inspection Daily/weekly* 9.2.6.6 Control valves Inspection Quarterly Table 12.1 Water — level Inspection Monthly/quarterly 9.2.1 Air pressure Inspection Monthly/quarterly 9.2.2 Tank — exterior Inspection Quarterly 9.2.5.1 Support structure Inspection Quarterly 9.2.5.1 Catwalks and ladders Inspection Quarterly 9.2.5.1 Surrounding area Inspection Quarterly 9.2.5.2 Page 46 Register2009, Na. 45,11-6-2009 Address: 1 - 5000 PARK NEWPORT DRIVE k Occupant: PARK NEWPORT 7 VCOURTALL BASKETBALL COURT PLAYGROUNDS h e C COURTS HODS �CLUB T sHo° O b O lb - p o °° . �0 F,OAO SqN JOAQUIN DISTRICT 4528 31- * FIRE ALARM PANEL rjv p ^b� �b6° b 7��0 ^ ^p ry0 NOTE: KNOX BOX AT EACH LOBBY Drawing Saved As: SAM31 Date: 03/24/05 Drawn By: MULLEN / BEUCH 1 OF 1 I Name: Hills Boat Services Inc. Occupancy/Use: Address: 814 E. Bay Ave. C"�t/,i►�� Construction Type: ;: City: Newport Beach No. stories: ��,�aF : a ZIP: 92661 Year Constructed: �+ Contact: Carson/Marlene. Telephone: (949) 675-0740 Name. Orange County Fire Protection Copy sent to: Address: 137 W. Bristol Lane 0 Owner Date: 05/19/16 City: Orange ❑ Fire AHJ Date: State: CA ❑ Contractor Date: Telephone: (714)974-9025 NOTES: 1) For specific inspection, testing, and maintenance 326604 requirements and Information, see NFPA 25, 2011 CA License#: Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: Josh 2) inspection items may be performed by the owner in Performed by: accordance with California Code of Regulations, Title 19, §904.1(a) ❑ Automatic Sprinkler System 5 0 ® Standpipe and Hose System `6 " 0 : ❑ -211 ❑ Private Water Supply System 7 0 ❑ ❑ Fire Pump 8 0 ❑ ❑ Water Storage Tank 9 0 ❑ ❑ ❑ Water Spray System 10 0 ❑ Foam Water Sprinkler System 11 0 El 0— El Water Mist System 12 0 ❑ ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes ❑ No AES 1 September 3, 2013 MA Property Information Building Name Hill's Boat Services Inc. Address 814 E. Bay Ave. 7, 814 E. Bay Ave. City Newport Beach License # Contact- Person . Carson/madene SFM Phone (949) 6-176-0740 . .......... -j-[]tSLB' Manual Wet. E] Automatic Dry Manual Dry Semi -Automatic Dry - Automatic Wet 66n�hlndd Sprinkler/Standpipe Contractor or Licefis6d O;Nn6i Inf6ftnation le rest St ne d� A L] Class of Standpipe System Glass E] "Glass ill Riser Information Main Drain Test (ANNUAL) -Z* 7 7 1.1 1 Control Valves - Identification Sign 13.3.1 05112t16 1.2 1 Control Valves - Inspection 13.3.2 05/12/16 NZA 1.3 1 Waterflow Alarm Devices 5.2.5 05/12116 N/A 1.4 SupdrVisoryAjarm Devices - 5.2.5 06/12116-- NIA 1.5 1 Prdssure Gauges Pass '"Normal Pressures -621 6.2.2 05/12t16 OJI-i-O N 1.6 1 t WaerSupply Pressure Below Dry pipe or Preaction Valve 6.2.1 6.2.2 05/12116 Psi N/A 1.7 1 Water Supply Pressure Above Dry pipe or Preaction Valve 6.2.1 6.2.2 05/12/16 1.8 1 Pressure at Top of Sandpipe Riser 6 ' 2 * 1 6.2.2, 13.2.7 05/12/16 psi- N/A 1.9 1 Air/Nitrogen Pressure 6.2.1 6.2.2, 13.2.7 05/12/16 pal N/A 1.10 1 Pressure at Discharge of Fire pPmp or Pressure Tank 6.2.1 6.2.2, 13.2.7 05/12116 psi N/A 1.11 1 Pressure Readings Acceptable 6.22 13.27 . 05/12/16 1.12 1 Hydraulic.Design Information. Sign (Forhydraulically designed systems) --F-5.2J 6.i3 05/12/16, /Ak 1.13 1 Heat Tape 05/12/Te Form AES 3.1 Sept3i'2013" Inspection, Testing and Maintenance Includes ALL Quarterly6-Year 1 =Inspection" T =Test M =Maintenance, P=Pass F:6' ``-&1A=J4btApplicable 1.14 1 Standpipe Hose Valves 13.6"AA 1.15 1 Pressure Reducing Hose Valves 13.6.2.1 " -1'05/12/16 N/A.. 1.16 1 Pressure Reducing Valves "13.5.�.1 0$/12/16 tJ/A"'=' 1.17 1 Fire Department.Connections " 13.7 " " - 05/12/16 , . NIA 1.18. 1 Back$ow Preventers " - 13.6.1- -05/12116 " 'F ` : N/A 1.19 1 Buildings (Freeze Protection) d.1.1.1 05/12/16 • Owner's ResponsibfiH ' N/A 1.20 1 Pipe and Fittings 66.1.2 Tablee 6 05/12/16 N/A 1.21 1 Hangers -6.2.1 06/12M6 N/A 1.22 1 Seismic Braces 6.2.1 05/12/16 'N/A', 1.23 1 Hose Connection 6'2.1 Table 6.1.2 1.24 . 1 Cabinet 6.2.1 Table 6,1.2 05112/16 1.25 I Hose 6.2.1 able 6.1.2 T 05/12/16 1.26 1 Hose Storage Device 6'2'1 Table 6.1.2 05l12/16 P 1.27 1 Hose Nozzle 6.2.1 "Table 6.1.2 05/12/16 P" ' 2.1 T Control Valve - Position 6.3 05112/16 r N/A 13.3.3.1 2.2 T Control Valve - Operation 6'2'1 05/12/16 "N/A 13.3.3.2 2.3 T Supervisory Devices 13.3.3.5 05/12/16 N/A 2.4 T Waterflow Alarm Devices 5.3.3 05/12/16 'sec. N/A 90 sec max. Enter time 13.2.6 , 2.5 T Main Drain Test 13.2.5 05/12/16 N/AR (Enter data on Page 1 of this form) 13.3.3.4 2.6 T Standpipe Flow Test 6.3.1 05/12/16 provide results in table on NIA 1st a e. 2.7 T Standpipe Hydrostatic Test 6.3.2 05/12/16 N/A 2.8 T Hose Rack Assembly Flow Test 13.5.3.2 05/12/16 NA 2.9 T Backflow Preventer Assemblies 13.6.2 05/12/16 NIA 2.10 T Pressure Reducing Hose Valves "13.5.2:2 '05/12116 ' " ' " -N/A 2.11 T Pressure Reducing Valves .13.5.3.2. 05/1.2/16 2.12 1 T Pressure Gauges 6.3.4 05/12/16_: ' : WA Form AES 3.1 Sept. 3, 2013 • Name Hill's Boat Services Inc. 7 814 E. Say Ave. Newport Beach lations - Title 19 5-Yeis ar id Maintenance 30f4 Report Contractor or_Ucensed ONrnerinfd Name Job# 6-Year Inspection, Testing and Maintenance Includes ALL Quai-terly and Annual Inspections, Tests, and Maintenance Items Inspection -7,'_ T' Test:....: U UAW 2.13 T Hose Test 6.2.1 NFPA 1962, '05/12/16 Lin 3.1 M Control Valves 13.3.4 05/12116 M N/A, 3.2 M FDC"- Ba ckffush-- I 06/t2/16 3.3 M Ilntemal Pe Inspection: See CornmehtiipSection for keiblfii Deficiencies and 14.2 05/12/16 3.4 M jObstruction Investigation required. If -'Yes", see 14.3 OVUM Yes WA — ' Deficiencies and Comments Section for Results 3.5 M System Returned to Service 4.5.3 1 06/12116 'No WYes .15.7 - . .. No. -,I-- - Table for Standpipe Flow Test Results (item 2.6) No. Standpipe Risers 'Flow Rate at Remote Hose Valve Total Flow Rate Required Pressure at kein6ii Hose Valv'ebuim Flow Rate Supplied at FDC leit Flow Rafe SUppliedat PUMP""' Pressure Supplied at FDC Pressure Supplied at Pump D =:Deficiency C =Comment (indicate type) Flow Test: 35 PSI @ 48 GPM,70 PSI 0- 32 GPM, 100 -6 1.0 22 GPM Fire Hose is i'1/2"'outlet, 75' 'hose, ma_n`6r'd'&_d_r--'i�"'d' Forrii AES 3.1 sipt" 3;2013` Building Name Hill's Boat Services Inc. Address 814 E. Bay Ave. Pity. Newport Beach Contractor or UqOr!;,eFO_9WpkQ Oh- 3 �o9n: Name,` J6b D = 136fih:$iene M7 7, 77777777 []Check here If additional Deficiencies and Comments are listed on Form AESO Number attached: ElSee Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully -Inspected, fe-wed,,and-maintained-on Mls.date by the company indicated above, in accordance with CCR, 77t(e 19, Sections 901 to 906 and that thi equipment 1i fulij operable bkcept as noted in the "D6ftlencies-and Comments" secdon--of this fbim; -- 4 - -- Print Name Jesse Mald?9 'Pel-0 Signature. Dat4 105/19/16 Form AES 3.4 Sept., 3,,2013 r 9 rat Reference Number: 46813 Inspection Date: 04-27-2016 Certificate Valid Until: 04-27-2017 Type of Inspection: Annual Issued to: Fletcher Jones Motorcars 3300 Jamboree Road Newport Beach, CA 92660 This certificate is issued for the following: Fire Alarm and Life Safety System Inspection Certificate Testing Notations: Test repair performed on work order 47376 and 47272. See attached document. Standard(s)for Safety: NFPA 72 Standards This inspection was performed in accordance with applicable NFPA 72 Standards. Whenever discrepancies exist between acceptable performance standards and actual test results, notes and/or recommended solutions have been proposed or provided for immediate review and approval. Additional Information: Pyro-Comm Systems, Inc. specializes in Fire Alarm System Testing in accordance with NFPA 72, Underwriters Laboratories and local Fire Department requirements. Pyro-Comm Systems is an Underwriters Laboratories listed and certified testing, service, and installation company. We utilize an Underwriters Laboratories listed and certified Central Station Monitoring Facility for off -site monitoring. We can monitor your system over dedicated phone lines, IP (Internet Protocol), or Cellular -GSM (Global System for Mobile Communications). Our monitoring station has UL inspected and approved backup power systems, and redundant receiving stations to ensure i00% up -time and continuous monitoring of your system. Visit Pyro-Comm Systems, Inc. at kttp://,tvm,,,.pvrocomm.com YOUR SINGLE SOURCE SOLUTION FOR LOW VOLTAGE SYSTEMS SINCE 198o CORPORATE OFFICE: 15531 Container Lane Huntington Beach, CA 92649 714-902.8000 PYRO-COMM SYSTEMS, INC. C-io #612153 ACO 5998 SAN DIEGO OFFICE: 5115 Avenida Encinas, Ste G Carlsbad, CA 92008 760.930.6014 NORTHERN CA OFFICE: 10966 Bigge Street San Leandro, CA 94577 510.632.1208 Pyro-Comm Systems, Inc. INSPECTION DEFICIENCY AND TEST REPAIR SHEET DEVICE TYPES: SD -Smoke Detector, eat Detector, uct Detector. eam Detector,PS-Manual u tation, a ve Tamper Switch, PIV- Post Indicator Valve WF-Water Flow Switch, DH-Door Holder Release, AUD-Audible, VIS-Visual, AV-Audio/Visual, SPKR-Voice EVAC Speaker, GChime, FP -Fire Phone, FJ-Fire Phone Jack, FCP-Fire Control Panel, EVAC-Voice Evac. Panel, PWR-Power Supply, FAN -Fan Damper Panel, ANN-Annunciator, PRT-Printer, DIAL -Dialer, BELL -Sprinkler Bell Scope of work explanation (A) Coordinate w/Pyro-Comm Systems (B) Facilities to coordinate w/additional vendor ADDR. DEVICE FLOOR DEVICE LOCATION DATE FAILED REPAIRED DATE COMMENTS M16 PIV Outside 4/27/2016 5/4/2016 Replace bad device 4/27/2016 5/4/2016 Made label changes in program AV 2nd Floor 4/27/2016 5/6/2016 Replace strobe 2nd floor corridor DD Throughout 4/27/2016 5/6/2016 Tested missed duct detectors during annual Equipment Retested and Description - Additional Notes: Test repairs performed on work order 47376 and 47272. See attached field ticket for more information. Date: 5/6/2016 Technician Name: Jamal Gatlin Technician Signature: I HEREBY CERTIFY THAT THE FIRE PROTECTION EQUIPMENT LISTED ABOVE HAS BEEN FULLY TESTED IN ACCORDANCE WITH THE CALIFORNIA FIRE CODE AND THAT THE RESULTS ARE ACCURATELY LISTED ABOVE AND THE EQUIPMENT IS FULLY OPERABLE EXCEPT AS NOTED. SERVICE ORDER NO. 75484 BILL TO NAME: ADDRESS: ATTENTION: PHONE: WORK ORDER NO.-;. Pyro-Comm- Systems, Inc. HUNTINGTON BEACH OFFICE C-10 #612153 * ACO 5998 El WWW. PYROCOMM.COM PHONE (714) 902-8000 FAX (714) 902-8001 SERVICE INFORMATION JOB NAME: ADDRESS: 37uu (�n,I�o•2� ��. NL,,, ot} �2cu� SYSTEM FIRE ❑ SECURITY NURSE CALL []lNTERCOM ❑CCTV OTHER: . PANEL TYPE MODEL: Zco LOCATION:t/�� r✓IT„Z� CALL TYPE SERVICE ❑ TESTING ❑ MWO ❑OTHER: :PROBLEM(S) REPORTED REPORTED BY. st uff' PHONE: PROBLEM(S): „_ i- ry" l�si /cf�irS . TECHNICIANS) DATE ARRIVAL - DEPARTURE ... _- DATE . ARRIVAL , .° f `b . k ;. DEPARTURE DESCRIPTION OF WORK/TEST PERFORMED - t Wf r Flow 6a fe I d r t v zIrda �c i G L 5 142 ` I i I s s �1-� 0 11V1611. QTY MATERIAL- PARTS- _PARTS',- 1 w TEST RESULTS ❑PASS -NO DEFECTS ❑FAILED METHODS "R E ALARM SYSTEM ATTHE ABOVE LISTED ADDRESS WAS TESTED IN ACCORDANCE WITH THE AND REQUIREMENTS OFNFPA 72 DATE COMPLETED: PRINT NAME- ❑ UNABLE TO OBTAIN SIGNATURE - EXPLAIN: _.,SERVICE RATES ❑STANDARDEj SAME DAY WEEKEND/HOLIDAY [:]DIAGNOSTIC FEE Ej CALLBACK MILEAGE: PAYMENT METHOD INVOICE CASH CREDIT CARD OTHER: PO: SPECIAL BILLINIS ❑MWO-BILLABLE [:]MWO-NONBILL WARRANTY CHANGE ORDER �PCMISJDh: INSTRUCTIONS CORPORATE OFFICE * 15531 CONTAINER LANE * HUNTINGTON BEACH, CA 92649 REGIONAL OFFICES: NORTHERN CA * SAN DIEGO INVOICING TO FOLLOW SERVICE ORDER NO. 75473 BILL TO NAME: ADDRESS: ATTENTION: PHONE: WORK_ORDER N0: PyPo-Comm Systems, Inc. HUNTINGTON BEACH OFFICE C-10 #612153 * ACO 5998 El WWW. PYROCOMM.COM PHONE (714) 902-8000 FAX (714) 902-8001 'SERVICE INFORMATION JOB NAME: pletG6r 1v�e5 %vjp fUrGcwS ADDRESS: SYSTEM EgKRE ❑ SECURITY NURSE CALL INTERCOM ❑CCTV ❑OTHER: ,PANELTYPE MODEL: -24,v LOCATION: rG� �I(� CALL TYPE ❑SERVICE QTESTING ❑MWO ❑OTHER: 'PROBLEM(S) REPORTED REPORTED BY: s� Mun . L5�G✓ PHONE: go Ztll _ Q 8 7 PROBLEM(S): f esd- rrs TECHNICIAN(S) DATE ARRIVAL DEPARTURE DATE,- _. _-,ARRIVAL_ _; .,:DEPARTURE; C. DESCRIPTION°OF 1NORK/TEST'.RERFORMED .( AI( c l Z -) 1.4.- Ks1 r � t �s pv 8 tin is L I QTY MATE AL- PARTS QTY V TEST RESULTS PASS DEFECTS FAILED THE METHODS FIRE ALARM SYSTEM AT THE ABOVE LISTED ADDRESS WAS TESTED IN ACCORDANCE WITH THE AND REQUIREMENTS OFNFPA72 DATE COMPLETED: TE 7 - L1 - 7i47/i t? CUSTOMER SIGNATURE: PRINT NAME: ❑ UNABLE TO OBTAIN SIGNATURE - EXPLAIN: .SERVICE RATES, ❑STANDARD 0 SAME DAY WEEKEND/HOLIDAY [:]DIAGNOSTICTEE ❑ CALLBACK MILEAGE: PAYIYIENT METHOD FINVOICE CASH ❑ CREDITCARD OTHER: El PO: SFECIAL;BILLING ❑MWO-BILLABLE [—]MWO-NON BILL 0 WARRANTY CHANGE ORDER []PCMISJob: INSTRUCTIONS CORPORATE OFFICE * 15531 CONTAINER LANE * HUNTINGTON.BEACH, CA 92649 REGIONAL OFFICES: NORTHERN CA * SAWDIEGO INVOICING TO FOLLOW Pyro-Comm Systems, Inc. 1 Your single source solution for low voltage systems since 1980 C-10 #612153 * ACO 5998 FIRE PROTECTION AND LIFE SAFETY EQUIPMENT PERFORMANCE REPORT SERVICE ORGANIZATION Corporate Office 15531 Container Lane Huntington Beach, CA 92649 714-902-8000 Phone 714-902-8001 Fax www.pyrocomm.com E-mail: testingna,pyrocomm.com San Diego Regional Office 760-930-6014 Phone Northern CA Regional Office 510-632-1208 Phone TEST SITE INFORMATION Business Name Fletcher Jones Motorcars Address: 3300 Jamboree Road City/State: Newport Beach,CA 92660 Telephone: (949) 244-8879 Owner Contact: Scott Manchester 'Technician Name(s) : Corey Osburn Adam Whittle Inspection Type: 100% Fire Alarm Test Total Inspection, Hours: 8hrs x 2 techs `RECOMMENDED ACTIONS TO BE TAKEN ;TEST RESULT =PASS: NO DEFECTS THE FIRE ALARM SYSTEM AT THE ABOVE LISTED ADDRESS WAS TESTED IN ACCORDANCE WITH THE METHODS AND REQUIREMENTS OF NFPA 72 AND THAT IT MEETS ALL APPLICABLE CODES AND STANDARDS. =PASS: ADDITIONAL REMARKS FX FAILED THE FIRE ALARM SYSTEM AT THE ABOVE LISTED ADDRESS WAS TESTED AND IT DOES NOT MEETS ALL APPLICABLE CODES AND STANDARDS F7X AREAS/DEVICES/APPLIANCES NOT ACCESSIBLE FOR TESTING - THE TEST WILL NEED TO BE RESCHEDULE. Note: A minimum of 90%testing is required.lfless than 90% testing is conducted, do not submit this report. The test will be reschedule. SYSTEM IS OPERATIONAL WITH THE ABOVE NOTED SYSTEM IS OUT OF SERVICE. THE FIRE DEPARTMENT DEFECTS. PLEASE CONTACT OUR OFFICE AND SHOULD BE NOTIFIED. SCHEDULE AN APPT FOR THE REPAIRS REPAIRS AND RETEST: IF DEFECTS ARE FOUND IN EQUIPMENT TESTED, CORRECTION OF SUCH DEFECTS SHALL COMMENCE FORTHWITH AND SHALL BE COMPLETED AS SOON AS POSSIBLE, PREFERABLE WITHIN 30 DAYS OF INITIAL TEST. Serving Pyro-Comm Systems Inc. From Three Locations Design, Installation, and Service 24 Hour Service * UL Certified Instailatiion and Monitoring * Factory Trained and State Certified Technicians i Nicet Certified Technicians and Engineers tG101{fi1N. ' Pyro-Comm Systems, Inc. SYSTEM RECORD OF INSPECTION AND TESTING Inspection/Test Start Date/Time: 100%Fire Alarm Test/ 04-27-16/ 8:00am Inspection/Test Completion Date/Time: 100% Fire Alarm Test/ 04-27-16/ 4:30pm 1 PROPERTY INFORMATION Name of property: Fletcher Jones Motorcars Address: 3300 Jamboree Road Newport Beach,CA 92660 Description of Property: Auto Dealership Name of property representative: Scott Manchester Address: 3300 Jamboree Road Newport Beach,CA 92660 Phone: (949)244-8879 Fax: N/A Email: N/A 2 TESTING AND MONITORING INFORMATION Testing organization: Pyro Comm Systems Inc. Address: 15531 Container Lane Huntington Beach,CA 92649 Phone: (714)902-8000 Fax: N/A Email: N/A Monitoring organization: NMC Address: 25341 Commercentre Drive Lake Forest CA 92630 Phone: (888)815-6268 Fax: N/A Email: N/A Account Number: 691306 Phone Line 1: N/A Phone Line 2: N/A Means of transmission: uDACT Entity to which alarms are transmitted: NMC Phone: N/A 3 DOCUMENTATION On -site location of the required record documents and site specific software: N/A 4 DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Manufacturer: Notifier 4.2 Software and Firmware Firmware revision number: N/A 4.3 System Power 4.3.1 Primary (Main) Power Nominal voltage: 120 Overcurrent protection type: Amps: N/A Amps Model number:- AFP-200 20 Location: N/A N/A Disconnect means location: N/A SYSTEMS RECORD OF INSPECTION AND TESTING (Continued) 4 DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type: Powersonic Location: Janitor/Data Room Battery type (if applicable): 12v7ah sealed Lead Calculated capacity of batteries to drive the system: In standby mode (hours): 24 In alarm mode (minutes): 5 NOTIFICATIONS MADE PRIOR TO TESTING Monitoring Organization Contact: NMC Time: Building management Contact: Scott Manchester Time: Building occupants Contact: All Time: Authority having jurisdiction Contact: N/A Time: Other, if required Contact: N/A Time: 6 TESTING RESULTS 6.1 Control Unit and Related Equipment 5 8:00am 8:00am 8:00am N/A N/A Description Visual Inspection Functional Test Comments Control Unit Q Q Lamps/LEDs/LCDs Q❑ Fuses Q Q Trouble signals Q Q Disconnect switches Q Q Ground -fault monitoring Q Q Supervision Q Q Local annunciator Q Q Remote annunciators Q 0 Power annunciators Q Q Other (specify) ❑ ❑ N/A 6.2 Secondary Power Description Visual Inspection Functional Test Comments Battery condition Q Q Load voltage Q Q Discharge test ❑ ❑ N/A Charger test ❑ ❑ N/A Remote panel batteries ❑ ❑ N/A SYSTEMS RECORD OF INSPECTION AND TESTING (Continued) 6 TESTING RESULTS (Continued) 6.3 Alarm and Supervisory Alarm Initiating Device Attached supplementary device test sheets for all initiating devices. 6.4 Notification Appliances Attach supplementary appliance test sheets for all notification appliances. 6.5 Interface Equipment Attach supplementary interface component test sheets for all interface components. Circuit Interface/Signaling Line Circuit Interface/Fire Alarm Control Interface 6.6 Supervising Station Monitoring Description Yes No Time Comments Alarm signal 21 ❑ Alarm restoration 21 ❑ Trouble signal 0 ❑ Trouble restoration P/1 I ❑ Supervisory signal [D ❑ Supervisory restoration 17,71 ❑ 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal ❑ ❑ N/A Alarm restoration ❑ ❑ N/A Trouble signal ❑ ❑ N/A Trouble restoration ❑ ❑ N/A Supervisory signal ❑ ❑ N/A Supervisory restoration ❑ ❑ N/A SYSTEMS RECORD OF INSPECTION AND TESTING (Continued) 7 NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: NMC Time: 4:30pm Building management Contact: Scott Manchester Time: 4:30pm Building occupants Contact: All Time: 4:30pm Authority having jurisdiction Contact: N/A Time: N/A Other, if required Contact: N/A Time: N/A 8 SYSTEM RESTORED TO NORMAL OPERATION Date: 4/27/2016 Time: 4:30pm 9 CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72. 2013 edition, Chapter 14. Signed: Printed Name: Corey Osburn Date: 4/27/2016 Organization: Pyro Comm Systems Title: Tester Phone: (714)902-8000 Qualifications (refer to 10.5.3): 10 DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEMS INSPECTION, TESTING, OR MAINTENANCE Test is incomplete. Need to return to locate and test devices. 10.1 Acceptance by Owner or Owner's Representative: The undersigned accepted the test report for the system as specified herein: Signed: Organization: Printed Name: Title: Date: Phone: Pyro-Comm Systems, Inc. INTERFACE COMPONENT SUPPLEMENTARY RECORD of INSPECTION AND TESTING 1 ANNUNCIATORS Location and Description of Annunciators 0 This system does not have annunciators Annunciator 1: N/A Annunciator 2: N/A Annunciator 3: N/A Annunciator 4: N/A 2 AUXILIARY FUNCTIONS Description Visual Inspection Functional Test Comments Door -releasing devices 21 Fan shutdown 21 Smoke manage/control ❑ N/A Smoke damper operation Smoke shutter release Li N/A Door unlocking ❑ N/A Elevator recall ❑ See Notation #1 Elevator shunt trip ❑ See Notation #1 MNS override of FA signals ❑ N/A Other (specify) El ❑ N/A 3 MONITORED SYSTEMS Description Visual Inspection Functional Test Comments Engine -driven generator ❑ N/A Fire pump ❑ N/A Special suppression systems ❑ N/A Other (specify) LJ ❑ N/A 4 COMBINATION SYSTEMS Description Visual Inspection Functional Test Comments Fire Extinguishing monitoring device/system ❑ ❑ N/A Carbon mono detector/system ❑ N/A Comb fire/security System El ❑ N/A other (specify) ❑ N/A See Main System Record of inspection and Testing for additional information, certifications, and approvals. C :MPONENT SUPPI_ENTARY RECORD OF INSPECTION AND TESTING 5 SPECIAL HAZARD Description (specify) Visual Inspection Functional Test Comments See Main System Record of Inspection and Testing for additional information, certifications, and approvals. Pyro-Comm Systems, Inc. Your single source solution for low voltage systems since 1980 C-10 #612153 * ACO 5998 FIRE INSPECTION RECORDS SYSTEM STATUS ON ARRIVAL NOTE ALL TROUBLE LIGHTS, MESSAGES, CONDITIONS, OR ANOMALIES BEFORE INSPECTION BEGINS. NOTE * NOTATION SITE REP'S INIT Normal upon Arrival I SYSTEM TAKE -DOWN / REINSTATEMENT CHECK OFF LIST I STEP k TAKE -DOWN ACTION DESCRIPTION STEP REINSTATEMENT ACTION DESCRIPTION DISABLE POINTS: M05,M07,M10,M11,M12,M13,M21,M22,M23,M24,M25 SYSTEM STATUS ON DEPARTURE INOTE #I NOTATION I Normal upon Departure Date Site Representative Title Date Pyro-Comm Systems, Inc. Rep. 04/27/16 Corey Osburn The undersigned Pyro-Comm representative certifies that the above listed information is accurate and is understood by the site representative. Pyro-Comm Systems, Inc. NOTIFICATION APPLIANCE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING 1 NOTIFICATION APPLIANCE TEST RESULTS Appliance Type Location/Identifier Test Results AV Devices See Notation #5 Pass See Main System Record of Inspection and Testing for additional information, certifications, and approvals. Pyro-Comm Systems, Inc. Your single source solution for low voltage systems since 1980 C-10 #612153 * ACO 5998 NOTIFICATION APPLIANCE POWER PANEL SUPPLEMENTARY RECORD OF COMPLETION BATTERY TEST MAKE -MODEL -LOCATION QUANTITY SIZE/TYPE MANUFACTURE DATE CONNECTION CHECK AMPERAGE PASS FAIL Powersonic-FACP-Janitor/Elec Rm 2 12v7ah 2/24/2024 Pass 7ah X Duracell-FCPS-Janitor/Elec Rm 2 12v7ah 12/7/2014 Pass 7ah X Duracell-FCPS-Janitor/Elec Rm 1 12v7ah 11/20/2014 Pass 7ah X Powersonic-FACP-Janitor/Elec Rm 1 12v7ah 1/12/2015 Pass 7ah X Duracell-FCPS-Janitor/Elec Rm 2 12v7ah 12/7/2014 Pass 7ah X F-H See Main System Record of Completion for additional information, certifications, and approvals Pyro-Comm Systems, Inc. INSPECTION AND TESTING FORM TATIONS (I FAILURES AND RECOMMENDATIONENCOUNTERED DURING INSPECTION AND TESTING II Notations: #1 1 Elevator functions tested by others #2 Located behind Collision Center Sign, in bushes. #3 High Smoke Detector. Need 50' test pole or lift to reach and test device. Customer has lift on site. #4 Could not locate device. Need a set of asbuilds to help locate devices and test. #5 Need to get a count of all Audio Visual Notification Appliances on site. 1 #1 IM16 PIV WEST, located behind collision center sign. Did not activate when tested. Need to investigate further. 11 Pyro-Comm Systems, Inc. Your single source solution for low voltage systems since 1980 C-10 #612153 * ACO 5998 INSPECTION AND TESTING FORM NODE LOOP ADDR. DEVICE TYPE LOCATION EXT LABEL PASS FAIL COMMENTS D01 SMOKE(ION) 1ST NORTH CORRIDOR X D02 SMOKE(ION) 1ST NORTH CORRIDOR X D03 SMOKE(ION) 1ST NORTH CORRIDOR X D04 SMOKE(ION) 1ST NORTH CORRIDOR X D05 SMOKE(ION) 1ST BY STAIR 3 X D06 SMOKE(ION) 1ST BY STAIR 3 X D07 SMOKE(ION) 1ST BY STAIR 3 X D08 SMOKE(ION) 1ST BY STAIR 3 X D09 SMOKE(PHOTO) 1ST FACP RM X D10 SMOKE(PHOTO) DUCT DET. AH 14A SEE NOTATION #4 D11 SMOKE(PHOTO) DUCT DET. AH 14B SEE NOTATION #4 D12 SMOKE(ION) 12ND NORTH CORRIDOR X D13 SMOKE(PHOTO) 1ST ELEV LOBBY X D14 SMOKE(ION) 2ND TOP OF STAIR N X D15 SMOKE(ION) 2ND TOP OF STAIR N X D16 SMOKE(ION) 2ND NORTH CORRIDOR X D17 SMOKE(PHOTO) I DUCT DET. AH 1A SEE NOTATION #4 D18 SMOKE(ION) DUCT DET. AH1B X L.C.- SMOKE(ION) 2ND NORTH CORRIDOR D19 SMOKE(ION) 2ND NORTH CORRIDOR X D20 SMOKE(ION) 2ND CENTER CORRIDOR X D21 SMOKE(ION) 2ND CENTER CORRIDOR X D22 SMOKE(ION) 2N0 CENTER CORRIDOR X D23 SMOKE(ION) 2ND SOUTH CORRIDOR X D24 SMOKE(ION) 2ND SOUTH CORRIDOR X D25 SMOKE(ION) 2ND BY STAIR 3 X D26 SMOKE(ION) 2ND CONFERENCE ROOM X D27 SMOKE(ION) 2ND STAIR 3 X D28 SMOKE(ION) 2ND BY STAIR 3 X D29 SMOKE(ION) 2ND BY STAIR 3 SEE NOTATION #4 D31 SMOKE(ION) 1ST ELEV MACH RM X D32 SMOKE(ION) 2ND ELEV LOBBY X D33 SMOKE(ION) 3RD ELEV LOBBY X D34 SMOKE(PHOTO) DUCTDET B BUILDING X D35 SMOKE(PHOTO) DUCTDET B BUILDING X D36 SMOKE(PHOTO) NEW -SHOWROOM A-120 X See Notation #3 D37 HEAT(ANALOG) 1ST NORTH DISPLAY X Pyro-Comm Systems, Inc. Your single source solution for low voltage systems since 1980 C-10 #612153 * ACO 5998 INSPECTION AND TESTING FORM NODE LOOP AODR DEVICE TYPE LOCATION EXT LABEL PASS FAIL TIME IRMI COMMENTS M02 MONITOR(WF) NORTH FLOW SWITCH X 52 LOCATED BY HD NORTH DISPLAY M03 TAMPER PIV SOUTH RISER X M04 MONITOR(WF) SOUTH FLOW SWITCH X 52 M08 TAMPER SUPPRESSION SYS TESTED BY OTHERS M15 TAMPER OSY WEST X I See Notation #2 M16 TAMPER PIV WEST X See Notation #2, Defect #1 M17 TAMPER PIV NORTHEAST BY B BUILDING X M18 MONITOR(WF) WEST FLOW SWITCH B BUILDING X 36 M19 TAMPER PIV WEST RISER X M20 TAMPER B BUILDING TAMPER X BI LL TO NAME: ADDRESS: ATTENTION: PHONE: WORK ORDER NO.. , -lb our -1_ J:.. Pyro-Comm Systems, Inc. HUNT1NGTON BEACH OFFICE C-10 #612153 * ACO 5998 WWW. PYROCOMM.COM PHONE (714) 902-8000 FAX (714) 902-8601 SERVICE INFORMATION 10B NAME: �VO hD r n es I v1,0 r V IGO „Ar.� ADDRESS: 'V SYSTEM IRE ❑ SECURITY ❑ NURSE CALL ❑INTERCOM ❑ CTv ❑OTHER: PANEL TYPE MODEL: .. LOCATION: CALL TYPE ❑SERVICE ESTING ❑ INSTALL PCMIS # OTHER: PROBLEM(S) REPORTED REPORTED BY: PHONE: .,. PROBLEM(S): 16-A r' r� 1�� 'TECHNICIAN(S) DATE TRAVEL ARRIVAL `DEPARTURE -alirasiE,HouR{sj.=oFFicE_useori�Y I • AM r DESCRIPTION OF WORK/TEST'PERFQRMED- AM 1h P'ZhAklo 4t LaeAk AM r � QTY MAT RIAL - PARTS Q,t,Y: . ,. ATERIAL-PARTS,:_ TEST_ RESULTS PASS DE ECTS FAILED THE FIRE ALARM SYSTEM AT THE ABOVE LISTED ADDRESS WAS TESTED IN ACCORDANCE WITFHTHE METHODS AND REQUIREMENTS OF NFPA 72 DATE COM ETED: CUSTO ER S G ATU� PRINT NE, 91ca J ❑ ABLE TO OBTAIN SIGNATUR - EXPLA : ECIAL;BILLING'INSTRUCTIONS-„=OFFICE`H15EQNLy-4:.'-r_,: SERVICE RATES. ❑STANDARD ❑ CALL BACK ❑ SAME DAY ❑ WEEKEND/HOLIDAY ❑ SALES QUOTE ❑ OTHER: PAYMENT METHOD ❑ INVOICE [:]CASH ❑ CREDIT CARD ❑OTHER: ❑ PO NUMBER: MAINTENANCE ❑MWO-LABOR/PARTS ❑ MWO-LABOR ❑MWO-PARTS ❑ MWO-NOCHARGE TRAVEL CHARGE ❑ PORTAL TO PORTAL CHARGE ❑ MILEAGE: ❑ NO CHARGE FOR MILEAGE NO CHARGE ❑ WARRANTY ❑ NO CHARGE - JOB WALK ❑ NOCHARGE -MONITORING ❑ CONTRACT BILLING INSTRUCTIONS CORPORATE OFFICE * 15531 CONTAINER LANE * HUNTINGTON BEACH, CA.92649 REGIONAL OFFICES: NORTHERN CA * SAN D,IEGO INVOICING TO FOLLOW 04/28/2016 15:59:28 CS# 691306 to 691306 Name to Date Operator Zone Area 691306 - Fletcher Jones Motorcars 04/27/2016 16:17:10 KCH 04/27/2016 16:17:04 KCH 04/27/2016 16:17:01 KCH 04/27/2016 16:07:48 OE308 0 04/27/2016 16:07:45 E308 0 04/27/2016 16:07:42 OE308 0 04/27/2016 16:07:39 89 0 04/27/2016 16:07:34 88 0 04/27/2016 16:07:31 87 0 04/27/2016 16:07:29 86 0 04/27/2016 16:07:26 75 0 04/27/2016 16:07:22 72 0 04/27/2016 16:07:19 71 0 04/27/2016 16:07:14 69 0 04/27/2016 16:07:11 OE300 0 04/27/2016 16:06:08 E308 0 04/27/2016 15:31:43 89 0 04/27/2016 15:31:40 89 0 04/27/2016 15:31:37 75 0 04/27/2016 15:31:34 75 0 04/27/2016 15:31:31 72 0 04/27/2016 15:31:27 72 0 04/27/2016 15:31:24 71 0 04/27/2016 15:31:21 71 0 04/27/2016 15:31:18 69 0 04/27/2016 15:31:13 69 0 04/27/2016 15:31:10 18 0 04/27/2016 15:29:15 18 0 04/27/2016 15:28:13 89 0 State Event History 04/27/2016 to 04/2712016 Site# to City to Event ID to State to Zone Comment Page 1 of 9 Primary Secondary Sort User Name User ID CLTEST-CLEAR TEST *Test (Site Codewordl) Cat:1 Cat:1 IC -INCOMING CALL (Site Codewordl) corey 1999-CODE VERIFIED (Site Codewordl) R CIR308-RESTORE SYSTEM SHUTDOWN *Test A 2115TR-TROUBLE *Test PROGRAMMING MODE R CIR308-RESTORE SYSTEM SHUTDOWN *Test R CIR380-RESTORE SENSOR TROUBLE *Test RELAY ELEV RECALL R CIR380-RESTORE SENSOR TROUBLE *Test STROBES R CIR380-RESTORE SENSOR TROUBLE *Test RELAY HVAC SHUTDOWN R CIR380-RESTORE SENSOR TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS R CIR380-RESTORE SENSOR TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR R CIR380-RESTORE SENSOR TROUBLE *Test R CIR380-RESTORE SENSOR TROUBLE *Test R GIR380-RESTORE SENSOR TROUBLE *Test R CIR300-RESTORE SYSTEM TROUBLE *Test Caller ID: (949) 721-0673 A 2115TR-TROUBLE *Test Caller ID: (949) 721-0673, PROGRAMMING MODE A 2115TR-TROUBLE *Test RELAY ELEV RECALL SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY ELEV RECALL A 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR SE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test R CIR110-RESTORE FIREALARM *Test PIV TAMPER SOUTH RISER Caller ID: (949) 721-06 A 2115FV-FIRE VALVE TAMPER *Test PIV TAMPER SOUTH RISER Caller ID: (949) 721-06 A 2115TR-TROUBLE *Test RELAY ELEV RECALL SENSOR TROUBLE Page 1 of 04/28/2016 15:59:28 Event History Page 2 of 9 04/27/2016 to 04/27/2016 CS# 691306 to 691306 Name to Date Operator Zone Area 691306 - Fletcher Jones Motorcars 04/27/2016 15:28:09 89 0 04/27/2016 15:27:31 75 0 04/27/2016 15:27:28 75 0 04/27/2016 15:27:25 72 0 04/27/2016 15:27:21 72 0 04/27/2016 15:27:19 71 0 04/27/2016 15:27:16 71 0 04/27/2016 15:27:12 69 0 04/27/2016 15:27:09 69 0 04/27/2016 15:27:06 88 0 04/27/2016 15:27:03 87 0 04/27/2016 15:26:59 86 0 04/27/2016 15:26:56 24 0 04/27/2016 15:26:53 23 0 04/27/2016 15:26:50 19 0 04/27/2016 15:22:29 19 0 04/27/2016 15:09:34 23 0 04/27/2016 15:04:43 88 0 04/27/2016 15:04:40 87 0 04/27/2016 15:04:35 86 0 04/27/2016 15:04:33 24 0 04/27/2016 15:02:17 89 0 04/27/2016 15:02:14 89 0 04/27/2016 15:02:11 75 0 04/27/2016 15:02:08 75 0 04/27/2016 15:01:30 72 0 04/27/2016 15:01:27 72 0 04/27/2016 15:01:24 71 0 04/27/2016 15:01:19 71 0 04/27/2016 15:01:18 69 0 04/27/2016 15:01:13 69 0 Site# to City to State Event ID to State to Primary Secondary Sort Zone Comment User Name User ID R CIR380-RESTORE SENSOR TROUBLE *Test RELAY ELEV RECALL Caller ID: (949) 721-0673 A 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR SE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test R CIR110-RESTORE FIREALARM *Test STROBES R CIR110-RESTORE FIREALARM *Test RELAY HVAC SHUTDOWN R CIR110-RESTORE FIRE ALARM *Test RELAY DAMPERES/DOOR HOLDERS R CIR110-RESTORE FIRE ALARM *Test WATERFLOW WEST R CIR110-RESTORE FIREALARM *Test PIV TAMPER NORTHEAST R CIR110-RESTORE FIREALARM *Test WATERFLOW SOUTH Caller ID: (949) 721-0673 A 101-FIRE- DISP 1ST *Test WATERFLOW SOUTH Caller ID: (949) 721-0673 A 2115FV-FIRE VALVE TAMPER *Test PIV TAMPER NORTHEAST Caller ID: (949) 721-067: A 2115FT FIRE TROUBLE *Test STROBES A 2115TR-TROUBLE *Test RELAY HVAC SHUTDOWN A 2115TR-TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS A 101-FIRE- DISP 1ST *Test WATERFLOW WEST Caller ID: (949) 721-0673 A 2115TR-TROUBLE *Test RELAY ELEV RECALL SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY ELEV RECALL A 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR SE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR Cal A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test Page 2 of 04/28/2016 15:59:28 CS# 691306 to 691306 Name to Date Operator Zone Area State Event History 04/27/2016 to 04127/2016 Site# to City to Event ID Page 3 of 9 to Primary State to Secondary Sort Zone Comment User Name User ID 691306 - Fletcher Jones Motorcars 04/27/2016 15:01:10 88 0 R CIR110-RESTORE FIRE ALARM *Test STROBES 04/27/2016 15:01:07 87 0 R CIR110-RESTORE FIRE ALARM *Test RELAY HVAC SHUTDOWN 04/27/2016 15:01:04 86 0 R CIR110-RESTORE FIREALARM *Test RELAY DAMPERES/DOOR HOLDERS 04/27/2016 15:01:01 27 0 R CIR110-RESTORE FIREALARM *Test DUCT SMOKE BUILDING B 04/27/2016 15:00:58 26 0 R CIR110-RESTORE FIRE ALARM *Test TAMPER BUILDING B 04/27/2016 15:00:55 25 0 R CIR110-RESTORE FIRE ALARM *Test PIV TAMPER WEST RISER 04/27/2016 15:00:51 18 0 R CIR110-RESTORE FIRE ALARM *Test PIV TAMPER SOUTH RISER 04/27/2016 15:00:47 17 0 R CIR110-RESTORE FIREALARM *Test WATERFLOW NORTH Caller ID: (949) 721-0673 04/27/2016 14:52:55 25 0 A 2115FV-FIRE VALVE TAMPER *Test PIV TAMPER WEST RISER Caller ID: (949) 721-067 04/27/2016 14:51:10 17 0 A 101-FIRE- DISP 1ST *Test WATERFLOW NORTH Caller ID: (949) 721-0673 04/27/2016 14:37:55 18 0 A 2115FV-FIRE VALVE TAMPER *Test PIV TAMPER SOUTH RISER 04/27/2016 14:31:03 88 0 A 2115FT FIRE TROUBLE *Test STROBES 04/27/2016 14:30:58 87 0 A 2115TR-TROUBLE *Test RELAY HVAC SHUTDOWN 04/27/2016 14:30:56 86 0 A 2115TR-TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS 04/27/2016 14:30:53 27 0 A 101-FIRE- DISP 1ST *Test DUCT SMOKE BUILDING B Caller ID: (949) 721-067 04/27/2016 14:27:46 26 0 A 2115FV FIRE VALVE TAMPER *Test TAMPER BUILDING B Caller ID: (949) 721-0673 04/27/2016 13:35:50 89 0 A 2115TR-TROUBLE *Test RELAY ELEV RECALL SENSOR TROUBLE 04/27/2016 13:35:47 89 0 R CIR380-RESTORE SENSOR TROUBLE *Test RELAY ELEV RECALL 04/27/2016 13:35:43 75 0 A 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR BE 04/27/2016 13:35:40 75 0 R CIR380-RESTORE SENSOR TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR 04/27/2016 13:35:37 72 0 A 2115TR-TROUBLE *Test SENSOR TROUBLE 04/27/2016 13:35:34 72 0 R CIR380-RESTORE SENSOR TROUBLE *Test 04/27/2016 13:35:30 71 0 A 2115TR-TROUBLE *Test SENSOR TROUBLE 04/27/2016 13:35:27 71 0 R CIR380-RESTORE SENSOR TROUBLE *Test 04/27/2016 13:35:24 69 0 A 2115TR-TROUBLE *Test SENSOR TROUBLE 04/27/2016 13:35:21 69 0 R CIR380-RESTORE SENSOR TROUBLE *Test 04/27/2016 13:35:18 88 0 R CIR110-RESTORE FIREALARM *Test STROBES 04/27/2016 13:35:16 87 0 R CIR110-RESTORE FIREALARM *Test RELAY HVAC SHUTDOWN 04/27/2016 13:35:11 86 0 R GIR110-RESTORE FIRE ALARM *Test RELAY DAMPERES/DOOR HOLDERS 04/27/2016 13:35:07 75 0 R CIR110-RESTORE FIRE ALARM *Test RELAY NEW SHOWROOM ROLL DOWN DOOR Cal 04/27/2016 13:34:31 72 0 R CIR110-RESTORE FIREALARM *Test Page 3 of 04/28/2016 15:59:28 CS# 691306 to 691306 Name to Date Operator Zone Area State Event History 04/27/2016 to 04/27/2016 Site# to City to Event ID Page 4 of 9 to Primary State to Secondary Sort Zone Comment User Name User ID 691306 - Fletcher Jones Motorcars 04/27/2016 13:34:27 71 0 R CIR110-RESTORE FIREALARM *Test 04/27/2016 13:34:24 28 0 R CIR110-RESTORE FIREALARM *Test SMOKE NEW SHOWROOM 04/27/2016 13:34:21 16 0 R CIR110-RESTORE FIREALARM *Test SMOKE 3RD FL ELEV LOBBY 04/27/2016 13:34:18 15 0 R CIR110-RESTORE FIREALARM *Test SMOKE 2ND FL ELEV LOBBY 04/27/2016 13:34:15 13 0 R CIR110-RESTORE FIREALARM *Test SMOKE 2ND FL CONFERENCE ROOM 04/27/2016 13:34:12 12 0 R CIR110-RESTORE FIRE ALARM *Test SMOKE 2ND FL BY STAIR 3 04/27/2016 13:34:07 11 0 R CIR110-RESTORE FIREALARM *Test SMOKE 2ND FL SOUTH CORRIDOR 04/27/2016 13:34:04 10 0 R CIR110-RESTORE FIRE ALARM *Test SMOKE 2ND FL CENTER CORRIDOR 04/27/2016 13:34:02 9 0 R CIR110-RESTORE FIRE ALARM *Test DUCT SMOKE AH-1B 04/27/2016 13:33:59 7 0 R CIR110-RESTORE FIREALARM *Test SMOKE 2ND FL TOP OF STAIR N 04/27/2016 13:33:56 6 0 R CIR110-RESTORE FIREALARM *Test SMOKE 2ND FL NORTH CORRIDOR 04/27/2016 13:33:53 2 0 R CIR110-RESTORE FIRE ALARM *Test SMOKE 1ST FL STAIR 3 04/27/2016 13:33:48 1 0 R CIR110-RESTORE FIRE ALARM *Test SMOKE 1ST FL NORTH CORRIDOR Caller ID: (949; 04/27/2016 13:24:50 16 0 A 101-FIRE- DISP 1 ST *Test SMOKE 3RD FL ELEV LOBBY Caller ID: (949) 721-0 04/27/2016 13:20:47 9 0 A 101-FIRE- DISP 1ST *Test DUCT SMOKEAH-16 04/27/2016 13:20:44 6 0 A 101-FIRE- DISP 1ST *Test SMOKE 2ND FL NORTH CORRIDOR Caller ID: (949 04/27/2016 13:17:22 1 0 A 101-FIRE- DISP 1ST *Test SMOKE 1 ST FL NORTH CORRIDOR Caller ID: (949; 04/27/2016 13:16:08 72 0 A 101-FIRE- DISP 1ST *Test Caller ID: (949) 721-0673, FIRE ALARM 04/27/2016 13:15:24 2 0 A 101-FIRE- DISP 1ST *Test SMOKE 1ST FL STAIR 3 Caller ID: (949) 721-0673 04/27/2016 13:08:20 10 0 A 101-FIRE- DISP 1ST *Test SMOKE 2ND FL CENTER CORRIDOR Caller ID: (94 04/27/2016 13:07:32 11 0 A 101-FIRE- DISP 1ST *Test SMOKE 2ND FL SOUTH CORRIDOR Caller ID: (949 04/27/2016 12:57:47 7 0 A 101-FIRE- DISP 1ST *Test SMOKE 2ND FL TOP OF STAIR N Caller ID: (949) 7: 04/27/2016 12:54:53 12 0 A 101-FIRE- DISP 1ST *Test SMOKE 2ND FL BY STAIR 3 Caller ID: (949) 721-06. 04/27/2016 12:54:08 13 0 A 101-FIRE- DISP 1ST *Test SMOKE 2ND FL CONFERENCE ROOM Caller ID: (9 04/27/2016 12:53:31 71 0 A 101-FIRE- DISP 1 ST *Test FIRE ALARM 04/27/2016 12:53:26 15 0 A 101-FIRE- DISP 1 ST *Test SMOKE 2ND FL ELEV LOBBY Caller ID: (949) 721-0 04/27/2016 12:29:44 88 0 A 2115FT-FIRE TROUBLE *Test STROBES 04/27/2016 12:29:41 87 0 A 2115TR-TROUBLE *Test RELAY HVAC SHUTDOWN 04/27/2016 12:29:36 86 0 A 2115TR-TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS 04/27/2016 12:29:33 75 0 A 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR 04/27/2016 12:29:31 28 0 A 101-FIRE- DISP 1ST *Test SMOKE NEW SHOWROOM Caller ID: (949) 721-067 Page 4 of 04/28/2016 15:59:28 CS# 691306 to 691306 Site# to Name to City to Date Operator Zone Area State Event ID 691306 - Fletcher Jones Motorcars 04/27/2016 11:21:37 E608 0 A 04/27/2016 11:21:13 E608 0 A 04/27/2016 11:13:40 89 0 A 04/27/2016 11:13:38 89 0 R 04/27/2016 11:13:33 87 0 A 04/27/2016 11:13:30 87 0 R 04/27/2016 11:13:27 86 0 A 04/27/2016 11:13:24 86 0 R 04/27/2016 11:13:21 75 0 A 04/27/2016 11:12:44 75 0 R 04/27/2016 11:12:41 72 0 A 04/27/2016 11:12:38 72 0 R 04/27/2016 11:12:33 71 0 A 04/27/2016 11:12:31 71 0 R 04/27/2016 11:12:28 69 0 A 04/27/2016 11:12:25 69 0 R 04/27/2016 11:12:21 88 0 R 04/27/2016 11:12:18 87 0 R 04/27/2016 11:12:15 86 0 R 04/27/2016 11:12:12 12 0 R 04/27/2016 11:12:08 11 0 R 04/27/2016 11:12:05 10 0 R 04/27/2016 11:12:02 9 0 R 04/27/2016 10:54:46 12 0 A 04/27/2016 10:54:08 89 0 A 04/27/2016 10:54:03 89 0 R 04/27/2016 10:54:00 87 0 A 04/27/2016 10:53:58 87 0 R 04/27/2016 10:53:55 11 0 A 04/27/2016 10:53:50 86 0 A Event History Page 5 of 9 04/2712016 to 04/2712016 to Primary State to Secondary Sort Zone Comment User Name User ID 2115TR-TROUBLE *Test Caller ID: (949) 721-0673, SYSTEM TEST WITH TROUBLE 2115TR-TROUBLE *Test Caller ID: (949) 721-0673, SYSTEM TEST WITH TROUBLE 2115TR-TROUBLE *Test RELAY ELEV RECALL SENSOR TROUBLE CIR380-RESTORE SENSOR TROUBLE *Test RELAY ELEV RECALL 2115TR-TROUBLE *Test RELAY HVAC SHUTDOWN SENSOR TROUBLE CIR380-RESTORE SENSOR TROUBLE *Test RELAY HVAC SHUTDOWN 2115TR-TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS SENSOR TR CIR380-RESTORE SENSOR TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR GIR380-RESTORE SENSOR TROUBLE 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE CIR110-RESTORE FIREALARM CIR110-RESTORE FIRE ALARM CIR110-RESTORE FIREALARM CIR110-RESTORE FIREALARM CIR110-RESTORE FIRE ALARM CIR110-RESTORE FIREALARM CIR110-RESTORE FIRE ALARM 101-FIRE- DISP 1ST 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE 101-FIRE- DISP 1ST 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR *Test SENSOR TROUBLE *Test *Test SENSOR TROUBLE *Test *Test SENSOR TROUBLE *Test *Test STROBES *Test RELAY HVAC SHUTDOWN *Test RELAY DAMPERES/DOOR HOLDERS *Test SMOKE 2ND FL BY STAIR 3 *Test SMOKE 2ND FL SOUTH CORRIDOR *Test SMOKE 2ND FL CENTER CORRIDOR *Test DUCT SMOKE AH-1B Caller ID: (949) 721-0673 *Test SMOKE 2ND FL BY STAIR 3 Caller ID: (949) 721-06; *Test RELAY ELEV RECALL SENSOR TROUBLE *Test RELAY ELEV RECALL *Test RELAY HVAC SHUTDOWN SENSOR TROUBLE *Test RELAY HVAC SHUTDOWN *Test SMOKE 2ND FL SOUTH CORRIDOR *Test RELAY DAMPERES/DOOR HOLDERS 0 0 Page 5 of 04/28/2016 15:59:28 CS# 691306 to 691306 Name to Date Operator Zone Area 691306 - Fletcher Jones Motorcars Event History 04/27/2016 to 04/27/2016 Site# to to City to State to Page 6 of 9 Primary Secondary Sort State Event ID Zone Comment User Name Caller ID: (949) 721-0673, SENSOR TROUBLE 04/27/2016 10:53:13 86 0 R CIR380-RESTORE SENSOR TROUBLE 04/27/2016 10:53:10 75 0 A 2115TR-TROUBLE 04/27/2016 10:53:08 75 0 R CIR380-RESTORE SENSOR TROUBLE 04/27/2016 10:53:04 72 0 A 2115TR-TROUBLE 04/27/2016 10:53:02 72 0 R CIR380-RESTORE SENSOR TROUBLE 04/27/2016 10:52:57 71 0 A 2115TR-TROUBLE 04/27/2016 10:52:54 71 0 R CIR380-RESTORE SENSOR TROUBLE 04/27/2016 10:52:51 69 0 A 2115TR-TROUBLE 04/27/2016 10:52:48 69 0 R CIR380-RESTORE SENSOR TROUBLE 04/27/2016 10:52:45 88 0 A 2115FT-FIRE TROUBLE 04/27/2016 10:52:42 88 0 R CIR110-RESTORE FIRE ALARM 04/27/2016 10:52:39 87 0 A 2115TR-TROUBLE 04/27/2016 10:52:34 87 0 R CIR110-RESTORE FIREALARM 04/27/2016 10:52:31 10 0 A 101-FIRE- DISP 1ST 04/27/2016 10:51:54 86 0 A 2115TR-TROUBLE 04/27/2016 10:51:51 86 0 R CIR110-RESTORE FIRE ALARM 04/27/2016 10:51:48 75 0 R CIR110-RESTORE FIRE ALARM 04/27/2016 10:51:45 72 0 R CIR110-RESTORE FIREALARM 04/27/2016 10:51:42 69 0 R CIR110-RESTORE FIRE ALARM 04/27/2016 10:51:38 17 0 R CIR110-RESTORE FIREALARM 04/27/2016 10:51:35 15 0 R CIR110-RESTORE FIRE ALARM 04/27/2016 10:51:32 14 0 R CIR110-RESTORE FIRE ALARM 04/27/2016 10:51:29 9 0 A 101-FIRE- DISP 1ST 04/27/2016 10:51:26 9 0 R CIR110-RESTORE FIREALARM 04/27/2016 10:51:23 7 0 R CIR110-RESTORE FIRE ALARM 04/27/2016 10:51:19 6 0 R CIR110-RESTORE FIRE ALARM 04/27/2016 10:51:16 2 0 R CIR110-RESTORE FIREALARM 04/27/2016 10:51:13 1 0 R CIR110-RESTORE FIREALARM 04/27/2016 10:48:49 9 0 A 101-FIRE- DISP 1ST 04/27/2016 10:43:10 6 0 A 101-FIRE- DISP 1ST 04/27/2016 10:42:08 7 0 A 101-FIRE- DISP 1ST *Test RELAY DAMPERES/DOOR HOLDERS *Test RELAY NEW SHOWROOM ROLL DOWN DOOR SE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR *Test SENSOR TROUBLE *Test *Test SENSOR TROUBLE *Test *Test SENSOR TROUBLE *Test *Test STROBES *Test STROBES *Test RELAY HVAC SHUTDOWN *Test RELAY HVAC SHUTDOWN *Test SMOKE 2ND FL CENTER CORRIDOR Caller ID: (94 *Test RELAY DAMPERES/DOOR HOLDERS *Test RELAY DAMPERES/DOOR HOLDERS *Test RELAY NEW SHOWROOM ROLL DOWN DOOR *Test *Test *Test WATERFLOW NORTH *Test SMOKE 2ND FL ELEV LOBBY *Test SMOKE 1ST FL ELEV MACH RM *Test DUCT SMOKE AH-1 B *Test DUCT SMOKE AH-1 B *Test SMOKE 2ND FL TOP OF STAIR N *Test SMOKE 2ND FL NORTH CORRIDOR *Test SMOKE 1ST FL STAIR 3 *Test SMOKE 1 ST FL NORTH CORRIDOR Caller ID: (949; *Test DUCT SMOKE AH-1 B Caller ID: (949) 721-0673 *Test SMOKE 2ND FL NORTH CORRIDOR Caller ID: (949 *Test SMOKE 2ND FL TOP OF STAIR N Caller ID: (949) 7: User ID Page 6 of 04/28/2016 15:59:28 CS# 691306 to 691306 Name to Date Operator Zone Area 691306 - Fletcher Jones Motorcars 04/27/2016 10:38:58 17 0 04/27/2016 10:35:39 75 0 04/27/2016 10:35:15 1 0 04/27/2016 10:32:08 72 0 04/27/2016 10:32:05 15 0 04/27/2016 10:30:47 69 0 04/27/2016 10:30:44 14 0 04/27/2016 10:29:44 88 0 04/27/2016 10:29:41 87 0 04/27/2016 10:29:38 86 0 04/27/2016 10:29:36 2 0 04/27/2016 10:22:05 89 0 04/27/2016 10:22:02 89 0 04/27/2016 10:21:59 87 0 04/27/2016 10:21:56 87 0 04/27/2016 10:21:53 86 0 04/27/2016 10:21:49 86 0 04/27/2016 10:21:46 75 0 04/27/2016 10:21:43 75 0 04/27/2016 10:21:40 72 0 04/27/2016 10:21:37 72 0 04/27/2016 10:21:34 71 0 04/27/2016 10:21:31 71 0 04/27/2016 10:21:28 69 0 04/27/2016 10:21:23 69 0 04/27/2016 10:17:00 89 0 04/27/2016 10:16:57 89 0 04/27/2016 10:16:54 87 0 04/27/2016 10:16:49 87 0 04/27/2016 10:16:46 86 0 04/27/2016 10:16:43 86 0 Event History Page 7 of 9 04/27/2016 to 04/27/2016 Site# to to Primary City to State to Secondary Sort State Event ID Zone Comment User Name User ID A 101-FIRE- DISP 1ST *Test WATERFLOW NORTH Caller ID: (949) 721-0673 A 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR Cal A 101-FIRE- DISP 1ST *Test SMOKE 1ST FL NORTH CORRIDOR Caller ID: (949; A 101-FIRE- DISP 1ST *Test FIRE ALARM A 101-FIRE- DISP 1ST *Test SMOKE 2ND FL ELEV LOBBY Caller ID: (949) 721-0 A 101-FIRE-DISP 1ST *Test FIRE ALARM A 101-FIRE- DISP 1ST *Test SMOKE 1ST FL ELEV MACH RM Caller ID: (949) 72 A 2115FT-FIRE TROUBLE *Test STROBES A 2115TR-TROUBLE *Test RELAY HVAC SHUTDOWN A 2115TR-TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS A 101-FIRE- DISP 1ST *Test SMOKE 1ST FL STAIR 3 A 2115TR-TROUBLE *Test RELAY ELEV RECALL SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY ELEV RECALL A 2115TR-TROUBLE *Test RELAY HVAC SHUTDOWN SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY HVAC SHUTDOWN A 2115TR-TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS SENSOR TR R CIR380-RESTORE SENSOR TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS A 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR SE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test A 2115TR-TROUBLE *Test SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test Caller ID: (949) 721-0673 A 2115TR-TROUBLE *Test RELAY ELEV RECALL SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY ELEV RECALL A 2115TR-TROUBLE *Test RELAY HVAC SHUTDOWN SENSOR TROUBLE R CIR380-RESTORE SENSOR TROUBLE *Test RELAY HVAC SHUTDOWN A 2115TR-TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS SENSOR TR R CIR380-RESTORE SENSOR TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS Page 7 of 04/28/2016 15:59:28 Event History Page 8 of 9 04/27/2016 to 04127/2016 CS# 691306 to 691306 Name to Date Operator Zone Area 691306 - Fletcher Jones Motorcars 04/27/2016 10:16:40 75 0 04/27/2016 10:16:37 75 0 04/27/2016 10:16:34 72 0 04/27/2016 10:16:31 72 0 04/27/2016 10:16:26 71 0 Site# to to Primary City to State to Secondary Sort State Event ID Zone Comment User Name User ID A R A R A 04/27/2016 10:15:50 71 0 R 04/27/2016 10:15:47 69 0 A 04/27/2016 10:15:44 69 0 R 04/27/2016 10:15:41 21 0 R 04/27/2016 10:15:38 71 0 A 04/27/2016 10:15:35 71 0 R 04/27/2016 10:15:30 69 0 A 04/27/2016 10:15:27 69 0 R 04/27/2016 10:15:24 21 0 A 04/27/2016 10:15:21 88 0 R 04/27/2016 10:15:17 87 0 R 04/27/2016 10:15:14 86 0 R 04/27/2016 10:15:11 21 0 R 04/27/2016 10:15:08 3 0 R 04/27/2016 10:13:27 21 0 A 04/27/2016 10:04:30 88 0 A 04/27/2016 10:04:27 87 0 A 04/27/2016 10:04:24 86 0 A 04/27/2016 10:04:21 3 0 A 04/27/2016 09:32:07 OE308 0 R 04/27/2016 09:31:34 E308 0 A 04/27/2016 09:31:31 OE308 0 R 04/27/2016 09:31:27 89 0 A 04/27/201'6 09:31:25 88 0 A 04/27/2016 09:31:22 87 0 A 04/27/2016 09:31:19 86 0 A 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE 2115TR-TROUBLE Caller ID: (949) 721-0673, SENSOR TROUBLE CIR380-RESTORE SENSOR TROUBLE 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE CIR110-RESTORE FIREALARM 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE 2115TR-TROUBLE CIR380-RESTORE SENSOR TROUBLE 2115FV-FIRE VALVE TAMPER CIR110-RESTORE FIREALARM CIR110-RESTORE FIRE ALARM CIR110-RESTORE FIREALARM CIR110-RESTORE FIREALARM CIR110-RESTORE FIRE ALARM 2115FV-FIRE VALVE TAMPER 2115FT-FIRE TROUBLE 2115TR-TROUBLE 2115TR-TROUBLE 101-FIRE- DISP 1ST CIR308-RESTORE SYSTEM SHUTDOWN 2115TR-TROUBLE CIR308-RESTORE SYSTEM SHUTDOWN 2115TR-TROUBLE 2115TR-TROUBLE 2115TR-TROUBLE 2115TWTROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR SE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR *Test SENSOR TROUBLE *Test *Test *Test *Test SENSOR TROUBLE *Test *Test OSY TAMPER WEST *Test SENSOR TROUBLE *Test *Test SENSOR TROUBLE *Test *Test OSY TAMPER WEST *Test STROBES *Test RELAY HVAC SHUTDOWN *Test RELAY DAMPERES/DOOR HOLDERS *Test OSY TAMPER WEST *Test SMOKE 1ST FL FIRE ROOM Caller ID: (949) 721-06 *Test OSY TAMPER WEST Caller ID: (949) 721-0673 *Test STROBES *Test RELAY HVAC SHUTDOWN *Test RELAY DAMPERES/DOOR HOLDERS *Test SMOKE 1ST FL FIRE ROOM Caller ID: (949) 721-06 *Test Caller ID: (949) 721-0673 *Test PROGRAMMING MODE *Test *Test RELAY ELEV RECALL SENSOR TROUBLE *Test STROBES SENSOR TROUBLE *Test RELAY HVAC SHUTDOWN SENSOR TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS SENSOR TR Page 8 of 04/28/2016 16:59:28 Event History Page 9 of 9 04/27/2016 to 04/27/2016 CS# 691306 to 691306 Site# to to Primary Name to City to State to Secondary Sort Date Operator Zone Area State Event ID Zone Comment User Name User ID 691306 - Fletcher Jones Motorcars 04/27/2016 09:31:16 75 0 A 2115TR-TROUBLE *Test RELAY NEW SHOWROOM ROLL DOWN DOOR SE 04/27/2016 09:31:13 72 0 A 2115TR-TROUBLE *Test SENSOR TROUBLE 04/27/2016 09:31:10 71 0 A 2115TR-TROUBLE *Test SENSOR TROUBLE 04/27/2016 09:31:07 69 0 A 2115TR-TROUBLE *Test SENSOR TROUBLE 04/27/2016 09:31:04 E300 0 A 2115TR-TROUBLE *Test Caller ID: (949) 721-0673, SYSTEM TROUBLE 04/27/2016 09:29:57 E308 0 A 2115TR-TROUBLE *Test Caller ID: (949) 721-0673, PROGRAMMING MODE 04/27/2016 08:34:39 OE308 0 R CIR308-RESTORE SYSTEM SHUTDOWN *Test 04/27/2016 08:34:36 E308 0 A 2115TR-TROUBLE *Test Caller ID: (949) 721-0673, PROGRAMMING MODE 04/27/2016 08:29:41 88 0 R CIR110-RESTOREFIREALARM *Test STROBES 04/27/2016 08:29:38 87 0 R CIR110-RESTORE FIRE ALARM *Test RELAY HVAC SHUTDOWN 04/27/2016 08:29:35 86 0 R CIR110-RESTORE FIRE ALARM *Test RELAY DAMPERES/DOOR HOLDERS 04/27/2016 08:29:32 3 0 R CIR110-RESTORE FIRE ALARM *Test SMOKE 1 ST FL FIRE ROOM Caller ID: (949) 721-06 04/27/2016 08:24:01 88 0 A 2115FT FIRE TROUBLE *Test STROBES 04/27/2016 08:23:58 87 0 A 2115TR-TROUBLE *Test RELAY HVAC SHUTDOWN 04/27/2016 08:23:55 86 0 A 2115TR-TROUBLE *Test RELAY DAMPERES/DOOR HOLDERS 04/27/2016 08:23:52 3 0 A 101-FIRE- D1SP 1ST *Test SMOKE 1ST FL FIRE ROOM Caller ID: (949) 721-06 04/27/2016 08:14:12 RRM CHTEST CHANGE TEST *Test (Site Codewordl) Cat:1 Expires: 04/27/201617:00:00 04/27/2016 08:14:05 RRM CHTEST CHANGE TEST *Test (Site Codewordl) Cat:1 Expires: 04/27/201617:00:00 04/27/2016 08:14:03 RRM CHTESTCHANGE TEST *Test (Site Codewordl) Cat:1 Expires: 04127/201617:00:00 04/27/2016 08:14:01 RRM CHTESTCHANGE TEST *Test (Site Codewordl) Cat:1 Expires: 04127/201617:00:00 04/27/2016 08:13:59 RRM ONTEST PLACED ON TEST *Test (Site Codewordl) Cat: 1 Cat: 1 Expires: 04/27/2016 17:00:00 All Zones 04/27/2016 08:13:30 RRM 1999-CODE VERIFIED (Site Codewordl) 04/27/2016 08:13:26 RRM IC -INCOMING CALL Cory Page 9 of SONITROL: VERIFIED ELECTRONIC SECURITY F �- 3 a 3 FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM INSPECTION AND TESTING FORM To be completed by the system inspector or tester at the time of the inspection or test. It shall be permitted to modem this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets, data, or calculations as necessary to provide a complete record. Date of this inspection or test: 1. PROPERTY INFORMATION Time of inspection or test: Name of property: Urban Decay Address: 845 West 1611 Street Description of property: Office Occupancy type: B Name of property representative: Barry Pratt Address: 845 West 16t' Street Phone:949-515-1241 Fax: E-mail: bpratt@urbandecay.com Authority having jurisdiction over this property: City of Newport Beach Phone 949-644-3275 Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Service and/or testing organization for this equipment: Sonitrol Gold Coast, LLP Address: 30 Fairbanks # 114 Irvine, California 92618 Phone:949-768-1414 Fax: E-mail: Central@sonitrolsl.com Service technician or tester: Qualifications of technician or tester: A contract for test and inspection in accordance with NFPA standards is in effect as of: The contract expires: 2 years Contract number: GC 18621 Frequency of tests and inspections: Annual Monitoring organization for this equipment: Pacific West Security Address: 1587 Schallenberger Road San Jose, California 95131 Phone: 800-310-5772 Fax: E-mail: Entity to which alarms are retransmitted: Cellular Communicator Phone: 3. TYPE OF SYSTEM OR SERVICE Fire alarm system (nonvoice) ❑ Fire alarm with in -building fire emergency voice alarm communication system (EVACS) ❑ Mass notification system (MNS) ❑ Combination system, with the following components: ❑ Fire alarm ❑ EVACS ❑ MNS ❑ Two-way, in -building, emergency communication system ❑ Other (specify): Leader in Commercial Security and Fire Systems ?ctecaior, Fleet Management y _ SONITROU. VERIFIED ELECTRONIC SECURITY 3. TYPE OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2013 3.1 Control Unit Manufacturer: DMP 3.2 Mass Notification System 3.2.1 System Type: ❑ In-buildingMNS—combination ❑ In-buildingMNS—stand-alone ❑ Other (specify): 3.2.2 System Features: Additional description of system(s): Model number: XR150FC [Jf This system does not incorporate an MNS. ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Combination fire alarm/MNS ❑ MNS ACU only ❑ Wide -area MNS to regional national alerting interface Local operating console (LOC) ❑ Direct recipient MNS (DRMNS) ❑ Wide -area MNS to DRMNS interface ❑ Wide -area MNS to high -power speaker array (HPSA) interface Qn-building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation d j An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the record drawings are stored on site. Location: FACP Location 3.4 System Software This system does not have alterable site -specific software. Software revision number: 112 Software last updated on: 7.20.2016 A copy of the site -specific software is stored on site. Location: FACP Location 4. SYSTEM POWER 4.1 Control Unit 4.1.1 Primary Power Input voltage of control panel: 120VAC 4.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: Type of fuel: 4.1.3 Uninterruptible Power System Control panel amps: 3 dThis system does not have a generator. O/This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): 24 In alarm mode (minutes): 5 Leader in Commercial Security and Fire Systems v�;-e0 Surveillance Fire Detection I Fleet Management A0k SONITROL VERIFIED ELECTRONIC SECURITY 4. SYSTEM POWER (continued) 4.1.4 Batteries Location: FACP Location Type: Battery Nominal voltage: 12VDC Amp/hour rating: 7A.H. Calculated capacity of batteries to drive the system: In standby mode (hours): 24 In alarm mode (minutes): 5 ❑ Batteries are marked with date of manufacture. 4.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ❑ This system does not have an EVACS or MNS. 4.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS/panel amps: [J 4.2.2 Engine -Driven Generator This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.2.3 Uninterruptible Power System This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 4.2.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture. 4.3 Notification Appliance Power Extender Panels 4.3.1 Primary Power Nominal voltage: Amp/hour rating: In alarm mode (minutes): ❑ This system does not have power extender panels. Input voltage of power extender panel(s): Power extender panel amps: 4.3.2 Engine -Driven Generator ❑ This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.3.3 Uninterruptible Power System ❑ This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): Leader in Commercial Security and Fire Systems Fire Detection, ! Meet Manageinent SONITROL VERIFIED ELECTRONIC SECURITY 4. SYSTEM POWER (continued) 4.3.4 Batteries Location: Panel Type: Calculated capacity of batteries to drive the system: In standby mode (hours): 24 N Batteries are marked with date of manufacture. 5. ANNUNCIATORS 5.1 Location and Description of Annunciators Annunciator 1: Main Entry Way DMP 630F Annunciator 2: N/A Annunciator 3: N/A 6. NOTIFICATIONS MADE PRIOR TO TESTING Nominal voltage: 12/24 In alarm mode (minutes): 5 Monitoring organization Contact: Pacific West Security Building management Contact: Barry Pratt Building occupants Contact: Urban Decay Authority having jurisdiction Contact: Newport Beach Fire Other, if required Contact: 7. TESTING RESULTS 7.1 Control Unit and Related Equipment Amp/hour rating: 7 ❑ This system does not have annunciators. Time: Time: Time: Time: Time: Description Visual Inspection Functional Test Comments Control unit ❑ ❑ Lamps/LEDs/LCDs ❑ ❑ Fuses ❑ ❑ Trouble signals ❑ ❑ Disconnect switches ❑ ❑ Ground -fault monitoring ❑ ❑ Supervision ❑ ❑ Local annunciator Remote annunciators Power extender panels Isolation modules Other (specify) Leader in Commercial Security and Fire Systems Cort of 1 Vi leo Surveillance I Fire Detection I Fleet Management 7. TESTING RESULTS (continued) 7.2 Control Unit Power Supplies Description Visual Inspection Functional Test Comments 120-volt power ❑ ❑ Generator or UPS ❑ ❑ Battery condition ❑ ❑ Load voltage ❑ ❑ Discharge test ❑ 1 ❑ Charger test ❑ Other (specify) El❑ E❑ 7.3 In -Building Fire Emergency Voice Alarm Communications Equipment Description Visual Inspection Functional Test Comments Control unit ❑ ❑ Lamps/LEDs/LCDs ❑ ❑ Fuses ❑ ❑ Primary power supply ❑ ❑ Secondary power supply ❑ ❑ Trouble signals ❑ ❑ Disconnect switches ❑ ❑ Ground -fault monitoring ❑ ❑ Panel supervision ❑ ❑ System performance ❑ ❑ Sound pressure levels Occupied ❑ Yes ❑ No Ambient dBA Alarm dBA (attach report with locations, values, and weather conditions) ❑ ❑ System intelligibility ❑ CSI ❑ STI (attach report with locations, values, and weather conditions) ❑ ❑ Other (specify) Leader in Commercial Security and Fire Systems ,.1, "0:' ;L;rve,!lance 1 rire Detection Fleet Management 7. TESTING RESULTS (continued) 7.4 Notification Appliance Power Extender Panels Description Visual Inspection Functional Test Comments Lamps/LEDs/LCDs ❑ ❑ Fuses ❑ ❑ Primary power supply ❑ ❑ Secondary power supply ❑ ❑ Trouble signals ❑ ❑ Ground -fault monitoring ❑ ❑ Panel supervision ❑ ❑ Other (specify) ❑ ❑ 7.5 Mass Notification Equipment Description Visual Inspection Functional Test Comments Functional test ❑ ❑ Reset/power down test ❑ ❑ Fuses ❑ ❑ Primary power supply ❑ ❑ UPS power test ❑ ❑ Trouble signals ❑ ❑ Disconnect switches ❑ ❑ Ground -fault monitoring ❑ ❑ CCU security mechanism ❑ ❑ Prerecorded message content ❑ ❑ Prerecorded message activation ❑ ❑ Software backup performed ❑ ❑ Test backup software ❑ ❑ Fire alarm to MNS interface ❑ ❑ MNS to fire alarm interface ❑ ❑ In -building MNS to wide -area MNS ❑ ❑ Leader in Commercial Security and Fire Systems Detectior. i Meet Management 7. TESTING RESULTS (continued) 7.5 Mass Notification Equipment (continued) Visual Functional Description Inspection Test Comments MNS to direct recipient MNS ❑ ❑ Sound pressure levels ❑ ❑ Occupied ❑ Yes ❑ No Ambient dBA Alarm dBA (attach report with locations, values, and weather conditions) System intelligibility ❑ ❑ ❑ CSI ❑ STI (attach report with locations, values, and weather conditions) Other (specify) ❑ ❑ 7.6 Two -Way Communications Equipment Description Visual Inspection Functional Test Comments Phone handsets ❑ ❑ Phonejacks ❑ ❑ Off -hook indicator ❑ ❑ Call -in signal ❑ ❑ System performance ❑ ❑ System audibility ❑ ❑ System intelligibility ❑ ❑ Radio communications enhancement system ❑ ❑ Area of refuge communication system ❑ ❑ Elevator emergency communications system ❑ ❑ Other (specify) ❑ ❑ Leader in Commercial Security and Fire Systems Vtceo Surveillance Fire Detection I Fleet Management 7. TESTING RESULTS (continued) 7.7 Combination Systems Description Visual Inspection Functional Test Comments Fire extinguishing monitoring devices/system ❑ ❑ Carbon monoxide detector/system ❑ ❑ Combination fire/security system ❑ ❑ Other (specify) ❑ ❑ 7.8 Special Hazard Systems Description (specify) Visual Inspection Functional Test Comments ❑ ❑ ❑ ❑ ❑ ❑ 7.9 Emergency Communications System ❑ Visual ❑ Functional ❑ Simulated operation ❑ Ensure predischarge notification appliances of special hazard systems are not overridden by the MNS. See NFPA 72, 24.4.1.7.1. 7.10 Monitored Systems Description (specify) Visual Inspection Functional Test Comments Engine -driven generator ❑ ❑ Fire pump ❑ ❑ Special suppression systems ❑ ❑ Other (specify) ❑ ❑ Leader in Commercial Security and Fire Systems vic_c Survoillarice ; Fire Detection I Meet Management 7. TESTING RESULTS (continued) 7.11 Auxiliary Functions Description Visual Inspection Functional Test Comments Door -releasing devices ❑ ❑ Fan shutdown ❑ ❑ Smoke management/smoke control ❑ ❑ Smoke damper operation ❑ ❑ Smoke shutter release ❑ ❑ Door unlocking ❑ ❑ Elevator recall ❑ ❑ Elevator shunt trip ❑ ❑ MNS override of FA signals ❑ ❑ Other (specify) ❑ ❑ 7.12 Alarm Initiating Device ❑ Device test results sheet attached listing all devices tested and the results of the testing 7.13 Supervisory Alarm Initiating Device ❑ Device test results sheet attached listing all devices tested and the results of the testing 7.14 Alarm Notification Appliances ❑ Appliance test results sheet attached listing all appliances tested and the results of the testing 7.15 Supervisory Station Monitoring Description Yes No Time Comments Alarm signal ❑ ❑ Alarm restoration ❑ ❑ Trouble signal ❑ ❑ Trouble restoration ❑ ❑ Supervisory signal ❑ ❑ Supervisory restoration ❑ ❑ Leader in Commercial Security and Fire Systems l.c,,, ,urvedlarice j cire Detection ' Meet Management 8. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: Time: Building management Contact: Time: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other, if required Contact: Time: 9. SYSTEM RESTORED TO NORMAL OPERATION Date: Time: 10. CERTIFICATION 10.1 Inspector Certification: This system, as specified herein, has been inspected and tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 10.2 Acceptance by Owner or Owner's Representative: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Date: Organization: Title: Phone: Leader in Commercial Security and Fire Systems Surveillance j Fire Detection I Fleet Management DEVICE TEST RESULTS (Attach additional sheets if required) Leader in Commercial Security and Fire Systems VlceO SUrvel[lance il Fire Detection I Fleet Management 07/21/2016 15:11 ID: 1985 Daily Signals Report Urban Decay Cosmetics, LLC, Anis^pi n S W & 0 St Customer ID: A62825 Dealer ID: OC Include Details Group By: Dealer Summary: Each Day Contacted Types: Signal, Alarm, Ignored Signal 07/21/2016 00:00:00 Thru 07/21/2016 23:59:00 [Pacific Time (US & Canada), Tijuana] OC - Orange County 07/21/2016 Time Customer ID Type Cat Signal/Alarm Contact 09:59:02 A62825 S SYS Late -To -Test (System: 1) 11:17:35 A62825 S SYS Land Line Link Fail 'Warning - Transmit Fail' 11:17:36 A62825 S SYS Trouble Restore Network Restore: Occurred; Cell; Primary' 11:20:18 A62825 S SYS Activation 'Warning - Local Programming' 11:20:57 A62825 S SYS Test'Panel Test Signal Received' [NO CODE REQUIRED] 11:25:45 A62825 S SYS Bell Trouble'Warning - Bell CircuitTrouble' 11:26:14 A62825 S SYS Low Battery'Warning - Low Standby Battery' 11:26:16 A62825 S SYS Bell Restore 'Bell Circuit Restored' 11:28:24 A62825 S SYS Supervisory 'RISER TAMPER' 11:28:25 A62825 S SYS Restore 'RISER TAMPER' 11:29:14 A62825 S SYS Battery OK 'Standby Battery Restored' 11:29:17 A62825 S FIRE Fire Alarm 'RISER WATERFLOW' 11:29:56 A62825 S FIRE Fire Restoral 'RISER WATERFLOW' 11:38:55 A62825 S SYS Supervisory'OS&Y STREET' 11:38:56 A62825 S SYS Restore'OS&Y STREET' 11:40:34 A62825 S SYS Supervisory TIV 11:40:48 A62825 S SYS Restore'PIV 11:42:35 A62825 S SYS Supervisory'DUCT DET HP-l' 11:42:49 A62825 S SYS Restore 'DUCT DET HP-1' 11:43:37 A62825 S SYS Supervisory'DUCT DET HP-1' 11:43:39 A62825 S SYS Restore 'DUCT DET HP-F 11:43:41 A62825 S SYS Supervisory 'DUCT DET HP -I' 11:43:43 A62825 S SYS Restore 'DUCT DET HP-F 11:43:44 A62825 S SYS Supervisory 'DUCT DET HP-l' 11:43:46 A62825 S SYS Restore'DUCT DET HP-1' 12:01:12 A62825 S SYS Test'Automatic Recall Test Okay: Communicated; Cell; Pr' ** Summary ** Cat Description Signals % Alarms % -ignored % Total % FIRE Fire Alarm 2 7.7 0 0.0 0 0.0 2 7.7 SYS System Alarms 24 92.3 0 0.0 0 0.0 24 92.3 TOTALS: 26 0 0 26 ** Grand Summary ** Cat Description Signals % Alarms % Ignored % Total % FIRE Fire Alarm 2 7.7 0 0.0 0 0.0 2 7.7 SYS System Alarms 24 92.3 0 0.0 0 0.0 24 92.3 TOTALS: 26 0 0 26 Daily Signals Report Page 1/1 R "a 0 t tX N\�t IQ UP-_- 1� 9C- AZ*PV(A- "p o Cv inn � �` tG A- ADMINISTRATIVE OFFICE OF THE COURTS 01TICKoil COURT CONATNU TIt1N AND MANAG:L\11iN7 Inspection, Testing, and Maintenance Form - Fire Alarm System . Annual Date of ITM: " Z w! 6 Building Specific Information: Property Information: E ( Frequency L] Weekly Bldg No: Q Monthly Name: f-F arbor J—a,6 i- G e G� © Quarterly Q Semiannual M Annual 4,0 l �� m In, o re Address: City, Zip: • +f C.fi- �12•� � a Activity Key: Formal: [411.(#21-RXl I = Inspection #1: i = Inspection T = Test 2 = Testing M = Maintenance 3 = Maintenance A•O = After Operation #2: Item Number MI - Per Manufacturer's Instructions M. Frequency W = Weekly M = Monthly Q = Quarterly SA = Semiannual A = Annual Procedures: - All ITM activities to be conducted by qualified personnel, - Work with AOC FMU District & Area Supervisors to co-ordinato scheduling. - Before commencing any ITM activity, adviselcheck-in with building management (FMU) personnel. Verify what ITM activity can be conducted, and if any notification appliances and/or Interface equipment must be silencedfdlsabled before the start of activity. Before commencing fire alarm system ITM activities, contact the remote monitoring station and advise of the work to be conducted, who Is performing the work, request that the system be put "On Test" and that the fire department not be dispatched, and expected duration of the work. - If appropriate, sllencefdisabie notification appliances and/or interface devices. Perform ITM and fully restore ail systems to normal operation. - All systems are to be fully restored to service at the and of each work shift. Contact the remote monitoring station, advise them the work is completed, the system can be taken off "Test", and normal service should be immediately restored. fire Alarm System ITM -Annual Pagel/12 ADMINISTRATIVE OFFICE OF THE COURTS c�Ft7CIE OF CAURT UUNRTRIt(_ -10N AND MANAGEWRNT Incnarfinn —A ------ ______, . __-...�,-...�......•.•wnwu�.c vin, - ruc lawto, Jybier i-iannum Item Activity Frequency Description Additional information NFPA72 Fall N/A Pass Reference 1.1-W I Weekly Control Equipment: Fire Alarm systems unmonitored Check Fuses, interfaced equipment, lamps and LEDs, and for alarm, supervisory and trouble signals. primary (main) power supply for proper operation. Table 14.3.1 f Batteries shall be inspected for corrosion or leakage. 1.2-M I Monthly Batteries: Lead -acid, Primary (dry cell) Tightness of connections shall be checked and ensured. if necessary, battery terminals or connections shall be cleaned Table 14.3.1 and coated. Electrolyte level in lead -acid batteries shall be visually inspected. 1.3-Q I Quarterly Initiating Devices: Radiant Energy Fire Detectors, Supervisory Visually inspect each device for proper operating LED lights, damage to the device and surrounding Signal Devices, Watertlow Devices area, and obstructions Table 14.3.1 that may prevent the device from operating. Batteries shall be inspected for corrosion or leakage. 1.4-SA I Semiannually Batteries: Nickel -cadmium, Sealed lead -acid Tightness of connections shall be checked and ensured. If necessary, battery terminals or connections shall be cleaned Table 14.3.1 / and coated. 1-5-SA I Semiannually Transient Suppressors Tightness of connections shall be checked and ensured. Table 14.3.1 1.6-SA I Semiannually Fire alarm control unit trouble signals Verify operation of LED lights by operating the lamp test. Table 14.3.1 1.7-SA I SemiannuallyIn-building fire emergency voice/alarm communications equipment Verify operation of devices. Table 14.3.1 1.8-SA i Semiannually Remote Annunciators Visual inspection of LEDs and associated control functions. Table 14.3.1 Initiating Devices: Air Sampling detectors, Duct Detectors, Electromechanical releasing devices, Fire Visually inspect each device for proper operating LED lights, 1.9-SA I Semiannually Extinguishing Systems or Suppression System damage to the device and surrounding area, and obstructions Table 14.3.1 Switches, Manual Fire Alarm Boxes, Heat Detectors, that may prevent the device from operating. Smoke Detectors 1.10-SA I Semiannually Combination Systems: Fire Extinguisher Electronics Monitoring Device/Systems. Carbon Monoxide Visually inspect each device for proper operating LED lights, Detectors/Systems damage to the device and surrounding area, and obstructions Table 14.3.1 that may prevent the device from operating. 1.11-SA I Semiannually Interface Equipment Visually inspect each device for proper operating LED lights, damage to the device and surrounding area, and obstructions Table 14.3.1 that may prevent the device from operating. 1.12-SA I Semiannually Alarm Notification Appliances - Super'vised Check appliances for damage, obstructions, and other items Table that may impair the device from proper operation. 14.3.1 Semiannually FHL:,:: Exit Marking Audible Notification Appliances Check appliances for damage, obstructions, and other items that may impair the device from proper operation. Table 14.3.1 Fire Alarm System 1TM • Annual Page 2/12 4ADMINISTRATIVE OFFICE I = OF THE COURTS \ ' • c�Frtc a: OF COURT cc>>sTtetxmuN �,t� ANDMANA(MMENT inseection. Testina- and Maintenance Form - Fire Alarm Svstem - Annual Item Activity Frequency Description Additional Information NFPA72 Reference Fail NIA Pass 1.14-SA 1 Semiannually Supervising Station Alarm Systems - Transmitters: Verify that no trouble conditions exist and that the device Table 14.3.1 DACT operating properly. 1.15-SA I Semiannually Special Procedures Table 14.3.1 1.16-A I Annually Control Equipment: Fire Alarm systems monitored for Check Fuses, interfaced equipment lamps and LEDs, and Table 14.3.1 alarm, supervisory and trouble signals. primary (main) power supply forproper operation. 1.17-A i Annually Fiber-optic cable connections lightness of connections shall be checked and ensured. Table 14.3.1 If an engine -driven generator dedicated to the system is used as a required power source, operation of the generator shall Table 2.1-M T Monthly Engine -driven generator - Fire Alarm Systems be verified in accordance with NFPA 110, Standard for 14.4.2.2, Emergency and Standby Power Systems, by the building Table 14A.5 owner. The maximum load fora No.6 primary battery shall not be Batteries - Fire Alarm Systems - Primary type (dry cell) more than 2 amperes per cell. An individual (1.5 volt) cell shall Table 2.2-M T Monthly - Age Test be replaced when a load of 1 ohm reduces the voltage below 1 14.4.2.2, volt. A 6-volt assembly shall be replaced when a lest load of 4 Table 14A,5 ohms reduces the voltage below 4 volts. With the battery charger disconnected, the batteries shall be toad tested following the manuracturees recommendations. The voltage level shall not fall below the levels specified. Under load, the battery shall not fall below 2.05 volts per cell. The specific gravity of the liquid in the pilot cell or all of the cells shall be measured as required. The specific gravity shall Table 2.3-SA T Semiannually Batteries -Fire Alarm Systems - Lead acid - Discharge be within the range specified by the manufacturer. Although Test (30 minutes), Load Voltage Test, Specific Gravity the specified specific gravity varies from manufacturer to Table Table 14 14.4.5 manufacturer, a range of 1.20.5-1.220 is typical for regular lead -acid batteries, while 1.240-1.260 is typical for high- performance batteries. A hydrometer that shows only a pass or fail condition of the battery and does not indicate the specific gravity shall not be used, because such a reading does not give a true indication of the battery condition. Batteries - Fire Alarm Systems - Nickel -cadmium - Under load, the float voltage for the entire battery shall be 1.42 Table 2.4-SA T Semiannually Load Voltage Test volts per cell, nominal. if possible, cells shall be measured 14.4.2.2, individually. Table 14.4.5 Fire Alarm System ITM • Annual Page 3/12 AUMINIS—MATIVE OFFICE OF THE COURTS 01TICG OF COURT (:ONSTRt;(MON AND MANAOUNSIN'T InSneCfinn_ Testinn_ anti Mnintananna =~— _ cl— Al— c..s...,.. _ A - Item Activity Frequency Description Additional Information NFPA72 Fail NiA Pass Reference 2.5 SA T Semiannually Batteries - Fire Alarm Systems - Sealed lead -acid - under toad, the battery shall perform in accordance with the Table Load voltage test battery manufacturer's specifications. 14.4.2.2, Table 14A.5 Flame detectors and spark/ember detectors shall be tested in accordance with the manufacturer's published instructions to determine that each detector is operative. Flame detector and sparkfember detector sensitivity shall be determined using any of the following; (1) Calibrated test method (2) Manufacturer's calibrated sensitivity test instrument (3) Listed control unit arranged for the purpose Table 2.6-SA T Semiannually Initiating Device - Radiant Energy Fire Detectors (4) Other approved calibrated sensitivity test method that is 14.4.2.2, directly proportional to the input signal from a fire, consistent Table with the detector listing or approval 14.4.12 If designed to be field adjustable, detectors found to be outside of the approved range of sensitivity shall be replaced or adjusted to bring them into the approved range. Flame detector and spark/ember detector sensitivity shall not be determined using a light source that administers an unmeasured quantity of radiation at an undefined distance from the detector. At a minimum, control equipment shall be tested to verify correct receipt of alarm, supervisory, and trouble signals (inputs); operation of evacuation signals and auxiliary functions (outputs); circuit supervision, including detection of open circuits and ground faults; and power supply supervision for detection of loss of ac power and disconnection of secondary batteries. The rating and supervision shall be verified, integrity of single or multiple circuits providing Control Equipment- Functions, Fuses, Interfaced interface between two or more control units shall be verified. Table 2.7-A T Annually Equipment, Lamps and LEDs, Primary (main) Power Supply, Transponders Interfaced equipment connections 14.4.2.2. and shall be tested by operating or simulating operation of the Table 14.4.5 equipment being supervised. Signals required to be transmitted shall be verified at the control unit. Lamps and LEDs shall be illuminated. All secondary (standby) power shall be disconnected and tested under maximum load, including all alarm appliances requiring simultaneous operation. All secondary (standby) power shall be reconnected at end of test. For redundant power supplies, each shall be tested separately. Fire Alarm System ITM - Annual Page 4/12 ADMINISTRATIVE OFFICE OF THE COURTS OFFICH OF COURT C ONNTRI.X-TION AND MANAGEMENT Insnactinn_ Testinn. and Maintenance Form - Fire Alarm Svstem - Annual Item Activity Frequency Descriptign Additional information. NFPA72 Reference Fall NIA Pass At a minimum, control equipment shall be tested to verify correct receipt of alarm, supervisory, and trouble signals (inputs); operation of evacuation signals and auxiliary functions (outputs); circuit supervision, including detection of open circuits and ground faults; and power supply supervision for detection of loss of ac power and disconnection of secondary batteries. The rating and supervision shall be Control Equipment - building systems not connected verified. Integrity of single or multiple circuits providing interface between two or more control units shall be verified. Table 2.8-A T Annually to a supervising station - Functions, Fuses, Interfaced Interfaced equipment connections 14.4.2.2. Equipment, lamps and LEDs, Primary (main) power Transponders shall be tested by operating or simulating operation of the Table 14A.5 supply, equipment being supervised. Signals required to be transmitted shall be verifred at the control unit. Lamps and LEDs shaft be illuminated. All secondary (standby) power shall be disconnected and tested under maximum load, including all alarm appliances requiring simultaneous operation. All secondary (standby) power shall be reconnected at end of test. For redundant power supplies, each shalt be tested separately. With the batteries fully charged and connected to the charger, 2.9-A T Annually Batteries - Fire Alarm Systems - lead acid - Charger the voltage across the batteries shall be measured with a voltmeter. The voltage shalt be 2.30 volt- per cell t0.02 volts Table 14.4.2.2, Test at 777 (25'C) or as specified by the Table 14.4.5 equipment manufacturer. With the battery charger disconnected, the batteries shall be load tested following the manufacturers recommendations. The voltage level shall not fall below the levels specified. Batteries - Fire Alarm Systems - Nickel -cadmium - With the batteries fully charged and connected to the charger, Table 2.10-A T Annually Charger Test, Discharge Test (30 minutes) an ampere meter shall be placed in series with the battery 14.4.2.2. under charge. The charging current shall be in accordance Table 14A.5 with the manufacturers recommendations for the type of battery used. In the absence of specific information, 1130 to 1125 of the battery rating shall be used. Fire Alarm System ITM. Annual Page 5/12 ADMINISTRATIVE OFFICE OF THE COURTS OFFit ai OPCOURT OURT CUN.sTIa;t'Tlt?N AND MANAtaNrsNT inSDection. TBStinn_ and Mainfennncn F:nrm - Rirn Aim..., e....6— A.. Item Activity Frequency Description Additional Information NFPA 72 Fail NIA Pass Reference With the batteries fully charged and connected to the charger, the voltage across the batteries shall be measured with a voltmeter. The voltage shall be Z30 volts per cell t0.02 volts at 77°C (25°C) or as specified by the 2.11-A T Annually Batteries - Fire Alarm Systems - Sealed lead -acid - equipment manufacturer. With the batterycharger Table Charger Test, Discharge Test (30 Minutes) disconnected, the batteries shall be load tested 14A.2.2. following the manufacturer's recommendations. The voltage Table 14A.5 r/ level shag not fall below the levels specified. Replace battery within 5 years after manufacture or more frequently as needed. The fiber-optic transmission line shall be tested in accordance with the manufacturer's published instructions by the use of an optical power meter or by an optical time domain reflectometer used to measure the relative power loss of the line. This 2.12-A T Annually Fiber-optic Cable Power relative figure for each fiber-optic line shall be recorded in the fire alarm control unit. if the power level drops 2 percent or Table 14.4.2.2. more from the value recorded during the initial acceptance Table 14.4.5 test, the transmission line, section thereof, or connectors shall be repaired or replaced by a qualified technician to bring the line back into compliance with the accepted transmission level per the manufacturer's published instructions. Operation of control unit trouble signals shag be verified, as well as ring -back feature for systems using a trouble -silencing switch that requires resetting. If control unit has disconnect or isolating switches, performance of intended function of each switch shalt be verified and receipt of trouble signal when a supervised function is disconnected shall also be verified. If the system has a ground detection feature, the occurrence of ground -fault indication shall be verified whenever any Control Unit Trouble Signals - Audible and Visual, installation conductor is grounded. Table 2.13-A T Annually Disconnect Switches, Ground Fault Monitoring Circuit, An initiating device shall be actuated and receipt of alarm 14.4.2.2, Transmission of Signals to off -premises location signal at the off -promises location shall be verified. Table 14A.5 A trouble condition shall be created and receipt of a trouble signal at the off -premises location shall be verified. A supervisory device shall be actuated and receipt of a supervisory signal at the off -premises location shall be verified. If a transmission carrier is capable of operation under a single or multiple -fault condition, an initiating device shall be activated during such fault condition and receipt of a trouble signal at the off -premises location shall be verified, in addition to the alarm signal. Fire Alarm System ITM - Annual Page 6f ]2 ADMINISTRATIVE OFFICE m OF THE COURTS OFFICE OFCOURT CONSTRUCTION ANDMANAti1iMEN'T incnnntrnn Tnctinn and Maintananca Fnrm _ Fira Alarm Svstem - Annual Item Activity Frequency ---------• - --- -- Description - Additional Information NFPAT2 Reference Fail N/A Pass Correct switching and operation of backup equipment shalt be vedred. Function shall be operated and receipt of correct visual and audible signals at control unit shall be verified. In -building tine emergency voicefalarm Phone set shall be installed or phone shall be removed from Table communications equipment - AmplitierJtone hook and receipt of signal at control unit shall be verified. 2.14-A T Annually generators, C Signal Silence, Off -hook Indicator phone jack shall be visually inspected and communications .2, t/ (ring -down), Phone Jacks, Phone Set, System path through jack shall be initiated. Table 14.4.5 Table T Performance Each phone set shall be activated and correct operation shall be verified. System shall be operated with a minimum of any rive handsets simultaneously. Voice quality and clarity shall be verified. The correct operation and identification of annunciators shalt Table 2.15-A T Annually Remote Annunciators be verified. If provided, the correct operation of annunciator 14.4.2.2, under a fault condition shall be verirred. Table 14.4.5 Duct Detectors shall be tested in place to ensure smoke entry into the sensing chamber and an alarm response. Testing with smoke or listed aerosol, acceptable to the manufacturer of the aerosol or the manufacturer of the smoke detector/smoke alarm and identified in their published instructions, shall be permitted as acceptable test methods. Other methods listed in the manufacturer's published Table instructions that ensure smoke entry from the protected area, 1 / 2.16-A T Annually Initiating Device -Duct Detectors through the vents, into the sensing chamber shall be , Table able 14.4.E V permitted. Duct smoke detectors utilizing sampling tubes shall be tested by verifying the correct pressure differential (within the manufacturer's published ranges) between the inlet and exhaust tubes using a method acceptable to the manufacturer to ensure that the device will properly sample the airstream. These tests shall be made In accordance with the manufacturer's published instructions for the device installed. T Annually Initiating Device - Electromechanical Releasing Correct operation shall be verified by removal of the fusible link and operation of the associated device. Any moving parts Table 14.4.2.2. 2.17-A Device shall be lubricated as necessary. Table 14AY 2.18-A T Annually initiating Device - Fire Extinguishing System Switches The switch shall be mechanically or electrically operated and receipt of signal by the fire alarm control unit shall be verified. Table 14.4.2.2. Table 14.4.8 Fire Alarm System ITM • Annual Page 7/12 •cu, a ADMINISTRATIVE OFFICE OF THE COURTS 01-T T OF COURT CU\STltla TittN AND `tANA(i1f.%tE\T Insnection. Testina_ and Matnfananon i:nrm - FT:ra Ahrm _Q c _ A..1 Item Activity Frequency Description Additional information NFPA72 Fall NIA Pass Reference Fire -gas detectors and other fire detectors shall be tested as Table 2.19-A T Annually Initiating Device - Fire -Gas and other detectors prescribed by the manufacturer and as necessary for the 14.4.2.2, application. Table 14A.9 Heat test shalt be performed with a heat source per the manufacturer's published instructions. Atest method shall be used that is specified in the manufacturer's published Table able 19 2.20-A T Annually Initiating Device - Heat Detectors instructions for the installed equipment, or other method shall 1 2, Table be used that will not damage the nonrestorable V.4 fixed -temperature element of a combination rate-of-riselfixed- 14.4.10 temperature element detector. Manual fire alarm boxes shall be operated per the Table 2.21-A T Annually Initiating Device - Manual Fire Alarm Boxes manufacturer's published Instructions. Key -operated presignal 14.4.2.2. and general alarm manual fire alarm boxes shall both be Table tested. 14.4.11 Smoke detectors/smoke alarms shad be tested in place to ensure smoke entry into the sensing chamber and an alarm response. Testing with smoke or listed aerosol, acceptable to the manufacturer of the aerosol or the manufacturer of the Table 2.22-A T Annually Initiating Device - System Smoke Detectors - smoke detector/smoke alarm and identified in their 14.4.2.2. Functional Test published instructions, shall be permitted as acceptable test Table methods. Other methods listed in the manufacturer's 14.4.13 published instructions that ensure smoke entry from the protected area, through the vents, into the sensing chamber shall be permitted. A functional test shad be performed on all single-and-mulliple station smoke alarms connected to a protected premises fire Table 2.23 A T Annually Initiating Device - Single and multiple station smoke alarm system by pulfing the smoke alarm into an alarm 14.4.2.2, alarms condition and verifying that the protected premises system Table receives a supervisory signal and does not cause a true alarm 14.4.14 signal. Valve shall be operated and signal receipt shall be verified to Table 2.24-A T Annually Initiating Device - Supervisory Devices - Valve be within the first two revolutions of the handwheel or within 14.4.2.2, one -fifth of the travel distance, or per the manufacturer's Table ✓ published instructions. 14.4.16 Switch shall be operated. Receipt of signal obtained where the Table 2.25-A T Annually Initiating Device - Supervisory Devices - Pressure required pressure is increased or decreased a maximum 10 14.4.2.2. psi (70 kPa) from the required pressure level shall be verified. Table 14.4.17 Fire Alarm System ItM • Annual Page 8/12 ADMINISTRATIVE OFFICE OF THE COURTS OFFICE: OF COURT t-ONSTRUH TION AND MANACIEMmn IT Inanartinn Tas4inn and MMntannnra Fnrm - Fire Alarm Svstem -Annual item Activity Frequency Description Additional Information NFPA 72 Reference Fall NIA Pass Switch shall be operated. Receipt of signal indicating the Table water level raised or lowered a maximum 3 in. (70 mm) from 14.4.2.2, 2.26-A T Annually Initiating Device - Supervisory Devices - Water Level the required level within a pressure tank, or a maximum 12 in. Table (300 mm) from the required level of a nonpressure tank, shall 14 418 be verified, as shag its restorat to required level. 2.27-A T Annually Initiating Device - Supervisory Devices - Water Switch shall be operated. Receipt of signal to indicate the decrease in water temperature to 40OF (4.4'C) and its Table 14.4.2.2. ✓ Temperature restoration to above 40'F (4.4'C) shall be verified. Table 14A.19 Initiating Device -Supervisory Devices -Room Switch shall be operated. Receipt of signal to indicate the to 40'F its Table 14.4.2.2, 2.28-A T Annually Temperature decrease in room temperature (4.40c) and Table restoration to above 40'F (4.40c) shall be verified. 14.4.20 Water shall be flowed through an inspector's test connection indicating the pow of water equal to that from a single sprinkler Table of the smallest orifice size installed in the system for wet -pipe 14.4.2.2, 2.29-A T Annually Initialing Device - Walerflow systems, or an alarm test bypass connection for dry -pipe, pre- Table action, or deluge systems In accordance with NFPA 25, 14.4.21 Standard for the Inspection, Testing, and Maintenance of Water -Based Fire Protection Systems. Interface equipment connections shall be tested by operating or simulating the equipment being supervised. Signals required to be transmitted shall be verified at the control unit. Test frequency for interface equipment shall be the same as the frequency required by the applicable NFPA standard(s) for Table Interface Equipment and Emergency Control the equipment being supervised. Emergency control functions 14.4.2.2, 2.30-A T Annually Functions (i.e., fan control, smoke damper operation, Table elevator recall, elevator power shutdown, door holder release, 14.4.22 shutter release, door unlocking, etc.) shall be tested by operating or simulating alarm signals. Testing frequency for emergency control functions shall be the same as the frequency required for the initiating device that activates the emergency control function. Flre Alarm System ISM . Annual Page 9/12 ADMINISTRATIVE OFFICE OF THE COURTS OFFICE (IF COURT CONSTRUCTION IN ANO MANAti MENT InsnEBfinn_ Tantina_ and Mnintean2nra I:nrm _ Fira All— Qs—f— _ A—s-1 Item Activity Frequency Description Additional Information NFPA72 Reference Fail NiA Pass (1) initial and reacceptance testing shall comply with the following: Sound pressure levels for signals shall be measured with a sound level meter meeting ANSI SlAa, Specifications for Sound Level Meters, Type 2 requirements. Sound pressure levels throughout the protected area shall be measured to confirm that they are in compliance with Chapter 18. The sound level meter shall be set in accordance with ANSi S3.41, American National Standard Audible Evacuation Signal, using Table 2.31-A T Annually Alarm Notification Appliances - Audible Devices, the time -weighted characteristic F (FAS7). 14A.2.2, (2) Periodic testing shall comply with the following: Sound Table pressure levels for signals shall be measured with a sound 14.4.23 level meter meeting ANSi SlAa, Specifications for Sound Level Meters, Type 2 requirements. Sound pressure levels shall be measured for conformity to Chapter 18 where building, system, or occupancy changes have occurred. The sound level meter shall be set in accordance with ANSI S3.41, American National Standard Audible Evacuation Signal, using the time -weighted characteristic F (FAS7). (1) Initial and reacceptance testing shaft comply with the following: Sound pressure levels for signals shall be measured with a sound level meter meeting ANSI S1.4a, Specifications for Sound Level Meters, Type 2 requirements. Sound pressure levels throughout the protected area shall be measured to confirm that they are in compliance with Chapter 18, The sound level meter shall be set in accordance with ANSI S3.41, American National Standard Audible Evacuation Signal, using the time -weighted characteristic F (FAST). Audible information shalt be verified to be distinguishable and understandable and 2.32-A T Annually Alarm Notification Appliances - Audible Textual Notification Appliances shalt comply with 14.4.13. (2) Periodic testing shall comply with the following: Sound Table 14.4.2.2, pressure levels for signals shall be measured with a sound Table level meter meeting ANSI S1.4a, Specifcations for Sound 14.4.24 Level Meters, Type 2 requirements. Sound pressure levels shall be measured for conformity to Chapter 18 where building, system, or occupancy changes have occurred. The sound level meter shall be set in accordance with ANSi S3.41, American National Standard Audible Evacuation Signal, using the time -weighted characteristic F (FAST). Audible information shall be verified to be distinguishable and understandable and shah comply with 14.4.13 where building, system, or occupancy changes have occurred. Fire Alarm System ITM. Annual Page 10/12 ADMINISTRATIVE OFFICE m OF THE COURTS t?I°FlGi OF COURT CUNSTItl1t: I'It)N AND MANAOUME'NT ..as.... 'rwsaiA M�infananna Rnrm - Kira Alarm Cuchtm . Annital item Activity.... y, Frequency _ Description Additional Information NFPAT2 Reference Fail NIA Pass Test shall be performed in accordance with the manufacturers published instructions. Appliance locations shall be verified to Table be per approved layout and it shall be confirmed that no floor 14.4.2.2, 2.33-A T Annually Alarm Notification Appliances -Visible Devices plan changes affect the approved layout. It shall be verified Table that the candela rating marking agrees with the approved 14.4.25 drawing. it shall be confirmed that each appliance flashes. Initiating device shall be actuated. Receipt of the correct initiating device signal at the supervising station within 90 Table seconds shall be vedrred. Upon completion of the test, the 14.4.2.2, 2.34 A T Annually Supervising Station Alarm Systems -Transmitters system shalt be restored to its functional operating condition. if Table test Jacks are used, the first and last tests shall be made 14.4.26 without the use of the testiack. Connection of the DACT to two separate means of transmission shall be ensured. DACT shall be tested for line seizure capability by initiating a signal while using the primary line for a telephone call. Receipt of the correct signal at the supervising station shall be verified. Completion of the transmission attempt within 90 seconds from going off -hook to on -hook shall be verified. The primary line from the DACT shall be disconnected. Table indication of the DACT trouble signal at the premises shall be 14.4.2.2. 1'/ 2.35-A T Annually Supervising Station Alarm Systems - Transmitters - verified, as well as transmission to the supervising station Table DACT within 4 minutes of detection of the fault. The secondary 14.4.27 means of transmission from the DACT shalt be disconnected. indication of the DACT trouble signal at the premises shall be verified as well as transmission to the supervising station within 4 minutes of detection of the fault. The DACT shall be caused to transmit a signal to the DACR while a fault in the primary telephone number is simulated. Utilization of the secondary telephone number by the DACT to complete the transmission to the DACR shall be verified. Table Time delay and alarm response for smoke detector circuits 14.4.2.2, 2.36-A T Annually Special Procedures identified as having alarm verification shall be verified. Table ✓ 14.4.28 Page 11/12 Fire Alarm System fTM -Annual ADMINISTRATIVE OFFICE OF THE COURTS OFFll:li OF COURT C0\.;T1t1:l:Tl0N AND �LANAt.7ti\tt:\T Insnection. Testinn_ and Maintanano%n f:nrm - Mra Al— e—s..... _ A».......I Item Activity Frequency Description Additional Information Reference Fail N/A Pass System equipment shaft be maintained in accordance with the manufacturer's published instructions. The frequency of maintenance of system equipment shall depend on the type of equipment and the local ambient conditions. The frequency of 3.1-MI M MI System Maintenance cleaning of system equipment shall depend on the type of 14.5 equipment and the local ambient conditions. All apparatus requiring rewinding or resetting to maintain normal operation shall be rewound or reset as promptly as possible after each test and alarm. Fire Alarm System ITM - Annual Page 12/12 ADMINISTRATIVE OFFICE OF THE COURTS i� C)FFtCE C,)F COURT CC)NtiTRUCTION w2n AND MANAGEMNT Inspection, Testing, and Maintenance Form - Fire Alarm System - Annual item Deficiencies and Comments: Deficiencies and;Comments Item number must correspond to the Item number of the Activity listed above. C C� c G f e/iL d Cd G See Continuation Page(s) (Indicate the number of continuation pages) El Pass // i /on� [I Fall /��/ END Fire Alarm System ITM - Annual 0 re"O -36 8115 35, 8114 -34 M 8000, co Rgp�l gw 6317' t64-17 M OM -3 -35 641" cO,. ev T ,6314 W'2 -34 62-1,j' '34 N _j cv -35 61'Is 6216 61,16 36 36 6217 low 4:i_ -7 7 '6118 -38 SO ViLAGGlO -5114 r34 4 '51i5 0 _35' is' :521-35, � 5,116 -36/ 5216' 5117 OC 37 v 0 z D n z 0 z v RESIDENCIA C==:--::� GNIS an"i�tlDtlW Hd 38889gNmiggss8 $ �gJ mg wmg ego . O =sm RESIDENCIA 36W -3 57 3067` 3068. - 069= 3070 ' 3658 3066 - 307.1 ;. 3060 . °' �' = N. •�'; 3059 3065 `, 30 0! '3079 5l43 .' 3060 3064., Soo` 3078 _. 3�J , ,33 , = $662 3061, 3063 ' 3074 " 3077 . � 61,10'. S1.12 51,1 3076 3075- -30, - ` 511,1 . 079 40804031 4 J52 4053' 054 4655, 4067. 406$ ' 069 4070 a078 , L 4088 4651 ' -- ' ` 4066 4071. AM, g o 40 50 dos? aoss 4072 g g' $ 404 4058 4064 $ c, 4094, oi�i --�-�o ■• a-33 4095 4102� D90 4103. ;,rWi •'wN v '. 09L 0 0 0 4047. _ 4046 - .. City: Newport Beach No. Stories: 3 co ZIP: 92660 Year Constructed: 20 Brandon Lawritson MI Contact: Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive Fv� owner Date: 08/11/15 Address: Huntington Beach, Fire AHJ Date: 08/11/15 City: CA Contractor Date: 08/11116 State: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Job #: SIO-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1 (a) 0 El El 21 Automatic sprinkler System 5 • Private Water Supply System 7 0 El 21 Foam water sprinkler System 11 0 21 0 0 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) Yes No Ewa — September 3.2013 Asa1 Riser • Location Riser: Diameter ; `Ma n brain,; '.Diameter , Iriitiai"Stat c' Pressure ,_.._• ;. ;Residual Pressure ".Final Static Pressure P F N%A '- .' Building 5000 100 90 100 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: Mm'' On-0 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable :Item . • Description „ NFPA 25 CA ed-1 ,.� ' : Reference •„ Date CoinmentsOnly P,:F 1.1 1 Control Valves - Identification Sign 13.3.1 P 1.2 1 Control Valves - Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 100 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 100 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves - Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 I 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 I = Inspection T = Test M = Maintenance P = Pass F= Fait NIA=NotAppticabte Item Description, .. FN FPA:25,•CA. ed.. Reference Date•.- .. ,; tomthents Qnly- -:. ;' : P,F;N/A` , 1,17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 Yes No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 1 T Control Valve — Operation 13.3.3.1 P 2.7 1 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable Item.. :.: Descron. NFPA 25 CA ecJ.. Reference. Date-' .' ;;Comments Only N7A. , .R;F,r, , 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 P 3.4 M Internal Pipe Inspection - See Deficiencies and Comments Section for Results. 14 2 Yes No 3.5 M Obstruction Investigation Required. If "Yes", see Deficiencies and Comments Section for Results 14.3 P 3.6 M System Returned to Service 4.5.3 Nos P D = Deficiency C = Comment (Indicate type) aateiri _ 'Date Riser" . -- D ' C. Defidiencies Arid -Comments indicate all'equiprn&nt:�deviees,and parts (haf.we're.repaired orrepiaced 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 5137: Replaced one painted fire sprinkler head 04 07/10/15 Unit 5227: Replaced one painted fire sprinkler head 05 07/10/15 Unit 5426: Replaced one painted fire sprinkler head 06 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature F Date 07/10/15 Form AES 2.2 Sept. 3, 2013 Bluffs I gToLLP R Name.. Newport Occupancy/Use: rOu. 100 Vilaggio V-1 HR Of- C Address: Construction Type: Newport Beach No. Stories: 3 City: 92660 Year Constructed: ZIP: Brandon Lawritson Contact: Telephone: (949) 467-2133 Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive 21 owner Date: 08/11/15 Address: Huntington Beach, 2 Fire AHJ Date: 08/11/15 City: CA 21 Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA-26, 2011 513781 Edition Is amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1 (a) b Mr 'H' VA 1, &QejR0 41", MQ�5.qpdg 1, in Automatic Sprinkler System 5 0 Standpipe and Hose System 6 0 Private Water Supply System 7 0 Fire Pump 8 0 Water Storage Tank 9 0 Water spray system 10 0 Foam Water Sprinkler System 11 0 7y/ 1:1 1:1 Water Mist System 12 0 21 0 1:1 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) Yes ID No AES 1 September 3, 2013 Q i� a Riser 4• ocation: :. = Riser, :. Diameter'- Maiti.'Dra"in': Diameter Initial'"Static • Rressure.' Resd,ual : " .Pressure:., ' Final'Statc ; Pressure: Building 7000 95 85 95 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: a ai;kP:t':r^'i'@'4'i�3sa• df- - I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable :Item: ' ; ' Description. , ': . - A S- C "N F-p 2" A :. ` ed.: Reference Date ..,. ; : Comrhdnts.Only.-• " _ - �P,°F,''N1A: 1.1 1 Control Valves — Identification Sign 13.3.1 P - 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 95 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 95 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.1 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 `�• 1 =Inspection T =Test M=Maintenance P=Pass F=Fail NIA Not Applicable Desc'fiption ::. ...- ., •..:.. -NFPA 25-CA ed • i2eference. Date; : ' ; .. Comments Only 1.17 1 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5•2•2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 j I Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 rjI Yes ® No 2.1 j T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 1 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 1 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 1 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 - 0 - .. • - . •.. 3 ma_ -a =- 1 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable Item . ,_ :. . D`eicription .. :NFP.,A 25-CA ed. Reference: , Date,,- : CommentsQnl Y I? .� 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 P 3.4 M Internal Pipe Inspection - See Deficiencies and Comments Section for Results. 14.2 HVI Yes No 3.5 M Obstruction Investigation Required. If "Yes", see Deficiencies and Comments Section for Results 14.3 P 3.6 M System Returned to Service 4.5.3 Ye 0 Nos P D = Deficiency C = Comment (Indicate type) Item - Dfe 'a Riser D C - Deficiencies and'Cor►7mmts. Indicate a16.equipmenf:deVices.arid parts•tlfat were;:repaired:orrep'laced" . 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 7137: Replaced one painted fire sprinkler head 04 07/10/15 Unit 7436: Replaced one painted fire sprinklerbead 05 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 99, Sections 909 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013' -.tX r ...{. `x . R•P=; - =t�; .."'"i". sr':.'.r''h�,j .., 3i,5.w`=. -w}F' ii:i3.%'.'¢•, t� +r Cl• _•�,:r-..F�"i. •::. "�.'::P': n f1",'�`�y., `Y: f,-aX4<t ,,�,...._..v'•`tr,_�,�� ;�,-.yC.r,...-x,i?�..� w:.F«�z,V'ra,S�7�::�.,':?i':v�-F`,s,�3,�.";�..a':k.,.t.3•e�'<a",w.�',�.;c'°`a...' V:7,;;"^ "�'ii �- .�'.+ s.'a.� V:>- syr�i ^c•d*,.a 3-;: -,h„„+ .A•.*{, �. ,t 5v 7::n.� 7..: mcz; .� $S u; �,.r. "��.2�^ _ 'F....: .``��-�Y. i, -�'c .. � � 4;>?'�...... H:L'r. .;s=1�=` �'�e.=,•Y-A, �. �',�:, Y ,� ..�r�" ._ grope"" , � -s � �.�,- .tik �: � � � - � «;,.;�_...__ �.•��,. �•� ,I!n�fo m�bto.n.,e; ��; .��xt>'� -:� ,��_. .k,� .�;:`��_':: °:&:,N�'n.{�•„ _ �t:.•��,,. `.-g#. ._i r".?,.. ?t ��•, fi,-�..� x: •k%�Y �..<'iw�. �t•'r ^h.:5 ;+,�5,-• p _ � m:�,r ,dY'�;.-,.;�M-.- . . ,_.. ,.. �'te 1�^,.�i �r?'•.c'.?-',cs �y - ,c..t'•-"-:... u -` r'c-�`` �,. �i:=. .v za ,'�+"� .t•: ,, ,�r`-..,.ld;��f,.r�^'.y..>..,�nA. � Name: Newport Bluffs Occupancy/Use: rOIL � (r1� R 100 Vila io nn Address: gg Construction Type: _ �/— � 1'� Newport Beach No. Stories: 3 0 ,�� p� City: ZIP: 92660 Year Constructed: Brandon Lawritson Contact: Telephone: (949) 467-2133 y� �:r. �.3•?%1 :T -L..dY P�'. `. ;lnr J•"�' 1 `�' S��^' i'�'� ;d.`� .T. ta•o •.i�� ':a ' w. '-,�"g:�'. ?+�E.` 'u'�*:,< r'i«,�` -"'...raw,%-L>;;..• }'-ti Mn,, ,..'�",'s,;; w« ",'' :� ,�'�an-i �.T,L�`^2�:1.'�;. yu_.t�"v,��;,..rY. ::"`. •r., n••'i.,. r:r 3;F t�. as•-,.;7�' ,:.�fi�.a.v�M:n, �Ew Hai `.yti � �`. a,. rxf'.,�,��„4`%t»� " o;.� E r,�.��^ '.'., -1 -�" .�• ��, .�G'o`ritra�ctor,�'In�o � ,._;� :,�:�•�a.=''�� 'k,''.'•r-aj'k' c'�-Y.i�ZinieS a,�/w +L",�G'v��"i°b '`'t z#' �- 3 �y'. 3"� Y%?'1v' v{ iF,« ? 0. F h�'•,It.. Name: Automatic Fire Sprinklers, Inc. Copy sent to: , 7272 Mars Drive 2 owner Date: 08/11/15 Address: Huntington Beach, 0 Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 For specific inspection, testing, and maintenance Telephone: ) p p � g, requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) +^..Na'.2 '^i•'-Y' Kisr.yrvc aMr e^'h'i�N''tt"'. ;^'Y <c-y N?.:.. .vnP^� i."o nPae K v-.• "wa '`•P• +asncz'a tFr.:.�°( ',, j Ogg -yx =,L.„ ;,; "� s° texi + s ected�an enter' he+number of,fgrnas use;foititspectcn¢ :; ,, F ,;.: °.x�':�,�r:a,. Ohe`u•�,_fi-Woz�fo"r�ea,� Y� �p p _ (� �t�,�. ,. � _ -_. � : . .;.>•-e.... '-..- "r".%rr'% r''K"'+'sr'C?m na"'h'.-.!# ' .-�;.•o, y r^}. .s. • fi' -�z ^?-r�'_%. . • :;f Uffi ors ass' toy Eels us of eel tlPs�ys xn�a rid of 4i s ec ro0 't .,r:: v: 4; , l�• . Chec§oxen (Fa t Pt ;d� '�Fc_:�:•-'+..�r.•.: n•:�.�u7t11�nC:w'*,^.� �"tE."€,�t^r:u�`.�"+,3:�.,a��%•3....'�Z„' :,:�a..a.'t�,t� . Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ Standpipe and Hose System 6 0 ❑ ❑ ❑✓ m Private Water Supply System 7 0 ❑ ❑ 0 Fire Pump 8 0 ❑✓ ❑ ❑ Water Storage Tank 9 0 ❑✓ 1 ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes m No -^•.`�Y,%'�,»^*a. See®elciencles�nd:C>m ;.sectOatn� FIRE` IN =3 �'. y}w�. •. i5r" �.,+_ Y.��'':I 3•` lr',��t.;;T•fi'�Y. �, .X'\sg �}�� „tl ".'`F: `v sP0fiue_:foi3r.�=`:w � •,'Y,�. fl-cX?( R.:i:. , i '� :A<ia.�i«ovSs.,, .S �., ..-:.k..:?n•a. .�•�. .h-s...,.<;a3- c4'.La` w.a.�'t,-.k _. �zre ��rs.u_y.zkw.❑ AES 1 September 3, 2013 Riser• :'_ •No: _ Location: Riser: - . ; ,Diameter , ;M'ain-Dram :' _Dia_'meter _Initial $fate P,res"sure: - ; R""esi "Wit'.. .. Pressure, Final'Static Pressure: ' t?, F;.N%A, Building 6000 100 90 100 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: MUN I = Inspection T = Test M = Maintenance P = Pass F = Fail NIA =Not Applicable Item Description . _ Ae.d5 A:• 'NFPC • . •:Reference, Date ., . �::...:.. ., • : ,. Commenfs•Only P, ;F, N/A 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 j I Waterflow Alarm Devices 5.2.5 P 1.4 1 I Supervisory Devices 5.2.5 P 1.5 1 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 100 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 100 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 - NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 j I Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 I Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable 'Item ` esc ripti o gn A 25'GA ed Reference-� ` . Date ' Comments.Onf y � P F N%A• �. 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.6.1.1 N/A 1.19 1 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 j I Unsprinklered Areas CFC 901.4 Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Pagel of this form) 13.2.5 13.3.3.4 P 2.5 1 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 - • _. •e - ®'• jo? �4�. {Y,_ ,.c: &ri4±}� ,,},yam. PM a I = Inspection T = Test' M = Maintenance P=Pass F=Fail NIA Not Applicable Item "Des_.cription _ ;. 'NF 'A 25 CA ed. : Reference'' -Date Cdr i,frients drily R;F,N/A 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14 2 RNo Yes 3.4 M Comments Section for Results. 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 P Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 E] Nos P D = Deficiency C = Comment (Indicate type) Item .: , '.Date Riser D C' - ' ' Deficiencies; and •Conmen#s IndIlpate all;equiprrlent'devices-and parts thatwer0-repair66orreplaced• -.•. 01 07/10/151 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 6124: Replaced one painted fire sprinkler head 04 07/10/15 Unit 6311: Replaced one painted fire sprinkler head 05 07/10/15 1 Unit 6437: Replaced one painted fire sprinkler head 06 07/10/15 Placed Five Year Sticker on Riser rk hereif additional Deficiencies and Comments are listed on Form AES 9 Number attached: Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 . Sept. 3, 2013 .• . • • :NFPA26,-asAme•-• 'oqRj mg+=d'++""-Ft+<'l�:>."v°'eiv,'.t°•f..•''�,z".",,•�1°j"!;l'.t�y.?.?°.zne%''°"_'a,�•sw�t, r�C,',ziS;t,F::n;,.},.,;t::%;N`_tt^`.'F>lb`;'q't_y?3:,u..-�'[%6;e,4i"°'".rni' ��:- `Ae :r-+x�>.. .i.`l„a�•i•.;it.1; ts.ti�.: �i „y>,S;q x.M"'a',no..�t>3;ti: :Lu,.£M•.°.M1':3:::k„i?' �i •.!l �. -.y y. .+aa,-.;f`-.:"c�;. c'•.'-,4':'„F •vp. 'n:'(yt A 'Y -; S., `P,'�i2 l i•>f+� �y A. - � r , yY•V. ' i:ti?}^",'3a ' r'%4:t�;�Ris'. �,� b 'Y ' .�;5+ �G.: "d .. @y` ^ ,,:z Y-T��'r.N 7 i T 4a. ,: �. A .�v�} V;�i . _ 1 I � ` c�,�F..s •f+s.+=�- n' �' .:w ..vp,r. r>`�,=�4„r„?;E, •ti.:i��;$dt.��C:.a?7, ?�i: Y".i S:,'.. •a> >, �µX�,. •t cs,~ °� .,r >T�, ��;. r�;> �,:r�`.;:M'a,�' t .�;�=�';ft^••�. pe�'nby�iln:o,m'`atio��a,� �:%;: SJ�,. T i. �•'Fk,'.0 �:��-�::-.~r.t��•.� _ .ate. �4. .ti.� _ ,�:•� SF' � Wes; Y�..S i:a:.�u°:°y �+i7 SSy a. T, "+`�;5•�...L�.L'_Z. ti"_ .,-� Newport Bluffs occupancy/Use: Name: Address: 100 Vilaggio Construction Type: U- .� ti°f ca41�,a� Newport Beach 3 z No. Stories: City: y 92660 ZIP: Year Constructed: Brandon Lawritson E MP Contact: Telephone: (949) 467-2133 • i .ram., .C+� d :�a'} L't y��.. �+t,' •; YLr•" t'��:�'4i�,.', t iz: r�rFr »!' �"^r1,'::E' i .P-rg :�""5�' dv`c;.rtizi;7:i�5.' r ,�..r.;��v=.R",`.','�.,,e..T.. i r °'�' pC�" �'wN � � .+1 Vr � ,.0 n t `y. •v. `iz'.. ;.r ��...'.t :." - .'fi,,,.. YE",.rR. �m i',^Ai�tfid..k>.'(7", ..�! j3iv t' �"R�'... ��'v�N, ••fL '�,F �"4 _ �n-�4. �..z °i3a d.Y� Y L S"„<".e-�" .$'.r, l ��„�c��.,l,�yt� f';., i?',. ,�, wiz',as t�•t yn. ,� 7,. �3 ! t r� .�, r' t..:F.,_�t ,S,` ,f �aT- y„nJ��,vn,??r_.t�,.- y ;� ��7`t ��s:E�r ,c :5�e�`r.cH�'k�a�•-'�'a.t��.5"�J:J'4�'+.i'a..�i�..'S»aa��'ra�i,�=`':�'"`� •• •y .6Lr�'„� Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA 21Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 specific inspection, testing, and maintenance ) For Telephone: p p , g requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) ;.��'z,a.�rr_}I:�', p'�^..V;��s�ft�ry1 '�;-1....-� >i mr di'tLtma1Cre�a't.Sxnu"�a''s&f��'•eked`cl'.c�f;i,,'Qh'u��i �:I i`.s'>i:i.,sp. pe�ee'}'c�,i,A .,ic�� o?k•n.i,, +,�,} fi�cetiteca.X�rS.it.'.i�'.w eMxe, Ms':�`•`.,F=Ix„N.° i..:r� ','M'z_,, ycS;ihxe-�t`s1.r=',�t�JaePcxdtmy�ae,ii..io.su_Y�Ti►•s, sv.m_.Ra"K.,� e(4li.';ti,"aynp^:�'uiyfe"�Y1mct %>;b.a`.c=i!1 `'xk`b...�'o'b_':cxv`o�:,.k C' ,vsRr,r.."s�iu�'�s.;n,;:5 :foes3i=Tw.ir4.h.i.$..e:Y",�s aa;��ans ha.sn LYa soirY'�ttSf .zn\:ery.'z.:cCc'..) d.54�-"m.��'�3�S.�i' S�ssY) .=i"Eti'e .�s.e? .x :::aWW',.N.-.'J<1��r``�,� .',3.d+=:�p5yi.C.ti:s' Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ GZI Standpipe and Hose System 6 0 ❑ ❑ ❑ Private Water Supply System 7 0 ❑ ❑ ❑✓ m Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ m Water Spray System 10 0 ❑ ❑ ❑ 0 Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes m No .�T+7..`.v. ,•., ti ,�,. ,v�^ '�,^ �..�'�F'�. .a'P°. K"e•z :P,.m+-• ;.`�'w'P' '��.'. e.�,, :%ivy';,-�''` �L� Yiii+':i:. w,.S• ��.;.��.u�.��i�.�4.-_:_�:��,�. �.. `�=�"�",; � �" I "re c era fed Corrtmen: �s :,seal.© � ati,end off - acli Pe ecfi I eF or�►'Ti ��, � �'�� 7�� ..:t, k��„�`iti::. _ ��s��`�_r= �' a= j�:�� Ae��:p,-e��'�..��rl��,�.��n�;....�..�--_��=.�,�•..,.��.�'.�x_�.,.�.,.:�3,_��N,��?.�-��...�k.�:�k��Kr.t�'.��::::,,.��:.m,:�;.��a'�v�..�. AES 1 September 3, 2013 ^.s�—.'"% •'d.>' 1•i; l.n '�,'/.,:' f':F AWJ »4� '�^Ys:" :T>'•'r�� s 3:t fts. 'i ..„3';x nf# a G 'c< ';t'T'' :Rressure`v` i 5 £.. n� ` 'sftlual'; FirialS fatia 'Ftir .>. ` �e�,•�: Units 1000 - 1029 90 80 90 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: � Y-i tit; ` i r+q .. •.'s�`> e + �•t'�i a.;ti'v'".3�°• f,..j3�.J'\a FBA• p� = Inspection T = Test M = Maintenance P = Pass F = Fail N/A =Not Applicable Item:;;,-:,.., _�__< •' r,..,:�..:•;......�>.....:,:...,."'Desrit�on.•..... :� ..'_... • '- is ' .:-, .':'; ;..-.. :• :...:P. ;`� . ..•:�:� '..� . «:.,.. :'-: ,:...,,.:... ecl-:' References' �':°Date 'aConrieirifs:Onl%y,`''�-•:.z:#?...,.,. - 1.1 I Control Valves — Identification Sign 13.3.1 P 1.2 I Control Valves — Inspection 13.3.2 P 1.3 1 Water low Alarm Devices 5.2.5 P 1.4 I Supervisory Devices 5.2.5 P 1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 I Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 Props Building Name Newpc Address 100 Vilaggio Information a �� , ti Bluffs co Newport Beach, CA 92660-9021 Contractor or Licensed Owner Information Name Automatic Fire Sprinklers, Inc. lJob # S10-12; Phase 3SA605 77, I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable ren ate Gviiimerits 0ialy `;;"` : .:P' F'N!A 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 I Pipe and Fittings 5.2.2 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers /f not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 Inspection T = Test M = Maintenance P = Pass F=Fail N/A --NotApplicable N escrijA'- 664A66e," 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backflush 14.3.2.4 Pipe Inspection - See Deficiencies and Yes 3.4 M lInternal Comments Section for Results. 142 . No obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M I Deficiencies and Comments Section for Results YeNo Is 3.6 M ISystem Returned to Service 4.5.3 Ej P I D = Deficiency C = Comment (Indicate type) fte "R ind h4h Iwk Cky— �44�04.1, d 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/151 Unit 1015: Replaced one corroded fire sprinkler head in hallway 04 07/10/151 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature t e� Date 07/10/15 Form AES 2.2 Sept. 3, 2013 l ,. y�- _ vim--.i.. ..£. ., _ .`,.•`-'-' �. �. �Yi"�•.��•ri�.''•*i�,*�s�"F'v""c+a;`.,s•L�+i� ,.�t.. "r'��" .� . v.��2 , • �;�6,:+s-s. ;�:tY'c:.'i"3'.� si.e 3,Y:* �r�: �•'°k',.�i; .:�:.. �� ea�s`".'g`•��fi"" '3'., w„ �s�.,,� b,3^, �{sue �{,..,-,�,'.- t,.:,'$"cr,�x•-k�..w '},,, � _, �,;;� 'aaka , Yy..a.: ., ,;�, • =' �. •.%^-rr rt; , y, . ,ay,,. b, e�".�� a�r-�^u; >v� :. -Y;_ y�., - , ..2..x3wi a .:t�v u`49.. b' S Y , •.1?..:.-Y s� j net,-t # ".;"t,:. ; i, •i; i<a.t �„. w � �-.�pJ�� s#�-: =� >x�..n5, ��,:::t� g�wF�, �`�+�. � �� o'�x++ �. j •,±�;.:,z: �-��3r.F: ; 5�" �� '� �j' �:�. '^3.�, F" ",-F'� �W-" ?•g'1';;y � y 3 i,. 'S.-._ _. - .A.��i.:x-•' 3n��.rS.i�tWCui Name: Newport Bluffs Occupancy/Use: 100 Vila io \ I Of CA<7,c Address: gg Construction Type: 1/— �� O� City: Newport Beach 340 No. Stories: [� ZIP: 92660 Year Constructed: Brandon Lawritson'�`� �5 Contact: Telephone: (949) 467-2133 �'+,R'c ra�P's`,�-„=a�5s ..,�;," "„� ..'n" �'•" „'� +a; ....�`-`�.>,+"rw:��,�i �..t-`F,':n:°us..� ..^.its,.. 3'h'�ti,:"t; ( :.,,• •�;.tt it >.�<,=s� - r•„_ ,�'. .'v`;:�„"��.;� „ w. ��rn�!4 Y,'• „•�',��_t•. .r3 :<,t:'' ^t �, ;� , .'+, < ��,. .�?;3,,�:.%�+v�'ss ;;:�;t�, r�.'�. , �< r �.�' t ,,. „ � �:,- - f �2 = x�, �;h ` -',t � u' �.ei' o��. �'�` �R�r§erg. z;;:?'; • ��, �;. ��: xx';f�`,„3[Ni §�, �� N �ti,� '��. �•Yf �; � �:� u�-N- y. �;�o�n�tractoe.��n�o mafiian>:;� �,.��.��.,�.�.�� xx a:• 3s;t`'�?',�. -,f;. �j '�.�,"-;^�m��^fZ.- 'rd., ', <� t5 k��s*.k ^r 4_: ,•.'�.3,.t;.,,` , �+". _ti. 5. �.E�d.-Ci l "w= ml+e+�i �E� �.� - `4V � �6�-''' `ST.:$7�.•-£�'� fi R " ! -.ti .. 4n' .d. �,r �':Y`.. .- 'K t . t' Y+ S �'y�i: y�p ; V � .-v-, .mY.i,aY.lAai.-.3a._ `rLuxl.v.!]I^b;'`��- w5i: '.�`.6'-• Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive Owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor pate: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) ' a)nsp'en- :.7 �a . , j- �• �. w M, t-- [i�P,.r ',Y.�r.�d�"4'i;!"d f,H.sAro.�-. yy,.�,s't�•we5�.s:.p-:�edc4"i3ll of:osf 4fii' ;1_tispero;no1: �,r „+r•:M1".;Y"'RN '<-�5..e,^st'+.t:"yfi..ot�.:^^'lfo' "";`'ea�wwacpc4h��Y,�sf. ,ts;�, t•< ae�Via'e, idP`«e. ntea.£h.'e.$)"`��pr9..esu..�,.' ee1{{��1€Ye� c!s3i.'sx:uN_.�foie.u^+z£m.�e` : wiiotAi�'s',dwT.r'..r"-ei• icc.lvtl,"ceYC: .cu- ^t- _1 :«�Ic♦�# ?ys�+�atk'o 46 ;;:k�";>i? z�:wn=.' ``„nx.w}c^''>C.'�1d5V' f ff rs a f . f Z Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ Standpipe and Hose System 6 0 ❑ ❑ ❑✓ m Private Water Supply System 7 0 ❑ ❑ ❑✓ • Fire Pump 8 0 0 ❑ ❑ m Water Storage Tank 9 0 7 ❑ ❑ • Water Spray System 10 0 ❑ ❑ ❑ ill Foam Water Sprinkler System 11 0 ❑ ❑ ❑ • Water Mist System 12 0 ❑✓ ❑ ❑ 0 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes No '�'�SS'i°d i'c`-�',€"�S7>y'`�+„�n�_ r, t .�•'?,F� n.: � s ;• �.,. F.-,..- - ;;�.�u' ''6'; ,.-iv:,y.�.°�'-,�,,rA',�G'.Ss,,t..-,:r::..;:,ii='.�-.:'..`�a;�,>r irr 're`ctriK r',-h4�'t��.`at`•�"^�y,��`,<;r; �. i�De •tcle , es an -�?Co„ t t e '�s��seetio�'% n 't�en:��b aQh�i�e� e"��i,,enfior �:�.-��-��»,�� '.�::,, -. '`,. � �`,� „��,..t n. mm n �� ero�- � ,�;..�.� f .�y�:�_, ��,��.;�::�xY-;<.�_a,.��.�... u:,�.rs_�.s�.�ta•�.u�.��. ...-C•as...�cc.•n�+vn..tr...-�+-ts &ae�.,.�exs�.sS..tRt st. ..dr-.._d•.�`, ern max..-aiw A .k c,.�:.`,.en ,� � = AES 1 September 3, 2013 4nitia;Btatid-_� Re.6k F iitj inilt Units 1030 - 1056 90 80 90 P E] This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I= Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable 6d. bmmLinfir DrilyRIM 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 p 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 I lGeneral Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 I Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 I Inspection T Test M Maintenance P Pass F Fall NIA Not APPlicable 1.17 1 ISmall Hose Connections - Hose Valve* 5.1.6, 13.5.2 N/A 1.19 1 IBuildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.27 1 ISeismic Braces - Accessible Concealed Space 5.2.3.3 P 2.1 T IField Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 1 (Enter data on Pagel of this form) 13.3.3.4 2.9 T Small Hose Connections* I w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, 11, o standpipe systems. Form AeS22 Sept. �m�u k.., ash., `..ski �:� z�a3 f:C,. ,--'1��`: ia:�3 $ " � � � 4 .+II� i K'.,`, i.: is �:: "�•'::.' ,{p;,xr 1 Inspection T =Test M = Maintenance P = Pass F=Fail N/A =NotApplicable �N e 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 3.3 M JFDC - Backfiush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14.2 Yes Nos 3.4 M Comments Section for Results. 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 P Deficiencies and Comments Section for Results Yes 3.6 M I System Returned to Service I 4.5.3 No P I D = Deficiency C = Comment (Indicate type) 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15. Unit 1044: Replaced three painted fire sprinkler heads: 2 in living room and one in bedroom 04 07/10/151 1 Garage 107: Replaced one painted fire sprinkler head 05 07/10/151 1 Garage 110: Replaced two painted fire sprinkler heads 06 07/10/15 Garage 151: Replaced one painted fire sprinkler head 07 07/10/15 Unit 1054: Replaced one painted fire sprinkler head in Bathroom 08 07/10/15 Unit 1054: Replaced one painted fire sprinkler head in Bathroom Placed Five Year Sticker on Riser E]Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 0 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith I I -- Signature Date 07/10/15 Form AES 2.2 Sept. 3,'2013 P l • • • �.roperty Info'rmatiot?: Name: N@Wport BIUffS Occupancy/Use: R _ ,3 �_ 1 100 Vllaggio Type: V" ) of C-44/ Address: Construction � City: Newport Beach No. Stories: ZIP: 92660 �j�Q p Year Constructed: Brandon Lawritson ��iE Mpg Contact: Telephone: (949) 467-2133 Contractor Information: , : Numbell System -Risers - Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive Address: ❑✓ Owner Date: 08/11/15 City: Huntington Beach, 2 Fire AHJ Date: 08/11/15 CA [Z Contractor Date: 08/11/15 State: 714 841-2066 Telephone: () NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 CA License#:. Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Performed by: Billy Smith accordance with California Code of Regulations, Title 19, §904.1(a) Check`boX for eacti'system.inspected.and enter the number of forms used for inspection: :C.heck,boxes;(Fail or Pass} to indicate stags gf'inspect@d.systemi,at end of°inspection. low ,. ❑ ❑ ❑✓ 5 0 91 Automatic Sprinkler System m Standpipe and Hose System 6 0 ❑ ❑ ❑ m Private Water Supply System 7 0 ❑ ❑ 0 m Fire Pump 8 0 ❑ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ m Water Spray System 10 0 ❑ ❑ ❑ m Foam Water Sprinkler System 11 0 ❑ ❑ ❑ • Water Mist System 12 0 ❑ ❑ ❑ m Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes m No See: ";Deficiencies .and.` Corrimeiits" section a# end:of each •res�ecfive forrt�,:. � , AES 1 September 3, 2013 ,i i�:'3;'�=-n"'.'y ✓s; k:'r�,. 9`< 0 �1= �';YK<•dc'�"�� , P�i'^el'a" ;h9� n �•v Js. v"v�'-y �:l.�. `� 'sTr,� `'c.. ,�. ,n^�w" �; "�",' �',z J'ser ':No ,.<• - 17aiiie't'er: "fn ..iNairE::l)rari", E :::Pressuie :: `; Fressure- • `a1,Sta `;;Pressure:: °. -.,,.: 3- , Units 1057 - 1058 90 80 90 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: ::t,.�.,•> �y �`"i�, `::.�:. ';, ,ei, '@•`� • V�a?.\•<x .?R 'a?s �, 8 $ . � , e } ,. r?b '�" �.,a,3'. •;�,y.ma"€± • = Inspections TH= Test M=PMaintenance P =Pass F = Fail N/A = Not Applicable < C ICm ents:0in 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 I General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5 2 8 NA 1.11 I Heat Tape 5.2.7 NA 1.12 I Spare Sprinklers 5.2.1.4 P 1.13 I Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 ' A i,?A"✓$�, ; fa$% st )'r , rt? • :.•ti:" >•e �3•=.: ,'a� £i3 •.q. -•ii l' i .sz a>c>: k\>. - �^.r..�;�>•s. a t z r •^S' •per.: `�•isa'�'`[V'ti. �.'.:' ;�'`.i', :'� .', cia a . , h�: • n � i1t• I = Inspection T = Test M = Maintenance P=Pass F= _ Not item: > .:, ....... r_ .., .:. ,,, ,; ::. t >:. » >` '°' �> a.•;.:.•.: ,., , D.escrtptlo�i. 'NFpA'25yCA ed: = -ire : :, Date;:`': ``> `: .:Coinineii#s'D:riipp�ca` 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 I Pipe and Fittings 5.2.2 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5•2•3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass, if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 1 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 - - =1119 I Inspection T Test M Maintenance P Pass F Fail NIA Not Applicable NFRAA �,C , A', 7, ale T "ants- ce, �3- "-PM 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backfiush 14.3.2.4 Internal Pipe Inspection - See Deficiencies and RNo Yes 3.4 M Comments Section for Results. 14.2 Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results ZYe 3.6 M System Returned to Service 4.5.3 0 Nos P I D = Deficiency C = Comment (Indicate type) ,at % "D W 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/151 1 Unit 1057: Replaced one painted fire sprinkler head in bathroom 04 07/10/151 1 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: D See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature r v Date 07110/15 V Form AES 2.2 Sept. 3,2013 )I Newport Bluffs Occupancy/Use: Name: Address: 100 Vilaggio Construction Type: Of CA41 Newport Beach No. Stories: City: 92660 ZIP: Year Constructed: MPS Brandon Lawritson E Contact: Telephone: (949) 467-2133 1,1. M. Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive owner Date: 08/11/15 Address: Huntington Beach, Fire AHJ Date: 08/11/15 City: CA Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title'19, Performed by: §904.1 (a) 0 1MGSP ec "'fox e gom 64 qE00 Y; aW hRy 0W,I 4 MINN I 0 Automatic Sprinkler System 5 Standpipe and Hose System 6 0 Private Water Supply System 7 0 Fire Pump 8 0❑ ❑CL Water Storage Tank 9 0 21 7 EL Water Spray System 10 0 21 0 1:1 Foam Water Sprinkler System 11 0' 7,( Water Mist System 12 0 1 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) Yes 0 No '' 4I pefi.I - AES 1 September 3, 2013 01, itia On' a "e'r" SNO, rigs �,P�iF /A, "P Units 1059 - 1088 85 75 85 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: "N' M. tWA- WA I = Inspection T = Test M = Maintenance P Pass F = Fail NIA = Not Applicable CA, C e so e ce' 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 lControl Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P Design Information Sign 5.2.6 P 1.6 1 jHydraulic (For hydraulically designed systems) 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi I P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 jPressure, Readings Acceptable 5.2.4.1 P 1.10 1 lGeneral Information Sign 5.2.8 NA (not required for system prior to 2007 Edition NFPA 13) 1.11 1 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 - Backfiow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 I Inspection T Test M Maintenance P = Pass F = Fail NIA = Not Applicable item e erence 1.17 1 Small Hose Connections - Hose Valve* 13.5.2 5.1.6,13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 jBuildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 jPipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes No Field Service Test Required 5.3.1 If REQUIRED, Enter'F'until 2.1 T Send Report to Fire Code Official results are returned from Lab 2.2 T Recalled Sprinklers Title 19 P If not present = Pass; If present = Fail 904.1 (c) 2.3 T Water Flow Alarm Devices 5.3.3 60 sec. P 1 90 secs max. Enter time 13.2.6 2.4 T IMain Drain Test 13.2.5 P (Enter data on Page I of this form) 13.3.3.4 2.5 T lControl Valve - Position 13.3.3.2 P 2.6 T lControl Valve — Operation 13.3.3.1 P 2.7 T ISupervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* 13.5.2.3 NA w/PRV Hose Valves — Partial Flow Test 13.5.3.3 2.10 T I PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 (A v� Inspection T = Test M = Maintenance P Pass F = Fail NIA = Not Applicable it -dt pD• NFA46'-cA.e 9�t� PA Wt '' 1 " r ' - 3.1 M ICheck Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P I 14.3.2.3 P 3.3 M JFDC - Backfiush 14.3.2.4 Internal Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M lComments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results 0yes 3.6 M System Returned to Service 4.5.3 EjNo jP_ D = Deficiency C = Comment Indicate type) ell 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 1074: Replaced one painted fire sprinkler head 04 07/10/15 j Unit 1077: Replaced one corroded fire sprinkler heads in bathroom 05 07/10/15 Unit 1085: Replaced two painted fire sprinkler heads in master bedroom 06 07/10/15 Garage 300: Replaced one fire sprinkler head 07 07/10/15 Garage 314: Replaced one missing Trim 08 07/10/151 Garage 350: Replaced one fire sprinkler head 09 07110/15 Placed Five Year Sticker on Riser E]Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 1:1 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith —1 Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 t'vusc"�„+c;4'7�..;n7^�e'.nx3'''^�' *:$::'''�`: .�-s`-'`.T :• �:;.�.: s'•'i,, &: '- Ptrw ar-fi,-: ,F4`fi--�,.iu, "s =:v:, `� Z i!Pt':''�., .�.y.. r:i"•.'�h". ..�5;- st.in r... u,y s',. `.°jt.;., ,":1t •.'a�.is c`{ ..:.':y'+•:, .:�?`•,n :t:�::.o.-a`7.i:3" ;:"�:.,3.„-4 v1,. �:r,.; r--*o.:._bSs„^'fi•L�L �r�p%•5 :. ;nx=4•`�z' r"z4`S.•r;:'rakb: :-'� ;L a! •A.:- 'ago-,': vr:'•" A'"`.tt �.:, {§,i* �1'--r: i a r' e ,r..?,�:i • {'yip u� ..., Newport Bluffs occupancy/Use: R 3 Name: . Address: 100 Vilaggio Construction Type: _�� °� cAL� City: Newport Beach No, stories: 3 I�agZIP: 92660 � Year Constructed: �Q Brandon Lawritson�1R Contact: Telephone: (949) 467-2133 k', +{+� •'fa`T',^ .;}�/ ..,; �,5 'h''�"rn %S' �"L�,s�"13,�15 �y.. ct-'�'� .nfd�f,..._.`r'a�� '�,,�S.i �y.',i`µ a'�� .i� +.y„�.'-:i'3,tc�yY' fgiN�' •.,�.:, a...M ,�, r= a°°i-... �t ..s.!,�ax �� ,� , t.. �;��. 4� 'K.�tF:� t;. �`" t i t W. .:....�.,,,..t �,y''stk'f�%...,�,,�t �» -�'�;,� �.-�� (, �, ��-G©ntractor��n� I_�� .� �' ��. ,�. •- �. . I� ti� tc�+r�,.r 3 ��,,� �:-' � �4 1 ..r,>�._. � � tv.. ;asi �• Cm '�k^',.'' "'�•`�'`°' �' > �,a��`a,"��'.,y "kr !-a>��.�:�,.�.,.aa r.,,- - � #� wmL(z4.,1i�:'k'P�tiva]+..,.tn- ._ u+--�:.. ,��"'•� Y . :Q?v " i �;>�•" '�'^rT A� ni.�,,,�ii.uEdM ]�� ,,,� .a.�.�:-,.��tiwti.:�dG�tlr�lo Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA 0 Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#:. Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) - �, w �• ' , _.� : .. >�. ,R ms t i.,.:,,ber off 'ii' : sup steed �fo.[ins: ems : } 5a • ;,� t C K+)Ci'"o- ��'or em s sft""Ie nspect dW d�1ifer"�'I"e,-, aM , p . o , ,.. IS t§J..� 1r,> ., -U ti d :met r. ue:�;tt➢ [5,;-;;s's'_}'FLU'�Cteofbxes�siailory'P.gas,�y`.I1)r`arnea�tes''atusQfins',ec;e�i;s`saferU�.�a�endofihs�p�'ion,.,. }' @=,.i*,'r�.'3i K's:.n ui3',t]ri'Y-'$t>.%n... a.3„=csa.�JS...w�rJ' } 1yI'i 1kf.,._.s.Ks 4.3�lli.S:3vSL�•M'F+..:'srski+a�s'a.... •-'?°A-ai,'u+w:.-..:,�tn` w,Ctf":i:i ,u`tc.rY.L•K:T^y$t+a�3Jt'�ifias s^'P-s-?t>Kroi3�'atv.,AH 0 Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ • Standpipe and Hose System 6 0 ❑ ❑ ❑ m Private Water Supply System 7 0 ❑ ❑ ❑ Fire Pump 8 0 ❑ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ m Foam Water Sprinkler System 11 0 ❑✓ ❑ ❑ m Water Mist System 12 0 ❑✓ ❑ ❑ Z Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) © Yes m No j� -•r'z •aar;""''c.., ^';.^'.� - , of''• �.�cq�-^'2:� ;,.': ..g;^;?•:" ,s''':•.�1'`•:'5-:;"�`.,1�.,;z�k ; >,• . ``::"c'n ='fie,<$Defil rena�es a '.dam,.C�ornm�:e�� s,"-secfi►o�e, d,ofi eae�i�1esne,={i ;M'�4=; a5i:SkX;i;.;ui`•�c e�•:r'�-`-?!':e-e �,-.'a'+~�... *y,;,,.t w': .• s° :•,nig, �. ..ems. ra�sf.-rRh.e.:_r;s x3n '.>`.xa.. :.-,, aiti -, av, +._, svh.-+Ar.-�,...h'�x :et�i'wa tis �,d'.. .s tCG.xZ.. ...''v. AES 1 September 3, 2013 j", mi Arm 141 t P. F" A,'� Ir t Units 1089 - 1090 85 75 85 p ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: "iM 1SI P 'M v io-i,> u\ �� . '^ F S :. 'l "^ � ,e:: 0 a a :�. a ' S.°? � •�: i`^$'§.f'.�q '$ n I Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable N 41 77 :::`Date,e C M 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign 5.2.6 P (For hydraulically designed systems) 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 I lGeneral Information Sign 5.2.8 NA (not required for system prior to 2007 Edition NFPA 13) 1.11 1 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 1 Fire Department Connections 13.7 P 1.14 1 jAlarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 lBackflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 Property Information of CAL/.c a Name Newport Bluffs s 100 Vilaggio Newport Beach, CA 92660-9021�� Contractor or Licensed Owner Information Name Automatic Fire Sprinklers, Inc. jJob # S10-12; Phase 3SA605 £..a' (,. "km�,v°;�E3a . _ ��A �•Y :. �`•'AA:Stt ,S,ti:v ,"C,�'hS ,9 A:: n`f:i•^10 MW = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable z:; :lterll: -, .r.,C. - Ci fCttl- at ltrtamen (3 x l M .S..l 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings -Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ®No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'P until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass, If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable T NFPI� -�QA ornt Rd Orenpe,".J, 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backflush 14.3.2.4 Pipe inspection - See Deficiencies and Yes 3.4 M lInternal Comments Section for Results. 14.2 No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results Zs I 3.6 M System Returned to Service 4.5.3 E]NoYe P D = Deficiency C = Comment (Indicate type) 4MdAeh.d#ssan Z-ammen 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 1090: Replaced one damaged fire sprinkler head in breezeway 04 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10115 V Form AES 2.2 Sept. 3, 2013 j •-• o `«...-,w+,:-�ti ar 2�e"""��e_: - ,;.��. t � �"' �:"� ��,�` ;�.,,,,,n.�'�'�, •�`�"n^"s''� `fir �'.x,'-...�.s^.:�-�R��.:�R-r`:.z�;�,e.�-ir�'s'""• 777.71, ' •; n,_:5n` '�,ai2"',`.5^ .!_ee_"u-`?,-. ..m T.�r"Y 4':¢:1»..?',:bG ,'Y u.x_e 9• _Trv.S�':'r`,l.??, ,{t .. ,D`.ri;'k*ai`ix5°`�t'.z. ll.e ,:M..:.}. �,i .. _?: - -....<4:":s='::v"%'':CKn.: ';7.t ��.'('°f.;. `_.. y ,7�, .X Ftp ,,,,�, >�7t' V�r :!Gl�'4'.IPI• (r!Y*k?ILO„a�R. U 'toia l L�%�?'. x+"iycf, +N 1��4ti_�='��"f]. .. y`�C�%�7.,?�i'�t.kS :.Yx 1.0�}rY;'3�".7,'k�y.f.. .,.�,•'.n �": V' .i��. ��1,1H1-,y� I o ;:�!?: �""� ,�'1�`-•2;�• k '9,ef. a4 �so .ef��.. 4' .r..-`..j.� "�R �. t :.5;; '.^ x,' r • : �i` . 4 : `` k.d'• Newport Bluffs Occupancy/User _ Name: Address: 100 Vilaggio Construction Type: �— ,`�OF CgLy�0� Newport Beach 3 x No. Stories: City: y 92660 ZIP: Year Constructed: Brandon Lawritson Contact: Telephone: (949) 467-2133 �':�`?;.y `.e2 jyN..W,�iLLi v:"`k '� _i�s.,'a. �.�� Kizv�'Fu��#'=Eje»'3„�'.�: �..PF.�'.G �.}r so}�" t. .3''}'Di'.��. .� ��'�`, a �t ��.. �,-•'i,.� �.t."..jris�.�..:�i�: b r a�i�n'�'��: ��:�.��a�. ;��•:��,. ^,b��.1�' .t�,,,"t�urnlie`r ii�f:S� °te Rrs �`�;��:' �>>x.7. � ��+�;�r��„v� a'��_�;. -� � �:�. r� �. s�.�= �+;}1,f41 . [;�� ,�;a,i.� .��:,,�,. �Qon��a'�,�or�,� w,rn ��,� �, •�, � �,. � �� _�"�k-� .,�� Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ Owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) shy. w•S'r .z:¢aw.j ^'^'fl^" erR's�^r.,,s ...�'+e. 'z "5 "sr'.ect ari" �e for he m,pi`e of�,oriims' us,' El fio�^' s «r„ �,. C E.ck b �foea.ch',s%ste(n in -_ ..f<.:r' k`�.�.1?,at ?( :s"°'a5 tt�.rb +S+.y,t�'y1000>r'S +l.'asj.=w_ nx✓ip '<+ •- 7`r•��i .....y�„= S' t ^, 'o iis, tetin;• t e��:. ,�.r,....�; Q -• a� or�Pass irk ica� sta of ns ected s, �I:�pM •' u; rrti_ ,� �;,:c�` Checktbr�xes�(IF_�Y .,.5.1%r: s.3<'>a..,.,,,.�;._a.=: 'f_..a',}u+.:Y`,'F'.:;1: .:t^n:i'a"A_...s,,:•;r.«roir`�. REi^.nc�Z...�s;¢::...,:::.f:min«.:'a.-,,,or:.'"?.,S:.r°•.., 0 Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ 0 Standpipe and Hose System 6 0 ❑ ❑ ❑ Private Water Supply System 7 0 ❑ ❑ ❑✓ m Fire Pump 8 0 ❑ ❑ ❑ Water Storage Tank 9 0 ❑✓ ❑ ❑ Water Spray System 10 0 ❑f ❑ ❑ Z Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Z Water Mist System 12 0 ❑ ❑ ❑ ® Yes ® No Z Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) `_i-r-'':'Wi;.c'�„'c h, s is S,e�� De,"c eaC��omrnets Rsecbionae d bfelitespec I�eXfor °Y, r,`;, AES 1 September 3, 2013 I f y,Risef-" ta P �j §�q Units 1091 - 1117 90 80 90 P E] This building has more'than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: F WOW-403" PS-J A111 �. m� .o'I, "I I Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable, -Des 4 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 lControl Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 L Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves— Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 lBackflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 1 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable Descx tiori=.;'-.;.: Cr. -, Date;.;;. f� . a:<Comments:sQn(�!:'°' Pq y -7, 1.17 1 Small Hose Connections -Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers -Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 .1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ® No Field Service Test Required 5.3.1 If REQUIRED, Enter'F' until 2.1 T Send Report to Fire Code Official results are returned from Lab 2.2 T Recalled Sprinklers Title 19 P If not present = Pass; if present = Fail 904.1(c) 2.3 T Water Flow Alarm Devices 5.3.3 60 sec. P - 90 secs max. Enter time 13.2.6 Main Drain Test 13.2.5 P 2.4 T (Enter data on Page 9 of this form) 13.3.3.4 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* 13.5.2.3 NA w/PRV Hose Valves — Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T jSmall Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 w_ I = Inspection T = Test M = Maintenance P=Pass F=Fail N/A =NotApplicable t1 4qn Ate 6nt nm' 3.1 M ICheck Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 P 3.4 M Internal Pipe Inspection - See Deficiencies and Section for Results. 14.2 Yes No 3.5 M -Comments Obstruction Investigation Required. If "Yes", see Deficiencies and Comments Section for Results 14.3 P 3.6 M System Returned to Service 4.5.3 Yes No ]No P D = Deficiency C = Comment (Indicate type) Vq lhi. -77, 777 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Placed Five Year Sticker on Riser El Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: D See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 andthatthe equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith 99 Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 a � was r�:s-• x� .�,> , ��• � ^•�r.••=�'•C.s�•; �..� 'a��s. `� , �'�F,�'`,r¢: •��<,�^�-,,�,,. \wc*`;'S�"`F''.4; :�,�''. .:sS'4 "�'•,,''R,>t°•�y.�,k;,-. v�;? ;,;y �,.-3ix y i=: T'�:?L°y'Ci :1;�,'`."'y4y�}i'., . ii.„�` '."''�a''i•`, u.,qF,.�.. '�s:�.. }•' SM'-1 f+ • �.�a 'i^'r��}r •�.:��r�r,�'''..t ,tya.; J.,;j.�r-^;,.:-�� r "c+. �tai�r. �`. =:`s, .��'s:k e'�•-, �'"��v.+>.', 3•.?'i. �'�`'� .,Lc.";.,;.a,.t. .}.� e.. ;i� ..,,; T,`,. ,,.:zY-;.\�c�...e„r�'?•iS. r'w E-. ':�::. ,, "Ri<+�,.• ^� �Q�- r.YtS`LstiyitC;{,^- �....-[�s3>, ,S n'-j t,a`im:....x..+ .�W'.�2 rm .�Y. �.? r,.',i��' }:�Y li x't.'i:'nQj"�.�'Y".i �;a. aiLeaF�ii �. _�}' :�N,:.:��' �C�iY.. ,',P.4•'�`�•�� ''•fir ��;��:•.:,"..rpa[�!-. u'a�=-=..,��. ,,�.. � �,�.. � _ �.,. „>� ;��"�: d: �,�r..,,x .. .�. �onn•.e,,�py�t' I. fior,� � a�to ; , �:��• ,,�--�h�� --�,�_�,.�,.�� :..�r:�:> � , -F. q 2 � �4 � Ka.: � � t:=ti•7��J..,yxv _�.�� t�._ "q: �r ^2 .�Y xs..� 1i� � iyY``� ik` �. fk'. ,,�.,1+.�wnwT`5e'.�"�[Ri �.^ _ `�St.,n�.�f�1� 1 ��4ti•"-' �'?_-�L`�u1.��R•bye;�an'y�-,•y1:):a61�1a*��<'�.[„zyy5�(,-t f r' °'i t1 nr'.d�"-�.. .�`'i-.ey.'i, ks�"-� - ' Newport Bluffs occupancy/use:�- Name: Address: 100 Vllagglo Construction Type: V-1 Of C�{7'�p� y No. Stories: co � City: Newport Beach 3 (� n, 92660 ZIP: Year Constructed: Brandon Lawritson �E MR� Contact; Telephone: (949) 467-2133 m'�'.�•Yo: t-s- 3• �o��*r .•'''" ay'--„�^9" �Y`. :x"sea�i. .y5�'�3-ro�.tc°y�2,'� .RTt;�..'Y,,7i-u :;tz..f�`,,ra,�sa��{w_ q�Y'. ...a. .err a�� .�.a: .?�.";��:n L.�i� .�',� ey, R� .. Y.,- i zd� i� 1 x't Gq`-•h F�n�yi�r�.i. 1'G� }S?� H�s�..$'.•i 'Li: `S. firti �:5.-°,`-E.1.�y Y!%�",YE- t � � :'4�.�. .'� �i�K ��A ^;�. rr�'�'` a` '�:::' L ,S; s .,+}�.-_'+" x�' •�; Y�r �`;'<.,3 '+.�'�arri��, v^ ='•.' �-��"t,, �. t,�_.,:? +�:k.�,.�.,.� um�ei��of�S,�y�tem�`f?►s ;.�� ::-� �u:�`o.`+us:..i.�3-�.-r••n >oonbra�to•r�Cnfonm_'-fiio.n.�. � 5:�._�,°,��'<,,_��.�y.� �r:,��:�,�,��.•r�; �.,.=.�.r��E� �-�^�. ,r:Y� �zy. fir.: bk�v-.o y:,� "i� �+.''i.'�;9'"L;-rc,�i.1'+�,'Yw_+�.Cep:yu.'�'$n•.ds,Tk.,''X�..v.'Y`r��,•.�•,.��7..y«. <.,��-.�"`l.�'��,r�r--,`�^d�V�s:�,: _: ,�`:afa w.'mr `��"Y+-.-.. '+� .,..«.,ir .:x'xi,�t rfiC��,�`)wxG$,K1i tiu�z5-�u +L:k"a�' ,�;• Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA 171 Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 For specific inspection, testing, and maintenance Telephone: ) p p � g requirements and information, see NFPA 25,.2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) .:cr,.q m..�.,,c,.:.;. :.�• s;..ah'.+E,.� '*': •}t •rzaa,=Yv - :a�..rr•y..,-�va u.m_.-, rg. p c�� ^ye. .F ...;� h, ..,x-.?-era at"•2. •e^-?l';?. AA',+,. }:,"' . �' o: each" ""steiniiis' ect�clynde,:t r�theanu e,ofsfgtin's `s�ecfiirtinspecfii,on:' the k b- :xFyf. r �/ �,� i� Jp s= ;; s,- ,�•,. ��. .•.. .'%i�%;c +t� %S.. V Cv'-., A.f s U1,. i • i +'Y''.�4a1':. SC7 b'v*::'i. y:'•, fi- d .c Fit .[' 1-ii 3.r+,'.: ii9•� m`i-; xp�a::T.'�',a., k' .(Y 1ym:....' r T•LS ;< Ch` o p°ee_RRd% em en, of i s e fiortb...s s ,oil r �, .., usTof Pass n" 'esr�F a' o°.� t cafe staf In . �.'?.,: ':«u'..a..:s'o..�`-�.,h.�s....1.7X2 :�,fic.�. k, w„s.,.ii.•1:.,..',.we_n3' c.a-,..'.s:°. ,�3i..:ULr,'r..s w:xa�s. ..,"xa.a, MINN W1 Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ 0 Standpipe and Hose System 6 0 ❑ ❑ ❑✓ 0 Private Water Supply System 7 0 ❑ ❑ ❑✓ Fire Pump 8 0 ❑ ❑ ❑ Water Storage Tank 9 0 ❑✓ ❑ ❑ m Water Spray System 10 0 ❑✓ ❑ ❑ Z Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes m No -,�"''' fir". ` K +J`sx;"2fI1( y� tl� t S. D�` Legg,, h respeei:i 3rg� ,r'_ .. k,•.' '_- ,. _: < �z t, .7 n aMI-1 ,.:-,: ; . ��'.• �,- :r• { 3`csr"- ;�,':�„.:`�', =} .� .� iiSee�." �crer1�c .X,:+. :Gy .. x ..;3se.��rtfd:,...�`:n.-suYev:H �l,a:✓3.,.J..a-•�+.•v. b'4a5.f'"a'.» -:i:' -.�.a _ IN: ,� AES 1 September 3,.201`3 .,� ..; a` • :., . t.' .: � ;� ,:. .., a ,..�✓�•' ,. � e;Jry ,.<. _ .,Ji,„r S` ">'"s '.a ,£,os,�f;:.M �� „,+=` ;No;< = •• yDiaiiieter a l •%2x Diamete"'r.;r 'iriiiialS'ta .',P.ressure;;: " �Pressure�`" ra Y' •.xP„ Units 1118 - 1121 90 80 90 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable L. '• ,,, w, ., :r. 3,..:., ::.,. •. r:. =, :.>,,•:.: ` :, ;.: „ S,, <.-` ••..- :sue" '. � eCl. G'O(nIIlEAtS:Q211, 1.1 I Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 I Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 ��R: .., •�.: Y��\e��m i.,." i'Cl :" >i %.a. 3�w irv�?¢, w4 y L.jn �.�� d �� L. "Y Ei. ,,??t ys{,: :'`J: ;v '�;::=": <R3..:4.L•F��"F: `Y, R .\: ..„y: 5'r' `F= = I:. nspection T = Test M = Maintenance P='Passy Fail` NIA Not Applicable t ;Date "'.Co' ; tints �rC! <Y • 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC• 901.4 MYes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 I = Inspection T =Test M = Maintenance P = Pass F=Fail N/A =NotApplicable - n Item 6 77� NFPA """06 OM 0"1" e- 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 1 M JFDC - Backflush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 142 Yes 3.4 M 1 Comments Section for Results. . No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 Q No 1P D = Deficiency C = Comment (Indicate type) qV4, 01 07/10115 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith I Signature r Date 07/10/15 Form AES 2.2 Sept. 3, 2013 • ' • • • • 1 •' • • :.'Rh_w, „: M$"'ay.3?rFT?Y";,.. e">. "`c �•+'.""�`,..`v'.%" rov,C+i??;�'%yp`-;,..rr�'�P:f^mac°"gr�t:.'it'rT+-":'Y;4''i'.^' „�� - 01, .. . 1.. " + ' .,,� .. - 'a fie+ - T '^v-•;,' .,«=+.,,t. i ,.Tr m'! •r i',Sk.-., .�`�,..<<' crs.:;y;?K''1:t'.:a�.Y.yi ,'+ .,'t-ram€." u.7+, .s; f.r-a: -'k'`a.Rs" *' ..c,»r' w•.'`z1; Z� •.c; $;' _ ''r�. , >n •x•'�.' x,,..:. �f _,.r:, i $ ti'., _s cY.-k}:'^.vn�_:, "'S}.c. ah .1:'r�'� e+ (� ;h; s i :+..`h, '}i •"'i,`�iw.-! .,�.i � f �-.,' ` i '�;�,'�.t �'� ..`,_3+ y'�:e�5 �: 1 r �S ,,�:;�� r. ��• :.'3..r..�.>,"� ,:5, �� .;t;,,an ...n-` s�'�. ,«.�.: rr ..�s= `..�,,�° �, ��...�..�a r �'�,.,�;,,4':=°=;�:,;~:3..,., ..*� �.4J �;,,.:,_. '.t,_ -"r_: r.j��,(>i,.=>4�YY� 3T,. 3#,�� "^-E•'��Y 3= x::ik'a-'r•..r. ;':�'�'�t'. S,:^a �9�,.,4>:: .. 4=&'� �:r ;, rafr .�,"�',' �>-e ��ur,� "��t man _�_z- w� Newport Bluffs Occupancy/Use: Name: Address: 100 Vilaggio Construction Type: U - olf CA4 Newport Beach No. Stories: City: 92660 1 I _►� 9 ZIP: Year Constructed: ,�,ZQ Brandon Lawritson�� MR�� Contact: Telephone: (949) 467-2133 4 •��,:ic;r �� H� yun`CS' F R Z�.�tut✓#.rr n� i� �.-% i6r�.�e . '.W is ''w'-•- u�:F � .. {}...` , • 'i . '.k.}y<�^}"��`.��K•t`�'.."a'F .ca'St. �''n M S '`l�vq ,�`.,:`.}v�.h '.4+5� ht '%��'. <.`x�i�.'�,-. �T'£_r�., `�ti1.i ef..$- _t_."1ii��A�"-'�4if'.}'i''S'Y:r:.•,�r..L.F,j:L��Si`}'i:;i.'tt ,�'e`.R�: L.iY';L''J,rYi rti%•Y . �:.� .__.�-.�.;; �...�. ��;� �� , �-`�•�. � .�� >: � ,�. , � .-Nwm`�er of.�S; �s�t'� , s��Ys. �, -{� firtaetaFon ��a�ti,�n�` �,,� �=�,�.,.,;k:�: �r$��:• �.�� gb.�� ;.: , _ �,t.�-�.t..�4�...}„r_w.,�.�.:..,�.._ a:��a.e,.+s:Aititi >v-c=��'c q -rF�rds""e'_:X=�":�'�'�"iy�.z��"�„��Sl+.3�0•' �5...ts::.k - Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ✓❑ Owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA 0 Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 For specific inspection, testing, and maintenance Telephone: ) p p g requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) .u.r. - '� "',`C'T cc:R'; y s.,,v i...� .ez"M`.r..y d Tv..�uc^.e'w3 W •; "+t'"x- tiT-R'�'.�t"_ ,,gg '^-� T-.✓4 ''_� w; c ..-.r "s'" cdand ter. �lieri:�m�.ber ifr : s u:ed(afar i , sp,c> ion�rr;;. <n srs� 2.: y,a mob.-« Gltee5k.� boxesfo ea' oh"€s, stem ih pe. -, .. .3 .r :,.t ,. ^x�;e.. -'f •-'Y.1!'.'(+N. .•rq ,�='.'�'ilfirS .e7k,-e�1'Kg- h}:: )..n A. S'' F `W ••v:.�y'i' h+� s boxes +Fai c Pass'�io inclicatetstSE s of in ected � s em, �we cl`of ion',.` G euK �.�e X. Z Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ [a Standpipe and Hose System 6 0 ❑ ❑ ❑✓ Private Water Supply System 7 0 ❑ ❑ ❑✓ Q� Fire Pump 8 0 ❑✓ ❑ ❑ Water Storage Tank 9 0 0 ❑ ❑ Water Spray System 10 0 ❑❑ ❑ ❑ m Foam Water Sprinkler System 11 0 Lr I ❑ ❑ Water Mist System 12 0 0 ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinkiered Areas) ® Yes No e"OffY 'r¢et,- 1 i ( x.'.. ,,�;s:•':': ^w.x•adf�`-.• encl`es� d` Coo; r en's ssc l©n qy en o ach �espe It e ofi m -f.:`- Y - : i e �.Y1'. ",?�',..i��.�,4�'<`.. " g. ..,�,.. !B."'':. m... , .: 1 ;4 ";ter 4'.. Ta'�...J.�}. :t'c MFiS,ieH•�K.Yi:fiC'in r.. Fd,^.wM ;+'.S.l ..y.•'�i�ur wA..•.S`a.:�a:.. 2=�w"ASa.�YV: U.�=Lk�..Y§/+T�}k��3�w �..a'3"�F;�.><. .l'.iY. •"v.Flae �:.9�5 AES 1 September 3, 2013 1 011",175 M&Nffi 1,w atl .4 Tr "P,, R Units 1122 - 1129 85 75 85 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 0"4 1-11, W!wo 1 = Inspection T = Test M = Maintenance P=Pass F=Fail NIA=NOtAppli-cable z. -N1,A,EF ,25 , A C om jn 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 lControl Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 p 1.4 1 1 Supervisory Devices 5.2.5 P 1.5 1 lGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I jHydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 lGeneral Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 p 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 ' A •;., NEW•.>;•;?.�ik?...'.f• ;3;� •; _' i <:.,%a:if^�..• I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = NotApplicable ahem ` �., . %.: ;�; <, -..4 'E` �. ;; . • =• -=;--�:. , ; '::; ;;.desc�pY on ;=:;� .;.:;; �>: =< < `;.: =;�;' >•; .. ,:•., .4.; . .•<T M NI= :A ;25 A.e P :�-- '�teferenceF � . �`a to ='• ' om eri n :. ;�1' 'C m is t ,. , x 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes M No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fait Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 4 4 Zk' 04 I= Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable A r1l R 6 , n 3.1 1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 1 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 1 M JFDC - Backfiush 14.3.2.4 Pipe Inspection - See Deficiencies and 142 ENO Yes 3.4 M 1 linternal Comments Section for Results. . Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results ®Yes 3.6 M System Returned to Service 4.5.3 ONO P D = Deficiency C = Comment (Indicate "'o type) e1c WOMW 01 07/10/151 Replaced Water Gauge 02 07/10/151 Placed one Hydraulic Calculation Plate 03 07/10/151 Unit 1124: Replaced two painted fire sprinkler heads (SW) 04 07/10/151 Unit 1125: Replaced two painted fire sprinkler heads 05 07/10/151 Unit 1129: Replaced one painted fire sprinkler head (SW) 06 07/10/151 Placed Five Year Sticker on Riser El Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: D See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 - & Form AES 2.2 Sept. 3, 2013 ..'s.' r?:`b'::r�'�"'° .�r„�3mii a'fi'Ti•�a?'�'i. `�.�5��£, 2 } �?',J'.'a'uY Sf'r.M"�,y`.j�''�'•`�t4aF}{�+7y-�y"'�+ !+i;s.�r. �o' Infofm w�,£: ;a►1F�f:K:•1 v. J Y°i :• 'cr;,:v N Newport Bluffs Occupancy/Use: Name: 100 Vila io l f OF ca�,1,� Address: gg Construction Type: 1!— '�G p� Newport Beach No. Stories: c Y City: [�3 92660 ZIP: Year Constructed: Brandon Lawritson�'Re MPS Contact: Telephone: (949) 467-2133 C�Si✓_-°_'�af�^'c..^..,�'�'�$n .-; .' ..,°'^'�-v, rr r a^�� fiS' "u: e� �J �nF'J i.,., Fi T $ .t e`T'4 �"e' t'ti'r G : .. %3' ` n.f,� � s...a'. , ,,�`".;`t^%'�":s'•' �,�s. $t� .� t�'l �; ..i,.'�, .,��LLuu 5� �,wff�� u:4h'`::i r' °,,,.'[=' �..L :ai'�"+,.i .; Sfv�=ia, Y�.%�;sj'^'�+�y',+,9x•Y: .�r '.�_� an-;;,-;..'. •'1N�'*',,�+„,",. ��w +t_ .�, , , '.r'et,. ?��... . .t.JS �;4., �,. re .�:",?'4"�j3 k,-' fitit� ram:'* ay-Y'k:�.�e .Y^i s` `r �,� , � r'•r.��1., .'', § s•..'''§,5,,��, h��?r. � y �«l�.s�'.z."`+°� a'yJ.t��° Y'c�.4"l�x��i iv 9.�y.." - `ram i� t i��rSs ..�i>�-�SsL>m,..S.t..S.'z�L,b�� 'iia.x.�e.�.'�. .s},�`avnf�di:,Gt�.a',!&�•.tax.�'."�ky1�'i'.��+�.i'.'&dL3>�,LttuY.41-tsu:�.'3J�c+tsG.2o'�iwm.a.`�.4".ts:a3� Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ owner Date: 08/11/15 Address: Huntington Beach, ✓❑ Fire AHJ Date: 08/11/15 City: CA ✓❑ Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 specific inspection, testing, and maintenance ) For Telephone: p p , g requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#. Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) -/"'+d „Y R 51 .rS�^_'''°"•.✓i-' YiC': f$a e'rY�.,a...�^ta[ �-{^ -"^ :•. ., ,x.,' '. I F; r aEs' . :' .. ' .;H:F^ f��-�:�aR•j� t ,> µ�� +"" ":�; es �`'t" m m� c`ted a�nd�e �`fe,r�t, e�nu °eriof�formsu�'ell"foi'�i!r�sp_.ctiio'n.��, .; � �,�.,'�.X'x,� „>.�r'f�r�,,�,;..�,•�,.��,��.,�zr=�,.� �.a�..-:��r.-,. - rso wi : s �.ec ion: �,r�;,:�;•:.:;•.F.-,1�o f.l:oJ ,, �fes`,ta1`'use`of�mSpecte.ci�sY�t�'rehd^f''`n�p � •��.- ,. t f'f off = f� f ► . f Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ m Standpipe and Hose System 6 0 ❑ ❑ ❑✓ [� Private Water Supply System 7 0 ❑ ❑ ❑✓ m Fire Pump 8 0 0 ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ Water Spray System 10 0 0 ❑ ❑ m Foam Water Sprinkler System 11 0 ❑✓ ❑ ❑ Water Mist System 12 0 ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes ® No ,+� :..u3: t N �+*/T;x ,7 e+ rcw ,M :.�y{".+�t .J-'^-t. � s ,;k4�,. r:: � %� <t]rv2PS�+5�• '��ri �s��s�e� �I: o �a �e��h�"r s��'�ecitl�i �-,.'for ��.��,. �`��a 7v` �f ''.t}.4•k{"iri' .'..5.' 1-: 'i �"itntiy �:,�.�_.x�,.,�f_ ��.d,�:��:� ��w,~�u�...N:r,�n�� i� �,�}•�-r,__.�,��. AES 1 September 3, 2013 '. '.� '. :•W a<%',. >�. �� sC•; s,. yy, t'i".'• .r,5;5,�..N! •..' .' ai.. ;- ., JNr.=rr§..;.i �i-„•y ,•__ �� •')a"'; -f. _1'c%.�s:'-.'�Nrss i..S`„=a ia. fd �� "'3 a'y`r SJ'S�n p�� v,; w s hswk' ' ,.. , ,,��; • i S T,a, :'?" 6 ,.„$ ', 'r,f1^.v' ' y'y'b,A;;J% n� ai^'j, �•'T';:#,sF" ��, , s :" . R er "' NfafinrD,rairt initial _Static Residual°,'. '`I= vial Static`: 'L ocati4n ....,:, . G •'^: >;.; ' P9ssure ' ::`Ltariieter%�. '=''Diaineter: � ?Pcessurer . - ��Pressure>,,;. .'x; .��4 qi si < ;- �P; rF; ;NIA i �... . Units 1130 - 1137 85 75 85 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable :::I#em ".:.: ;, r ' . -. ... w .,.: .• `; ::'•� , ., _ • .... , Descrlpbarr.:: ;;. � • FPA'.2' - - �%� Gomnrtsflnkjr .p =ILA? 1.1 I Control Valves — Identification Sign 13.3.1 P 1.2 1 1 Control Valves — Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1.4 I Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 I General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 I Alarm Valves — Exterior Inspection 13.4.1 P 1 Pressure Reducing Valves 13.5.1.1 NA E1.15 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 •�,}'%'''. £Si=�a, .fr,L�v;�.,,t53;:Z�}eS :;, ,x,�';4S�iv+ A e � `°4`j. �;m+ w. ,�;ew.¢.�.=`A i.;(.+' �. x• = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable '... _.,.. ':. : :; "Devil' f p :`� -' :•, .: ' <` ",: ;4z5~CA e, > Referee Date': :.` Goepme tsdnl}r • f.• q P, ;NI „, 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ®No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 ;;Iai I= Inspection T =Test M = Maintenance P Pass F = Fail NIA = Not Applicable NFFiA`,z26 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 p 14.3.2.3 p 3.3 1 M JFDC - Backflush 14.3.2.4 Pipe Inspection - See Deficiencies and 14.2 RNo Yes 3 A 1 M lInternal Comments Section for Results. Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results W]Yes 3.6 M System Returned to Service 4.5.3 nNo P D = Deficiency C = Comment (Indicate type) 'R s, it M Ica 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Replaced one Tamper Switch 04 07/10/15 Unit 1131: Replaced two painted fire sprinkler heads (SW) 05 07/10/15 Unit 1134: Replaced one painted fire sprinkler head in living room 06 07/10/15 Unit 1137: Replaced one painted fire sprinkler head (SW) 07 07/10/15 Placed Five Year Sticker on Riser E:]Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 11 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 i • • • • EEM ".L,'�^.-,�,'>�'�.v(-; :7, .j7 ..`�::'t,`. : r�.`rV-:'dt;a::�• �"..�i'"....^i✓�..6.'t".=�" '.�h i: .�, •"-rr.y"+,�'.'+:rQh`A�i F.t �=�._�i�-T4p',Qe�'`.Y.rv.�;f.�.Yit sT':'� •:I .:��-0: S.,`�K�..','n4 ::.,.a.r vn`"=c,h,r-f.==�;.F.�>.iYS:4Bc+.N"�+.^.,i5",-�.+At..v':�'...r'..i: m� w� :� , ;.;�.� ""aC'.��'ii �'oRPii�;a.:�St."�%:�a> 3�.x.��t,y.� ,.w��r.:P;.�;'�3x�g%r .^ �t'�.�.,gYy.'y-�t_e,5�cFtj..� �.srsi.+'e'�7>.£fi�• 4n-':4�^y>�-� bfi ,qx'-.�.d�_-£L.A'tt^,.(:J'+p+c.<`a-..5,�i2 ��';�fi.RYiyR,om �.7,.nyx,i.d�k�.� .iaM;�'t1t.4hi��•a,,Yi:V?«,n-.:-^=t��`'?sF,fer ('�-�,:4,' `-,ak'r.-a �. "i/i�'£=�^�.d,i(xt+��•.i-:�4``•�:.3i_.a,a�;., .S'l.nrtsali .iJ;.i';�C-tK.?�z•4i+3�er^v�a�i...�`ti=}°�i ,� iy y:rfi„.aMttn.�" Bluffs Name: Newport occupancy/use: - l 100 Vila io 1 I Of C'4Ly,�, Address: gg Construction Type: V— ,�� O� Newport Beach 3 No. Stories: City: y ZIP: 92660 Year Constructed: Brandon Lawritson Contact: Telephone: (949) 467-2133 a?s;:"'�• k'. &.l. + �: 1..i.�` sl -y-,�+ ��i: �,w rL .+r�l':vv c`.'�k' e�i(��l.A��.ia��'.SR.4�.J�`�vN.-, S�':G7. I?y< 1�4 t. y.w.t_4�:t�'�'+�4:ti�su'-li +f, •L['�.=rrr ts^ Jt ay'i we ice.. �,:.�.�`.`Y rya.%.�R, �x �, ...f• rfn �„ �,>-r �: �� .,�.,��a,,;;��-,,.;,,� � ,�T �,.I�tirm'�er•'o��Sj�s e�ailR'�ers,- 1.�;� �:r�-��n :y�, ��:IePN. 01L01, Sac. t j"•. �= - r. h� -fd*�L. e.,v..: t e r ti'sR,- .,�r}'� Fsi,,, �.�^ t ?'t�" ? �•Gs'-rr ro-. fct„ 4 ; ixZ'. '�� ,a:;�s,-%ate, "ay,.,` •a�s;r.:ax l" -• �:;�disaa:@.,ritS".tz ari.:,�+c� Av3ai.?;`'Sa ". Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive 0 owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA 21 Contractor pate: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection; testing, -and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) �•..��ry�. � Y . �; � ..;�.� Be ii0'X410rt`eaa ls, Este' e,a1�aF��'',;?y�.:i „3'.`r�-44.k>''-&'„n3N: ✓,aa: •�t,(�M�a: Yn,trr.n,',- J 'des F�ai 'o`"rhPass %nrlicate sta!Gus�ti•of,,ln""s"pe`cted 'steiri'°�a't a cl�o'f :a x 4 yWh 'yi• '�:=i ?' o F'[. �±'vulT_,a-s"R:.�1� il'tL�'Cast!-.�i.W....'-Cafk�k:�4i�i�T4��lS`?.:.ti Y!�'+i�tLi:'a�..d's2.1e4��3:itT:=.lJ�i.ai::.�ir{:>xis'.a.1:Na.izti+:�+i.........'.{•w'�i MR?, • Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ • Standpipe and Hose System 6 0 ❑ ❑ ❑✓ • Private Water Supply System 7 0 ❑ ❑ 0 • Fire Pump 8 0 ❑ ❑ ❑ • Water Storage Tank 9 0 0 ❑ ❑ m Water Spray System 10 0 ❑✓ ❑ ❑ • Foam Water Sprinkler System 11 0 0 ❑ ❑ • Water Mist System 12 0 0 ❑ ❑ ❑ Yes No 0 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) . w .o'''-,YF"-"v's"`4�.:'=w",^..R'- '-1, ,4 .} 61, ) ' �^.'. t:},e} �r�=wa :-iti}S�R�k'Y ��i. �,«' i;:,::: .;,'��711 eci�neies.=a dC,omme� ecCn,atedfreac�h ��uli+..ii�':fes�-_ :}t,sirod�.b.....�kn �rK •`:�c... .:?t.'R+... NON 3'•:,Y+ .,•W^t�,. F.Y�.�v; N.3`. u�7 ,Se? .D.s'�iaA -E- :.� A»Cc�'�ie` 'Xv .2- .3. _ 'K�*.:'.$�.«i�+b rt.�., e r. AES 1 September 3, 2013 „i1, a;/,a s Ott xCl:e n8:=•.3,�,.'';',n;x , � Si: •F �.'�,'.. 41�� > x< ,, �-.irial _ :Rt diameter:• . •<r;�iii:'g `;;Qiametei•? ` b< ;t . 7rntiai:Stat ,.P,r'essure'- �e's"iduafl� =� ' Pressure'. ;. -�F 'StatlG ' > ° t?re`ssiiri.r "P �.:,. Units 1138 -9141 85 75 85 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: ��` . ,';9g�+�t^"..,�,y ; `.i.L`.a''.4= Ve:�,• =3 t .-...4: �� et � t �j�,�', +•.�-I , ) d- .,� �•'lV^ ;j3;:FII� a m�II�.F.. 6” W Y II-D�.•nw..,A".":°„i",�,`".°:.:c;".fl °,:S"sy'?•.4...,• <;;s:: •.. ''v:'e -....e. . ; .<. I =Inspection T =Test M =Maintenance P =Pass F =-Fail N/A = Not Applicable ,liem...:; sz ... <. .. � •i. '� :, %: ,- ^..tea _ .°.n ' FPA; ZTasGa4�;.= f2efereflce:;:'.: ' Y. <i � -Gamme'ts::Unl" 'P°�:;NIH;' F 1.1 I Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5 2 6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 I General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13•7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 '(%�,,:,'tt''£sk�: ;"+'`.`a�,: Et'•;ivk,,t'� r. .; F,i=„.�+.{.a^.: •`€�P+: d W!,,, '� ��ENB " MC b1 .,�•e .Y;•,,:. Gu,,.:> i:°bda0 n�•aii..n.',.•i 1.T•, K = Inspection T = Test M = Maintenance P = Pass F = Fail N/A =Not Applicable v, tem ':,,:-.':'••.. x.,,...: .. .....,. •,':.. -. ...,r,` :.:;- .: Descripflon, . >;'• -` :.-�.,:y.••; »•. .,: ,,_', .ia„i ^_:'!,: :.';": .`..ice. •'ti.,,,... PA 2 a.h._ Vim,+• =Gamiments;Oii1.;':.-'. •>. 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'P until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 r-.09011�0;Ak 40W • I Inspection T =Test M Maintenance P Pass F=Fail N/A =NotApplicable 77 !o -NF 5,C FPAl Pat - 3.1 M ICheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backflush 14.3.2.4 Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M lInternal Comments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 E]No P D = Deficiency C = Comment (Indicate type) & '-Wimnenft bn 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Replaced one Tamper Switch 04 07/10/15 Unit 1138: Replaced three painted fire sprinkler heads 05 07/10/15 Unit 1138: Replaced one painted fire sprinkler head (SW) 06 07/10/15 Unit 1139: Replaced two painted fire sprinkler heads 07 07/10/15 Unit 1141: Replaced one painted fire sprinkler head (SW) 08 07/10/15 j Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith 02 [Signature 'Date 07/10/15 Form AES 2.2 Sept. 3, 2013 .- • • "'.'Y. +:A'{.`+f•'t.i .�C'4Ul'c :,."}!Y .X.'•� .''•ftv�> J %'•• .� .1 _ •S ry :aeL`4`!•";wc'.i.:. 4� .. :a;ir•.,s •-}„::,c*,�T�„; '%�w ::r "E' .{r{.4a f„' .. �:'3rm'.rFg,. `-Si., .:'fi,... `fci F. �y .:f �1"e✓`r,�'1�¢'.&i*•...r-v .;�w 4T'..n'; �Y^."`'�` ,Yoxea..N'+l3gu �r exn� .ss.;:-.�.�{"S;-r'i"w7;, .F ..��,1,tv t%,• 1;:i 7:i�Frr�Yayi %` ,A Yam. .;.!v tul,.�t; 51g 7•Yu, a' .�T I.l:)ii�.tii.:4x '>-. .�%J�,O ` f'ti`��'inlftarrr��a�_IO'. :�a.', ,�=N.'�Y.�.•:f�ta:azaL �. �p:3.^�ib%�!r'�•• c�'.'�,3'S '�.-,f'�'..�i,}�9�'i}rs;�,}".G1:=.:ri•afY}"rca'-'=,lfxts/i.�.�,'.�r,a�u i t:-,i"` dt'i t �i v�?y�'f't�'°„"<,��=s4'�,`'�.,'a•� .ty�('.`4::� .t'� :a,�-:;.Sit:�,n`-;'1i'.ii-i�1n;,,,s,"�`,'8�.s,r u'. a+x :,a. - 5�z�, _ .?. dName.. {{''�� +.IcN, J Newport Bluffs Occupancy/Use: Address: 100 Vilaggio Construction Type: U- �4��or CA4 0� Newport Beach 3 x No. Stories: � a City: y 92660 1-1� 9 ZIP: Year Constructed: _; �Q Brandon Lawritson�� Contact: Telephone: (949) 467-2133 r, 4♦`r'"�i�'Pc". ',f!� ):. .. '++`-tr�'N^�5'tr ij�14 '+'`'^�'e,�',3 ,{� e+��,j�±"9'�.�.$.+''�y'�f�.�` 'r5'�t,�•J'.^�`�$.. ^Y`XL?.H::'+�i „,-iYt .K,sG .;,.v'a;••�>^v�:x�4fm�.Ya�. �'~ii•f.S'f�:"yr w ..h... �'1r,t, .f,.,,,�F¢�n�cr� � lY..tti: Y`t11..,,4: �>,.�p •�:a'�fj�rr ` {itw,�i2-... ��'Si,� �'F'�*�.41.:��'Y" ` �1 a l : �A�'td+ AY _ �wri1��. i'x. "y` ' �.a. '; �SNI't`�.-' Yr'.- � '{i ..d n is . , � • tro,n:��y,- �,��:�:��• .� �.4 �a.a�� er�of 5 ��E.e"�' R��sers,.�.- � �•, ,... � �:4.�,r,a•..,-. <� � :.��. ,�,�� ..� Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive 7 owner Date: 08/11/15 Address: Huntington Beach, []✓ Fire AHJ Date: 08/11/15 City: CA ✓❑ Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 specific inspection, testing, and maintenance ) For Telephone: p p , g requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) -, �.� .„ ...� ,zw+a: ,., _ x, .c,r'7•,� "' yu U9 „+.. x.« r"�, rau C,e.a WR ..,Y.. ,. ' ..�q Apr.,- r 5 r -- „* v.�: J,r, :�F� •i «- k' <�i"z.,."'r; px, are: �.: r :° c s' fe siFis ecedand a fe,%sthe. fi ,bero o s`iise fo „i'n o.ri; �, �,�,� . r_ , � { C't�:ck boxfor a hn f j�I x ': O �.,, j� ,gip �a:` �,ta:;._.�' ,,,.� .x.'3,T�f..� ..,Kaa.,; . t i�f'a,Y'x?x ilR i"I' J ' :k:.G, ' z a'i�a 4„>s (, :w "r f''t k^ /.;:, k-��'ev ,. 'rTv.... !i..r3& ., aS • ` t tl s{�em,'tercl ofins ec;ron+ �'<. t;rF'zs -G.fe boxes fail b' Piss :o �n, tca exst"afus o•,f{spe , S3?&;,'�4'S�.xRly aaw•:y.�a.,,,.,,cs::'�rn r "�+.�,'�:=,.;s 5 • Automatic Sprinkler System 0 .❑ ❑ ❑✓ • Standpipe and Hose System 6 0 ❑ ❑ 0 Private Water Supply System 7 0 ❑ ❑ ❑ Z Fire Pump 8 0 ❑ ❑ ❑ 21 Water Storage Tank 9 0 ❑✓ ❑ ❑ Q� Water Spray System 10 0 ❑✓ ❑ ❑ Foam Water Sprinkler System 11 0 ❑✓ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ ® Yes No Concerns that are not deficiencies (i.e. Non-Sprinkiered Areas) n .,�;'�tr�i: z�srPeaq .,•�'k=^^n, - ="4:'.,a-,'',�a.,�,"'�,; . ',''T�'6w 'a.$ 'rr.'z'� S , P`< 1f A ' ur=_ s�ctl®., � e d of re`�.e t o m .�- �F �6� f '� • e sna I7,-�.-3�•�,r'.:s, ,�.,3".,«i•�=rG'� "F d`r4 u�:aed+•�i , ;men ,s+� kp"' ,�.ta�:"= ..�,,�� ...0 „S"�,"an' r '..cErr. x..x• �rc4 .� 4..x �m.� 3»Am..�;.,.t b,-a..�t..�.....,,-.•r See�Dlen,� Qom' .5 ,;:rK-•c::,u'.a�ii.:x;r AES 1 September 3, 2013 T J Ani virttiffl6z atloh, si Units 1142 - 1171 90 80 90 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: ;K ako I Inspection T Test M = Maintenance P Pass F Fail NIA Not Applicable '�Ddscrlp 2 e ae 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 jHydraulic Design Information Sign 5.2.6 P (For hydraulically designed systems) 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 lGeneral Information Sign 5.2.8 NA (not required for system prior to 2007 Edition NFPA 13) 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 jAlarm Valves — Exterior Inspection 13.4.1 P 1.15 1 jPressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 - .3`�,'>: •.:^ a .3<a<t .y„>>'.: �,t tt a $' 8:W9}yF ,�� , (<e, M•:t Stk >•'F..': Tz ,�:'\�i; ref'" „u+. d(l fr% m� �` A e yam t��e ' `,3:b'4'�� '�"�a`RB., '3 �"t4..at $ Qm•' � $ n $ A ,R <y4j,, �,.�5.�,` � ss" , •F�h„�„a• •»ems, ^^.t'"� .$l�uaa .: i'C:<i`��j,�M• t.26a'. ;4�aa W, d r•A a:3`; i.; .1..—,,.�-�: =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable f m: ...;:':.• >::, t- ,:.::.. p ,.; 1VfiPR25>CA'e #�efsreace'= Coir�nientsOiil ..;,•>_,,^,,:; F,:N P• %A'::� 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes 0 No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 ISQ, "M � ft�*' 0a I Inspection T =Test M = Maintenance P = Pass F = Fail NIA = Not Applicable )n NF • :,1P 0 men "bosdapt'c'GA P .qk 3.1 M ICheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backflush 14.3.2.4 Internal Pipe Inspection - See Deficiencies and 14.2 Yes M l3.4 Comments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results Yes System Returned to Service 4.5.3 No P D=Deficiency C=Comment (Indicate type) Riser epciencif Oto fid, 01 07/10/151 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Garage 200: Replaced one painted fire sprinkler head 04 07/10/15 Garage 207: Replaced one painted fire sprinkler head 05 07/10/151 Garage 213: Replaced one painted fire sprinkler head 06 07/10/15 Garage 224: Replaced one painted fire sprinkler head 07 07/10/15 Garage 252: Replaced one painted fire sprinkler head 08 07/10/15 Garage 256: Replaced one painted fire sprinkler head 09 107/10/15 Unit 1152: Replaced one missing trim in bedroom 10 07/10/15 Unit 1154: Replaced two painted fire sprinkler heads: bedroom & bathroom 11 07/10/15 1 Unit 1160: Replaced one missing trim 12 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: CI See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith P Signature Date 07/10/15 Form AES 2.2 . Sept. 3, 2013 'Ins•ecti es MM,-and-White a 66�t Sheet n n 26asamen NF-PA dec•1;by',CCR"T1t1ej9 "T, 41- 1 4M 1� -, fq-- W AWR AMALRTRRITRIM LIMITIREP, Newport Bluffs Occupancy/Use: Name.. Address: 100 Vilaggio Construction Type: Of C 4 Newport Beach No. Stories: City: 92660 ZIP: Year Constructed: Brandon Lawritson Contact: Telephone: (949) 467-2133 Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive 21 owner Date: 08/11/15 Address: Huntington Beach, FD Fire AHJ Date: 08/11/15 City: CA � Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1 (a) em f e gq, qdfiifi, "A X0014114RAt I51rfR6`fj�!.7,-,*'?--11�,� ge '7 . lngp c ttv—n,iJ spea To 'n, Masl 'd t4maX WhUtR, MR, 01 ffindicaU 16 T M 41 g 9F, -ZFW.� EMU- R— 0 Automatic sprinkler System 5 Standpipe and Hose System 6 0 QI Private Water Supply System 7 0 Fire Pump 8 0 ❑El EL Water Storage Tank 9 0 21 11 1:1 Water Spray System 10 0 2 ❑ El Foam water sprinkler System 11 0 Z El El Water Mist System 12 0 Z El 0 Yes No Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) 7�70PUAWAA� "INEF'Mo- =,,R, uR� AES 1 September 3, 2013 :R "fina tatic ,- , - ""'; Riser r 'N Units 2000 - 2029 90 80 90 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 4% Inspection T = Test M = Maintenance P=Pass F=Fail N/A =NOtApplicable ite zz n e 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 lControl Valves — Inspection 13.3.2 P 1.3 1 lWaternow Alarm Devices 5.2.5 P 1.4 1 1 Supervisory Devices 5.2.5 P 1.5 1 lGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 jHydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 S lk Inspection T =Test M = Maintenance P = Pass F = Fail NIA = Not Applicable cri 06t Ot t 1.17 1 ISmall Hose Connections - Hose Valve' 5.1.6,13.5.2 13.5.5.1 N/A 1.18 1 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 IBuildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 ISprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 lHangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 jUnsprinklered Areas CFC 901.4 ®Yes No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F'until results are returned from Lab 2.2 T Recalled Sprinklers If not present= Pass; lfpresent =Fail Title 19 904.1 (c) -P 2.3 T Water Flow Alarm Devices I go secs max. Enter time 5.3.3 13.2.6 60 sec. 2.4 T IMain Drain Test (Enter data on Page I of this form) 13.2.5 13.3.3.4 P 2.5 T lControl Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T ISmall Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T JPRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA -L- Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 Inspection T Test M = Maintenance P = Pass F = Fail NIA = Not Applicable N17PA-,264-A,at Date 3.1 ii M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 14.3.2.3 P 3.3 M FDC - Backfiush 14.3.2.4 Internal Pipe Inspection - See Deficiencies and Yes 3.4 M Comments Section for Results. 14.2 No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M 1 Deficiencies and Comments Section for Results 1 ®Yes 3.6 M ISystem Returned to Service 4.5.3 E]No p D = Deficiency C = Comment (Indicate type that i�oopfrpd" g 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15, Garage 400: Replaced one painted fire sprinkler head 04 07/10/15 Garage 421: Replaced two painted fire sprinkler heads 05 07/10/15 Garage 423: Replaced one painted fire sprinkler head 06 07110/15 Garage 424: Replaced one missing trim 07 07/10/151 Garage 440 Replaced one painted fire sprinkler head 08 07/10/151 Garage 441 Replaced one painted fire sprinkler head 09 07/10/151 Unit 2012: Replaced one missing trim in W/H closet 10 07/10/151 Unit 2014: Replaced one missing trim in bat hroom 11 07/10/15 ' Unit 2017: Replaced one missing trim in bathroom 12 07/10/15 Placed Five Year Sticker on Riser E]Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: E]See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name I Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 MR 7z"'Ur 4 Newport Beach No. Stories: City: ZIP: 92660 Year Constructed: Brandon Lawritson E ta pg Contact: Telephone: (949) 467-2133 Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive Fv� owner Date: 08/11/15 Address: Huntington Beach, Fire AHJ Date: 08/1 1/15 City: ' CA Contractor Date: 08/1 I'M 5 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#-. Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1 (a) Fl hffidR"EnEP edefflf Automatic Sprinkler System 5 0 Li Li Standpipe and Hose System 6 0 ❑ El 21 Private Water Supply System 7 0 ❑ El 1Z1_ Fire Pump 8 0 0 0— Qi Water Storage Tank 9 0 77 El EL Water Spray System 10 0 _21 0 EL Foam Water Sprinkler System 11 0 21 Water Mist System 12 0 concerns that are not deficiencies (i.e. Non-Sprinklered Areas) 0 Yes m No 7_,��F 7; W- �WF'F7! T-7 'E' 777"�' RAN!, ga, 7; � , i F I � Z �_ � 7 WT 3 Q _7 AES 1 September 3,.2013 7-, 146 -, lam , e; ia P-Or _y Units 2030 - 2056 90 80 90 P E] This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I= Inspection T = Test M =Maintenance P =Pass F = Fall N/A =NotApplicable 0 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 IGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 lHydraulic Design Information Sign 5.2.6 P (For hydraulically designed systems) 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 lGeneral Information Sign 5.2.8 NA (not required for system prior to 2007 Edition NFPA 13) 1.11 1 jHeat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 lFire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1 Pressure Reducing Valves 13.5.1.1 NA E1.16 1 Backfiow Preventers 13.6.1 --- I - NA Form AES 2.2 Sept. 3, 2013 RP' yKw $ 0 = Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable item> ,: .. ,:...:. :........... •: ,-; . < , :.; •: Reference'`" wD#e<: •. :.s... ininents:Cin.Y.. a• 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.23 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Pagel of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 SWAN Q! M�, I = Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable ff— I I'll., I I I NFRA" 7513k d -Je , " , , I co On Rik 00m,rinents es74P jj�je7r 3.1 M ICheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 3.3 M JFDC - Backflush 14.3.2.3 14.3.2.4 P Pipe Inspection - See Deficiencies and 142 Yes 3.4 M lInternal Comments Section for Results. . No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M I Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 No P D = Deficiency C = Comment (Indicate type) 4", , sAn �- omi 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15, Unit 2049: Replaced one painted fire sprinkler head in kitchen 04 07/10/151 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: E3See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 �';9'+e ,.':•'.u„y` Ra .4 Fb9V, �.,"�.«';J�,:'�-vC`_.`.�"„;3+}i�.L>f:°�S ��^4d°ER?'�`yEi: ^o-�p'*W'i �-L��„+"'Y' n3•,�..��.�.�'"i'^;FF'f� is ��¢� .�! }�� a+ t.f" s.,,.::. �.:;"� ",,•y ti LY"e:•:'�"�T`4i .,-+.tt ^'. a-^".,.w_(3"a`-� ,'+fii--'Stu"F' •.:±.ma'.��(. "` .g_ri.MSt?`�+:£ ,cP Cf"✓yvi, rfY;_3af J�a n--.M'f^!�i m!, '`y, +t. .k0.�;:z.,%urn daTy,=-,v�'.3',^r'vP' !K:e'li^`i :.,: ",i'x Zi.+t�+F, wo-°.'s ,�+.`u �'i`�:.::yy,�,F', ,,.'`i� ...^a. t, ;tk.,i,....: 4i" .,}.9A 4Vu^}�'3� .�_. jC.R„ ..�.�'.,. ..��Rn+,7x ...,Yates: k'•':..>, �i': L.v� $.�:�„�y,i`r�{ ,k:;a-..:}..t. ..�e.�.y+u-. K � :.i),..�• %' ?!� k w. e'r f .•.t.; .-.,, .f lx.�; A•2i, � µ S..& • 7 , " A n r ti S; s.. %' J�`' ,t..; • i�;�0.s1,-L-�� 'bl0p;:i�-'�'., s .r•��i�3,,��,'s�'•,�. t'��.meeti�^�S-�M��'',��'�' _...i<iM,*� .Y:1>>&i�: � ^A Y., a"{� �<.rs .:, �r .t._,, - �, �� .,-.w��r::,: ;��i.. d�:•'. ,,�-,.,s a r�: x"°iipe�Gy�, 1�. .i'fF".:: �t'-'1,�"ii&,.,,:�}�•. w.:;is..�:�"�n�"�'�'4L,. {µku a. �: a'Ssa.-..m. �!L'�14� .rl i><.,:�a.��i 61`:6-s, ,,.}A,. 4.i.S�N� Yk.0 .•k 9,:'Y�4P'i.w ;. i�i�fwi�7,`.t`1•a :�,S.i1uAYa7'...3.atata �.�' u+.+l.wf, N@WpOrt BIUffS Occupancy/Use: � 3 1A- 1 Name: _ Address: 1 OO Vllaggio Construction Type: � ��OF Cq4��p� ht B oreac CO A Newport No. Stories: City: (�� 92660 19 ZIP: Year Constructed: r.g Brandon Lawritson Contact: Telephone: (949) 467-2133 .'u°M�a f..-•'<[.;.^+'.Ia,�1 t'4 � .i. ^iit�•}•t�}i ` 15- 'A'r•� E: ` u�� - rYe.l*-r�ti" ��t, : l:c�i; k a s'i.: ,.r''�.• <, �f•�'.L .`"�":'.[, 1`_+i-.4'='.{t^M,i f 't'�'i% 'x4. L )''ry:v �yv4`.` '#1`:.fP�'�..; .t+" .v^`�•.'y {� �'Sr'i.�Yca,�G sr •�. �'f^n. �, '�>?��.''•r"�ryv-••-,�-�kS.Y��' '4 4 � :.Y �: �� _� :t+ii iwv ,.A"sT 4aTif1 ".v "3'k ryrt.f � p r. � �•�, r r.�;#� � _ ax'�;�,,�, `„�, �, .�'�w�,_ :��':��. �•...::;�'��:�`iemb. r°of Sr ,ste Rise:K�x��,��'�. �is,:'��:�-•,xt,,-,w:;. Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive 21 Owner Date: 08/11/15 Address: Huntington Beach, Z Fire AHJ Date: 08/11/15 City: CA 21 Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 For specific inspection, testing, and maintenance Telephone: ) p p g requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#:. Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) 4}1'L%edF'�kb..ue��u(�r3s.Ft;�ovary .•u oop000w 0 ❑ ❑ ❑✓ 0 Standpipe and Hose System 6 0 ❑ ❑ ❑✓ z Private Water Supply System 7 0 ❑ ❑ 0 m Fire Pump 8 0 ✓❑ ❑ ❑ m Water Storage Tank 9 0 0 ❑ ❑ • Water Spray System 10 0 ❑ ❑ ❑ • Foam Water Sprinkler System 11 0 ❑ ❑ ❑ • Water Mist System 12 0 0 ❑ ❑ 0 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) © Yes 0 No y, r :�y s"'�" ?} .y •�T '"'-'. n"- C a' *' .;', ot. .: 'i".'.'�,'f' 3i`,'wj:�i` ,,,^ "r.-i" � efi:c'�enr�ie�an;d�Go �,Ezts.:��ecfii`�;rp;'aa`f�eyi;d af�e,,a.ch,resr�eofilue�m��.,s_>t; _a��K,u�,x�:.l, g,,.,Y .�>� �"�3a; ''a. `r•z%- ;�. `,-, � �-.•�;.�� , �.�. ,. ,�- •'�ee�' ii :a'a wa-:.��:a, e�.?':::.. sxe'r.,k...:."'.,,G?..L.,..:-^.Ydu„+."�,rt�_"_,+:aT..�.X.%Vie-.�;.-z4;•. �,,.•�. �:?T�.zam".,c.1��s�wrr •.�...-,i•-vu4�.C�'91.�.•x�.,t...,,A�.�:v.•.,v�Nen,,s�++�•ava,cr nav�via.,ee., se. �r1 AES 1 September 3, 2013 'air 15 "Statt Units 2057 - 2058 85 75 85 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: �, - W-011 W I = Inspection T = Test M = Maintenance P = Pass F = Fait NIA = Not Applicable te"" scrin iid N e0k pnts-O 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 1 Control Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 ISupervisory Devices 5.2.5 P 1.5 1 lGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I jHydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 jPressure Readings Acceptable 5.2.4.1 P 1.10 1 lGeneral Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 1 Fire Department Connections 13.7 P 1.14 1 jAlarm Valves — Exterior Inspection 13.4.1 P 1.15 1 1Pressure Reducing Valves 13.5.1.1 NA 1.16 1 1 Backfiow Preventers 13.6.1 N Form AES 2.2 Sept. 3, 2013 z by- =01 ''M fi 1 = Inspection T = Test M = Maintenance P = Pass F = Fall N/A = Not Applicable , ....Item, •. ... ,..<.�,..:.=..,` ,..,<>,, e , IVFRAr25'CA'etf.; onm 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 040-0,vi- I =Inspection T =Test M Maintenance P Pass F Fail NIA Not Applicable UF1 11 -15- 'PA'2 ... .... 1 -�'.;FNIA .... 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 3.3 M JFDC - Backfiush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M lComments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 m Deficiencies and Comments Section for Results Yeso I 3.6 M System Returned to Service 4.5.3 0 Nees P D = Deficiency C = Comment (indicate type) Lute�,'R.Jsier ;`7�eficcericie an 01 07/10/151 Replaced Water Gauge 02 07/10/151 Placed one Hydraulic Calculation Plate 03 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: E] See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith X Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 M77577,F,, '�7mMo MV -TUPRNUM Newport Bluffs Occupancy/Use: Name. of CA4& Address: 100 Vilaggio Construction Type: 0 Newport Beach No. Stories: ) City: ZIP: 92660 Year Constructed: Brandon Lawritson A Contact: Telephone: (949) 467-2133 ME,! 110 � =1 YNN. MIR Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive Fv� owner Date: 08/11/15 Address: Huntington Beach, 0 Fire AHJ Date: 08/11/15 City: CA M Contractor Date: 08111/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: 510-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1 (a) RY 0;i1*'1164MWAqi MIA! pr' gftg p6gpece, -n- gm '�� . , ", � "..'M I - -f� A, 'A dtl Automatic Sprinkler System 5 0 El El 21 Standpipe and Hose System 6 0 ❑❑21 Private Water Supply System 7 0 ❑❑21 Fire Pump 8 0 ❑❑0 Water Storage Tank 9 0 77 ❑ El Water Spray System 10 0 Foam water Sprinkler System 11 1 0 ❑EL Water Mist System 12 0 21 El 0 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) Yes m No 'a =T-Yz F17 7,��7' e., , 7-7 5,M1, 05 AES 1 September 3, 2013 :+•. :.�� '« � �':ti"'d� , J<, � fY.e,,, u:."Y� f � �: 'F, _ .£ F � 1•�� 'r'i.; •� ;`oj<;,>=%i.'%m� ..,.�,. ✓.'r . i, '°` i �.✓, <i,e'��' � :•f ,;% }:. � •`Riser °a;�: -11llafn orairi=: �ilri'i#iai S:ta i <l.ocatiD`ameter\' Pressure' ,gam,, ,$,,,�� 5 .'%�, »•nq,�?!N�'�r="� :'iluai=•:: ''FiTiial>Sta . F'.'F;'N ;Pressure Pressure=<`.' Units 2059 - 2088 90 80 90 P J] This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: gyp-j.tib B_ @ ':� 0`,� iga WKg r ,�.,,,y .%...• >� "e•'xNA ""b =Inspection T=Test M=Maintenance P-Pass F=Fail NIA Not Applicable ::'Item•:; ._�;"•: n-„ s+c, on ' :''.,,,:;....:-�•: 'De'-r•�pti mod'• -;e .<Dat e,.,° m. Y 1.1 I Control Valves — Identification Sign 13.3.1 P 1.2 1 1 Control Valves — Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5 2 6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA F.76 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3,.2013 Y1F 'Fn`i—�t.•�..:, •k uses kV e:y .� mi. ''y .:t;: ! .Y' .1 „�.. ..•y,'t'g.. .et et- $P' .i>Y✓t�''t.. S•..,.MVY. .&a'rR.`t:Y., ,.,,.:(atl�'¢i'�ai3:'�..u'"' i,� 1 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable Item ....:':'..• :..-, , :: •.; : v .•:,: ' ?s .-. .,:. ., .., ...... :NF, . A ,. .. , :. 'a:, .:`J„s, -coininents oiy iv.,: %.:. ••..5:'<: Dye, .' � _ .,'. 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 NIA 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers -Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 ( Unsprinklered Areas CFC 901.4 ®Yes No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'P until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T I water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 177, T W Al Inspection T = Test M Maintenance P = Pass F = Fail NIA = Not Applicable -MF 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 14.3.2.3 P 3.3 M FDC - Backflush 14.3.2.4 Internal Pipe Inspection - See Deficiencies and 14.2 RNo Yes 3.4 M Comments Section for Results. Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results -- - Yes 3.6 1 M iSystem Returned to Service 4.5.3 E]No I P D = Deficiency C = Comment (indicate type) p,' 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 2060: Replaced one missing trim 04 07/10/15 Unit 2063: Replaced three painted fire sprinkler heads 05 07110/15 Unit 2077: Replaced three painted fire sprinkler heads 06 07/10/15 Placed Five Year Sticker on Riser ❑Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith I Signature o, r Date 07/10/15 Form AES 2.2 Sept. 3, 2013 � Je�T :; -!i. - f ��R r.�"4• .,Mfz. �Jt;�u>� �ay�-...: �.?if�fl'M�iM1V�. {tY'FC•a'�ni�n'-.� r?�v°p.`ii'3�•YT'�+`ti�='.$�t,'�q''�m:-v °t`.r�E��.'��"` lw.. ^ti''riMz-iile'� %. �" "..*. -`�'� «"14,�x!a.�r�`..�-"d :-i..;,u-v`` 7,e:;e;�x.r.;r,:r;,d•.. :'-s:t Hsu, = `, Wr .Suae av4 la } ?� �� h4v :3 ^`i =;KH'S-IYs`"^�;�'�,,;,.. Newport Bluffs Occupancy/Use: R _ 3 T U- 1 Name: �QCP Cq� Address: 100 Vilaggio Construction Type: — 1z y No. Stories: City: Newport Beach 3 92660 1 t 1 ZIP: Year Constructed: Brandon Lawritson�'� Contact: Telephone: (949) 467-2133 6:R"S:C�FP , s '�?'zm'#;°�.^4 .�� p-,s: r,�>, - �..,, .;f.�: .��1 �:.r_�t;.5�1'r;;`_ 4 'r 'r _ �'� "•'x' cs' . �' ,°f - ;�.'-", 3 .ti ,$r' S,-p"r, _ a,i:, y"q+ F,� - ,. r`3+'�'�5. z ,.��ea �-.. a.'�``� �'_.'^. �s�.'�'•:'t?: •�. a,.'" �_.: .'�:a�. �'3'e�^t?+h e�1:n`:l )c'v7: a*.�+.a "sat,,..�1•ii''ij4��;• '.�j}"•s`,i =:tt. �,.�'F,-,':.t .r:'i�?+�9 �,.,: •i.�'•.t`i•�"`?�i-"yaV.'� .,j .�t-?•-.e,":i, i;`.., �f..t, ��rt✓i�$�� i.?,• '1; �'.;,t, � �4��. X•x �•� �"��;- ..2:,•��;:��.,. �..�;,��:.,N"�mb rof�$,yste,�,��sers• .�;�g.�,�; ,�..ky;�;�._' •��'�� .. �;n �,'� :-:�„� �:,. !'�.��!�: �-';��. � `�•�--r.�-�.�,... ln:�o4mtr.�ac�q�'�Jlnfo�rm�,�ion��#. r. �; �. ,� • 'b^c ''`:ttti�'v.��'a �3�^,,�;'•;-„�tia..�.>`-v�•'s�� .�"�`r-`:.c.'c i,��"'`t.2�-r"t�': �.r.'.�:��a.�, L-�y��`%�s�ro'_•�+•�`' 'fi #�"'""" � ,.�.t kssr+,±."�,su�.�u`�,�,!%oa _v,�,'d�,,:..,"m Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive Owner Date: 08/11/15 Address: Huntington Beach, Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 For specific inspection, testing, and maintenance Telephone: ) p p � g# requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#:, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) r- epr:pa..e..-.#»x:.�au"ls.;, . �+.. -wv.g�.a �i ce ., n.�,.,yk'3 d r'• ;t+ =r;:.S F"'• �Y+L =3a. '•{:,+=" eckju"r `"� ste �i s • ecfed an:d enter" h gnu �e°r of?f"or `susef `r%trisjeG,r.:>; ax'fo-eac,:,; �, Y i n.:R .<M ..t#y t: , ,�a,: ,W�s.� :<-rt . r , .�4 2..a'a 4, .� :''�,j�1-,S.,n'y�"'SX;e� c_: - #f r3?''s �,�,.:'v.S .- `t.,X `O5?=..Y+ wue r '" t-i Y.#6 w:a.":`.',S-+... ,7�.✓,.. h,: t —a �t. t;'C t;y,. ,. � h ss�mtb t` r�s; o ect�oria,�: em ate fir , �.�:,-Q11",�. :„ , ; •b•,, P_ t to u. p g4=,,txz,., i �ieolC bo. a �F•ail r P Indic s, t s of°i s e t(s. ''.Fen-�ta7'r'.•�:�.c.+xv:- i:a:rr_.:. <.••ism:�'z�ta�s.s#t-��tsx.�.,c..�:r4a:n.w,:�vzc,,:e..�:.,�w;t.fl's�.,w:,x:.� . s 0 Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ 0 Standpipe and Hose System 6 0 ❑ ❑ ❑✓ m Private Water Supply System 7 0 ❑ ❑ 21 m Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) © Yes No e RKCn.,- . b ; .1'•, n-;$..t'��, %•_� ^�?'="r. ; . 3.' z� 'f'- .. . �.3 � `#` ��;�^' ."° ;�,�'•,e_, ', �;it, t�,y�^�fi"�.r3ft.`�..SyIS�` 4 e)®.efilc�noes andG� s; t e�4s`sectibI';a•�ndMof��ch�r+es 4 1. AES 1 September 3, 2013 I 'A �-Loc i h ?1_0 nF U at Units 2089 - 2090 90 80 90 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 7,77 7, NW7 Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable A Ne cri n z nts,.'On P 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 1 Supervisory Devices 5.2.5 P 1.5 1 IGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1,13 1 1 Fire Department Connections 13.7 P 1.14 1 jAlarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 1 lBackfiow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 o: �.':1.:'Y .a `Y~i �.i;'}�f �'�J ;•'n\.'.pa N`�, .:.i.y d � d � as sA�fl�i •`x.L\�y:'iJ ��': x `� �c.�..:. �\�i3 iiJ I I MOR 1 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable diemt :. ::.. ,SDeseription? NFf'AA25 l4 . : ' .,, DaEe••..: Ooiilhents •Orii < Y. t. 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ®No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass, If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 ..... ..... OEM - I = Inspection T =Test M = Maintenance P = Pass F = Fail NIA = Not Applicable NFRA,15' tA- U.S. e cr !0 3.1 M ICheck Valves Internal inspection 13.4.2 P 3.2 2 M lControl Valves 13.3.4 p 3.3 M JFDC - Backfiush 14.3.2.3 14.3.2.4 P Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 m linternal Comments Section for Results. ONo Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 . M Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 Q No P D=Deficiency C=Comment (Indicate • 1W type) 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Placed Five Year Sticker on Riser E]Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 0 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 1 Sept. 3, 2013 • • • • • • ' • • „ r ;m•s.,R _ro' ' x`�; :asp ry i°'Vs•;�`".g' y '_r,•,°< •.,wry.' `5 '::r; _ �?rn;mmxn—r,;>,^,k. + .... . `SE*?� ..sk..� !4:`%S s,' .'�^^5��, u'�:.�'�..xr .a-v-S�!'d,-dry`-''''�'F' w,=a `�- ...s_t -•3 �='�.x.,.:','e-;..�<i.. ..f�1^��..:.a _ �e<:;at �.�? .,,�r...t, :,-".� ;=�''`��`� `-;�. ,�.�,?:.:�,�. ...:� ;�4.�,�:`:. �•:es�•,.�.;a;.a��,s,,, : ��:r., ��{{KK-^.-. �:;�, z.3 �1 f .�; �"`r � F'r. s.t.'s,,, 'L ' -�" .H9. a",`i�, i e,;_ 't;�;�trY A�'yl%r��v"�: '�,:% k,.';,':. ryk . '^.:: �" ^i-•. 'diY:,. � : t � ;�` �+� �.� ��;,. ��,, �:.A,:;��,-� �::�,� ._s �"' .�ln'For�ma`�ra�a=•;h:��-.�_ �, ,t.s.._ ;;:�;t.� _x ,a,�, ` 1 .�:, N' -Ya .!i,�-. N. 4',vei, Tom" �,,"i .i'�'4^X. �y+,„f`�" :S' w 5"�.n.: `2 k'i 4- " 'Y• j�.�, .7^?M i�`'w:"t S.'�.do•'.�i`�Sm§'`�a." �...Y:�'�., �FS . 7Ly;>� : z =#A :a^ '_55' '§iF+ .:'t` - '.. - +;� . �s.w.�s"-E" . _ .' '.F d$'f+1�i((: �� Newport Bluffs occupancy/Use: Name: 100 Vila io 1 ` °F CA4/ Address: gg Construction Type: Newport Beach 3 City: p No. Stories: � 92660 ZIP: Year Constructed: Brandon Lawritson Contact: (949) 467-2133 Telephone: c�TC,'�".n.,.!�. �„^ .�"�^'•'`.y'•�'^' k�l-"G,'''L°��; S f� .ti�� -*,T��,"*'-1>' C' �aq�',�,LiiK" �5�,�"''„•,i3is�.c =fit ^"i'� s.r ' ae."�Y '�u�N'i..a:"�#-=!"Si? •'h kra .�S3i:'.�' tc ..✓r- � .`�`. �� .az't"aa;;-'Y•-Yr a.,. f v ,Y" `""" P `-,i" ++ • •„,4- ,.�' .,';.Y Y� ',•a zest' "'F, �'t. ;,fir, -g•* :� _ �i�..x ,.,;R. a<. ,-. i �, � r -�;: c� t �, 1� kkn •v'; ,�ni+'�." w �c �,'.r. k.kr 'e>' *;'•a 1 � •4°ks' ;:. 9"f'•' �. Baia... h)rc •,*�.'.�,....'G. y�yy.. � fo�ri�'�#io, � � ,,..xis_ � :- �; .,�,�d ..�� .''��,.,'�� :�, � , ��,��,...fES�'s;�em� Rrsers4., .�:;�> �, �',• _ �a �,t"r'S':, « ;au`�.. ��COul1' l 11 ��'�v1.��'�+r` '4 $ !-u".�a-:ti. `�'�'4§.L4 i�.l'v�il�l .a?.+'f'�.fi?:�. 4d'a �Pr.�'fr�;�•, t`r.."-. r,^::;.%-z�F (•=shy. br'` Q:�. • �in531�: `�+� s'.i .� td^ =�2 �wti4w�.:r."5:;'!ix"ict �:'' "�°—•,�. '`�4,•.,rny�,-.�'?C� C +'vSt-Y-•' � .• Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ✓❑ owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA 0 Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 specific inspection, testing, and maintenance ) For � es p p Telephone: g requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) xs� :v- serk:-.. a,;.R.c- rw,'-� a��'=.-x•,� ,y-'S- _awx+t .sv, q FPw'kvs ds; �.,. ;s"stei s` eotel"a"ncl a ,ter e, nra ,,,b'eroff °_rail useforltrs` eefii p,, ,. ?: '„E.c• bpxyfo "ea�ch� ' n p.-.,. �:fO.�. rC!.�. ar,�:,Q4 _ -� M�. ;:: • � .. s<- -V :�•,y , s.,.rv�b' �� .a'Sry Y:.s'>�. Ito spe'c:�eds+ ter��e �-��H''W.•.cwaib�� (��'rtY'yn.. tt< ,u ,,� ' .�.: hedk bo es iFait orYPass �nd�Ba a stausofi- �Fd�ofIrisiec�io �lu��'6af F.�..�rv.s�.i+_ .v..�?c'riFiw^riX_��•�.Fri'.:Ns:,Y�°�tx:14IY•'.^.Y,k.�l.�'t�4�t' Z Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ m Standpipe and Hose System 6 0 ❑ ❑ ❑✓ m Private Water Supply System 7 0 ❑ ❑ ❑✓ m Fire Pump 8 0 ❑ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ • Water Spray System 10 0 ❑ ❑ ❑ [� Foam Water Sprinkler System 11 0 ❑ ❑ ❑ QI Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) © Yes m No �`'-o�•ic "" '"� "''� ,J /+ ,[ } �» �a i{ g� y`1.•- a-. y,a�',i'4�"�,,:. ,�s` "!�i'+S,_:e"; i EsarcYt <...a .��..�^��¢� F'�5....(�'�Y'..�dZ...-°;.[S:k«.. Y•F'� -�'S .�+`'c4ls'bxsi.�. .w�1x'"q:5e-a�R+uNi,-v"�'1.. Yid-.? AES 1 September 3, 2013 Riser , :No: ' Location-. Riset = Diameter.. Main D"r'a ri'• •, Diameter' " Initial Sta"ti& . P"ressure :.R'esidual,-: - Pressure; ; FinatStatic : Pressure ,R 'P N1A , Units 2091 - 2095 85 75 85 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: Om %go -am, J I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A =Not Applicable :- ° Item . ` .. Description; 'NFPA,•25 Cd ed. '_ •- _ Refe,'rengc ., Date' TZ ,Comments Only P; F, N/A' 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5 2 8 NA 1.11 1 Heat Tape 5.2.7 NA 1,12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 pag0 V-0490so VI� F I = Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable Item. .:NFPA`25.CA Description: y :. ed... = Date Gommerits OFily P;F{iV/A, 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 I Hangers 5.2.3 P 1.25 1 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 1 . Seismic Braces 5.2.3 P 1.27 1 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 I Unsprinklered Areas CFC 901.4 13Yes No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed: by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 1 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 I = Inspection T = Test M = Maintenance P - Pass F - Fail N/A - Not Applicable Item. : , Description j ;. - r NFPA 25 . Reference' - Date : Commerits:Orily' ' P;F;N/A 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backflush 14.3.2.3 14.3.2.4 P 3.4 M Internal Pipe Inspection - See Deficiencies and Comments Section for Results. 14 2 Yes No 3.5 M Obstruction Investigation Required. If "Yes", see Deficiencies and Comments Section for Results 14.3 P 3.6 M System Returned to Service 4.5.3 ® Yes No P D = Deficiency C = Comment (Indicate type) Item Date . Riser. Q.. C , "." Defcieicies and. Comments . Iridicafe all equipinertt devfcesancbp''ants°that'were-repairgd'oi replaced _,.• ,_ 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 2093: Replaced two painted fire sprinkler heads 04 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: 1 hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 Jnsip'edti6njesting, and'Maiintenance Cover Sheet IN F PA a ende-4y 26, sarhq. M27-5"'- �U;T'Fv Newport BiUffS occupancy/Use: .- Address:Name: City: Newport Beach No. Stories: 92660 ZIP: Year Constructed: Brandon Lawritson E M Contact: Telephone: (949) 467-2133 Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive R� owner Date: 08/11/15 Address: Huntington Beach, 21 Fire AHJ Date: 08/11/15 City: CA O Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1 (a) AV47 W 2111M. Bas 'a A s' te p N 0 El E] [z] Automatic Sprinkler System 5 Standpipe and Hose System 6 0 Private water Supply System 7 0 Fire Pump 8 0 21 1:1 0— Water Storage Tank 9 0 1:1 El Water Spray System 10 0 ❑ ❑ El Foam Water Sprinkler System 11 0 0. F-1 El 0 Water Mist System 12 0 21 1:1 1:1 0 concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes No AES 1 September 3, 2013 liftD Riser No: .' ; '= "'- Location. - Riser. biarrieter- ..• Main.Drain, •Diameter:,; Initial Static' ,Pressure' Residual Pressure- , Final Siatia ` Frgsppre� P� F,,N/A". Units 2096 - 2100 90 80 90 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I= Inspection T =Test M=Maintenance P=Pass F=Fail NIA Not Applicable Item - Description. ed ' Date ' Comments Only • 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1 6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 j I Spare Sprinklers 5.2.1.4 P 1.13 1 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 6 0 SO I = Inspection T = Test M = Maintenance P=Pass F=Fail NIA Not Applicable item`; pescriptiori: ?NFPA.25' CA-'ed. Reference -: -. pate ` ' { ` Coinmerits- Onl Y P,F NIA. : 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 j I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 I Seismic Braces 5.2.3 P 1.27 1 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 I Unsprinklered Areas CFC 901.4 r1i Yes ®No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 j T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 w s MPFail Inspection T= Test = Maintenance Pass = = t i M I F P p N/A Not Applicable -Item Descriptioii„ : NERA 25 CA ed, , Reference •. : Date • • . ,....... Comments-Otily P,F,N/A. 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backflush 14.3.2. 14.3.2.4 P 3.4 M Internal Pipe Inspection - See Deficiencies and 14.2 Yes Comments Section for Results. No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 P Deficiencies and Comments Section for Results Ye 3.6 M System Returned to Service 4.5.3 Nos P D = Deficiency C = Comment (Indicate type) Risen, , 'D ::'G Deficiencies and Coinrrienfs - Indicate alltegi%ipm'ent devices.aridpa,'tts that were, repaired pr' replaced 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: l hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature �• Date 07/10/15 Form AES 2.2 Sept. 3, 2013 4 •^ - S}L; .S''-."-.".t'�t-t�-,�.i�*"'�',.-'�'�'1:� �^'+tP.:3:'vfi�i��'` S .�.`.',,'r�,"„`*,'. :T`�•� .£;,y�<+: •r.'i`.-. K �,� 4-`%a." g';du�'r.•fi� 'gyp.• `,-f,��^_'.,2`Sc�hr,` '''•'S'i .,. �' .;'S,'�sz Aat :fi.tirr..- ;+tx, ::s„ ,. �''•...$,"',�`�q�v �. �.etu•'A"n t",r's�i• .�5ia;g- .•Fr } -dgwizL, 'E+��xt��•-, R�i �.-s`-.:a3�":i�� ,f_�:•;: . <.... .s..�,. ni' }-� ..,?.„i:t :;kti ki." ... �" �`_ c t_ 4t:-, r ,;�h „"?�'i' -'1' "'rs -wa'rt�t`a�-fir tea;, a-,.,g,:.i�.'}r:' ast<�`,j,'':• ?'.^`+z-,4:rSi' n,;:.t>r:2?2.?.}r.1' a""�.ik'?it-S+'t�' '� lrt •1. �i--#t ?.,w., '',.fir, S' •��` � �,��.'�t1t �`,�nv:.,...s�. tO►/nl�a.l`�� -��, :{•� ,:;stt.S. 4'+.y.�'��.t,�7�A�:: ,�a,•i'� 3;.�t; ?- „i{ry5a"�rbin: :4C;.i,> r, ;yR�, �f.}i3t4i.�is• .p _ t .t -s;. � , S -yy 3X3 NeWpOrt BIUffS ((''��' J f Occupancy/Use: 'K.- 1 U.- Name: 100 Vila io Address: gg Newport Beach City: p 11 °F °gtr�c Construction Type: V — ��,�� O� No. Stories: (COO ZIP: 92660 Year Constructed: Brandon Lawritson Contact: Telephone: (949) 467-2133 'M, �..w�'v.g•e�.�W�'` �;="C v�`�+Iv. ^' `,,y 42Y iT•; "N`ai �"v i�z��3'±�.R J--"Ty��`•� e'�..�.. :iw'.dY� -ek .aty�Yh!�.`F� IF �e,.:.r �.: � .�• t�'.. tt nr�.�+•h-��•+�� ;.i •t b�N':* .�^ .ir^�'. .,3*'" et CF 2 '?i r>9._ �v� .1�:c.-. '7'�:�•"rr .��.+tt ;<rh,.t'Are SS; vU:..� ,s'.d�=,. �`ti-, ci: - } y,`�;v� )A"P`�`i'h�:�:F t�;��3'; ,pu, .,i,,, it-; Sk .,, ,�-„��.y lnc:'J:E:'�K"•5 } rr.C.'�,.!�.. *y �i; �,av �i.�n< `��3�iyi _;� .r,;cnr �3'�xs,•A•ay docNb'4 �Z. .'Lh1�, - ;3::. ,-,q �''M I. �' 'W-r>•.- ( b1+f.' :Q.` i"�v �f 1•�•r rre•. ,a,i��:: ��,�:.�.r�r. s•t�..4:.:. a��Confir=ac�ot;�infior�ma',`,to.r��,x�;_ ,a-��,,;:,;�� ;�<��,�; -.=1��:v,��f�;,.�rn•erx,.f•S-,y�sferra�R's �'9 �., �-.«�-, t ,,a� j„,,"°^�"'u��"s.tS.sik.��',.,,j`t`''�RAi'-��3%F�"�•'�' ��aai�£�r�"c�%ail'aff�-'�'vL�+�iu�uV�,.is'�,d, .•r.,.F..:.'',.f• ;�i.... <�dp: ,�;.,,"'•nLys ,., �. ..S„e`,.-'+:;eY.�,:;,5': .ate ta5��`'�I�t�-aa?l��y✓�s'.'�.a' Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ owner Date: 08/11/15 Address: Huntington Beach, ✓❑ Fire AHJ Date: 08/11/15 City: CA 0 Contractor pate: 08/11/15 State: NOTES: (714) 841-2066 Telephone: 1 For specific inspection, testing, and maintenance ) p p g requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by1he owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by. §904.1(a) e �e ., umber »o. ¢form`s.p'sed fio;r' uns •fii:o .. ; , Wit; u ' fi.;,.; u.- •. a°r� ; w„ ,..•.s : Cleckb: ` 'fo, "e cis �ate)ndms" ect'Edarl eirtter, n�a - .�w,� s--- �., �,.. •�+r s<;:.';.:, `-'n..:,�•;.-,pa'. ;::�" �; :Y%;:�`�s ,:a,:a, s xy�'•-��,hecklbo�,'es a�;��'�: ��f�'=�'��;�, QFai�o;��Pass��to•�i��Jicate�'statu�o��i �'Y».%bK'Y,'.akiA',.�.ta�,s�m ,,�pecyMesy�-s-- Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ Standpipe and Hose System 6 0 ❑ ❑ -2 Private Water Supply System 7 0 ❑ ❑ ❑✓ Fire Pump 8 0 ❑✓ ❑ ❑ • Water Storage Tank 9 0 ❑✓ ❑ ❑ • Water Spray System 10 0 ❑ ❑ ❑ • Foam Water Sprinkler System 11 0 ❑✓ El❑ • Water Mist System 12 -T 0 ❑✓ ❑ ❑ Z Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) © Yes 0 No ,3m. " o=,�J'd s si.+.-va.4,K�YYr_/.Fp.e- ai-•a Z'ry t, s$:�=:K 'F...•..,si"�tei`3a�J -S:, e'4e.z.;..•rR..�-Wca.lY-a4n,g.'.ie <-ks :Cc�2a^_tw•vmFa.e+ n Y.v=fna,,.s .»••.FEF.':i,t+..aiz«.+ii�z'�'`•tS2^&� i»go.F+'•f "'cr,+- -u9 .."Y widR�RU AES 1 September 3, 2013 ? n t �p Units 2101 - 2127 90 80 90 P L E] This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 1= Inspection T = Test M = Maintenance P=Pass F=Fail NIA =Not Applicable z OjO :wo t"b"A 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 1 Supervisory Devices 5.2.5 P 1.5 1 lGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 jHydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 lGeneral Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backfiow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 �<f,�'A \G ..,� R„ [ 1' ..M»°.%£.\°-:• .\L•.,�'. Y:t [y A $ H = Inspection T = Test M = Maintenance P =Pass F =Fail N/A =Not Applicable hill N ..P4F 5'CA eclx F . 2 ,�fteferentie� e `fl F r->y 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 I Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes M-No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 ......... Qw. 1we ......... "4: "Q I = Inspection T = Test M = Maintenance P Pass F Fail NIA Not Applicable .. . . .... 26CA e ,NWA oh� n n6b 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M JFDC - Backfiush 14.3.2.3 14.3.2.4 P Pipe Inspection - See Deficiencies and 142 Yes 3.4 M linternal Comments Section for Results. . P?] No 3.5 M obstruction Investigation Required. If "Yes", see 14.3 P Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 No P I D = Deficiency C = Comment (Indicate type) ", ie, 7,777, ire 01 07/10115 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 2109: Replaced one missing trim in bathroom 04 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: it See Correction Form AES 10 for corrected deficiencies. Number attached: hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith I Signature r Date 07/10/15 1 Form AES 2.2 Sept. 3, 2013 ^Crnee,_P;,4S "!!a 1•c-'va�34.V 0.�^.,{r.'.$` "h; e�-P'+va 1'%'°.r '�`I..SP_.,?..•rv,..5 '-'°`'P�'.'$;"�i4°�i+�?l'_ `'!"a•<<d%i•."..`_�raS;; 'f y�"Ss{` r{. �.�,z.':T,."..2;: F��i �•y.".,l "a`yvri:}';T`"-; ;a..: �..° fir. i1.�3: �•• 6� y1. S i .q;,,.`a4 �:&S{ $. �:'y`f:�@�y d. - ,o�•i?` �'��. °�, �a�.sj`„-, =:''�. :t'•� i}3.'',`;{ - - ':�� ka, ��' �:y,:7 :�.�� y�,,.,,u ..r� � K .ti 'UTa,M��y�x`aa°'.3°.» 13.E •{ '`Sfi.�i'fi..,�":^ Y'i}lY`✓,lti�`�: i' e'S(vsQ.''' 4iLY" 4�.`.: d.i,.• 'h'. - �R� o •:ert:'�i�nfo,m�t,-ans�•.�_� .�{� � _ .:�:fi� �.,..��`�,��,.;:��. hG"$+.�`"14 K •i i`.is e,.... Fd �t{rc}��.. ^,�""�it.".-':��:: �r�.. ��,,�.g,�..�-�;�,>�'%;.3,,.,.,�;-��„�..�:��=�,�''sr., �,�.,:�:�..�,., �u=w�:.. N@WpOrt BIUffS occupancy/Use: tt. � 'U,- t Name: Address: OO Vllaggl0 Construction Type: v— �C�OF CACGc� Newport Beach No. Stories: City: ZIP: 92660 Year Constructed: Brandon LawritsonE Contact: (949) 467-2133 Telephone: p- - ''$$;; to �h' .� qqp',�..:h.>:.,zf<'� �4 ^•�-y'py 'rYz c:. >a>k;-s' s•,- 'r:' s• ta•,. 'ifs. •"'`rt �° ° `-;,'�'Pj�'n ;�� ,�,..�A G�`,{'{' { a`.kv,.�to- .-1„ .�rY'' A j�`oi ^ w cti-vi'-.-. a53Z�� }4? '4:T Y,lia �. t.'�x 1• � 12x � 'r:.v , ,�,':7:�n �Y T'"`i�': �:F.. �.T.,:-d �wh+»:..: .''�:�� t� ` � `- .K93r_?? � �1.� � d� � {a.�� r lirifon z � a�i,o,n:<�� w':1- µ�.�• � -� '= �.u• ��E. �, �;,.7. ,�� N mb�eC��ofSj�st�rn�.::r� �,s�,,..,,.r�, a:, �v�,:�,.� , . ,�. Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive 0 owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) ,G�•5fh¢A'e'sack,iu�,» -:vY: s �qy(r�.+:`m..`�'?.°;+{i-,`i}:v'!�`i'd-o-.1. af.dso:cu;:`�h�,ssys"Ct.Ya'v��lrs'irif�s +, '_.4bv4.:t,x'' uetifmtn*t:�1e",�.Yep..:ec:to�it=i=••`;k;:�'�:�%;. t-fn. s'.�a�u�re•�.Cn,xe�d.•°A'fto'r'`t r�os�o',",Y,�fS�f,�a.e;,",n.`, .=fr.?xt;•`,v�v-,<^i ;v�xl-::� a:on,.` '_+•. S'd;; !+n.n.ir$n.,.�ksp oeFgbPefi•3rii.c�.Yt..h�p, .w:<.:,•�Frrq,FF� kiw ....r:�. i�,,:'h4f�4aytn,:%C>S 1 5 0 ❑ ❑ ❑✓ Automatic Sprinkler System 6 0 ❑ ❑ ❑✓ Standpipe and Hose System Private Water Supply System 7 0 ❑ ❑ ❑✓ m Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ m Water Spray System 10 0 ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ©Yes 0 No .�*��"'3i_-, „'*�' =� �. ate». ,>•'�,.'�,. ,. s A f . y : - - „"'•'�`��'z , y-r,�> w:..`�"_�"'r�_i°�s'h`�-'�r'.,'7`,Y`�r.,,»�l^•��`r,r' j` ' ;.M1 ea.Y .Gi'1�'?,'�..+Fa��s�Y 1:4s'+},.�;:3:.356 %{fiw'iM�.;�-V �t �'-+�%^ y:,:��:il�ir; . � . 'x 3 aa�_r�e p�A'a:. u;.fa3., bu��2:U�'�3ir_..•itn'xn�.i��Lay..iF3.v�v��o:`Gk'.x�CN6'c AES 1 September 3, 2013 n...... .... pin, �Odnz,,, clu n ip —0' -- 1 9 0s: Units 2128 - 2135 90 80 90 P E] This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 77 17777 77 7 a S31 -1`1 - A, FRE 'PA-P, 004'0 Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable PA Ddt—' me, 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 1 Supervisory Devices 5.2.5 P 1.5 1 lGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 1 Fire Department Connections 13.7 P 1.14 1 jAlarm Valves — Exterior Inspection 13.4.1 P 1.15 I Pressure Reducing Valves 13.5.1.1 NA 1.16 I Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 �°�r exii i,•e 1;'=a`.2.....x, �,`. .>•K". vx,...:•`.':•a�a � �� m` <�� #�V�`l` .'`: fix` �Aq °,3• • . "��. � :m as: 's",.. , s:i`....,,, .^ :.. � .., j.»._ „r.. `r.,r i:.:'', r.:=.::x..:.. ^i; xi,a x I = Inspection T\ = Test M = Maintenance P = Pass F = Fail N/A = NotApplicable Ite• m. .. '•' ",' <•: :.. ..:: : ; ..,'< ".Descrption;. CPA 5777, :N ate > • Caininetits inky' : p: <,E; -, %A... , 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5•2•3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 'TR I Inspection T Test M Maintenance P Pass F=Fail NIA =Not Applicable 14F —PA--,26,-CA-i 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M JFDC - Backflush 14.3.2.3 14.3.2.4 P Pipe inspection - See Deficiencies and 142 Yes 3.4 M lInternal Comments Section for Results. . No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results ®Yes System Returned to Service 4.5.3 Ej No D = Deficiency C = Comment (Indicate type) A v eri", 'y" _Dd Yelb —dmmen6, 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10115, Unit 2129: Replaced one painted fire sprinkler head (SW) 04 07/10/151 Unit 2130: Replaced one painted fire sprinkler head (SW) 05 07/10/151 1 Unit 2132: Replaced one painted fire sprinkler head (SW) 06 07/10/151 Unit 2133: Replaced four painted fire sprinkler heads: Garage, Office, Kitchen & Stairs 07 07/10/151 Unit 2134: Replaced one painted fire sprinkler head (SW) 08 07/10/151 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith [Signature e_r,040� Date 07/10/15 Form AES 2.2 Sept. 3, 2013 +"%`n`R "a�y:rf .,Y. S'.','w3+$,a'!'£: ram_ ;-'.� Y..y, "a-pcwgP 9t+i 4<.' ; a�ti;� :w ''�' ip"'.�x+ - S Y.,Y .:'MCI��gYi.-<.. •xa�F', `a, ti'•n'T '4;. �� , tK�* 'y-'',.'+•,.^`�, ik: jl s'a`,'=• X�.�. rol .� x�;Jr3r '1,: _ae�. �A,trA. �y.ars+-.- �`?A�i, rv� 'f^_'X -'t.; +.rr ,i�4"S,Y'fr1.. x1�r.a. vC*'1'�i.-(?•er�,�..v�M} `;�T =„a„-s:;•�=<..=i:,...c:Yie;°z � ••gse.+C'... .,.�???`t�>�,.•:c:-�4..',Ta'.a�.fi::��' ,£�,-''X,��r--,c�-r 3'>=.:•�,"'�- :`..Y t - ^o i\'..V. ..'h ., .f":rz.,s < 5..�i..r.•3;1'.i.+.......i:...^ , �.. 'h h, .>::, .�R4R , <�, i., -r..,Mr-'.rht`+^, '..,, . �' 1l .s.`n'??L�°'c :,,�ri': ..yNr,.-�„7`f•:,,t d ,_ -.,�,y Roj'��r�3� In'jfio'rma�ton` �,� � �,��.�4:_ :�_� �-�t�:k�,� ��7�X.�,.� k,�.:� �3,sz_•,•^ �;�% �, � :�,; �:,>,: +'e-..4 7' " xY a; s ' 1:. YF.i.;�':y-S:+rF Fc=n: u.�,. art' 3.-'.-,:�.:"S: a'i>s'ti,4i+ sN—�..'..£ �,.,9'�a"-c s9ei;:. ''h+.:.4,r Sbtr�: Newport Bluffs occupancy/use: Name: Address: 100 VilaOf CA ggio Construction Type: U— �4�{r�0� � a City: Newport Beach 3 z y No. Stories: a Q� ZIP: 92660 Year Constructed: Brandon Lawritson Contact: Telephone: (949) 467-2133 {r i.^.:�.�r •.i:� �:An :�,.. 4, `N' �' c, . .. 4 � g<:.yar' "`' s, �.� +f t° fr'fii�°X».ti .ii d.:., 7' u-.tis::i1' - �Yrvl. ' :.hY '`'e''w%��'.'<.'�-. �-s`.'C''=�. <:'�'4.µ.�; :�_ � �ry�i. !i:ya =' �`ti-.t'&ii'''-, W 4•.: j -.�. n�' �;'�?r-r'+y t .`. 1i,»,,;,, '^' i:.-y}, ��/, �r4{,KyC-T c, �r;5 r e''�,+, �s h''•�,s.;.1 g^'r,. k`?."z 3��I fJ'.' 'l'.J. �i '+�'•: � .*ti ��'�•�'� =a��ti�' :,e} .i u+�.` �V-O.IIe.Ur�,�-!es$�-�'Y'un:aryr s �' 's S,t�{�c'c 4' C'-"�b�AG�`t}�,q'�•�w4,_'%o:"r,.`s �t,a 1C g ,j`�rax7„'�, �� N r��.„� 'h h.� �.?.., w,;..S .; �:,'.s.�aadsas�".: ?µT. t` �Gi��'�"r'e5[t7:u1 .fi�:ti:n�usti• �' u....• Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ✓❑ Owner Date: 08/11/15 Address: Huntington Beach, Fire AHJ Date: 08/11/15 City: CA 0 Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) 'a _ t'`e ier offdrms used(foriiis "°cb'on i�„. box for" each sy tem inys �ecte ka. 41 Off-O.,h [?. F�.r�y 4.k^ „tor r? ��ssh;;.}r'- S/ rzCTL •. ^6=; . :Pri .�'yY {`n'. :vc�r.: '.i0.5.1.. d :+-tSY.f,§•(P,'.i: {xk i:.�+�.�'3yY.4:9.�N3..Y t:.. v gfin$' to j.";res,Pilo?Wassoi ciicate tatris ected . :<etlgf. •�•r. £a,.�'i`f_';&"«�riF�Y�`3..^F`a-.«i�.?i«• �X3it.K.-.ti,`�'u-'T".n+`"-.a'rii�ii�iBrN•%4tei�`��`s�si��"`-'2<,^."".�..:33L..:,�:%�:r�;`.�+ar,,.�Yc.t�".ti�:'~�'i?i>R>�"?i�rc`�aL4 Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ Standpipe and Hose System 6 0 ❑ ❑ ❑✓ Private Water Supply System 7 0 ❑ ❑ ❑ Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 0 ❑ ❑ m Water Spray System 10 0 ❑ ❑ ❑ Z Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ © Yes m No m Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) •e,+so'ac. ptepeofa AES 1 September 3, 2013 %%r,.z;,^�:r• _n,yr.&:%. 's�s.n., '�.:.s^,•':fin': ,y;z ,±$„ .<,Qr. ',aw z:f,� .F.J.,F: ,^;r "S I',<%S 6 ysS,: �•f,i„_,>,i. -. �'.:J ,l'..�.rc y, �..,. rt..F i'..c. ,. H.; .,,' •" .. ,. i.,, _ "' z,:: �,.lyz , ' 4".zr.m s E"""..: i; ;o`..z'' _ � A5 0468 ^t•C �ftis ocaiameter ". •'� •" 1Viairi�ir�Tin. "D.`ame£er, tUnits .y ' ��Statc - aL 185 °Residua OrP `'Ffnat:Sfa I 2136 - 2139 75 85 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I - Inspection T - Test M = Maintenance . Descrl tion . •.ed:'�`'�." . fide", r1.1 P = Pass F = Fail N/A =Not Applicable �<Dafe°;:,.., ' ,•>C..om`i%ents;Orijy;�; ,�•:'"-� _, r •. 1 Control Valves - Identification Sign 13.3.1 P 1.2 1 Control Valves - Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1.4 I Supervisory Devices 5.2.5 P 1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 I General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves - Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 r< 0rlta!l ,,g S S ej :'�:: o" :i: •,a`.,?yc:, y:�;:. a:.,`:i ..:�.ax.� =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable ' It ;> Rescri .p .. ,`a :� ;I+I Pu4:25<GA edt` F• -",• a,. s 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 F1, Yes ®No 2.1 T I Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, ►I, or 111 standpipe systems. Form AES 2.2 Sept. 3, 2013 I = Inspection T = Test M = Maintenance P Pass F Fail NIA Not Applicable P § 3.1 M ICheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 F, 3.3 M JFDC - Backflush 14.3.2.4 Internal Pipe Inspection - See Deficiencies and 14.2 RNo Yes 3.4 M lComments Section for Results. Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M I Deficiencies and Comments Section for Results I Zs 3.6 M System Returned to Service 4.5.3 NOYej O P D = Deficiency C = Comment (Indicate type) 1,,;,,11--,-1 ...... . kf bm e oor 'womwere 01 07/10/15 Replaced Water Gauge 02 07110/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 2136: Replaced three painted fire sprinkler heads 04 07/10/15, Unit 2137: Replaced one painted fire sprinkler head 05 07/10/151 Unit 2138: Replaced one painted fire sprinkler head 06 07/10/151 Placed Five Year Sticker on Riser E]Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 0 see correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith 42 Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 . 4°'"°'G'•"'"7. ?:."a�*'?';r• 'a''Tara v'y'r:.r,,%.,+� ^�'at%mr.C-, ,•__.• ,'.,:',—,+e�, . @@P •.'C�'`"�:.°z'HFf'� -'b, rn•,,^��.°C�.f .i'�`5�:,�'cY'•'aY` �`'it4,`✓7•,..t*r1t..,fx.:z;}Sr'.i:•..::: €•�'s:-•-.'r^."``:,:.�.,r..°.,.""d�L.r,'i F ,7+'^a, :, w^s g5nji" `.e '4: -9` .. ..�tifif?d. .e'.:"Y,: ,,,. ,,,p„ r' �.:.a.l. .t`d: �r•r 'r,.,+,. ,e:t'w; �1'•�?v;. ;: -.a i?•` .ter.. _itr` +� 'A.. x,}w. a;w,4y b::z^t�.� c" �" 'Je.T``:''',i' ,.,.r/'.,- ,ot d°.��v, ,t'b,•,aL+' ':x;` k.. t.P•n...rrfl.> ��. �•c•:: yx,-�r"ui�. y <*S`.,V$' - ,��:•�=��-°�°.� , � .� � �;i a.:. -'� <`�=:::i''�, s :�n',.k ice: -r t • r _ . ..... r , � �. r �t •n " Wa 3 n �. Ffi.*' ..a•* _, "�es�Ln' �'�� l��•?�:=`'"s � s''`i � �% �•`s:-* s�a,.�- 'St ��:�,.e:`�1��.�+.'�v{{��.`a�'" ,'� +Si' ,..��';'9x- a•�`S�aT`�:iti, f 11 Newport BIUffS occupancy/use: T�: � �,(,. 1 Name: 100 Vila io 1 t of ca�� Address: gg Construction Type: V — �4�� '"```��0� Newport Beach No. Stories: 3 City : ZIP: 92660 Year Constructed: Brandon Lawritson Contact: Telephone: (949) 467-2133 - 4: 4�, i u, as:, .' �,P, tea.: a •,-0x'�r � "y`::'.t. 'S;<.' ' s's. r�� Fy'��i Xti.�p� fix.; iy;;v':'".. ��t� .S•y.',; , �� i, ° �,YPr t �'9t� 1 N �4'r :'Z�iv .x36 J: .^'�/2:^--` n, ...� a ' 'F� � . kM ! 4 fr`•c�: ; � �' • t. ��" � .i: •, k, . ti: t ,�v i - i , •" ,� *'3' fit,' ;..,� .�_<� Ks:,�:�'3�'✓, =� +c•. ``-'F`t,�'t xR.-z th �:,� .�'„'� i ,�.�+'„1.�i.v 7 -3`�� k' r�^ �''t;,•r7t::?r'' ',ors^, �i,.`'•:�i4 ,n'�;-�;�„; ��-�,;,�� ..�� ,�_,_ ,�. f,�;F-. _,,_;�,.u, i�er 'yf�Sy�st Rrs�rs�%=->�>.' ryr �..� �, � a:w ,• �, ��•M�- �. - .,f�.:. �j��C''��o�ntt�ra,,ct°;�.Lmfito.rr�i'a�ro_u::;��j,�'�.{��[..�.. �.:��•. _.v�>r >'�.�4.�� r��. �,�;,:�r:<.b.,"��;�,:':�:•��.�:��s�.�: 4ciAu�:iG:,i��tXX�'��1'�=''C'•-5 �'tl�'#� "�,i�e�%��5 ��S We�uEwP4-�i5::ii:�ekYi'�rm'�°-1�, �u�-�9`.S-. Q �' •�'.:.i•.v .W tab�.�16�'t..a �'YLeA!� xi,.'a �. ^ni�'`s 1 �a.��:.✓�kS$,Yuzkc�Fl��eki� Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive 21 owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 For specific inspection, testing, and maintenance Telephone: ) p , g requirements and information, see NF•PA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) • _,•�F�,-..K�.=.:...,.,F�'•-.t.,, � � M� '�.�� =•�xN � @he'Ckl%xt o� ea"his ste s .eci a►�;d e�"rathe�ni�aber df�fo is - t; ,T.r �f ,-, y :�x��_' � s,r 'S. a a�r,�.:+rw� .. �., s,� :, a,='=`:r>< °,•..;n' , `ijserjtion;,,..-:s 3 heK boxei;Fa�ly�orPass1to I t da e. st�ttasgfins'pecteq'ysyxEertelosf t ,,.• a: +',3}Fr.«..`.'%i'.„Sri.-nk`,.x3'Atu:�+1iM•'+'.Ff'azU�...4C ESA'.'eYtr'e•1.`eiC•,�R.Sz.xi"..u5.s,...e't:"..£3'�.&�..�..dicA.: [� Automatic Sprinkler System ❑ ❑ ❑✓ 5 0 Standpipe and Hose System 6 0 ❑ ❑ ❑✓ Private Water Supply System 7 0 ❑ .❑ 0 Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ Water Spray System 10 0 0 ❑ ❑ Foam Water Sprinkler System 11 0 ❑f ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) © Yes m No r�• �• tl�se`ctiot n�a'ches'R°e;,o.r t= p,., tS�ce,De�e;ciesacCto �j: .=%�krC� AES 1 September 3, 2013 filtiftlaL M61:6 U 85 75 85 'P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: WX R I= Inspection T = Test M = Maintenance P Pass F = Fail NIA = Not Applicable 'F ZA -,N PAi#, e C 'P, A 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 F, Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 1 Alarm Valves — Exterior Inspection 13.4.1 P 5 1 Pressure Reducing Valves 13.5.1.1 NA E.1 ll 6 1 Backflow Preventers; 13.6.1 NA Form AES 2.2 Sept. 3, i 2013 I Inspection T =Test M Maintenance P Pass F Fail WA Not Applicable Itern 1.19 1 jBuildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.23 1 jPipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.27 1 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 1p 2.1 T IField Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 1 (Enter data on Page I of this form) 13.3.3.4 w/PRV Hose Valves — Partial Flow Test 13.5.3.3 * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, 11, or Ill standpipe systems. Form AES 22 Sept. 3,uM8 Mew 39 ew 1 "API. - I Inspection T Test M Maintenance P Pass F Fail NIA Not Applicable NFPX9&`tJA, -'d' z t A e— 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 3.3 M JFDC - Backfiush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M Comments Section for Results. N o M Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 Deficiencies and Comments Section for Results Yes 3.6 IM System Returned to Service 4.5.3 E]No 1P D Def ciency C Comm t (in te type) -i 4ild-t 617, at 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15, Unit 2140: Replaced two missing trims (upstairs bathroom & garage) 04 07/10/151 Unit 2140: Replaced three painted fire sprinkler heads 05 07/10/15 Unit 2141: Replaced three painted fire sprinkler heads 06 07/10/15 Unit 2142: Replaced one painted fire sprinkler head 07 07/10/15 Unit 2149: Replaced one painted fire sprinkler head 08 07/10/15. Placed Five Year Sticker on Riser Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: See Correction Form AES 10 for corrected deficien(:�ies. Number attached: I hereby certify that the 11re protection equipment listed above has been fully inspected, tested, and maintained On this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 Jnspectiqn,7,esting --6ndNa1htenanc6,CovarS eet -,'NFPA264§a�mend nm TRNcm PRMIT �1-00.11 i� �7 FXSRYOEPR'M� qp' RMti.3 t 5 ��jj" Newport Bluffs Occupancy/Use: Name., 100 Vilaggio Construction Type: or- C Address: 0 Newport Beach No. Stories: P, City: ZIP: 92660 Year Constructed: (A Brandon Lawritson E M Contact: Telephone: (949) 467-2133 Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive P] owner Date: 08/11/15 Address: Huntington Beach, 21 Fire AHJ Date: 08/11/15 City: CA � Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition Is amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1 (a) E10 7I 4# — - r"I PAg pi6Wpt sIl_,6p11p�fq.-s"eafIM"zEW6.30Rp�',§ , p, • Automatic Sprinkler System 5 0 ❑ El 21 • Standpipe and Hose System 6 0 ❑❑21 0 Private water Supply System 7 0 ❑❑21 • Fire Pump 8 0✓El ❑ • Water Storage Tank 9 0 7 F-1 0- • Water Spray System 10 0 7 0 0— Foam Water Sprinkler System 11 0 F71 0 0- Water Mist System 12 1 0 21 F❑1 11 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) T1 Yes -0 No �57;7 -`0 0,=br;qMjL n4xffiffip SRI 3, AES 1 Se pte mber V e ee on I In -a 'Viip;Nr 11a 04 'SWI iiliiiL 'i"' Ot e, P Units 2152 - 2178 85 75 85 P This building has more than 8 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: re I = Inspection T = Test M = Maintenance ni 116n e ce, P Pass F Fail NIA Not Applicable Vite 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 jHydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA im ow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 '-'..; a' F8x "i: 4„'^sA a 1= 1 = Inspectionx T Test M = Maintenance P = Pass F = Fail N/A =Not Applicable - -.>.. w.. ... .,.,;.; ,' .. � y ,, a -., :Coiriments;Onfy;�:::�:' =RAN/A�. 1.17 _.... I . Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 1 Sprinklers -Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Pagel of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges- Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 01 'AW31�1,�� I N011 M Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable -P-esc0Pxkqj1, iNFAA kid" :Rd ate-C- !iO ei 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backflush 14.3.2.4 Pipe Inspection - See Deficiencies and Nos 3.4 M lInternal Comments Section for Results. 14.2 Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 No P D = Deficiency C = Comment Indicate type) ' s3'-" z z d"t,"o-in' n- leo 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10115 Replaced one Tamper Switch 04 07/10/15 Unit 2156: Replaced one missing trim in living room 05 07110115 Placed Five Year Sticker on Riser E]Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: D See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith I Signature Date 07/10115 1 Form AES 2.2 Sept. 3, 2013 1 • - s • N'"'if;";' '=':.°,�cs e£: i.l �.x'"'''='?°'�E:tT7E°•"s.,-a,..x'"u',`:t,"`t4`:v:,'fi3R= . } nrv..'£ ',':...>�.r,.' j. ,�Y'JsMb ' •�.5tK+4 . �:c�-S.• ^c;2a+layS' y Y Tom. Sv= i'•:7`''..- +s...S•..SS" ,_«"•'V'r 4 'iea'f!••2 irk. Yr}5 M .. s3Y'.'q'k.r.°,: y'�• . ..A'Y•�:�L^ {' '4v ,:t: sY ..'....- :.4 5�4: '}; •A.t - "t': �"E,v; ��!�,��- '�., •YS M+g_�v 1.44. t�,` 3. Yx� Y ��val, i`Y�'ar >4e �. f. '�P�o 1 e�trt, �� nfo , � �t A� �, �;. 1:,., _ ��- �..:` �,�:�«:-�-'.u.,� �,�,j,.x �_�;.,n. • {•=r., ,�. C� `..ar7' re;a�-•(-�.;:.. �':,4«" F::z4,Ti�� a. a:�u�;. ` h"_ <.y"-. {� ,= <4,,, { @�K?✓�€�+� j�:�,'��'�' -�', vA3,Svi'tv'�ia�T-wf.�r'��fAt�A43�:r�0^•'�Yb�iS�Ad'1^.L.. s�:'��b�'+-��3. ;,r, r"m':x��3d�.ar.,��f :.-.,."Jv, i S�.N'>i� .-y+f�4-.; �;... '2�-u`GS�i'1J+�s.Yei�-•1>s�+YvF'�F"'q`�P BIUffS �- Name: Newport Occupancy/Use: _ Address: 100 Vllagglo City: Newport Beach `' Llo Construction Of C'4 Type: �I ... �4,�� p� No. Stories: 3 ZIP: 92660 Year Constructed: �4 Brandon Lawritson RE MPS Contact: Telephone: (949) 467-2133 €L"tFb _ ''�`,'f'^'�"Y]. s 'i-�� `fit.-# �?- ,.,•v � ;5S'' k" ikhh;Sih Ay5'�= Fj, t+. w :=�` �x'Fr��( u�'s:'n.'€ Ca','�R.,- < S•^t s�:•::'-` c+1h:,'?"��s ,•i,• �raci?or I of A •rma Ito �;�k , f:,��+;a�_- °°� t-� �z�,,,< ,�-��'n � � �-,�:�F��Y, �•�� , . � �be� • dS:y�;te, R��:ers>o- .� ,. ,��,�j � ,• rv-.,.,t, . yy ��•� ,, '�Yn�'t�'sin: }.:J"��v.^..L�4i�.L+� • �`nC� i f '� t.. ��N+{ }��Yi Te{ ��••byL�dS.�t��•Tv`��fa�i'�%..'4as..iS4'+_ �.ek�e�A�O�.2uR��Sw.1a'C'jC� ..i�� h. �?. YP"i.�,Y! ��Tti N,'l'�-',�:f: H{-..��a{i?°'{iv��v.l.�etY zk'vA .'"if..;•'#'.'< RV. w'bavd— `y�..�z.i.�'3+Z.i' � 1.�6an � • - Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ Owner Date: 08/11/15 Address: Huntington Beach, ✓❑ Fire AHJ Date: 08/11/15 City: CA Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 Telephone: 1 For specific inspection, testing, and maintenance ) p p � g requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of'Regulations, Title 19, Performed by: §904.1(a) l "F'} ' " `"i'rL ,. Wt.ei< rcascs]md" _ s fiecK''opfoeacissYs�feint'r►s;ct`clsii" .e?•`,�''y,k �a�, C`.ava- ,, n� m ,�� I•.or, assa to Inrd: p q -"^ J;�1 Rw Y` 1 A I R _a `-1'1 i� Y•4iJ,,�+ii, i11 V"YLY"'_t citfer�th"e l%er offc`ms syil"',S,tins` ectlo w �- i G3, Su. .�„: :. ..f; fp'., �? _3,.� w x, >s. •v tiy.. +.x,i3r.'M",,ate wife etn a�tenci9'sp caesaktu'so, n GIs. OIX _ , €sn�tx.? tx m�tr az Xrk- -tea 2 s sa s� w a� Automatic Sprinkler System 5 0 ❑ ❑ 0 Standpipe and Hose System 6 0 ❑ ❑ ❑✓ [� Private Water Supply System 7 0 ❑ ❑ ❑ m Fire Pump 8 0 ❑ ❑ ❑ [� Water Storage Tank 9 0 ❑✓ ❑ ❑ QI Water Spray System 10 0 ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑f ❑ ❑ (� Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) 0 Yes ® No c� yA .Y+"�y r, j ^^ G,.� ..rill->Y"'F'.''�nC= •�`','".a- `� _ y.. �r-+�r,..-..'i' "�' � � �K..TVS'•'Y� r'K+-':`nS.i x. �.-�"ir s''q-: �.Ne��IQeficenees-,a; ��Com�tetsi�tis. �:ectt�n a•�en•d�of�e dh re':s;tecfi { yam,, 'm•�+may'-�� '�c:P��'��i51.'pis."Ei'31i��t-°:..'a?.K�::xA%.Yf'u«'a"ai•:. iii,".:`v I i l}�. x'L� �Ai �• �'.'v8is�:Su'x",�in''!,Yy ,; 4 � :?.u�.�.�"r,;:.,..e.,. �. 6'r`�vA�r^:a:�•<a vm.Wti-si.lia.. 4:?c�.-».n�_-+.:. c„s._,+.L.._CdS�r. E.��.,..r3+et ..xr��'OS�t�.z�l�'z°'� AES 1 - September 3,"2013 Riser Location: Diameter.Diam.res °ain,Din-`1 Initial'Static -Residua Preure Final Static..M ,.' P -F' N/A Units 4099 - 4105 90 80 90 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 1 = Inspection T = Test M = Maintenance P=Pass F=Fail NIA Not Applicable :+ Ifem . , Descr-iption ' -_ ~ ed.: Rate GommeriYs Only „ P-, F,;N/A 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.1 11 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 �) I' = Inspection T = Test M = Maintenance P=Pass F=Fail N/A=NotApplicable Item =' ; ''Descriptioft -. :- ....: :. NFPA'25 CA ed: Reference . Date :. Comments Only, - : ,. P.;;NlA: 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 NIA 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1,28 1 Unsprinklered Areas CFC 901.4 Yes ®No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 1 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 ' r , �'� _ � n.•Yip, i�n�'�:'+F.fitJi>�c}s�°Ai 3'7+S"� t AW, '= I Inspection T =^Test M = Maintenance P = Pass F = Fail NIA = Not Applicable Item ..-• Descri tion '-' - NFPA Reference. Date, Cofbrhents Onl Y • P,F,N/A. 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 1 M FDC - Backflush 14.3.2.3 14.3.2.4 P 3.4 M Internal Pipe Inspection - See Deficiencies and 14.2 Yes Comments Section for Results. �/ No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 P Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 No P D = Deficiency C = Comment indicate type) iferii ` ` Date.' Riser D = ' G Deficiencies and Comments Indicate alhequiprrientdevice's and parts that weresrepaired orreplaeed _ 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature t Date 07/10/15 Form AES 2.2 Sept. 3, 2013 t G.C;zw ::�:�sc;.k,�;,�A�, '7Rv1`"`°g.;•`�S-'wr'��"' %itcP4N, .J 'w'�'•i'5 .:zg,.�, p,.;fiahn?r.Ys,.,.,0..';-,A"'- .y',,r "{:-�.;xa,^'�v''':.v,>�r.�i.-.-."P',,YY'�.{ jcti'-:4n�� .'iz-s .. -:. i+.yt.ii,�l,as.+,,aih:__-•ic�,.;'-yy�7'; 4�.; =Fi;`v y+a".Y, '-N,mo•,.� p�`e"v`"^.,,m'tt�"�?r'�,sP I�wwr%n-£ r �,;:TT��s�..;: �'�9y•ti,;'ti;�=?'�-��.s,.: •;^ •.9 �'L,ic>ti.t.,* a4;� on��.`.*:S,:� :'� ix'.r= k3Rr�eo �fivo'�"�jt Cr,, Name: Newport Bluffs occupancy/use: Address: 100 Vilagglo Construction Type: �j . �Q,��OF��p� Newport Beach 3 �, No. Stories: a City: ZIP: 92660 Year Constructed: Brandon Lawritson E MA Contact: Telephone: (949) 467-2133 my, y,� .�,�.� "' *a'' i '7T ��' i^e. y : I:��.i3'>:..s.>,r, c`ti�P.j�,�.� `..'n::..-.y •'?ce .C�:r. r�S ��A��'V ;dh "L :•'ji[^��',w'SJ?i �J ` �"iirl^ni 'a N. � .:- ,t�,-+dwJ^fl'1.,,,.•�Y t.._e�.v,:i-�.,.�.C` VtC';�r.'. li.�.Ew: 3_,,�: V�.. a^ --".`r�� .,�yr,"�",'?�.r.;s, ?o:.•:. . y<tr v , ,,�{'` 2'vy" 'Ofh� 5?.�: ad,,yy�x,�, �.; u't4, yin+<, a X..,<r�6A.5 z� .� `x a �$�.�i-�� `� "��•_,�.,fr�l; �y � �;� ": , N�rpabera �� stem i�er�;_�: .��,' ,� r,:,. ^Y� f_i;.i �":-•,i��.e �. ,.:: ;� `'f�--Yl>b � �-.e' r't»!l'�`�:'1 �. �._ }1��. �..�>... >. L ,,,, d-•,�"; t .•::'tik::•'h'�`,�k:.��s�".�tiv�,rs�,`S�,a��'�" 'cam` 4t=^-^4Y `k• w�� t .rt� sS:i�' . :r' f"'-`riv9Fr,:: A'� � �, ceY� ��41�'Y �. x^ +...Y�'e;s.�„ Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ✓❑ owner Date: 08/11/15 Address: Huntington Beach, 0 Fire AHJ Date: 08/11/15 City: CA 21 Contractor Date: 08/11/15 State: NOTES: 841-2066 Telephone: (714 ) 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) YS$•�q '.�r'Y^. _fir.`. .V'^ v-F ::fi •i'^I °:••..ngta s• .a.-r,..7+y .3+r *.s-+r.:..nh -5� g •� ,",. .,T�, ' <" �oM1r aches %;' : eccln.d'merh�liein�urameisof °prisaaaase forr'eioi ,a4 . 'f%�: •Cai : =;{: ,d' 'vr"7; w 1 ...j ter' , ss^rsMR-ofv ,:',,:.>;g' . , Y•y'°'e=s a. .. Sir, f..Fr ..'poxes (mailPas� 'ed ecsstetnlae Qfiy)s cat „� n'; r .s G ec ti ,��.., ,11. L_,A+...il-�a.:,+'A'"�-'.s:°:�.::2c&7..:•.. e a xLa.�:..:s_6.>-��?,.. n`lai�WSi2.r�'!�'*' Fi'dYvi+',�.�:1.a:2'.�kFi'93•�.�':u��e'.st+GrS"e��5r� 11f:.�kFc:3aYL:-.a_Y ..:pit..>:« Numberof KIM—= 1 • 1 1• 0 Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ 0 Standpipe and Hose System 6 0 ❑ ❑ Q 0 Private Water Supply System 7 0 ❑ ❑ ❑✓ W1 Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ • Water Spray System 10 0 ❑ ❑ ❑ • Foam Water Sprinkler System 11 0 ❑ ❑ ❑ W1 Water Mist System 12 0 ❑ ❑ ❑ Z Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes ® No .�-�,-�,�+.�, ++�.,'='t �'�r :"�-�"'�=. ''Y�,.. _=f'Y;'"„a�,- ..: ?E�.�-'?°Bpi:•,v�'",z'"',i`�'yi;,"t`"�';'"`i�,h.;a; n;: iy�.^a^=-' r;,: i,'�„ 5..-�t,ipz. �X•-._�`6;e.? �...� gi" eienolesan3mfnri"seefile.n�`e'htlofeaat .R*`k",�G+'�xi.'.as.�i3 dss;�'✓'3.,,,: :,:+at:��k�v�,?:...;�1GSy3'7� eepeeDef a�t,-.��+:SLu`kai:�XXaA. v,�d, SFx..,aieCw ._.. .R �,,.=.:2.za.mn`�,,:.mf ib.,�":w^„>:.,y�,'�.dna,.ab. T��w�,.at�s.•�s3"iu��.l..�.., AES 1 September 3, 2013 a oca I —R S Units 3022 - 3028 85 75 85 P E] This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 7 VIM :N aft )MA I = Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable em e• D s-cnPtiqrY--,, d jy 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 iWaterflow Alarm Devices 5.2.5 P 1.4 1 1 Supervisory Devices 5.2.5 P 1.5 1 lGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 M0112 = Inspection T = Test M = Maintenance P = Pass F = Fail N/A =Not Applicable ...1 nptlo -. .... h , : <.Re#ereriv 3 "::ADate : _ •< :^ aComriients>Onl P;F,I+ItAi - 1.17 I Small Hose Connections - Hose Valve 5.1.6, 1 13.5.5. . N/A 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 rjYes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 U-M ITO ~= I= Inspection T Test M = Maintenance P=Pass F=Fail NIA =Not Applicable 1NE Jon-, 0 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backflush 14.3.2.4 Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M 1Internal Comments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 El No P D = Deficiency C = Comment (Indicate type) r7, De w1bant --l0q0WAII, 64 le0ces 01 07/10/151 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 3027: Replaced one painted fire sprinkler head in laundry room 04 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: E]See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 v•a.., ^�'�`\.�.:.�=_• w..4'.:i�..:.1 ..d'�r� F�'�r :. dL`"-Hi:" .let'�r,3.'.., rt4. �i-e��'-iri �•�' `,`±'Cit-�3..1:. `i �J. ��',r'+{r�'� r,fi..:'Z.-:f�'5';rKs,;..�i - �, ,v, �w a,"' y 's^', s #u- ,a•;3,?"<<`(: a:. -.� . v�;.:s:, . ..�.:p?'vr. zt„ _ ;':?%F, �'�'-,� r - •S'.='+S*`.:, c',' ., �.. iw: , �.,} fi: r �-;�i':.. �',� LL ,.�,: ��S, sW"� %'3�jnrt•`-�`s .i��k �1. ;;+ic:'-w,aa:. .;k- .�, `-ea'• k x .7y-4't r,7.s "?SY'a ;:� A�l� �''_' ,y��:,"n�% Ss, ^:gip 0 ' e�ttk�ln, nor Lr-�:rt�,sp,�" >1!, ,lac,,. 4.�� 7;.i.C?,tS;�F�2�x �;•;5 �' ;!�^:,';i�`�,w?h�; �, ; �� .hn,,`rT*,�.�•�`�?cx, 'fi;�:;?;..r. � b� : �^y.r,. .�^^. InYa _� ��•� .h.`'•.iry '�D �.,�; C'.fa,�• �. '`�:� VRi;75 .z'•.in 4,�•.. •1. i. °y `:.4s;�'.•.�.%F-.a'y y-�.,��'��" .>r..��..,k:� =fie _ _<t :. - s-,��4 ;,"...,.: f}3F;�:i; .d� Newport Bluffs Occupancy/Use: l�� Name: Address: 100 Vilaggio Newport Beach Construction Type: V-1 �4,� 0V CA�r�'p� No. Stories: 3 coo a City: y 92660 ZIP: Year Constructed: Brandon Lawritson��'��'` Contact: Telephone: (949) 467-2133 ^.�zi:-` ,Say �v..2-�'�r'•+.,}'yR, •n ::;i•?'�'< bn+'M�: .'i•<c w"'x: 11 a^n.��j.. .Y;•�isj:�fC��m`.u�`:•,5��{L=yl:'�L',i'.,�,.'�'�_.-`.i,'',•.+-`7f ri,£�Ct+�+,r? :7Y }•r c;_� 7" }sr A+i�x tom, 1 �'W ,y.5.�� ,5�es.� t },,.i'kr�'�. +f •'`j '' 7 - S'�, r,t :i�. >r��s'2•u1'T�c,.�S'�.�,,. ";. v":,Xs:,�`i . `i ak '`=. '�+t "A`'•t�`'iw'<^h- y�. '� iiY. Ci.:t �, �'tC''a.rt>1 Y ` -,:; Rn,, ��, �< :��:�;�,��: �,' 4.a� � a%v �`� Nu , �e Hof �j+�s�e ;•,� Rrsa�;= r;:. �'} t'- �•-.r,..,.•..h �. s�:.. ," •°' ��oygnfirac;,fio•r�m�aa�io,n :�' " �� }��:..- �r�.r � �,.�;�_,z�;��=��•��: � . -a-��;.' � :>c,�:.:� fi F Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ✓❑ Owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/16 City: CA 21 Contractor pate: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#. Title 19, §901 to §906. Job #: S10-12 3SA605 Z) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) ",rty„__ system5IWi eeAed -xt:p a;nd enter £ e$ .0 a foes tis'e' fio I „(, , .4' Y . „r ?'t}'•'.-.r. .}tu$^'.... ?F:'4Nen a<•,"'.:� `•�;_;*_..- z#.}L��! .a,: u•L<•,-� .jpra=tf rz �..••.,�. g- }. f.'5 ors„ = F'ai`o aPassio;indicatestasfinsj�ected kstemrateplaofciq)peGfionutr, 1.. �. �.�.n,��.-.�•.��.3 Chec��b�xes�R � '�i. , ,�� x4a..i.:�v..�i..t,a..��.�.�r, �.....c.�•Y., c9.a:�,.>..d,�.as.. wx s�:k�^�`��.`rio.`5" Yam' ',s.. ,xf:,�.:=�'',tu'�'.Snu'• w�'r�:�`�wsireaw�;:'�y"�ns,�•.:s�s�'.,�'I �vrS; �!�"az��§&s.-tr .u.;,a'&•rs.,Mdx,i�.�..nc.,J�.�+_ ,a`?. 0 Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ 0 Standpipe and Hose System 6 0 ❑ ❑ Q 0 Private Water Supply System 7 0 ❑ ❑ Z Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ QI Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) Yes ® No -2n - 11 "a'.t V .. „�''4tf^3•faM':t.^•�.•. i.., rrµg:a>.q'Y", .�+{.:.:1. y _ <. ,L €'z" w s f'i*rn �• L•-',N�' ,�.._ x ��'. E..,= at�idf.,eaeh'tespecft�,-,o'r `��,f �,_,, �, .,� ,"'M r `i.yt_ � 3:"'z. �H d irk. >': .- . eaDe.kiciene�esatidCo„meF!?'s;so x� >., n,:..a w ._ : tea_ , � � t:�� Asti. .: � .a:.ty,. AES 1 September 3, 2013 -..,; :<.s.',"' l' ' :~ : "s'rF a .fsr:,RiJ'Y": SY • ..,,;;•, ,� : s vd:� •': ,ris..', i.�Y s. �; ^ x.>s, :. '. �dp....i i�"*�a:. 1..;,: �[3, sf .,< 'i.E /";•, si .�„', ,�G�;,P.;,'Z,..r� .Y F '2.;;�.4 s... :•iS i« ray: �v':si'J. ySt !? t>; �i, i.. >yJ' ,"� "� :.- �: ,A �,..I:9Yi(;."�Y'y d, ��:..l �i�;��, �'r! ia', t'•s •e`: :�'z^' ,.$�^: :: Ye"; f:°i'.. � fi s.��,3«^Ni"%,.tl'ss.�s; � y'::¢ �;• ;> kyi Sit ��'.�%J: y^ Iz;:; .,h;,..,;. ,az �_«i?C• °ili _ �i,s „cam• r a ,� =�� ;;:3c��.. `:� x: , �._ °;� .No,: ,�,� :Loaafiiori: -: •, Y;'�, � . "• - .:z, : - �. `;' :';''.•Riser:' ::-'13iaine%r c-''Drain; - ->1Vfan �s`Diame; r„` ;lriitialaSxatic` sssirre.` �`P'r '•ia i� ' Resiid ,�!ressure •:; ''Final. sure;:`: .-';F!i�es „ Units 3029 - 3035 90 80 90 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: Maw = Inspection T = Test M = Maintenance ';•; � -'44170-;A;2a EGA"' "- .: z. . = :,.,.::::':'.:'.:: ;,: a .i i!oii item .: Des r p .: P =\Pass F = Fail N/A = Not Applicable F 1.1 I Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 I Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 I Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 '� :•,5•, s`uT.e S'x3,Y : 6 cp S ,K..' �o'•l .. I'VE& \= = = Inspection T Testa M = Maintenance P = Pass F = Fail N/A NotApplicable ;'.'item'' ;,,.....<.::°> crlptto _ ., - • ' <pbs;x., \'` •�.;;`:::E`'�. _ 1Jt=1?AaCnA:d%:' e • Aafe; ,NIA � 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1220 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 F7Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'P until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 p 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 A AM I W10, 'K m I = Inspection T =Test M = Maintenance P = Pass F = Fall NIA = Not Applicable 77 77, Description r A c R ,e 3.1 1 M lCheck Valves - Internal inspection 13.4.2 P 2 3.2 M lControl Valves 13.3.4 p 14.3.2.3 P 3 3.3 M JFDC - Backflush 14.3.2.4 Pipe Inspection - See Deficiencies and 14.2 es 3.4 M jIntemal Comments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P . 3.5 m I Deficiencies and Comments Section for Results Yes 3.6 M ISystern Returned to Service 4.5.3 F-jNo I P - D = Deficiency C = Comm (Indicate type) C:1 w. n a dorfeplac6d, 'd�cd n ire I 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15, Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El see correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith I Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 Newport Beach No. Stories: co City: ZIP: 92660 Year Constructed: Automatic Fire Sprinklers, Inc. Copy sent to: Name: 7272 Mars Drive 21 owner Date: 08/11/15 Address: Huntington Beach, 2 Fire AHJ Date: 08/11/15 City: CA MY' Contractor Date: 08/11/15 State: (714) 841-2066 1) For specific inspection, testing, and maintenance Telephone: requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: WN gg lz INNER 5 0 Automatic Sprinkler System 6 0 21 Standpipe and Hose System Private Water Supply System 7 0 F-1 El 21 Z Foam Water Sprinkler System 11 1 0 El El Y es No 0 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) IP Res Rolle September 3.203 6� Ri6 iser, aln,: rain- P Units 3036 - 3047 90 70 90 P This build.ing has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 10"il "AW eV e, I Inspection T Test M Maintenance P Pass F Fail NIA Not Applicable -4,9m, 66 Fi� 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 lControl Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 1 Supervisory Devices 5.2.5 P 1.5 1 IGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 jHydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 1 jBackflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 .t`e rM1�S.i. 4, MR .r..w xii^ .:.,.�.a..♦ o"..i .. = Inspection T = Test M = Maintenance P Pass F =Fail N/A Not Applicable 41 -,,.,. ;.,_, �:-may :. `.r . , _:..,:✓`..:.':;;:. _ ^:ems 5:C .� eference �� ✓>N 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 I Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ®No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass, If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 49 �WA� P ^ I Inspection T =Test M = Maintenance P=P I ass F=Fall N/A =NotApplicable �NFRA� 6d.' "Pat'e', on Tip 'e, n 3.1 1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 1 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 1 M 1FDC - Backflush 14.3.2.4 Pipe Inspection - See Deficiencies and 0yes 3.4 1 m lInternal Comments Section for Results. 14.2 W1 No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 1 m I Deficiencies and Comments Section for Results ZYes 3.6 1 M System Returned to Service 4.5.3 ❑ No P D = Deficiency C = Comment (Indicate type) 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/151 1 Unit 3039: Replaced two painted fire sprinkler heads 04 07/10/15 Placed Five Year Sticker on Riser E]Check here if additional Deficiencies and Comments are listed on Form AIRS 9 Number attached: 0 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. I Print Name Billy Smith of 1, Signature 'ev r Date 07/10/15 Form AES 2.2 Sept. 3, 2013 Newport BIUffS occupancy/use: Name: Address: 100 Vilaggio Construction Type: v-1 ,��OF C&t,�o� Newport Beach City: p No. Stories: 3 ZIP: 92660 Year Constructed: Contact: Brandon Lawritson Telephone: (949) 467-2133 Contractor,Informatian ':Numb"er of. Systerri -Risers Name: Automatic Fire Sprinklers, Inc. Copy sent to: Address: 7272 Mars Drive 2 Owner Date: 08/11/15 City: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 CA Contractor Date: 08/11/15 State: Telephone: ( 714) 841-2066 NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 CA License#: Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Performed by: Billy Smith accordance with California Code of Regulations, Title 19, §904.1(a) Check bo>i ,for each system inspepfed aril ,enter.,'th'e nuriiber,of farms used,:for.inspection.. ' Check boxes, (Sail or Pass)ao indicate status 9f inspected'system�at ond,of'inspectioip:. . 0 ❑ ❑ ❑✓ m Automatic Sprinkler System 5 m Standpipe and Hose System 6 0 ❑ ❑ ❑✓ • Private Water Supply System 7 0 ❑ ❑ ❑✓ m Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 ❑ ❑ ❑ m Water Spray System 10 0 ❑ ❑ ❑ • Foam Water Sprinkler System 11 0 ❑ ❑ ❑ m Water Mist System 12 0 ❑ ❑ ❑ m Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes No _ 7— *S"ee"'pefi'ciencies, and'Comments" section af:en.d- o each.respctiVe form. AES 1 September 3, 2013 R1 16,1e "Sti �-,Fi•fid 'tati §kj 711: No. Units 3056 - 3062 90 70 90 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I= Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable e escr'] ti .1p '2 d Raf n .-,0, mment§ ?"T : 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 lGeneral Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 1 Fire Department Connections 13.7 P 1.14 1 jAlarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Reducing Valves 13.5.1.1 NA 1.16 I jPressure Backfiow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 w„r-. �,w "r+`v ra:• � aim •i2""� 'R'+LE"t�x, :C '2:i •`Tw :•Y: `e;.' £ a.r .'Aye^ Q•• s x 12� ";k'3• :.'tip • I, =~Inspection T =Test M= Maintenance P=Pass F=Fail N/A=NotApplicable Tite..ni:_ < ..�I/�v/.. escnpiran Reference,"_._ its`"=Oriiq 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers -Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 17, RIP I Inspection T Test M Maintenance P Pass F Fail NIA Not Applicable Internal Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M Forriments Section for Results. No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 P Deficiencies and Comments Section for Results ZYes 3.6 M System Returned to Service 4.5.3 No 01 07/10/15 Replaced Water Gauge, 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 3057: Replaced four painted fire sprinkler heads 04 07/10/15 Unit 3058: Replaced five painted fire sprinkler heads 05 07/10/15 Unit 3062: Replaced one missing trim 06 07/10/15 Placed Five Year Sticker on Riser Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR,'Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith I Signature Date 07/10/15 Form AEo2eo��omn 2 _ _ _ ' .-c�`."�„-n. �c r;�.K r""°[�•: x �'N'a, w12 : `".v"r n�"''r4"*a •�S["",^Y�. 3^,�;r,'xr' $iL'S,'�"ps^'''.'�;: •�• `,;:�'�'e , 'ew^�&1'�s��?'v �,R t� �:-..+�v.,�iah''��'�?'i,��,` �h • t„z?� �..c }4a, r.�-='„,.F",•, "<3 •F,•:;'�"4 .�i�3�t .�,''..•,,.,5#..+ ,1�3q.,1- +,f.. ,et's -'i rr,..''A. = :1'�.;�..=.:��iY?r,> "+3,i1h- fu._rry'•' w,;.;., �a:,..iJ;s.li .Y-J`'`•�F. `a�dc iaa.. (..�G• :'� 'iv' /u 2' �:. '�"I- 'F'L (,�}�y{, `v�,�%, 3� �,3 S.-,[, 1• f" tF i L tH"i 't ^FbF ^`3.M1��i,'t, •t'v"� t .ir1*Z y�_ 41 i {Lt1 J"t b °4' }3Y'('. �i:=., •, wft, ,1i1�.' ' nn �$ r�ta 3 ,1.: s ;�a �..'u:?•,tr.:�} y-7?- , ..nrFf o•�tiLy't 'ter -? d vn'•y7S' -i^'; �{"'-s; S•:- y F'�1.=v ,..1•�.•J4�r,'M�}�x'...., ,. y - t.� .:5•.i•.:��- i'��: �:�f.Ye:,�r.�q;">Y �..St.'u,�'u�''�aH"�{.°`�,ir k.:"i":"i 4Y.. 'f5s".k..,•y 4.. �• __ __ — _ �'.`'h�,rh/w,'�3^'"�a-"-+�r�,»�?'k,'Si..,. Name: Newport Bluffs occupancy/use:of Address: 100 Vilaggio Construction Type: V ... A:�l C /'�p� Newport Beach 3 No. Stories: `� 3� City: y ZIP: 92660 Year Constructed: I �Q Brandon Lawritson Contact: Telephone: (949) 467-2133 ,5: �'�,_ :y?s�•�„�4�'>,;: c.=.�'xT,�'ne+�[�.k:r � �.t �k� [;r„3-. �:]� .. L"^t', C.e",.y-.+1. ;. - >-�2:•.��y:eKx,�'.:��`. ,:`w��af.: %Yr'i'!,tT �: .,;��i ��?, N '�'^w'2�. '"��U�' � � ��t'�#'fsLk ::4'+i' �^l �:.Y`N.4'-4.#' i"- �. .3" 'C,. ^.s• i:21',x.�..Y3,�.Gn+-}' i "`'`. <'�' Y+'Y. �,Ta„�. 1}i:�>'i� '="Y�,,�••_ .;�s'S�''�.�'''3�.ti-�,:x:�4s »,-d_ ,£� nsw.�?,,x"�;'C�.�zii�u�'.�°�' r? h, r;, 'r�."",�,,-,.•r �", t�:.s �� ;.€'',.',#a'��;,�.-a t �ar'",«;.� G�� t , .z ��;� r n.. t. ��;. in%,• , rser 1 ��;; -� �:: � ;�,t�� < �� ,,;� �� t �•: ,,�;�.��:> � t�:,< �.. �..,' • x`� cz �� . o�fiX�ct,�a � l 6, ,: � �• � ,.�., ff,��,,'. �F--�.. � Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ Owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 For specific inspection, testing, and maintenance Telephone: ) p p g requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) �•. ;ter d-?y' �.� �_�t.- �<.. �K „ o'r'is"e`ioh'_ ., >>" d ac' s'`�'s,,`"fe zips' eEed. nde 'erfthen,um'ker� ffarrns,rsedf p, ,i„.,..0 eV b?16 ht� Y I►! d. (?`{ G 1 Es b3NSn,r :'r"'ue,. ,�.,'Y. `Sl�•*iia-iN T.v. 3fY,'Y%y,9F :?.ty''0r `�W..�.• .pi {{-zl° :ha= .. Gib, •:iitfS f*YI 4i, a+�it<:,ini j3F'• � m•dica�e': ta�G,s�or 1�'Y'�'�G:�iec4c,Pass`'�j'tes iaw.`'E, ��ah�..i:ti4kLt• a +dtkr.La��.�•....�tL4.N ,:�: .•w3'.a'., .°3�a.'�:::}!�.2�.��ua.;.._�'.t-J:�.'��'.�r_Y�eh:�.,�+,�.5»-,•�'•FLu��'w�aT3t�»,2�e:C�`�.�'vR..��_a�eA�T..ti• Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ Standpipe and Hose System 6 0 ❑ ❑ ❑✓ [� Private Water Supply System 7 0 ❑ ❑ ❑ Fire Pump 8 0 ❑ ❑ ❑ [� Water Storage Tank 9 0 ❑ ❑ ❑ Q� Water Spray System 10 0 ❑✓ ❑ ❑ Foam Water Sprinkler System 11 0 0 ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ ❑ Yes ® No Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) .=�eYFr'ePi.Fu`�>,-e��, yi,f°�o�vY+y.�.dFfaiw^a:��°'.�.'•-�p%�,-. •„`i','L�r;.�?j4�`"-c:. Cs'T�j-. k?^.:�:..,;:,•, �i,.S<'�`Y- t.-'fi=L:,'v -"rrc'St �.wf,.ie»Plt;'"'s, e,"qn�.S•fi.ta�s:ar 1.(ay.^'eI'An'.n;u�nyn4 3~a'a t cetp! rats-,. ,.:t�a..9a•u,levi/'✓;,:,ze_ro• ��e',+cii'�feJ�"7Ys'' r�,ra'uc�;�. �:a"a• Cko£w. .t.�::• „��r{�_.t•"^`r•ra'4r��3:tw. a... ?+,.vr�w.i�,e�*,3{t`s::g:+rtY,,n:. =+•P;�=�3 t'F t..:,; ..`sPw':.� S^Y ,.k.�eettqs: m.,n'm.."; ,e"„,i:a n4..c Sr-;r_`k:.:a-'r,'4}%.,�Y`i+r5:ea.-7.�5•.:Iin..tK',r.wnta,:4.. AES 1 September 3, 2013 A Y va ��fi.�,�r�.l;��.ti�...'%'xr:. c3 .�...,, , :.:,»�y<•x ;'-8,- si'.'{;•i+F<i7.<9'- OxL.Na xs a,.. �'., �:T nnxs �r- t•, .•;;%/S!s si"n�g��.'.q.i:;d r`Yy��ni:Y�" �;,��•a'�.'.xaw�•i•n,i,... -5.`,$'L; •%s: 6�i•�t.,^xk �'z•`;?x"kafHi'� ka phi , i-."c ,: t•. �.'»,. , k"!.: c .r a Riser •< . �.. ,".`Riser :. -, 'iaitiefier Main rain%� a £ >Diaineter . . ;},:. °°=1n t� "al `8ta rc . 1... : r�s re : :=:Res r ;1?Yessu e-: - inm "I;Stati Rressure`: P' NF,,N?A' Units 3010 - 3021 85 75 85 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: sA u: :F4 eta = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable "•item: • Descfi tiiii�:- � , =<... ; : ;< , . ^ .P :•1+1FRA�25C;4�� ;ed�:.;; :" ' nc ` .Dale::.: ;' :,� °' . Y ,.,,. n' :'P. -Gomments;tO 1 .. N 1= . li4': . r , .., . 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1.4 I Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2A.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 I Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 EMS 4 4 A,, X"A' 7*- L NON I Inspection T Test M Maintenance P=Pass F=Fail NIA=NotApplicable e DJ KfOA-15, C-Xt 7 - 7, 777 7-7777=, 7 p"n ,o 1.17 1 Small Hose Connections - Hose Valve* 5.1.6,13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 IBuildings (Freeze Protection) Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 'P 1.24 1 lHangers 5.2.3 P 1.25 1 lHangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 ISeismic Braces 5.2.3 P 1.27 1 ISeismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 lUnsprinklered Areas CFC 901.4 []Yes No 2.1 T IField Service Test Required Send Repoit to Fire Code Official 5.3.1 If REQUIRED, Enter'F'until results are returned from Lab 2.2 T lRecalled Sprinklers If not present= Pass; ffpresent=Fail Title 19 904.1 (c) P 2.3 T lWater Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 see. P 2.4 T IMain Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T lControl Valve - Position 13.3.3.2 P 2.6 T lControl Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T JPRV— Fire Sprinkler Systems 13.5.1.3 NA 2.11 T 1 Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 I Inspection T =Test M Maintenance P Pass F Fail NIA=NotApplicable me 3.4 M lInternal Pipe Inspection - See Deficiencies and 14.2 rl Yes Comments Section for Results. V1 No 3.5 m I Obstruction Investigation Required. If "Yes", see 14.3 P Deficiencies and Comments Section for Results 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 3010: Replaced one missing trim 04 07/10/15 Unit 3013: Replaced one missing trim 05 07/10/15 Unit 3015: Replaced one painted fire sprinkler head 06 07/10/15 Unit 3017: Replaced one painted fire sprinkler head 07 07/10/15 Unit 3019: Replaced two painted fire sprinkler heads 08 07/10/15 Unit 3020: Replaced two painted fire sprinkler heads 09 07/10/15 Unit 3021: Replaced five painted fire sprinkler heads 10 07/10/15 Placed Five Year Sticker on Riser Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that -the equipment is fully operable except as noted in the "Dericiencies and Comments" section of this form. Print Name Billy Smith I Sept. umo FonnAsau2 _ __,_ 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 3010: Replaced one missing trim 04 07/10/15 Unit 3013: Replaced one missing trim 05 07/10/15 Unit 3015: Replaced one painted fire sprinkler head 06 07/10/15 Unit 3017: Replaced one painted fire sprinkler head 07 07/10/15 Unit 3019: Replaced two painted fire sprinkler heads 08 07/10/15 Unit 3020: Replaced two painted fire sprinkler heads 09 07/10/15 Unit 3021: Replaced five painted fire sprinkler heads 10 07/10/15 Placed Five Year Sticker on Riser Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that -the equipment is fully operable except as noted in the "Dericiencies and Comments" section of this form. Print Name Billy Smith I Sept. umo FonnAsau2 _ __,_ I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that -the equipment is fully operable except as noted in the "Dericiencies and Comments" section of this form. Print Name Billy Smith I Sept. umo FonnAsau2 _ __,_ I'�49i9-'h"""Sc 'k.'^�^"` �is`�T`�' ` (ty�i�%Yrss :'t�'1W.: _'9'., '�. ,'�,F?w� - � '�� '.� i P �'�r,y 4,�}�. �L`-.• y`iy s',.1,•l•� .i.i� {'.ii {.. en-Lqy�°r z�*� `•r . �at:fiF' jar'-_'�f'-il•M L'..^"/�"T_ '.F�`n`�:� ..ati',:'VS °„`i,�r.'-�i'.•}�°�"�: i�', a+W, ��: l��.;y• �,-F luOv'. iSi•.R.��.L"^pt 5.'.+}� SYP•",-.'' � 1 p�`'L'...F'i e5'��..�.Hy -i,,., � �R ..Y,L�xaa•�43 �s'i .••'T: .,k^- } •W,..'., Y^r`':h. •Y�`; s•�..w:,.; �.' ��r i'a '.'..*��'�"' U'x InC.jfiE rY COY � �u� C. �.t` �?. a i f+i •{ 'v.�"� }�»a. ,�,33 �,j�[1 � ) ski �``�N K, K ^.`4'::GYW.s'r 5�.. �i.•�, ,*X:kF r,. �:�`^�df"•.: 'W� �s. �i r'y� ++�' ..*f. ;J. �Y.i, `6�' M. iy �_ t �¢� �iS`i"�.,' �a ��. Y':».�1 �' �..ao. YgaA'i,._ `�k rc'�AfS�.ru WfiC%-i'r5:i��}. �:ap�i�ir :�'�s,, �.1,�. „a---...Ytviu'�i;�..sa,:%�":i:l '£''--w �`%�:�°%�r.,, ."L'S. ,$.%, is • .'{ -. Pv .ti" tiy mli .h. .,:'�` .,e,-. s:: .. ,T�. :r.�•7'. ,�a"Sy Name: Newport Bluffs occupancy/Use: Address: 100 Vllagglo Construction Type: �I ,c�tiOf C�7�0� Newport Beach No. Stories: co3 w City: t : ZIP:92660 Year Constructed: Brandon Lawritson Contact: Telephone: (949) 467-2133 .aa • >l: •ta: " - •'k�, .t.y+.'�.fro:,. , "'A i+Ti>• YS.t: s�.i4•�Y:.f�n.�Y.:• d'in °~. %'`a 'YSa>'Sa3•- Y:er .iJ; <�.:.ur:... .?''f ."'::^4.,:.:,<', '^'y .t3jAr -i,. EAR �:F' ��'- �w.r.;�a, 2�,? ,ahs4s. ,vi}.$�.:�af#..G">.a `5 '�w.�:•kst.'."�f�"+..s-�^-ws-` Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA 0 Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 Telephone: 1 specific inspection, testing, and maintenance ) For p p , g� requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) .'a'r '� €+.' t �. Ys4+-'sr yr2:-r..t:r..;t:.;^r :,;�. ;.may.. �, A ' ' s'• a `' i s{:daeh "rat, tf a h:umbe of fio ` s sed3foF5 n ' ec ioh; �. ;,._ w': ;.. , .... }._. G��teKbox fqr each s stem n Xt nz _ 4.ra = S!?lw, N .p ,' ,r ;:t , r.__ ..;�"tea tr,,hx, Y •:gaG!d; de�h. :..,Y 2',a" �✓. tz;�;-;.,.°,k�,,:i:'.,J,'. yS'temjtendrQf#insnecti,ort y �,rm, es�(iFailorP�as�stoinlicafes"taus�ofinspstec� •, {., re b"N�A!3,iu C�'-.a.:k,`�.�°'dine;y`i�'.^�r...€..t.i5,"i's.'!n.,;5:`.s..'.zrea3,.:^:u'&.,lr'F"v.:'',�:,.+.'Jtd,..'a. Z Automatic Sprinkler System 5 0 ❑ ❑ ❑ Standpipe and Hose System 6 0 ❑ ❑ ❑✓ Private Water Supply System 7 0 ❑ ❑ ❑✓ Fire Pump 8 0 ❑ ❑ ❑ m Water Storage Tank 9 0 ❑ ❑ ❑ Water Spray System 10 0 21 ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ m concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes ® No - p ,`-`�"rs:�."t`'w-"V9:;«3r `'C:-.` ..,''�� i .`"r.";F� °,f �m�^ ::>. ,e.r '2°t�•< 'a;" a'`vrlt!:?.i o�',<' �•j: 7ruan�2'yiw: =,'®eflenclesa > ECo, me,nfis-ksec�Gon:,ew� s res ec�f4oh�.,_:= AES 1 September 3, 2013 Of Mom- Ad, Dim M 'Sta Ic R4iidb[4`,' A Units 3000 - 3009 90 80 90 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I Inspection T Test M Maintenance N J� r 199"� re P Pass F Fail NIA Not Applicable t4 ni 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 1 Control Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 lHydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 jHeatTape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 s r$ v' 2=4R = Inspection T = Test M = Maintenance P=Pass F=Fail NIA Not Applicable o `enfs:'fJiil _� .h"�,•[i s;cri tiiari`:-: , z�`.: �-,_ te�,",<"• C ,min .,>^..<°.;..; 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 NIA 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 I Pipe and Fittings 5.2.2 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 C " WO 77 3.1 1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 1 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 1 M JFDC - Backfiush 14.3.2.4 Internal Pipe Inspection - See Deficiencies and 14.2 RNo Yes 3.4 M Comments Section for Results. Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results Yes 3.6 M I System Returned to Service 4.5.3 I No P I D = Deficiency C = Comment (Indicate type) bat-', 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 3002: Replaced one missing trim in closet under stairs 04 07/10/15 Placed Five Year Sticker on Riser E3Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El see correction Form AES 10 for corrected deficiencies. Number attached: hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 =vyl! 4- MOM', WAR Bluffs Name: Newport Occupancy/Use: Address. 100 Vilaggio Construction Type: Of C Newport Beach No. Stories: 3 )> City: ZIP: 92660 Year Constructed: Brandon Lawritson Contact: (949) 467-2133 Telephone: T" Q'xl IsI.= *';'1' EF i mglsi 172NOM IP.� ' �i'qqjgp'g"P4 N TO' ffiR V 10 M I Dili R 1111,2011 �N-11 21 3, Automatic Fire Sprinklers, Inc. Copy sent to: Name: 7272 Mars Drive ❑ owner Date: 08/11/15 Address: Huntington Beach, Fire AHJ Date: 08/11/15 City: CA Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: SI0-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1 (a) 1 jRl V,6K, hffififi4& AMWN I Automatic Sprinkler System 5 0 Standpipe and Hose System 6 0 QI Private water Supply System 7 0 ❑❑21 Fire Pump 8 0✓ ❑ 1-1 Water Storage Tank 9 0 ❑❑0 QI Water spray system 10 0 Foam Water Sprinkler System 11 0 Water Mist System 12 0 1 21 F-1 11 No Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) iLRN AES 1 September 3, 2013 - Riser No: ,Locafion,- , ;Riser Diameter ,Main:Draih, ' : Dham'efer ,. Initial Static Pr-essure -.-Residual Rressure ,, Final S006 P essuYe• Units 4000 - 4009 90 80 90 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: o `xs s _ ,%f _, :� � � t.+cn, a � P�. 0 �� S�.bN 4P•'k',dM .S�t%aicYk Y� I = Inspection T = Test M = Maintenance P=Pass F=Fail NIA Not Applicable . . Descri - . -.. - .NWA 25'CA , Reference.. ate Crii-htOlte" P; F;:N%Am 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 6.2.1.4 P 1.13 j I Fire Department Connections 13.7 P 1.14 1 I Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 11 tp M-IM, I = Inspection T = Test M = Maintenance P=Pass F=Fail N/A=Not Applicable It P -, - Descri tion : N'_ , 25 CA-ed: :R Reference ..:. ; . Date• .• �Cominen'ts Only P,F;N/A: ' 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 I Hangers 5.2.3 P 1.25 1 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'P until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 F 2.5 T Control Valve - Position 13.3.3.2 P 2.6 1 T Control Valve — Operation 13.3.3.1 P 2.7 1 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV— Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 "_ b I = Inspection T = Test M = Maintenance P=Pass F=Fail NIA Not Applicable Item.' _' 'DeScript on, NFPA `25 CA ed:: Reference" . Date." Comments Qn(y : _ P,F;NlA _ 3.1 1 M Check Valves - Internal inspection 13.4.2 P 3.2 1 M Control Valves 13.3.4 P 3.3 1 M JFDC - Backflush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14 2 i Yes 3.4 M Comments Section for Results. No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 P Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 0 Nos P D = Def iency C = Comment (Indicate type) Item:. ;•Date Riser . D: C' Deficieficies;and"Comments: - Indicate. all equiprrienf. devices and gaits that1were, repair.'"ed-'orrepfaced 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 4000: Replaced one painted fire sprinkler head 04 07/10/15 Unit 4001: Replaced one painted fire sprinkler head 05 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: 1 hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 99, Sections 909 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 IW roperty.ltafbrmation°~ : .:: � , ; •.�A.. - - ' ' _�," . .,?.' ' ^ " ._`"`,� -.�- _. _ Newport Bluffs Name: Occupancy/Use: 100 Vila IO gg CA4, Address: Type: ��Of Construction T e: Newport Beach City: p No. Stories: 3 y, ZIP: 92660 Year Constructed: I yrQ Brandon Lawritson ARE MPS Contact: Telephone: (949) 467-2133 •- ' " ' Contractor information: - 'Numbei•'ofi System Risers - - Name: Automatic Fire Sprinklers, Inc. Copy sent to: Address: 7272 Mars Drive ❑✓ Owner Date: 08/11/15 City: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 CA ❑✓ Contractor Date: 08/11/15 State: (714) 841-2066 Telephone: ,NOTES: ) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 CA License#: Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Performed by: Billy Smith accordance with California Code of Regulations, Title 19, §904.1(a) Check box;fo'reacti system inspecte'd.aiid enter the number of`.focros used-for•inspection;. ... . bozes:(F:ail'-or Pass).to;indicate statusofimspec#ed system at.end.af."inspection: 0 ❑ ❑ ❑✓ m Automatic Sprinkler System 5 m Standpipe and Hose System 6 0 ❑ ❑ ❑✓ m Private Water Supply System 7 0 ❑ ❑ ❑✓ m Fire Pump 8 0 ❑ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ Water Spray System 10 0 ❑ ❑ ❑ Foam Water Sprinkler System 11 0 a ❑ ❑ m Water Mist System 12 0 ❑✓ ❑ ❑ m Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑Yes m No *S'ee "Def cienoes acid Comments" section at' end of each re pectiWfor.'m: ,. AES 1 September 3, 2013 {�7y. W";: ss'•y •=`•�n.:�„ €�`��., �"' t, t"F;::":�F;f'a�?",`S. ,<bi. "��6;:�:; �-,, a=°A?:,�°• ;;. .; .c , s�:�,- . .��,,". �? �b�;:';:,.,:f=':tr„r ,51 . ', ;;i,r •..� .�y�. h � - g� P `��'J�i; "�.,rem�r'!'�t';r^M-' �.;i�• ."�.s� "�" `,`�'�5",�;,t"!• �: a� . �� , y % -F."iiial :5tai�c" : . , -.. .,. .... . , >... , ser_ ,M .<., .., .... • \ _ ;.: �: -, ,., :�, f�:,>• .. Ris�t� w :�;Man<lyran,: Init :Luca ionmeter.'' `i)iaineter.'a "'P'ressure.,:; :Pressure::;<: t?"rassure Units 3063 - 3074 85 75 85 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 01, NO, ffl- 0�-, 1= Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable ,,D.escAp'Uorr'";, :. .:., ; : , ed:, .. �;� Date , .-- � Commerats :only. , . 1.1 I Control Valves — Identification Sign 13.3.1 P 1.2 I Control Valves — Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1.4 I Supervisory Devices 5.2.5 P 1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 I Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3,.2013 I= Inspection T = Test M = Maintenance P = Pass F=Fail NIA =Not Applicable o N*25,tX FP A 1.17 1 1 ISmall Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1,18 1 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1.19 1 IBuildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 ISprinklers 5.2.1 P 1.21 1 ISprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings -Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 25 1 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 ISeismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ®No Field Service Test Required 5.3.1 If REQUIRED, Enter'F' until 2.1 T Send Report to Fire Code Official results are returned from Lab 2.2 2 T Recalled Sprinklers Title 19 P If not present = Pass; lfpresent = Fail 904.1 (c) 2.3 2 3 T Water Flow Alarm Devices 5.3.3 60 sec. P 90 secs max. Enter time 13.2.6 Main Drain Test 13.2.5 P .4 2.4 T , (Enter data on Pagel of this form) 13.3.3.4 ]2.5 T lControl Valve - Position 13.3.3.2 P 2.6 T Control Valve Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P " a 2.8 T Backfiow Preventer Assemblies 1 13.6.2 To be Completed by Others NA Small Hose Connections* 13.5.2.3 NA 2.9 T w/PRV Hose Valves — Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 1 T ISmall Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, II, or III standpipe systems. Form AES 2.2 Sept. 3,20.13 60 'a, I Inspection T =Test M Maintenance P=Pass F=Fall NIA =Not Applicable 7777777 On Internal Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M lComments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results men id 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15. Unit 3063: Replaced one painted fire sprinkler head 04 07/10/151 Unit 3066: Replaced five painted fire sprinkler heads 05 07/10/151 Unit 3069: Replaced two painted fire sprinkler heads 06 07/10/15 Unit 3072: Replaced two painted fire sprinkler heads 07 07/10/15 Unit 3073: Replaced four painted fire sprinkler heads 08 07/10/15 Placed Five Year Sticker on Riser Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith z Signature Date 07/10/15 ' Sept. 3,omo L �.��. •-.c„!�a ?�,»'..-.+'�"a^^•.�..".,,w,..v.•�•-!��c,-�v��s�c. ;+•.n�.psd„7$'ss!.c,-et«�,�:�a "Li'±,� , r ?� mt �.�; �`.r,4-:}""iC''�F;t"` "v�,`;<%�;'''`3h'`�t 'Fy .,: �x:k. .?,rtc SI.'k`l--_, r-i*e•V=''^--a.... 'Y'-^ �?'o-" t' ,n - ei.-.?,..-iaxe�:.?y� � 625�•T+�. - _ _ �L.Y- !-� :4s"».} t» @"', ,.�»'�,'�';,':t-, q�'t" .ya;: ��'32 r.�;-,&0-i.:Ai' � z.F;( .. : �.J �' '��:.�:%f �;� .t•c.;rar: 3t• �; � .,� +6,i . �.ui�•. - �.f`:1`.,...:.aTY:f. ;e„ .;. s.,. gg ',� { y� y. l�;v,,. T t, ..t� Y�""^�, 't.',5"�yz.. z., ":mot•_5a;`=".rw:2�±..,z�>:,?,a._.�,b•'�''^'::i cht:~;s.��}yz,,:k'ar' '7 _ _ ,';b- zek-; � +?. a' �,�s,a� �:k3p§.ro '?p^�e.�ri, '.,t'•+,'•ti,fa's'xi`�?.. • e w 11'rt�;I��ir I I . W��n 'y` .; -r,_.,,.«E" �.�.: �,t: � �'�;-..,rs,• �.�r `•:�'u��a�•'"t a,�«,r•� ,�, .a ✓: a�-1;, �,.i5".,VS<«.a=•:� car f �;.>: �, �•� � v jTr it"?-x.�cy r�.': �5:� �- ��;.,,.� ,,.� � �.+,�.�` ' - � �.aa`. .'�a�,�,,•, •;�`''.•,..._,,;,..a,,.A,,.�,�, a�vti.+�w � li u ' �r i ,�%•� k. '3 l 4� ;t�p.�.•�''"9':;� M4r`�u�Gau.i�LW? 3 .�ao:I..�'d .�:iws9.4na�ai:ai1l� Name: Newport BIUffS Occupancy/Use: Address: 100 Vllaggio Construction Type: V Of - Newport Beach No. Stories: 3 City: 92660 ' ZIP: Year Constructed: t�Y K, Brandon Lawritson�� Contact: Telephone: (949) 467-2133 "- :J,, ;Xff' +. .s+.t - �,R � i i � � `+;,sd•� !�., !i �-.� ;"�3, fat �,5•`: _ t('..,oi'•..r �.a. sT' s!`�h.>".=.! ' �.:•,9':.�ir.'�,w 1:.,k.: ��?f?��k� �hx •= =� e'��'� h";`:? a L? rl', r d•artl:".iSw',.tr �>� et. «w,�. '��r,•�� ..felt ,m- ��+. T-�;� „`tt6''t..s.^c� i..t:",� t -,a a ";,ery,:.F `A ;h1• f',r Y„r}^.,, t. �. ;+3ir'; 3:. �"� s;��`��t- •.��,-��::1. .��,...'r7�'+�.,,,�w;..s.;4r�, u,fnber�ofi �ster�'�xRise"'tr`Yrwsy. �5•�,�_,� k<�,�.4,,,.,•�,,,,,.,�,�t,�,n'�r s� :`r•Ifo• ;,'afi r,� �. �d��i:�'i'�`. .x��"•t�^�.�+�:�..',-�"r�'3�a '1,i'..,'m.b...aA.-�y jht�, ,;�� ;a:`r '5'��'` ".�3..,, i'taar fin. � Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ Owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor Date: 08/11/15 State: NOTES: 714 841-2066 Telephone: () 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 CA License#: Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) „x+h„�'+'>"�arak7i,'-^ "':+"`.:'-"�+'`=^i •'t °8r,.-.s, -fir .�;..x. - s+a.}�-�,- nx. - ,y;,; ,.ylr .h a.f .�.;,s �e - _v."��-.��.-•�t+yn��;'s'i�^w,t�`''- .} ��A ,z• o sash's, sE ;�"�fis ec�tel,a :cl er% e'thenum a s"Affio ills fed torn Kati, ��. hes box �f rr ti.t ti' d=w a `-,'{!'.}�•- '3^.y 'SI '�.1� . i'�4i. .iv k oa`+ ♦ - r�'rii: dr' M:. �rYc y'rf.. +� s. nYRi'�.kJ✓-%s.+,.ft e'V'"Z �,�� •. pt .,, ,.r ,,.- �5.: Cheek bo es 1l�Fail, or�P�ass`) -`..�x�'S°;'.�.�aG:a iS?.�4a.t''L`,��,'.•-9yc��n,'-^3._m`.:.su"�e"��&^vt_��^k�w�'.tb'7�rsS�''m'^.a•�:rbl-'.'3�'.;.1 o �ndtcate s1a us ofc mspe fed s'yste�'ry:a en o PARRO`c"t''ro'ra ,..... m..�.:S..S7:=.r_r.,ha:.:a.:l.�m>2�-axi�;?.s4'P..!.•: �`;..'-."".,. .� -.v x.5.�?irk.,frvt'%:�at a- ❑ ❑ ❑✓ • Automatic Sprinkler System 5 0 • Standpipe and Hose System 6 0 ❑ ❑ ❑✓ m Private Water Supply System 7 0 ❑ ❑ ❑✓ m Fire Pump 8 0 0 ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ • Water Spray System 10 0 0 ❑ ❑ Z Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ©Yes No `S:ee��D.ef es��an � m� °°� ?• � t� S' ,� :, °h�s�'�� ...n cienl'�' ifi � ♦•.'.aar. `T .:-?a: �s�-: iuk:rca'$. .�. $s�`�..'q.-aS3�'sz'..: 1fv� � aw: �Zr 'a'c.:a.-+.:.a5,> ��.�:•:m.','..'.ESI`e Y.,r3k netdud...: i.. .n�..b'tiE''P�ik: �.eh::..: `a;+-;e.F�+, :4 y°: AES 1 September 3, 2013 3 - I", 6 'tatiaz tin P, Units 3048 - 3055 90 70 90 P E] This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: Z, "vow, all- 01 Inspection T Test M Maintenance P=Pass F=Fail NIA =Not Applicable ts 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 lControl Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 1 Supervisory Devices 5.2.5 P 1.5 1 lGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 lFire Department Connections 13.7 P 1.14 1 jAlarm Valves — Exterior Inspection 13.4.1 P 1 5 1 Pressure Reducing Valves 13.5.1.1 NA I E16 I I Backflow Preventers 13.6.1 NA Form AES 2.2 - Sept. 3, 2013 S�,:A >'=.,t':; .4.•h.^ '..'£. ,, '; ,..�:;b'.: "..".>.•t `�^s'>yE' 1 � s' � H. t 4. . •a y � . _ y„3 ... ,r.�` ' � y 'b 44 > •T,.a > I = Inspection T = Test M = Maintenance P=Pass F=Fail NIA Not Applicable tort;• NFPA,;Desert Date:.; ` _ominents Onl PFN%A•; 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 NIA 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 I Unsprinklered Areas CFC 901.4 ®Yes No 2.1 1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 1 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 _ 1 t e "x3 I Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable -NFP S, -, Date l of S�r �c ce, 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backflush 14.3.2.3- 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14.2 F7, Yes 3.4 M Comments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 m Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 E]Nos P D = Deficiency C = Comment (Indicate type) te:".1 R_ 'too 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: E]See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, andmaintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that -the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith APO� Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 Property'Informationr Name: Newport Bluffs Occupancy/Use: 100 Vilaggio CA�t�O� Construction Type: V Address: _ City: Newport Beach �Q�of No, stories: co p ZIP: 92660 43 Year Constructed: Brandon Lawritson ��E, Contact: Telephone: (949) 467-2133 Go itractor Infdrinatidna -NUniber'.of System, Risers' Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive Address: ❑✓ Owner Date: 08/11/15 City: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 CA 0 Contractor Date: 08/11/15 State: Telephone: (714) 841-2066 NOTES: 1 For specific inspection, testing, and maintenance ) p p g requirements and information, see NFPA 25, 2011 513781 CA License#: Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Performed by: Billy Smith accordance with California Code of Regulations, Title 19, §904.1(a) Ghi:ck b'oz forea ills ibcted,ihd:enter the'niamber of:forms`up0d'for•inspection, Ghe k boxes-(F.aiL'or;Pass:).to cate.status of inspeated'systgRJ 'K at end• oflnspection:: _ R Nam ❑ ❑ ❑✓ m Automatic Sprinkler System 5 0 m Standpipe and Hose System 6 0 ❑ ❑ 0 m Private Water Supply System 7 0 ❑ ❑ 21 m Fire Pump 8 0 ❑ ❑ ❑ m Water Storage Tank 9 0 ❑ ❑ ❑ m Water Spray System 10 0 0 ❑ ❑ m Foam Water Sprinkler System 11 0 0 ❑ ❑ m Water Mist System 12 0 0 ❑ ❑ m Concerns that are not deficiencies (Le. Non-Sprinklered Areas) ❑ Yes m No each: res ectiye form:' *:Seen"Deficiencies and-�-ornments Teofo7n :at and of . _ P AES 1 September 3, 2013 n. is building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I Inspection T Test M Maintenance P=Pass F=Fail NIA =Not Applicable edl ifirb zP 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.6 I Hydraulic Design Information Sign (For hydra0cally designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P i.io I lGeneral Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA Form AEG2.0 ^� . _ Sept..3, 2013 4�p:�xa `<•�:< .,.14�a. ?t .> '� E`. E �,:;0.= ,ir• :Z`i" �^'Fi °:e: '�i': ems, .r = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable y. ;.`, sF Pi4 5 C ....... ..2 ;,< • ;aDa�e';'.:-:`: r_:G'. � -` omtrt ..R:escr�piton�%��<:`:-,_<5: ., �;.-..; ;... Reference s>; . 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 I 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 MYes ® No Field Service Test Required 5.3.1 If REQUIRED, Enter'F' until 2.1 T Send Report to Fire Code Official results are returned from Lab 2.2 T Recalled Sprinklers Title 19 P If not present = Pass; If present = Fail 904.1(c) 2.3 T Water Flow Alarm Devices 5.3.3 60 sec. P 90 secs max. Enter time 13.2.6 Main Drain Test 13.2.5 P 2.4 T (Enter data on Page 9 of this form) 13.3.3.4 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* 13.5.2.3 NA w/PRV Hose Valves — Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 1 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 "'a #aW, I Inspection T =Test M = Maintenance P = Pass F = Fail NIA = Not Applicable N "F0 A, Jr, 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 3 M JFDC - Backfiush 14.3.2.4 Pipe Inspection - See Deficiencies and 14.2 RNo Yes 3.4 M lInternal Comments Section for Results. Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 m I Deficiencies and Comments Section for Results Z Yes 3.6 M ISystern Returned to Service 4.5.3 f--j No P D = Deficiency C = Comment (Indicate type) 77 A(C 01 07/10/151 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 3075: Replaced one painted fire sprinkler head 04 07/10/15 Unit 3076: Replaced one painted fire sprinkler head 05 07/10/151 1 Unit 3078: Replaced one painted fire sprinkler head 06 07/10/151 Placed Five Year Sticker on Riser E]Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: 11 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 :[<.- . ^,'?z. � a �ii: &. 2.':.t•�'mra-�...,..',.�+,+»w.''^fi�,-'d�-:. ^�.�,,"r'�,';E£ay:.'T„mk� �r S �_ r?;0�`;��`y�.g�::Y,�„--�`�,��3•'�sf".�;r`�;- �, . ' - n3: .'�\w'.�"-.''3 ae�-` is �;'•-'*.` �'��'"•3'"'aus ,2. ,��„. ,r".`.x. -�,.. �.�'�r-.ar a{.�"`'t,+.`�•�. ., �' �'�,""r,,: Ys.r i`i,.,'la:=`i '�"''.`,`$,. .,..�', �5�,::. .�{:: ??+�` i�a�'`.�. -.,,a .�$,.". ,frty?tS.F,mi.-"`'1:.. .: :-,.-r:=T.:�''�'<': a.,,; .r;`'-,., '^'`e7:- ,tr.., ,f;:,.:�e.,:.w•'a.'-`Y? �». �1 .�,.�^-r... �. ,,,�,�,, yy rt�� y tZ._-�ti.�rw:t .Je><, :^,a».: d4.,..J'SC �, -; l..tr ci`-%�.:.` .: 12u;>s?';s"•:.� t; :;y: J'4�ar_d•i�'„��'sr,}r..a,�,_g.;,, ._ ".",t::. (n� {{..�� E•+- �-- C. ;'r.<- 5zs�`.- _'�.-v,r.: gym- �r -_ �....ls„?� eJ9L!'��Iir:�i1CQ ail• ��t, s�.ynr <_='�a,,c.?. ,�.E :em �i'3•'.- ...k✓`.��.:�. `' .�i:A;,I ;. x,� „i'.'s,., �v a`��u,' ��..•�'. _ ,�'.' Name: NeWpOrt Bluffs occupancy/Use: _ Address: 00 Vllaggl0 Newport Beach `' Construction Type: V _ �4tiOF C�T�p� No. Stories: 3 City: ZIP: 92660 Year Constructed: Brandon LawritsonRE MPS Contact: Telephone: (949) 467-2133 ;w , *'°S'v+`.x?-.+T k.2'.P.,3'a��. m,.'� --e:X:i�r" '�; i'w ri^ � `i'v�5:� ,n ��},�� 3y 3�.;>< > x �• � "f7 '1 YY t _ q - � •�a .r y {�.� ,?i '_ ,tip:,.," ;S':i'.Gs3'�. �,�s?..7('. "t c$r��'i�:.Yt $` y,Z r-h:.. Yph .l. 1. Wi�'h�C:�:ac�ls.: .''�"=;.�:X.�.'� 59�Ki� �Yi�.ti/»•k: `,Ci 2-�.1,J�Y3��.Ly..„ "},w.�..-.'i�i a'..v°.i'"� _¢, .tC.n:3�S'it,'�`'yea+i:.k-.�•��y.''C'�S.c�.N�`7i. '.i n�Nt�..�St ��..�. ,s,��a..� �� ,,;� �"�", ��I;lumU�r�<v:.Y�s�e,;I�R�se'rs,.,,, ,r.�, ,�j;,.:r.,� r � �:��` tom_ ,..�..� :��:• ,,��. ,�. r;.Gon�r•,a�c�,4raln;�o�rt�a�io, � ,..�'� ,.��-,a��__..,-�� x�w;��,��`�.• , � �. <:;�. 4.,,�.,f,.4.:�_�.�_ ;� Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) w,,rx.» •n, y,ji: -r rPS ' ck•: +�r...T4...-..i,,' V v 1 y 'rz, � ,'i?'�i,FSayss „w. �M�u o". each s, 'te.I ,ins ect `cif yid' en r the h, mtier' f fi rarri ; 'se,,d;f�or � , speef `o'n . a �++' '�:4)Sa '., C-'C€,,. i- I h. Y�ty Y'>.A. 4i jLr W'.� !'i :u',ypp es(?Paila�P'ass)to i'dicYsfiausofned,e€yrt��rtdd4n�sp�iSo.ti,,�. �... ;� G'i)iekf3Qa �"rawb-..xia•'u?sng�3,:stxEi»..^s�:an.aetia>A,_saF'd;Y e..S?•,._SFsas'e�.+..k.,� ..x_'.�sr.:....?:i,..... .9sa: cY.'sL�"sw.: �C.� Automatic Sprinkler System 5 0 ❑ ❑ ✓❑ Standpipe and Hose System 6 0 ❑ ❑ Q Private Water Supply System 7 0 ❑ ❑ ❑✓ m Fire Pump 8 0 ❑ ❑ ❑ Water Storage Tank 9 0 ❑✓ ❑ ❑ Water Spray System 10 0 ❑ ❑' ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑✓ ❑ ❑ ©Yes No [� Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) a-.+si�w'�„+Hm'p'}m�w1`°•a+f��, e....,'w'�,•.v.., N i... . �,� •.�1;.6`A` �i l v sseeion "npf SeeryDefieiena�esandCo ena, 4 ��v.r�,�,��ei+Y 'TM:"`�'�.x��'�l "1��'i^"j�` each res eat' fan •.'�U•;<.x r v�'��,^�2,YS•�cn. i�•.:et't4,!:��L�.,• �kn. 7 r.R h r tn� : '.. ..,..a:,, :g.. x,,il�°,.,',.•�..,.,_.� 44...,�� AES 1 September 3, 2013 el� tin xessijr6 T, MA <N Units 4048 - 4061 85 75 85 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 rl Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign .,z (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 1 113ackflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 iP . 1• • Vie;":-n'i=4 ° S3 -S Gi i .. ° .•%,""`., .., . , ..3nt:<..; .il.'• %\"i�.:�'• E 6. �J' -g�e z,�,.\sc`..A £. "`lLi$+R'iiza'bA = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable . .. .v :..... ,... ., .., _ 7777 -. 3 :..:. :.. t. :i+fFl?A's25-'Ci4.;Date' :h.Reference : -. Jr .. ' -'". , - <Cotnrnents':Oh1 '.' P;F N!A 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 j I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 I Sprinklers 5.2.1 P 1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'P until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 J, I Inspection T = Test M = Maintenance P = Pass T = Fail NIA = Not Applicable t A T7, 3.1 M ICheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 3.3 M JFDC - Backfiush 14.3.2.3 14.3.2.4 P Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M lInternal Comments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M I Deficiencies and Comments Section for Results Yes 3.6 M ISystem Returned to Service 4.5.3 No D = Deficiency C = Comment (indicate type) e#6166 enWeM4 bropoir01a 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 4053: Replaced four painted fire sprinkler heads 04 07/10/15 Unit 4054: Replaced four painted fire sprinkler heads 05 07/10/15 Unit 4055: Replaced five painted fire sprinkler heads 06 07/10/151 Unit 4056: Replaced one painted fire sprinkler head 07 07/10/151 Unit 4059: Replaced three painted fire sprinkler heads 08 07/10/151 Unit 4060: Replaced three painted fire sprinkler head 09 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: E]See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 a 1 f •• E, -�' tv,; .;F.,.. ,.:f`•"`v .R'=ic`:; �.jv'•� "�t�c"s°a.�, 5 :�"�P,,•'aas,K, •~¢��?�;��:' �'��,,•;`�ti•-.,Ss::-�'..��',%"�"'�..:�:F�.i�';.i:,;,kF�.rx,_,�.�,t°,t:'•"�.o+:`�''.=d-at';�c'x.. �� .`,YiRt;'t"y`"ti✓ `fi••�.:'rr�.,ii.,)1b�fZ`,§!�. :A�S'' ;i,; .F�`7z �`^i z., �j yy:fSiti.%;n ,$�+ �.. .nY=w r "`.i`St:.. `ti: 7, .t .+�{,; Y' ..�.�;..�,.+� x.,3_ ,.u:s:�.. _�1,. ;mot t"?��. '..:i��.�'�..s4•^r`p- v4.?. ��S:,w�'<r;:z�„t�,a°�>+r�... �f .:yx;',r:,•.�_ "H,�xe�rk�:X=.;q r�,t':,.;1:� _r'a.,i. .3's•, 3R�5 •t'.y �,'Y5)i-F'n.+`,•..� �U.i; ?: {L�'.4: ��•7 1•� .. ..M �. �.t, �x; Gs �.: :.iF` ,1;�,': •ff v1S.<n....}i d... a.� '�"C �.,i �"`�yc.14't.: �(�i'- .� � �?� �..�i3�ti°��'��1�'a u��,S�,-�L•i`.s.,�.•, �. �. .,.biz �1�' ,8.`< "' " "t'-'' ��t h�� 7F ,,a i'"{'�- 5�.. f..c m,•. .'C• -,�."iiF; � � �.A' 3. j' "k�` �' S�a�.Y�•iw4.R.'1W�S9f�s'ds�L�.YiSS.�A� �~..� 1fs., y�°., �::..^-. �4^.K•„iF- � ` F sWa.Ni:](aesm.Sr«1t`.sL�''a`S,viu'�.+. 'Yw.tl.F lw •�• •.aA:.�.��Y1'.s3L$x`:, Aiw+,..Yt4: Name: Newport Bluffs Occupancy/Use: �- 1 100 Vila io °F ca<<,� Address: gg Construction Type: O� City: Newport Beach 3 a y No. Stories: I ZIP: 92660 Year Constructed: I t 9 _� 4-4 Brandon Lawritson Contact: Telephone: (949) 467-2133 �e -'—`y �i � M^4mr„��+.,.y �t ;�.+Yj'�vF �. �i.-v' -,�: � Y*'�I J!�' �'�1'<:''.Lf4t ��iuvf�:��{e�.1 �,:1..� •�'I Y�.��'�'�;�`P,q,Y_"' ! "�•".i. ,1 t `t .Yw, �5 - �' \ �'+'� » .da`� - `,9+dY 1'T.=. �*y"S�.no � i. W ' •e-Fa i. •. .a� %i SP':T°LA t3•S�.ti; ; j =f'�`�"°�'- � �2 :� :a, ��• .'�,��':.;*:.... ��, �,. be' ''f�S: to �R�is.er �; � � � v�: ��=:� y�' i'et1" +i '4'�F�k' +-. ,iw: .:%•.°i.:tv w.du' ^q ,•�' ��rr ��`�� A)' �`e�,Mt#v w: `2'. `a •P'-- i 'S' _ 1.{,.;�.^'2• .z;� J3•=i3" ��4477;;��Co�;�r��>�orilinfio_\�ra;�t:,on}�,,.�. �; .,� > fir:'>:, �.;�,;;��,�\�,- ;.�.Tir►„x-.�-�, �.; •.��:.,.,.,.�. :��;� `:� :.��z,.,. ��: s. i� �.,��,�.,r,1-.:��:�`. .4•,�:...^�&.i1.4.�Li'!�o`ii�d"��L�Yk�F1LtSC.b�::.� � Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ Owner Date: 08/11/15 Address: Huntington Beach, 2 Fire AHJ Date: 08/11/15 City: CA 0 Contractor Date: 08/11/15 State: NOTES: 841-2066 Telephone: (714 ) 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 513781 CA License#: Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) :,:;ss•-��;;;^ r>.w.s-� r-a�a 'r=�,.., g•�- :7:< - - r:,�. _„•��:•�•:,.�—.Y ;w.,{- ;:,yz ,, '; t° ° :ste�n`in ' �' fcln.ilen"rfheeh:utnberw�of�f"'rms•tused.afo� pecf o3s-.. �. L: {� ., .;a..c�,.G,sec-,k�blayyy,,,',o:teach�s -± .. g , �..,:, f•-.•,�.....d.�::�:s.r.cN- Fa.,.�..,: _4 ,:,t •:";t `'� J,!y i you ^�t:,LY`t,:'s 3;,'%}aiS-`2:n t."•: �.1 n:.`�"g ;. ':-i?X_. r: x: ;.�:r t.• 's`�. c�..,_ �•`:t«, c;•. `?�:,F. "ny i r�;u; x C�t11e,��k axes {I�Fa�l�;or Passe �n'V'ic te!"- a'`�, sxof�4 specie' sys m i entl of in sF wr �?n .� , t. ; •;, } �. 1,`�-<_,.".3*.w:-<ss �Ks'�+.`�..i:'�_��..l•'£y�'a"„ .�3s:n'it£.g+fxctke}aP"'�=�ci:f3�'uGA:��NPS��i*�r.'a:9�:.�;k•:'t.23'�'S°'�•Ck�.Ads..-�_•�L.ss,.,f...•s....rev..'�_'}.:•P„�,-„<.,5.0�_�..h•.....P • f• f• f' f� f • d • Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ • Standpipe and Hose System 6 0 ❑ ❑ o 0 Private Water Supply System 7 0 ❑ ❑ 0 m Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 0 ❑ ❑ (� Water Spray System 10 0 ❑ ❑ ❑ [� Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑f ❑ ❑ m Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes ®No ��Defici.� � �eGomYii.ei��s�s io �a n.•. ties s eeti, e�fo.rm` w, ..,s�,�-,.- �'` per., �ttrt:�,r.�,;�� .';:�et �nf�e�c' A, E _ ��, -,4� ��'_.,�,w�,�i�'�:�': F�a ,��i_., �,.ac„f;�',�iiF;�:x%•��a�t�s.��ar AES 1 September 3, 2013 I 'K lie es a F 1A Units 4079 - 4085 90 80 90 P This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: TV S I = Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable e c to 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 1 Control Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 jSpare Sprinklers 5.2.1.4 P 1.13 1 IFire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 >•':`�.ti ,,, 1�:: _ e'.::'Fo �Rx F. ;IJi. s•.A ;?:.'. "{E A EN ,:r4."w. yq i 1 B rv'� 1 = Inspection T = Test M = Maintenance P = Pass F = Fail .N/A =Not Applicable >.:..,^:.',=Des piion, reh Y r: 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5•2•3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2 2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 W --Z I Inspection T = Test M�= Maintenance P = Pass F = Fail NIA = Not Applicable D Z, 3.1 IM ICheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 3.3 M JFDC - Backflush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14.2 Yes 1 3.4 IM lComments Section for Results. obstruction Investigation Required. If "Yes", see 14.3 P 3.5 IM Deficiencies and Comments Section for Results ZYe s -3.6 MSystem Returned to Service 4.5.3 ONO P I D = Deficiency C = Comment (Indicate type) 01 07/10/151 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07110/15 Unit 4080: Replaced three painted fire sprinkler heads 04 07/10/15 Unit 4083: Replaced four painted fire sprinkler heads 05 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/16 — Form AES 2.2 Sept. 3, 2013 and over!Sheet IVP dbV=R, It Newport Beach No. Stories: City: 92660 Year Constructed: Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive R] owner Date: 08/11/15 Address: Huntington Beach, 21 Fire AHJ Date: 08/11/15 City: CA P(I Contractor Date: 08/11115 State: Telephone: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 CA License#: 513781 Edition as amended by California Code of Regulations, Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: M-M RINI, • Private Water Supply System 7 0 El 1:1 2 Water Storage Tank 9 0 Water Spray System 10 0 El Foam Water Sprinkler System 11 0 El 1:1 Water Mist System 12 0 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) Yes No AES 1 September 3,2013 v,e; ,s;� ;'V;:�s,.;, ,., e.', s(Fj s'--.l';,a,,', .,�.. u, ;.aps .0 W.:: �-.•%s. ��`-,.;y ��•;c s„s •. .��,��. �:✓ .s�d,e :"s rs i,_ -= x mm °`,' :.:�:�--,",';;;n�,-,• .I""s'�', i�',�;,Y•,,z",�s ram.3< mot': � k r ^�,p ry•.£�.• �^,:.� '`y°,_.. 9;.>. :..£:S ;. s.f'¢:r 'vs-;� .� f:"'S tj`;'"Tv �,,; �•0 a 'a :Sta � "' "�12iser �.1VIaii9"firaitt"-lri#t�1:Sta =;,,, -!� �Pcessure' Units 4086 - 4098 90 80 90 P Q This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: AKINC �' ffi .i«� s :, °; "{ 6•,, I = Inspection T = Test M - Maintenance P = Pass F = Fail N/A = Not Applicable _. rtptio �eCi�:•'e: Dafies< _ 1.1 1 Control Valves - Identification Sign 13.3.1 P 1.2 1 Control Valves - Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1.4 I Supervisory Devices 5.2.5 P 1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 P Hydraulic Design Information Sign 5 2 6 P 1.6 1 (For hydraulically designed systems) 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign 5.2.8 NA (not required for system prior to 2007 Edition NFPA 13) 1.11 I Heat Tape 5.2.7 NA 1.12 I Spare Sprinklers 5.2.1.4 P 1.13 I Fire Department Connections 13.7 P 1.14 I Alarm Valves - Exterior Inspection 13.4.1 P 15I Pressure Reducing Valves 13.5.1.1 NA 16 L11 1 Backflow Preventers 13.6.1 FNA Form AES 2.2 Sept. 3, 2013 YM I=AInspection T= Test = Maintenance P=Pass F=Fail N/A=NotApplicable .,--e. , `•.:tv < . <i;; �' : ., .,.�;....., ...Des dn=> < ci ti,D te::;- ;.��.>; >:�>.�: Gbmments.dn�j/" =PYF;1(A°< 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 I Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 t Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 MYes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5 3 1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; if present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA ___ * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 ly Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable r � W P F tic 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backflush 14.3.2.4 Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 m lInternal Comments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 m I Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 Nos P I D = Deficiency C = Comment (Indicate type efrcie ap mn n,�&m*,arej-aired d& ac� 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07110/15 Unit 4097: Replaced two painted fire sprinkler heads 04 07/10/151 Placed Five Year Sticker on Riser Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El see correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Date 07/10/15 Signature Form AES 2.2 Sept. 3, 2013 _ >�:=,5�0`.-. �•� ..."�j, '"'V+<z.T 4 �^.Ysi 4N ��b3,t?.R^+_�y'�...a„"`s¢q'�.e'.a`Sf,'^'s t�,1a„��,�'i^,?t-�.�..`��,Y��Nf,t�„ii,'�r",:�s�'`:,�'.c'tt+��i'm„'?<41>��k J:_^�y'Y,"�,-' �'�� * �'� 'Y l.�'33 F�`.`./it,•:Y � nV �- t �S= U 'a i� :S�:L.�p94r i y, Y:K `•� 4 S' o�,n 3+v) P:' - ..iF �y �.,� ni 4' iv y��`'t ,/, w. ,-� ,t �k�Y�� °r",,�t,, µ '.?t .rz r�,£`tc•:. _ -sue ti'`� _> ,.�w;;,t;%.. .;t:�.t .. `, 1 AA : �, '10�� "S�iU�tJ �'1{��+ .o,�'-�y�yy'�'''' ;iz `4T":','44`;i;�,�`f.-•d�,�„rn�� . Sx��ti' •c�a .�,;�;.r,., le'; 3--'" «ii i W;v ,5..,�;i�'•y rk �;A,v "n"!`..:?i}.„`'. !��= G p.nli li L Q�=Yn,.. ,cw�F' +' 7.., �C.a�.-mi `r-�^.; ••i<•:± �';�':a}�j<g SAS, •`ai N�d,i'.�C.. 4;.1!'..� 4`,'..+'',��:a At'+">�'rx„.'i - S' ��p'tii..�J :'r, �.. `n �.. "ti'. a2 r1'ad .Y: •i:+}l.`_: ,,.3r'v.: }, ,�n.; _R� "'i'.•�' _ 5fi� '�?{Y_ _ .;i '�s._, :L." �q fa. ..� •'� ;; N1'�:'S,T,' .a 'f, `4 v:m J< 5• :}k- il.r_:[i: _: Bluffs R Name: Newport Occupancy/Use: Address: 100 Vilagglo Construction Type: _ V -- �Q,r,�05 C ,�09 Newport Beach No. Stories: 2, 0 City: p ZIP: 92660 Year Constructed: Brandon LawritsonE Contact: Telephone: (949) 467-2133 s'e-_ss.,-'�.,-'c:".'y.•s..�ve,•'""'A;`Y„'_�,F;>�;,�:- :;r,`.".1.+.x ..u"�'��': 4w .[-'.°'•..,^rRx.''�x' '��?T?'�i°r�+�.:r i27'#K, .:n;r',,x. ,, .,:L�;:ail`^`-�'i�`'x;rj�`-tt'-'�;.,•'S.�',`i•-'''.p'�`••`'} •`�"'' ray,";Y?x•,�,''.•..�•."',"�.,""�, .e. �`,^�'s.s.-v.: s:.Y�k-, �'- ;-p." y�`s.,�a., �' :5 r�,•,:.a' � ,',.', .y.. ;c .,E � .9 r' 1 $be:�a£��m'..at,,,j.�t- "'�rd>`� y'��.'• �� o:'r'►�a'�lo`i°n'��'�`r�'��,c�'��`,�.� e,aa •�,� �� >"�:w:r��;;�¢��`.�'' �=�-�.r5,- �;N.um�iier�o�S��s.�C�!�sers'�;�.,..> ,.�;,,^ �y.�t:'�''." ��:=��,.�~. i � � °u �. � � �r.�t ��;�:�,==.rr. ,p, , � f y .r. i•.. �. r Q.rl�l'actor�.{wf � . „� �• �:.�.,�<N!Z! �,� ._,(�a, �;��::t,<.�. Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive Z owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ❑✓ Contractor Date: 08/11/15 State: NOTES: 714 841-2066 () Telephone: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 CA License#: 513781 Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code -of Regulations, Title 19, Performed by: §904.1(a) ..ay..,, 3' 'i �x _ r�,eai:r'.s 1 i ' Hof fi>`iims used or.'nsF ',e , _.., Ghee b fo reach":ei�'ferl"en.umb'`,. +. �.1 �� %, .rrY;;j'„�'3rv``�"lVt .ti•S'br'£f5xnil'vY`"' w t,w., t .emu"{ �'s'" cg .G'Y."fi, aK'iiK' �8 icF.f:'r, =s�e'�SJ , i2:S..-,+h?FF��.d`4^v."A\;'�,ia .ti.•,i'�'4; ..ix:Sit �,.t it . ', 5 e.y 7•,i ... G'.'e'-. �a�IoaPasstoinpe,Ctah,'_;_�.". ::- y'__,€iCEieelbo�'(es :mc3,ipa�eistaus:5ofs�ins♦'.eeaye�wsysteat:enci,u u;Y�:r•;.?:.�'Si'+:.`+�fid"L>., a.•:t%s:.tTCcGt.`•'nkmdix s:...a.trf3d:..�`.: Cm= Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ • Standpipe and Hose System 6 0 ❑ ❑ ❑✓ • Private Water Supply System 7 0 ❑ ❑ ❑✓ Z Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 ❑✓ ❑ ❑ Water Spray System 10 0 a ❑ ❑ (� Foam Water Sprinkler System 11 0 0 ❑ ❑ Ql Water Mist System 12 0 0 ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) [--]Yes ® No �- �•'�+"`"",�a-,yj ..T' � r o °�,[f,"°,}-..o V11 '.'-`..'�.�;.. - FstR'K^`-.. .'a, '°`�''.'S5T'v.�ti+�n':�:i . Fw� .� Y '°.'•+'�A� 1� ,.�y,.C..'�'at`i!?.f;:.� }'} cIe ces and �See��De :p'!�?�?:.•:?��=r,:�„�:...�,.,��.,.��=.�r.�.,�P�.-„�>��,�.��X;:-'„�.��,�...�.�.��,i>.�..�._.�..�:�a�.:.3'��:.�:<�:.=:Pr_�.~r AES 1 September 3, 2013 ,.V}em�s,. >.i;., �_F,• b.. .".T;', c.ss< �.�+�y a; . "� � � � ' �:, :,�- • - ... jz3J�� :".�'"'" g,. p�•i:� .`�,i, l..,'m-:.,"r. �7'� 0 O i"1Yr >S..i:i:- "ray f.,;, ,;.<bi TM'.isa<z,� ;, _ :'Riiser- >.:11Aain-brairi' "lriitiat��Stiatic:; _ . ' >:` ""lame%r..:'=;,<Dia'b>eter;'i �•-:Pressure;': _ :. • .Re§Tduai� . <�Pressu_re �-, �- - Staiic -gnat ;-.�P..cessure>,.;; . - Units 4075 - 4078 90 80 90 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: ;.S'SY Y[:'un t ,.ds EY3d '+ '� - •.,>: 3nz, s.& `S,zF,':. ...Q e4a5 •K w`: 'w° 3 3>..z��!a •II' A F^� X ';�F"S >�, w•v„,a`"r� ^N ?"x 'wl^" YS',a�e.L`;•r :^"a;:. �'R_"law ,�,"�+.. �`I-. 5 :"°"��. MF<.:�.:., r "°`Rsi..4•:<-�-:` I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable -ttetll:; •;.?^ ; "sr .:x '"""" •. •DeSCC!^t1O1Yic::;:,�.. .A 25`GA:- . .G"Qtrim � ` exits . n .. F {,}IA 1.1 I Control Valves — Identification Sign 13.3.1 P 1.2 1 1 Control Valves — Inspection 13.3.2 P 1.3 I Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5 2 6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 I General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 I 1 Heat Tape 5.2.7 NA 1.12 I Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 Fyx E. a, . ':�•'�Z,��a .,�'¢`.. ;;N S"�e, S n � S . S � t r .. S..Tu �:$:,: �.�.. : Y ^,�`. 'gsl .= \ 6"`.;.A •.�'e `fi ',S�xY 4s<:'. .2'i"; ';� °mot° : xi'P. = Ins ection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable ... #ern = .�;>.. ; ;.: . •.. ::,.m:,:.:.F. :. ...... = P , . �.: - 5 -Refer-.Brice "t' 1.17 1 Small Hose Connections -Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 I Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 -To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 I Inspection T Test M Maintenance P Pass F Fail NIA Not Applicable Internal Pipe Inspection - See Deficiencies and RNo Yes 3.4 M lComments Section for Results. 14.2 Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 m Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07110/15 Unit 4075: Replaced one missing trim 04 07/10/15 j Unit 4078: Replaced four painted fire sprinkler heads 05 07/10/151 Placed Five Year Sticker on Riser El Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: D See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the tire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AEG12 Sept. 3, 2013 jt.'f:'.a+ +'„"I>;•"�° '+ °�-+c, •�+�.��.`x=:'�g'�g`ti�.'.o�� ?.. `:•,�t*w,":i'...nf!a`-T`:- .``�'^�'9•^-.r"., .�...,_-..•�Na.-.,,1;:i^`Esr`'vn!nr;`"",wa.Fa...,'.,u�:cfd'.yR,]V'*'M •.'�,•;�`-~e.•yT/,N'a4s.�' Nam',•`j+mY_ 4 �J...Yv �'*YY`r`, �.,..,.�. •w.2 .yiv'nsl^�:' ,s, :?,• .>, ,{ -,��;� ��`„, „� ,*`' .;�% ,s. y _ _ BIUffS Name: Newport occupancy/Use: _ u-' Address: 100 Vllaggio Construction Type: ,.. ��Of Cat/ 0 Newport Beach 3 No. Stories: a City: ZIP: 92660 Year Constructed: Brandon LawritsonF�� MP�� Contact: Telephone: (949) 467-2133 t�-�'`4.��-`�'^.•', ..a�;"�tt'.}' '2^' Y'< `'� g�' `'� .s�,�r"'C-•wfg.-'•e�`;Y(.��iYfr �.r y�,`,ri4 'e"'� .t 1. `-,�i.-,� .�CCy y ,N; ji `...x' �'�P1:a�;f, 'yacS'�^Y,PJ y,.'P.-'�-, *4'?,'�;S{t�n ;'`"� r-` t'ro`Nit.:s. T�?:��''`'��yy�� I'-r �,<.b{,'. ,��x'•:'. twrS%. '. t ni..l_. 11'a"itayr�':.4".:*;'$f JJ��dyV�' �l� :ti '�+Wn :r"sT,-,.. ,, ta�'w �:,�� a�•`i`_>s r2. 'z,fi. _r4'�ri'3`'ti�'Li- C� tir.�i 4"-lri- 1 ..r�'s-•:: $��;�•, ''� %..... �i',4� �,_ 1 1$_ k-7� 4v* f"29. 3; g��.Co�n�tra�c}a !.-..��,�.J. �'a ��i, }", `�- % 4.�Y a kc� :�?, fb ap`.x. K'a� :d�_ .rSo. `��•r �.. �:t•....". kd{'�+..c.'��.,,�-. ixt`I"s�.'.,F�'ik:"s�F'�'e-et�a.iau".?aua 'u�.`, s.F'�',•'�•,.a.'.slat„�.°�x",�e3`=,.,"t..�..,>~-�,`u'�'°de".�,'f 6Q:- r+a 'ri�wnus.X�a� a ...-_._3_..�„SG:2 Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive 0 owner Date: 08/11/15 Address: Huntington Beach, 21 Fire AHJ Date: 08/11/15 City: CA 21 Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) e-sa - _ -. �' ;;•. ,, N'�« _ Y. r.s`edfi:7;in" ecl lio flor�v�ach��y te%n nspectedy u� gn ugui ;riuinbetrcffoxns- .:� �.p ,--, w�a. '',„ M.. '—',, :J.�.+,'kcj. P .f....tC.' .;%F+•'a.:s�a w :i $+t i�'::�,ri»'Rb'.xt�z': }:1ii'�Sh;-,", �c._'u,•i-#--.�£ usof.,�;.n§;pec;e�s,stem omspectio y' .�::.,.. N�C�hecl_(:a.es;iFa'ilox•P2a_ss�).o�i'ntlj':iz°atv's:4a .'t,"nd ,;•.,�.�z �,.. kc '!ri<,afd m' �:t5s�-'., w'-•:dzu �iaw¢.,a =d: :n�:n.4?5�_'k4'F4 "ah'.'etA-..a - 7'C 3.Yh�. nt,%>: Lail :.w .:.�1E'3P�;T,�n.X�^c::.'re8 • Automatic Sprinkler System 5 0 ❑ ❑ 0 • Standpipe and Hose System 6 0 ❑ ❑ 0 • Private Water Supply System 7 0 ❑ ❑ ✓❑ • Fire Pump 8 0 ❑✓ ❑ ❑ l] Water Storage Tank 9 0 ❑✓ ❑ ❑ • Water Spray System 10 0 0 ❑ ❑ • Foam Water Sprinkler System 11 0 0 ❑ ❑ • Water Mist System 12 0 ❑ ❑ ❑ Z Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) © Yes ® No q"�_,•Si. h.-{r;Sffi .. .,.r..-.:. .�,,.. +ryry, .^S'•'a^4., 4yn ;°'"J'�i •�.,�"' F'.n.'-.,'gym' - `�$CYy?'v`ngz .��. •:"F,•r},w: '_.-��'r�'e: a.:a�[--+-s�,+a,'.wT�^�. � t1�.y� pY1Yf �j py� � y� Gn `'p��yf,�nn �'' 'Ka.'F � ppX��j{� Sees.DFe��e1SpGJvGJ,WNYi'�il!Vll��st11��IjrIW'�S�e�U�iJI'si�rGi vl'I��y�{�1t>��'{.`s��i5�4,1Jt�1VjvYI;V1��Y�,�1F��;�•��it{yv t, '�1 �i.eTAn� �'��',-�.' ,>�-,' ^'y,•' a�• -;, �4�'o 3gc..:' "-,yT''.<i''d'�r." �a i'.: �•ysGwi.�I, it.._ s� ,�{%(�/� AES 1 September 3, 2013 Ab Oc bk This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: I Inspection T Test M Maintenance P=Pass F=Fall NIA =Not Applicable te 1.1 1 Control Valves — Identification Sign 13.3.1 P (For hydraulically designed systems) 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA Form xsSo.2 Sept. 3, 2013 - IN � .. pe� S W Wad = Inspection T = Test M = Maintenance P=Pass F=Fail NIA Not Applicable ,. "I. _ =C' =a3d:; NI?I'A 2 5 A = ;, • = Reference<.`Y ;. .... Q -t. C' "ens n iiirn t ;-. -P' FBI A�: 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A. 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings -Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5 3 1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 I 6M, I Inspection T = Test M = Maintenance P=Pass F=Fail N/A =NotApplicable itia, �FPA A Rd ii e 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backflush 14.3.2.4 Pipe Inspection - See Deficiencies and 142 Yes 3.4 M lInternal Comments Section for Results. . No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M I Deficiencies and Comments Section for Results ZYes 3.6 M ISystern Returned to Service 4.5.3 E]No 1P D = Deficiency C Comment (Indicate type) Jtem.. LA 'W lb, te,`al 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 4063: Replaced one painted fire sprinkler head 04 07110/15 Unit 4065: Replaced one painted fire sprinkler head 05 07/10/15 Unit 4070: Replaced four painted fire sprinkler heads 06 07/10/15 Unit 4071: Replaced five painted fire sprinkler heads 07 07/10/15 Placed Five Year Sticker on Riser ❑Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: Correction Form AES 10 for corrected deficiencies. Number attached: i hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith I Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2613 ♦• • • • • ` 1 • - ► • :K^^:p.-"-?","x"Ts.,'."-,':;,c,`;°?a•.""}'^°::«-°.„"5Y;`'.,T'_,,.,a,.'°^<`''��•'•i^�,v.•�'-•'4,'sa9 „-^., �.;':.re',•;r;`� 9i... 1wi:, �4:tr.-LLF �-,--3, e a;�'1h,4. ,?•t ��. ,*, ...l' ..tS {a•. 5-�•`k-x,1.f •r, "6�.: }t mi''.•ar-'��.,u�s; ,. R••.�:. .;:•i-.L':tj�,�y-"='t;C,;s�r.,•s�y; v's5,_A= .=`+a;<�f',"a��n: ..J'��`U'p�'j.�'zn-31}at,a• 3t> ..=R ei,^x'<P:•r;:q„r?;`1'IIs�'.?i'•,,.,:•r:,t .,+n'�'••t.o-„��,...>.`r �"F{'-'• •r�,nJ-" r�{ e s .I+ri .'E,ti_ �}�: �'T�,S.?�� 'ry �'+,4 S-t,r^ve'1'L1:i r...t''�J !'x4+i..� Yn,9.wS'.ir�du ;✓ �a-�.{�t�,.�y. .i. }':RYi-{ i. ',' �N... ktJ'-•i,6_4 _ L. :.�i Name: Newport Bluffs Occupancy/use: 100 Vila io Address: gg City: Newport Beach Of CAA Construction Type: _� — � ,�ti O No. Stories: Z p ZIP: 92660 Year Constructed: Brandon Lawritson RE M Contact: Telephone: (949) 467-2133 l::>�'�.y� ;a.IuC�r.criy►°vi°9 b-� t't.'''�r.-�]Y'i::r:ri,.• `��'oS`€y��"vs.'.ep:••rn: t'o _Ry�-.�•e+,i:F's°�;�','.r;s,f<ys>,k-;,`�:,Ti� n t�1:!i',A`,.�..' .4i.,?'<ti,.':A,4.F`=}�g,�1::;�::�'i';R�}n"<:`�, `a,�"<v.-.t�r..._.-��ir„ma. 's',.;j��`..i,Nj�.._ ,,45'�`f+h�,,�.:';$.�.{J3it,.•7 ,s� r{ .rr,f�r4a`` t5i�Vi:bdtwi3 �uf`.r-{- 'c�i,��-:j-. yt,�"r-L.,,. ,,r�.',. •f•be',:.r�`{,•", '�". 'S2�M6'n.•.,:e„ae�.};.;:f, ... i�.&*.,t �1�' (©� r1r, - :'r1c�'4• ,a {d j ,+xvt ,1.. i4'ti.::,2`? a`(w'''s`,5"'_'`":'t;::�r�m`�`%E.:e'.Ga"..<"&.'cC3xsd. -'r.; g' ?�-E: '.".J�Ltitl�t'�''`��r.v,,,^'��us#' _.s <s'.. may+_..^:, _ ..+�i`•' t:::.h„x! Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ✓❑ owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ✓❑ Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 Telephone: 1 For specific inspection, testing, and maintenance ) P P � g requirements and information, see NFPA 26, 2011 CA License#: 513781 Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) +*--'"a!L _ _.•t•4c.._ - _ i. w,:w-r5. - u.p- •-�•F.�.v:.. :•:,u z-.-•rx,.• m•, :max•.,-.-x..- rw , ,,,- "-{;;o'i'ac <si "ii '"'ected and'emtei�thenluimbe�Ptof,fortins'use,.af�forMit�s,`�e' Pion.,: t:T,fs,.. ,.{� ,,C , elboxf r m ,_ „r. yyy .},,g•.. :•?f:Ts�'„-�S a ,-�'"x7 sw:.u^;_.:i'Csi.�s-:�?.i. .r:y-.trek',: "�k xss".-•i5a: €+",:> ..f'k�•'•� M;yP. y^.":�., .:.i d.ca,�; ns.'etifa. 1` °z. .CMe.ckso='es�Faila rPassjh�toeaesatas gloAf_ins eceds`.ystemaat9e� ,_.j„" 0 Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ 0 Standpipe and Hose System 6 0 ❑ ❑ 0 z Private Water Supply System 7 0 ❑ ❑ 0 Fire Pump 8 0 ❑✓ ❑ ❑ m Water Storage Tank 9 0 0 ❑ ❑ Water Spray System 10 0 0 ❑ ❑ m Foam Water Sprinkler System 11 0 0 ❑ ❑ 0 Water Mist System 12 0 ❑ ❑ ❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) []Yes No .•,p i . i., a'r�"r,,,(�-�_,-tX`i,"ik`- -;,-:.w,.� .-.r �., ia- - .t .-,.Kn^.��".�•",,��`,;3�.,;�+v"`",'1' /;"_,",'st._.'iit?.•1Rfc. �f"�ai'7y,''S':v � { 1�.D.ef�c+e``es�aar��.ments ��ect��n�i�� hx, P �+ re`.>r1-.�'x�sS,y3K' 3rsvn. ..xYrtl �s>zwe �,'aa. sJs: �stZn•Nsm. �.�.m,:_:,-.��:�;;�'��'�:�:��,�.},.43a:.�{-r,:�,�>�r:��.•��>.�-.;-.y=<,��.,:,:�'�:�,�:�., �•l`�.-'. 3u[t�s'.•-�dy.....�w,:sn _ _ .� AES 1 September 3, 2013 _ '..t%:. C ��-�,r.t'-F'x , • _:»t.. ,z===s• •. "Y§4o:.: '%-';-;-"'"',,•�,,,,-: n' ;.mho?... , s'e•t Fti`se • No.•, ". �.�. - F.iser..��-" ` � ilairiefer=• "IVlari'•Drairi� b'rameter. " ;�in'i a , � _Pr.ssuce' f.a �u r ;s Przsse.,:•: `Pjressure ' .: Units 4044 - 4047 90 80 90 P [� This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: � see x•�,.0 •Sha•: •,i ggww Y\, y,>M 4 (•>Fn„F s�_t ?�... '3.� ..:t•N wc\f% � � � � i'"'fs"'• w�nlsx.Ry , 1 o = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable p , ,.Dates-> "C• "me is om n 'C1nt' l -" Y. IV� .., ,._..:., .......:.,..e fr• ;•::.::.....,,:..<,.,,� ..... ..�...-.:.;::�•'. ~:Reference"--�� .< 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Water -flow Alarm Devices 5.2.5 P 1.4 I Supervisory Devices 5.2.5 P 1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 I I Hydraulic Design Information Sign 5.2.6 P (For hydraulically designed systems) 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign 5.2.8 NA (not required for system prior to 2007 Edition NFPA 13) 1.11 1 Heat Tape 5.2.7 NA 1.12 I Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 •P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 I .r<" ni.F � ; Y'` YI,' `may.: '°c^` �� .�'< ✓^ � t � ip ;:�'<F :F N:`.a•., l' �.:i yw $ g' £� �•.H4 SxYYr'ati•X,`3 s.h: +d° = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable - Itern:: ::� :- ;Y .;;:: ,< . ;j.•:- ;;.A: K;; :....,Descr�piion,. s' `.• , r i:-.;;:,.::.;,:; ' `' .,: te-< Cotritrierits /A: 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 NIA 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 I Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 ®Yes No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Pagel of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 in B A, ZVOMM-F-M., "l-i- I= Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable jte iN `FP `151t T P Ojitii I ni On 3.1 M lCheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backflush 14.3.2.4 Internal Pipe Inspection - See Deficiencies and Yes 3.4 M lComments Section for Results. 14.2 No obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results Yes 3.6 M System Returned to Service 4.5.3 El No P D = Deficiency C = Comment (Indicate type) D, MR .... tile .. 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Replaced one Tamper Switch 04 07/10/15 Unit 4044: Replaced two painted fire sprinkler heads 05 07/10/15 Unit 4045: Replaced three painted fire sprinkler heads 06 07/10/15 Placed Five Year Sticker on Riser J ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El see correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith 1 Signature Date 07/10/15 J af 5_�e Form AES 2.2 Sept. 3, 2013 •' • • an worek ` j • • • + ?4 .4 `�1�j..Yn..i iss�'�'f,."�.��'+.'.��i''nl^.P+YRtm�ralsvv5`�.?.;+4'�J�a�`.��.-'�•+`'�i�'�.R.2.1 Z v�a"`t+ :`,F`i3-. 1R?-";E'";=;?"�,s.,��G�s :>-�., ::Y' ,"�� ><` �y�'" „'�"' :3��,;,E:: �a';c'c,"c• �.,:',;�.• ::,,> £, ca--a�-.c. stia-x 'r','•:;h'-��rr �:, - 6`e.;` "' G �k �>'�-:hf $ .� �,ti a [� ni. .4. �i• 4. ,rp�:' ;am;�'Y% �'`,-:":F�� s: �...h'<f "�1' - i \,.,3��a. �l�t.-'i�"':` �}y �:tk4F 4r. � l&;wry `• � :a;�a, ice, i:-:£�.'',a_ .ri'�, ^�A: y, \z ,�t. „!4i l+` �- 4K� _ �4•. ,$. �3:'A:ia�yr A��+.., ..:C, °3-� S-J:';i}: � },,', �.z+icr�n, .;"Yb?'T � V, A,}r. :[,� •:^5'-i}�: ?`�`z.":~w',r:.X<%z:; •_.: _ �{�S: 3�ati= rem d. Y �� `Kt `t..i 'Y' � �i"�: �'�<~•a:i4--i':a -. *,��::�- �`°:..�e;,�.a x< ate.!"::a e, - } .� ,J[]z #+j...> �a 2�� r xr 'y� �.- � '1� '�d-"-r-°.'`` S t+:. , 4«h �V►- N2WpOrt BIUffS Occupancy/Use: l Name: _ Address: 100 Vilaggio Construction Type: �I�F C�� Newport Beach No. Stories: 3 co � City: ZIP: 92660 Year Constructed: Brandon Lawritson Ma�� Contact: Telephone: (949) 467-2133 w�k'':^��;�e$4n. .r �.. .�y , svy.y 7'�}.. Y '•-r=�.�-Yr,�' ar`.'_,-. �'' � � ;tr'.:re-.#:, yr 4;�,' �`n'��_:� v #r �`_ .:, v'.'uo"., '.Y :�' ?,�J�. x.- «x.kc_,r- ,..y"+'din?:a�a�.a:w.=� k�,�+��vtit.?.1. +i x F� ..r•:.. �`� ,.-�rf.: '��1'�_-=..;s��i Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ Owner Date: 08/11/15 Address: Huntington Beach, ❑✓ Fire AHJ Date: 08/11/15 City: CA ✓❑Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 specific inspection, testing, and maintenance ) For Telephone: p p g' requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License* Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) a+r.zgTt�{ u. ¢.� r_xs�vn+:, �.' `� - _ r Rr"r?.'F.a: '__-'rh4!.'✓S: t.. �" wF h> .dnt rth'enumber'offah s'rsed`:o;i ectotnY ..;y. ?'Cieckboxfor eae'h s%ste ;,�nspced rJ ..> a ;mv� .s:f:y :,. ;r;-.�r; r �. b.c w �_ S .%U � t i" 4Ti G . 7?tr x�.n br d 'a, �. vYy �.`,t Ir< YAY 7 e,nt!-�yp��„.'frt.s,p�t1,ort,.;,: w;;_'z;,.+'-?C��h�.et�ckt'cires'ja��lvrPy�{ass�¢\/yry�t• hdi.ee✓s"Eatus�/fi�gfainspectetc�.sys.rna�. -:w-.�C.-YC.k..svK^y'�..4e.94}JL :i�nS.3�14'k.tr.h-'�Sa�sM �SN 43�s'.d?vixf':dr.Ft�Gi.11?fmk'Mit'�Y.Gt''rE:.L�Nif`ra�iw:a-•'L'�.sSRxt'�'a`5.tic"z."�'v�v+':af.[f3a1',_;Liv�firPtiJw • Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ • Standpipe and Hose System 6 0 ❑ ❑ ❑ • Private Water Supply System 7 0 ❑ ❑ ❑ • Fire Pump 8 0 1 ❑ ❑ Z Water Storage Tank 9 0 ❑✓ ❑ ❑ • Water Spray System 10 0 ❑ ❑ ❑ • Foam Water Sprinkler System 11 0 0 ❑ ❑ • Water Mist System 12 0 ❑ ❑ ❑ Z Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes ® No : k -' ? Ya -r ef�Defclencies and�C"i {menfi �s �tt�n:a� en - x- �" -� �'�-� � of'ea� "n��s ecfilu�, 1!onE��" • �r_`�u��fa`�L:�`;.�� .�, �� - . '-, rat ra •Y �^'`"��`� �>� ��..A AES 1 September 3, 2013 Location' Riser .. _piameter • :Ma n DPain ,Diameter, .-Initial Static P'ress'ure', • Residual ; :'Pressure :.: FiriafStatic Pressure . . ' F, F, .NIA . Units 4028 - 4043 85 75 85 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: > '•�/"1-a P l f a a +:1{t+�° �f:(�+faa'.::'i`+y.'°s�#::w '�'�'w"s�•u'.vey 1 = Inspection T = Test M = Maintenance P - Pass F = Fail NIA = Not Applicable .Description . >.... •ed: _ Refe-rence, Date :' Comments•On!y .. P, F, N%A. 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 Spare Sprinklers 5.2.1.4 P 1.13 1 Fire Department Connections 13.7 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept, 3, 2013 M 00-6- k >, f;,: 6 t '� . r' . ss. .'i d„',;'c�.3 S�. , '•:".;. ..,�ai�"' a '': Inspection T = Test M = Maintenance P = Pass F = Fail N/A = NotApplicable .• . .... � .,<: .,. ; -.... Y ,.,: _ ;:.�. ., -�� CAbed: <tJ S A Reference<.. f: �� ICI 5 ti =.�:�..,: - 1.17 1 Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV - Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 I Sprinklers 5.2.1 P 1.21 1 Sprinklers -Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 I Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 1 Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 ®Yes ® No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 9 of this form) 13.2.5 13.3.3.4 p 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve - Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves - Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV - Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class 1, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 WO W-0 W I= Inspection T = Test M = Maintenance P = Pass F = Fail NIA = Not Applicable DescryOti, �NF 5 Reference X "j 3.1 M ICheck Valves - Internal inspection 13.4.2 P 3.2 M lControl Valves 13.3.4 P 14.3.2.3 P 3.3 M JFDC - Backfiush 14.3.2.4 Pipe Inspection - See Deficiencies and Yes 3.4 M lInternal Comments Section for Results. 14.2 No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results Yes I 3.6 M System Returned to Service 4.5.3 ❑ No P D = Deficiency C = Comment (Indicate type) Icienc X, 7jen lt6 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Unit 4031: Replaced one painted fire sprinkler head 04 07/10/151 Unit 4032: Replaced four painted fire sprinkler heads 05 07/10/151 1 Unit 4033: Replaced two painted fire sprinkler heads 06 07/10/151 1 Unit 4035: Replaced one painted fire sprinkler head 07 07/10/151 Unit 4038: Replaced three painted fire sprinkler heads 08 07/10/151 Unit 4039: Replaced one painted fire sprinkler head 09 07110/151 Unit 4040: Replaced two painted fire sprinkler heads 10 07/10/15 Unit 4041: Replaced two painted fire sprinkler heads 11 07/10/15 Placed Five Year Sticker on Riser Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: ❑ See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature Date 07/10/15 Form AES 2.2 Sept. 3, 2013 ";'�,. ✓' i.'.-•�?Ft '�„$t .'.��; �._ _ ic. rre idC ."ii..fi�i"t .. �t.,1y..=•y"$:ti&, {i �/ Tx&4'43$r�q tr. f=S.n, i.. } g?^�x.�r�G„j. h-v. s-v`i5 uh y k:: ",n.. ` .�..:: ". ^. (' '%C� ai. ',+0.��Ya £Y' `(t.aT �±h„,^:y '-�Y�:1.•r -y, i�""�-�• �'Yh.j` '�' •i� '�f'u�..wt �:3 =S%,,`�T+,, i�Er"A�r tif=i `i,'�>=..� L'�r�2. �i••2 �rt,F•r .�iF1. `�iRrri � I�nrform�� "�-� �., .,rY.JJ.• Y � t:n;.y�J• "�k-i 3 I �:L A_,y.1 .� q ,,A .ds �. �. aryry: f ~M. =}. ..tt;«x•:i'� �=,�,F Y „fi x_ >'?a. ".'`a` ....";"pGa. ...�� - d 4:,^, rr; x ..'t;T � ,x:. ,n •" � " Ni`'z; 3-'..,;r . *. .iix a'. __ :>'�X ..w=-,ar.. - _ s }3,..+'�, .gym.,%:>«u?.c? ,,. e, 5�, A�49.'"' �' �«\''`�;'4 ^ii"t .g,1 ..ti6E'`f*v' .#�ru` ,n -„d r•'. '�. rC .T �.. k;'"3, _ I-' Name: Newport Bluffs occupancy/Use: — Address: 100 Vllaggio Construction Type: V — ,�tiO 0 Newport Beach 2, City: p No. Stories: ZIP: 92660 Year Constructed: Brandon Lawritsonfi E Contact: Telephone: (949) 467-2133 +`ror, !. v3:{'*e' : � j -�' {;,2Kzv'^ >,% �,�"+ •�.:i^,X`^'�r-.•1��+'26::6j6ia uL ,. � r7 '-'R�^s x�: sd4..�..r��y.�}r',ist w�.'•� ae:•a. t�t�"4 f;:;y. ''iSCS.'}?s?.`.y'�'i"t'= _ 8...s .A-�"."'��`t:`«?vi x k..s, s�1 ., •: Y""x'S.'�'Y. U.. .Yty rP•.- °er bfa4.i,.i l.�<. b �: .it k... 1..:� \ya .yA�,�1,} ..•,'. '° h 7 y, Y F ' 'rc 1'.;N nF1� ,. ��f.�'� i� � ,�umbe o s e �R'is sue.•-' sW �.�;'" ��.-.�= .� r.�'.��c, ..xxrnsi{RF..::�w'-ff'3y �.. ",.�'' m A: �' � eG:SL'�� .i�,� 1� ^r• 'tz"ia1 iota `' ��»Gi�vV.!.l1idai.s:71`�.a.�u-oiC�.,,�....�..� �e..�9..Y 1 Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive ❑✓ owner Date: 08/11/15 Address: Huntington Beach, ✓❑ Fire AHJ Date: 08/11/15 City: CA ✓❑ Contractor Date: 08/11/15 State: NOTES: (714) 841-2066 1 For specific inspection, testing, and maintenance Telephone: ) p P � g requirements and information, see NFPA 25, 2011 CA License#: 513781 Edition as amended by California Code of Regulations, Title 19, §901 to §906. Job #: S10-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1(a) n w,<.-dam K wx,O•= rr �..,:•-,.4;'..„_heokboKfo"r` ach C.°/s einjn pected�and en�erthenunaberofcfanmu -y=,F }~;. v.:Y ,�tv. ". �.tiao�"e'?�'.:!i :`-n q,-_ :.s`3,!x4 '":.��£t: #.•n .,x'r'�t'> +3•,. 7 i it4`[.. Ma..v ti'i Y M nnj i�^T�y�. i'� �j yI •S� fi., ecfec(sy�stern ase'gdYpit�S P..CI'�O' t� y" r Pas0 ��t•�'�4'[4 eMS'a"w,Se�f.rnS f ck¢bae�?: �'cta.:zn,� �_..-�{k: s . Z Automatic Sprinkler System 5 0 ❑ ❑ ❑✓ 0 Standpipe and Hose System 6 0 ❑ ❑ ❑✓ 0 Private Water Supply System 7 0 ❑ ❑ ❑ Fire Pump 8 0 ❑✓ ❑ ❑ Water Storage Tank 9 0 ❑✓ ❑ ❑ m Water Spray System 10 0 ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑ ❑ ❑ Water Mist System 12 0 ❑ ❑ ❑ m Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ® Yes ® No Se�..-, .�-.. i -.; �''? 5.,�k-s.,.. ..�; >,";rs.>�'[";?i `S'o. ✓..�i. y�,�:; 3.y,,,.y}�-'�-y��"p""��}"'ify,�`.TM-°,v,'%�s;�il�h7yjPJ:�i�.Rt.::>°..;1.fc:�yn`rna%''a�a�. D��icle��l s��'�i;"Co'►tt��.•n�e-cb��ate'n',"'�d.,vof�e�o�es eot•ri fionE.� �.:;� �� Y �a:,�,,;� ��w�:r.rt:�.ir�'Nx�'.�<�,k=�.-� p AES 1 September 3, 2013 S re M P, Units 4023 - 4026 90 80 90 P I L ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: 1.1 1 lControl Valves — Identification Sign 13.3.1 P 1.2 1 Control Valves — Inspection 13.3.2 P 1.3 1 Waterflow Alarm Devices 5.2.5 P 1.4 1 Supervisory Devices 5.2.5 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 90 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 90 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 I lGeneral Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 lFire Department Connections 13.7 P 1.14 1 jAlarm Valves — Exterior Inspection 13.4.1 P 1.15 1 Pressure Reducing Valves 13.5.1.1 NA 1.16 1 1 Backflow Preventers 13.6.1 NA Form AES 2.2 Sept. 3, 2013 "."9,.. :E`z \'Y:.t'�5.•vr r*3.d d .ti .' +p .-. <.. _m �:. 1. "'• �.�`., IV- = Inspection T = Test M = Maintenance P= Pass F= Fait N/A =Not Applicable •.item-: ::=. , -.:. ... < ,.Desc(!pton-`°;:,-.. ,°'.>`. <'` ?„ �•,,.. Date- •:;::,' .GoiniiientsKQiN A' �';F. . TNtA� 1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 I Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 I Unsprinklered Areas CFC 901.4 []Yes ®No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 If REQUIRED, Enter'F' until results are returned from Lab 2.2 T Recalled Sprinklers If not present = Pass; If present = Fail Title 19 904.1(c) P 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5.3.3 13.2.6 60 sec. P 2.4 T Main Drain Test (Enter data on Page 1 of this form) 13.2.5 13.3.3.4 P 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 NA 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 c Inspection T =Test M = Maintenance P = Pass F = Fail NIA = Not Applicable A, NFAI 00 `DA 3.1 M Check Valves - Internal inspection 13.4.2 P 3.2 M Control Valves 13.3.4 P 3.3 M FDC - Backfiush 14.3.2.3 14.3.2.4 P Internal Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M Comments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results ZYes 3.6 M System Returned to Service 4.5.3 E]No P D = Deficiency C = Comment Indicate type) J Aaiia , lier N 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/15 Placed Five Year Sticker on Riser ❑ Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached: El See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that thd equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Signature J 6640e Z— Date 07/10/15 Form AES 2.2 Sept. 3,2013 Bluffs Name. Newport Of C Construction Type: I 'AIR Address. 100 Vilaggio 0 Newport Beach No. Stories: 5; City: ZIP: 92660 Year Constructed: 4 Brandon Lawritson Contact, Telephone: (949) 467-2133 Name: Automatic Fire Sprinklers, Inc. Copy sent to: 7272 Mars Drive 21 owner Date: 08/11/15 Address: Huntington Beach, [;� Fire AHJ Date: 08/11/15 City: CA 21 Contractor Date: 08/11/15 State: NOTES: Telephone: (714) 841-2066 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 26, 2011 513781 Edition as amended by California Code of Regulations, CA License#: Title 19, §901 to §906. Job #: SI0-12 3SA605 2) Inspection items may be performed by the owner in Billy Smith accordance with California Code of Regulations, Title 19, Performed by: §904.1 (a) awn M, GEM AAK e [t , jig 'e, N, erg. a. Elm e 61. 'lf�s c" 11 ......... .... .111VIV 1P R-19 . MS W GO a; I'M Automatic sprinkler System 5 0 Standpipe and Hose System 6 0 ❑ E] 21 Private Water Supply System 7 0 El El 21 Fire Pump 8 0 7 ❑. - ❑ Water Storage Tank 9 0 ❑ 0 -E-] Water Spray System 10 0 ❑ F-1 1:1 Foam Water Sprinkler System 11 0 ❑El 0 Water Mist System 12 0 ❑ El 1:1 Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) Yes No , n; !!—' !�z. 'Mry ��7 W: -7 FT PA""47,7 -0 gf AES 1 September 3, 2013 F o,� er"JIZ 5 P , 50-4 sdT -nP Units 4010 - 4022 85 75 85 P ❑ This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached: o Z- Ai I= Inspection T = Test M = Maintenance j 4A, c c 1.1 1 Control Valves — Identification Sign 13.3.1 P 1.2 1 lControl Valves — Inspection 13.3.2 P 1.3 1 lWaterflow Alarm Devices 5.2.5 P 1.4 1 1 Supervisory Devices 5.2.5 P 1.5 1 lGauges (Wet Pipe Systems) 5.2.4.1 P 1.6 1 jHydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 85 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 85 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 NA 1.11 1 Heat Tape 5.2.7 NA 1.12 1 ISpare Sprinklers 5.2.1.4 P 1.13 1 lFire Department Connections 13.7 P 1.14 1 jAlarm Valves — Exterior Inspection 13.4.1 P 1.15 I Pressure Reducing Valves 13.5.1.1 NA 1.16 I I Backflow Preventers 13.6.1 NA7 Form AES 2.2 Sept. 3, 2013 „. `�„s- ..Z.• .. ::= : �:Yi^ 1.�\T� A d �.. � • A A ,;. +iR ',R"W; cA.?ww•. c YC,. •aS' a•i.; 4 di i F°. -4 ^ 4 =Inspection T =Test M=Maintenance P=Pass F=Fail NIA Not Applicable NE., - aim y: ;uC.o ents`fJnl, `P F+ilA . ,. ,•,; Descxt777 . :•.Reference,., 1.17 I Small Hose Connections - Hose Valve” 5.1.6, 13.5.2 13.5.5.1 N/A 1.18 1 PRV — Fire Sprinkler Systems 13.5.1.1 N/A 1.19 1 Buildings (Freeze Protection) 4.1.1.1 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 P 1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6 P 1.22 1 Pipe and Fittings 5.2.2 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 P 1.24 1 Hangers 5.2.3 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 P 1.26 I Seismic Braces 5.2.3 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 P 1.28 1 Unsprinklered Areas CFC 901.4 '®Yes No Field Service Test Required 5.3.1 If REQUIRED, Enter'F' until 2.1 T Send Report to Fire Code Official results are returned from Lab 2.2 T Recalled Sprinklers Title 19 P If not present = Pass; if present = Fail 904.1(c) 2.3 T Water Flow Alarm Devices 5.3.3 60 sec. P 90 secs max. Enter time 13.2.6 Main Drain Test 13.2.5 P 2.4 T (Enter data on Page 1 of this form) 13.3.3.4 2.5 T Control Valve - Position 13.3.3.2 P 2.6 T Control Valve — Operation 13.3.3.1 P 2.7 T Supervisory Devices 13.3.3.5 P 2.8 T Backflow Preventer Assemblies 13.6.2 To be Completed by Others NA Small Hose Connections* 13.5.2.3 NA 2.9 T w/PRV Hose Valves — Partial Flow Test 13.5.3.3 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 NA 2.11 T Pressure Gauges - Calibration 5.3.2 P 2.12 T Small Hose Connections* 13.5.6.2.2 NA * Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems. Form AES 2.2 Sept. 3, 2013 I Tv1-1 V-14"', A= 'N'-AN cr Internal Pipe Inspection - See Deficiencies and 14.2 Yes 3.4 M Comments Section for Results. No Obstruction Investigation Required. If "Yes", see 14.3 P 3.5 M Deficiencies and Comments Section for Results D Deficiency C Comm t (Indic te type) 01 07/10/15 Replaced Water Gauge 02 07/10/15 Placed one Hydraulic Calculation Plate 03 07/10/151 Unit 4016: Replaced three painted fire sprinkler heads 04 07/10/15 Unit 4019: Replaced one missing trim 05 07/10/15 Placed Five Year Sticker on Riser ,:�h"k here if additional Deficiencies and Comments are listed on Form AES 9 See Correction Form AES 10 for corrected deficiencies. Number attached: I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the "Deficiencies and Comments" section of this form. Print Name Billy Smith Date 07/10/15 Form xsau.2 oe��emo