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Home My WebLink AboutFIRE_INSPECTIONS1 4 INSPECTOR v' } N M to to I? O t v et 10 r � T J J U NO tl. O o ccm Q `N a U in W O Z E N m � W U s. a cr d - OY� U)-jz z o W a U�` Z to Z m 0 LL a = O U 2 c c 2 c rnd c in 'o O T•O O U) •O O G wU ¢¢ a w¢ n a° o¢ W c g W a) �N a (f% =M a Y Ln Q m U. —m _a t) a u N O M S�Nn ��M U N Q m Y m r �cv� LL O 0 Zar (n F O) _O U < ' J m a N Q c Z o H n. C,0,1 aao hNO` cao= r O Z J p F� Z coM O M O D U O N Orn v-OUo U) U) O co CL E O Z �O. L. .Ot d ..L.: co XJX ' ' N> N ty O Jto W A 010 t O U O U a) to O X v U •M/�1� U¢ a 0DcoZ ,Un.w N� fii U � m J ° � U) N Cn i U °7 W cc coM i" � Q Rt Z Z O T L O >� O A off �a H z O d Z 0 Z o0 co Z iJ a �UU Qm o0 X } O U 0 m�0Oza WQ� 0nU rn W >wo 3= mW z a a. UMo v= 00 k. 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Off- 0�UM Z o Oco + p m 0) D3 0) 3 U a V�. my (DU) C cw fE C `a o C rn-a 0 C cna o N c w _J ¢¢ n w¢ a o¢ a o00 CD 0o Ind. } J tU 69 o cn g a w u- Y IL ate- U) N N LL U O J W ago co Z € '( Ua N U o Q Zph O ��d LL N ¢ a a uy F c= �Zc, �, �, U m ry af- U- a`�i t9 ►W-aUc' ao�+ M.r moo �� v d o a T cn�o°° }Q2d/ c�c hNpN u,Mo COON SUN C C V Y J O z M M O M o U V O N 2 C C ZZ co m �- om v: mo uWU)) o T mca ==• LLaa as a a 0��T c o c T oN �• c 0 Z oca� mu= LL.�Ja' xi N c Ln XJ�X LLJ D V d co ❑ y O ov t U¢ a 0 c, � o U_ImJ w c`o o xa C)IL o J yU) 000ah0000 CD OCCGO i=MOC CO VT fH AA. V! 't W 6N IT N co VT 6% dT O O m co h O U C7 a z IW- z Wz o 0 co zLu QFa a0 ZQ m sm �a Xz o,...LL 0.. �uW. O �Om 0Y=� a°Li a °=WL° =emu J € : €a aw W ww0 �_ maa-¢p Z w Z a w E �-l- ca CD a�2 NOrn�ooi o�ovv o_ a.0WSEEav H '- N NU `� y iri .. ii rnrnrnrnE Ein'n ..-. 0 V N UI �. c C C C C Ci U Q v o'aa N W�mZ?ipZ)N`o c S'395��mro L? Q-a'� °a 0 V mmmm LLLLLL LL a a N °� tea` o 3a r- aa` o- as t -0 CX8*0 o> oaa m 0 0 ov S O¢ a ¢¢ a UI-O¢¢zZLL.m Z } W m Q Y w jU o J J m O W W U a IL O IL a C? z z N O W w W 1 � Ca J � a ."c Q =z .uu- 14 co w k w a a Q w w LL W a .I Alcaraz, Debbie ,,-From: Sent: To: Subject: Attachments: Please invoice TRL Systems: Saturday,3/22/14 2 inspectors (Morris/Wun) 6AM — 9:30 AM Total hours = 7 Morris, Nadine Monday, March 24, 2014 7:37 AM Alcaraz, Debbie Invoice ch1 d-01@newportbeachca.gov_20140324_073810_0000e600001 b.pdf Fire alarm testing on the attached permits. Thanks! Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net A - - ------------ KPRSCons-rrL.JC-'LJon Mike Souza Superintendent Corporate Headquarters T 714 672 0800 (J\ 2850 Saturn Street C 714 396 4664 Brea, Callforf;Oa 92821 F 714 672 0871 www.kprsinc.com E msouza@l<prsinc,com CSL #751130 All" h CITY OF NEWPORT BEACH REVENUE DIVISION i3300 NEWPORT BLVD P.O.BOX 1768, NEWPORT BEACH, CA 92658-8915 E-Mail Address: RevenueHelp@City.Newport-Beach.ca.us ;ANNWA—' SPECCXIL P�..... ITS , .. ...Q. C�:.::.:.....:....::..:.:,.:...... .. ....:: :.:.....::.:.......... . #BWNKJHD #AR00000200567# NUMBER: 0000020056 KPRS CONSTRUCTION SERVICES INVOICE: FS54004102 2850 SATURN ST INV DATE: 11/06/12 BREA, CA 92821 DUE DATE: 12/06/12 NBID: 17520 Description Qty Unit Price Tax Extension ------------------------------------------------------------- ---- ------------- OFF HOURS INSPECTION 1.00 290.00 0.00 290.00 INSPECTION DATE: 10.25.12 INSPECTION TIME: 6:30 TO 7:30AM LOCATION: 4000 MACARTHUR BLVD 200 AND 900 ---------------------------------------------------------------------------------- TOTAL INVOICE: $ 290.00 PAYMENTS/ADJUSTMENTS: $ 0.00 PAST DUE: $ 0.00 PENALTIES/INTEREST: $ 0.00 TOTAL AMOUNT DUE: $ BILLING QUESTIONS SHOULD BE DIRECTED TO THE FIRE DEPARTMENT AT (949) 644-3106. THANK YOU. 290.00 ko `::Merit::;;;'::<:>': ':''' •, "::::.``;a•::::.;; Please detach and return-the:`1o,Wax:.;pbrCion�6flth3rs.::invo3:ce;�titi.tfi�;:;yqur;p3'y'in..,••,,•,_;•„•,.•.••_,,,;_:,;,,,•,, ,,;,,,,,,,,,,,•;.,•,.:,• ANNUAL & SPECIAL PERMITS - INVOICE KPRS CONSTRUCTION SERVICES 2850 SATURN ST BREA, CA 92821 TOTAL AMOUNT DUE: $ AR 0000D2DD56 INVOICE: FS540-04102 INV DATE: 11/06/12 DUE DATE: 12/06/12 NBID: 17520 290.00 29000 r . N N 00 M Q 44 u M 'T N T� \^ L6 LU w� Z O •� Z L a co cu J � U E W a) ZWn cc cc O 0 N a�rn co a a? a�am ca O a n on �a0r co E 0 S Q m \ (. O �Lr)ZC) CD ( ) mm00 W ❑ aD T N d LL ap Ti .00. y N N cn Qj c cQ N •LL. O N c C C m C in c"IT L 4 N as n Wa d Oa a o m X o 0 0 0 0 L rn 0 O U w °= aC a .cco O U O. z C f� a) L .N z C.) _ Q�Q •� CO) o (%� .. 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N O LL LL QJ E y p) Y 0 > LL ( 0) (A E o apw cU =a c Cca O C C C C ---- a) N O CoMMCOU-LLCO U z t1l Z � W V O A S j LU w z CL O m ti w Alcaraz, Debbie From: Morris, Nadine Sent: Tuesday, January 26, 2016 3:54 PM To: Alcaraz, Debbie Subject: Off Hours Invoice Attachments: chld-01@newportbeachca.gov_20160126_074302 OOOOebcb001b.pdf Hi Debbie, Please invoice TRL Systems for 2 hours of off hours inspections: 01/26/2016 6AM — 7AM 4041 MacArthur Blvd #150 (F2016-0035) 01/27/2016 6AM — 7AM 4490 Von Karman Ave (F2015-0664) Thank you, Nadine f to 96-� 1 10*0 Alcaraz, Debbie From: Morris, Nadine Sent: Thursday, July 02, 2015 7:02 AM To: Alcaraz, Debbie Subject: Off Hours Inspection Invoice Attachments: chld-01@newportbeachca.gov_20150702_070527_OOOOc54f00lb.pdf Hi Debbie, W 00% �(4 wkl� Please invoice TRL Systems for an off hours inspection for the attached permits. 07/02/2015 6:00-7:OOAM-1hour Thank you! 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LL O LL J o aLL o � a� m.. as o '� LL w 0 2 oEw,rnY..LL a (D•— G +-• U N > LL a) y O CD g a0 c Via.. U mm 0)0) m N v�o�v v U m m m m LL U m J J o a > a a w a U Z Q O z Lu LL N L. 4pRT.8 NEWPORT BEACH FIRE DEPARTMENT FIRE PREVENTION DIVISION ti P.O. Box 1768, Newport Beach, CA 92658-8915 (949) 644-3106 DEPART Notice of Reinspection and Non-Compliance ................................................................................................................................: Date: [I t A member of the Newport Beach Fire Department conducted a fire and life safety inspection at the following location/business on r o -ft " Business Name: 3 r\ A 11-AR 711 A Business Address: � � PA b W VN R At that time, a Violation Notice was issued indicating the corrections required to gain compliance with the applicable codes, regulations, and ordinances pursuant to -the California Fire Code. This notice is to inform you that your business is entitled to one more fire company reinspection, which will occur on or after If all violations are not corrected at that time, your business will be referred, to the Fire Prevention Division. The Fire Prevention Division will perform a subsequent reinspection of your business at the prevailing fee schedule set forth by City Council. Your prompt attention in this matter is appreciated. Responsible Party: i � �� A Phone Number: %l �11 "�S� 7311 Fax Numben, Email Address:. ! K oU15 Inspector's Name: C-Mkl e- D A L i Phone Number: 710 O Left with Responsible Party O Faxed (Rev. 9-28-10) Original - Owner/Responsible Party Yellow - FPD * Emailed NEWPORT BEACH SIRE DEPARTMENT FIRE PREVENTION DIVISION P.O. Box 1768, Newport Beach, CA 92658-8915 (949) 644-3106 ....................................a::...:................................................. ...,.............................., Notice of Reinspection and Non-Compliance ................................................................................... _...........................................: Date: A member of the Newport Beach Fire Department conducted,a fire and life safety inspection at the following location/business on / 0 —0 Business Name: r 7 ✓,A A, pO T}) ug g Business Address: A 649 -rlUeR At that time; a: Violation Notice *�,s -isstf�d indicating the corrections required to gain compliance with the applicable codes, regulations, and ordinances pursuant to the California Fire Code. `a M This notice is to inform you that your business is entitled to one more fire company reinspection, which will occur on or after If all violations are not corrected at that time, your business will be referred to the Fire Prevention Division. The Fire Prevention Division will perform a subsequent reinspection of your business at the prevailing fee schedule set forth by City Council. Your prompt attention in this matter is appreciated. Responsible Party: FA Y/ 11 A Y169 Phone Number: ,7I 1 ' ` � S) - 7 3) -• Fax Number: Email Address: � t n�L�#�i E6 � /'�A I�- r Dm Inspector's Name: C W A U6 DAL,- Phone Number: 6'*— 710 O Left with Responsible Party O Faxed (Rev. 9-28-10) Original - Owner/Responsible Party Emailed , Yellow -FPD NEWPORT BEACH FIRE DEPARTMENT 100 Civic Center Drive P.O. Box 1769, Newport Beach, CA 92660-8915 Office (949) 644-3106 — Fax (949) 644-3120 VtOLATION NOTICE Business% �I�n Name: 3 , A cA Inspection Dated Unit: Address: Inspector* Phone: LUS72 ``7�93--73a-I Email: - -- �� r�'L�t� r, �� ,,,;�Fi�,C6YVI .As a result of a fire inspection by the Newport Beach Fire Department, the violation(s) listed below were noted. m -�-� FATF]m C1�C�C� CDCL� See reverse side for violation code descriptions Date Cleared' office use -only) l3 -� /� Vl tom ^ ; t { c fVW 41] ff j§M 1', O�v ; 2D-�� A A -TAE F*IJc SELF -CLEARING: Only a fire extinquisher'violation may be' selfi cleared. If one was noted above, it'may be self - cleared by certifying below that it has been serviced or replaced and tagged appropriately. Please return this notice to the above address within 14 days of the inspection date. I hereby certify that the fire extinguisher violation has been corrected on (Date) Print Name: Signature: ' ORDER TO COMPLY: You are hereby required to correct the above conditions) immediately upon receipt. Non-compliance with the foregoing order before the date of reinspection may render you- liable to the penalties provided by law for such violation(s). A re -inspection ate"isrrnoted on the b ttom of this notice. t/ i V i Print - Responsible Party ignature —Responsible Party Email Re -inspection Date Original White — Business Yellow -Life SafetySetvices Division Revised, 04-18-13 GENERAL PROVISIONS FOR FIRE SAFETY California Fire Code Sections A. Common Violations AA Provide extinguisher(s) with a minimum rating of 2-A:10-B:C. [906.1] - AB Mount extinguisher(s) where readily available. 40lbs or less = top, maximum 5' above floor / more than 40 Ibs = top, maximum 3.5' above floor [906 9] AC Service and tag each extinguisher annually and after each use. [906.2] AD Post signs indicating location of extinguishers when obscured from view. [906.6] AE Open burning, recreational fires, and/or outdoor fireplaces (objectionable or unapproved location). [307] AF Provide appropriate sign on fire department connection. [912.4] AG Fire department connection clearance is to maintain a 3' circumference. [912.3 2] AH Post street address numbers on front of building. Minimum 4" in height for residential and minimum 6" in height for commercial. [505.1] Al Fire hydrant clearance is to maintain a 3' circumference. [507.5.5] AJ Commercial dumpsters are to maintain a 5' separation from buildings, [304.3.3] AK Class K commercial kitchen extinguisher required. [904.11.5.2] AL Open flame cooking devices shall not be operated on combustible balconies or within 10' of combustible construction unless sprinklered. [308.14] B. Fire Protection Systems BA Provide Knox box for fire department access. [506] BB Extinguishing systems shall be maintained and operable at all times. [901.61 BC Service and'tag hood and duct extinguishing system semi-annually and after each activation. [904.5] BD Provide central station supervision of fire sprinkler system. [903.4] BE Inspect, test, and provide 5-year certification on sprinkler/standpipe system(s). [901.6.1] BF An approved occupant voice notification system shall be provided, [907.6.2,2] BG Hoods, grease -removal devices, fans, ducts, and other appurtenances shall be cleaned. [609.3.3] C. Maintenance of Exit Ways CA Remove all other locks or latches from doors and replace with panic hardware - Assembly occupancies (OL 50 or greater) [1008.1.10] CB Unlock all exit doors during business hours. [10081.9.31 CC Post approved sign "THIS DOOR TO REMAIN UNLOCKED WHEN BUILDING IS OCCUPIED." [1008.1.9.3] CD Post occupant load sign [1004.3] CE Means of egress shall be illuminated at all times when occupied. [1006.1] CF Remove obstruction(s) from exits, aisles, corridors, and stairways. [1030) D. Flammable and Combustible Liquids DA Provide approved liquid storage cabinet for all flammable liquids. [3404.3.2] DB Flammable liquids shall be transferred by one of the approved methods, such as pumps taking suction through the top of the container. [3405.2.4] DC Provide approved safety cans for dispensing flammable liquids. [3404.3] E. Storage EA Reduce storage to 18" below level of sprinklers or 24" below ceiling in non-sprinklered building. [315.2.1] EB Good housekeeping. Arrange storage in an orderly manner and provide for exiting & fire department access. [315,2] EC Remove combustible storage in boiler, mechanical, or electrical rooms. [315.2.3] ED Proper storage of oily rags and similar materials shall be in listed disposal containers. [304.3.1] EE Remove storage from under exit stairways. (315.2.2] F. Electrical FA Provide cover plates. [6051 ] FB Identify breakers in panel box. [605.3.1] FC Electrical panel and equipment shall have a minimum clearance of 36" in depth, 30" in width, and 78" in height. [605.3] FD Discontinue use of extension cords in lieu of permanent wiring. [605.5] FE Remove extension cords running through openings or attached in series, cords placed under rugs, furniture, or where subject to damage. [605.61 FF Maintain wiring in good condition and protect from damage. [605.5.3] FG Discontinue use of multi -plug adapters. [605.4] G. Hazardous Materials GA Provide approved hazardous materials storage cabinet for all hazardous materials. [2703.8.7] GB Secure and identify compressed gas cylinders with name of product. [3003,5.3] GC Provide MSDS information for hazardous materials. [2703.4] GD Mark all fixed storage facilities in accordance with NFPA 704. [2703.5] GE Update hazardous materials inventory statement and/or hazardous materials management plan. [2701.5.1, 2701.5.2] H. Combustible Materials HA Remove all cut or uncut dead and dying weeds from the property. [305.5] HB Cut and remove trees and shrubs in wildland hazard reduction area. [4903] Z. Miscellaneous Violations ZZ Other code violation Chapter 1 Requested Operational Permits— Not an all inclusive list, only the most common. See Section 105.6 fora complete list ofrequired permits. • Combustible Dust -producing Operations (i.e. wood working). [105.6.6] • Compressed Gases: corrosive/flammable in excess of 200 CuFt; toxic, highly toxic, pyrophoric— any amount; inert at 6000 CuFt, oxidizing at 504 CuFt [105.6.8] • Cryogenic Fluids: quantities on site are in excess of the amounts in Table 105.6.10. (i.e. flammable: more than 1 gallon inside and more than 60 gallons outside) • Dry Cleaning Plants: use of solvents to clean clothing. [105.6.12] • Flammable and Combustible Liquids: storage of Class I liquid in excess of 5 gallons inside or in excess of 10 gallons outside of a building; g,Estorage of Class 11 or Class II IA in excess of 25 gallons inside or in excess of 60 gallons outside of a building; or storage of Class IIIB liquids in tanks for fueling motor vehicles at motor fuel -dispensing facilities; or engage in the dispensing of liquid fuels into the fuel tanks of motor vehicles. [105.6.16] • Hazardous Materials- to store, dispense, use, or handle hazardous materials in quantities listed in Table 105.6.20, • Hot Work Operations. cutting, welding, brazing, soldering, grinding, and other similar activity. (105.6.23] • Industrial Ovens (Le parts, circuit boards, kilns, powder coating). [105.6.24] • LP -gas: storage and use. [105.6.27] • .Open Flames and Candles: in assembly areas, dining areas of restaurants or drinking establishments [105.6.32] • Place of Assembly 50 or more persons. [105.6.341 • Refrigeration Equipment: to operate a mechanical refrigeration unit or system. [105.6.38] • Repair Garages and Motor Fuel -dispensing Facilities. [105.6,39] • Spraying or Dipping (i.e. spray booths/rooms). [105.6.41] NBFDi In Area 3 p Fired Life SafetyIns ection Worksheet 3 an 3 - `Stati Occupancy Type B Occupancy ID # 15078 Assigned NT63C Inspection Month April Name: Macarthur 3991 Location: 3991 MACARTHUR BLVD Description: Complex (Building) —❑ Business License License Number? Business Phone: ( Business EMail Address ❑ Bldg Status Status? Email Addre ❑ Stories Building Stories? ❑ Fire Department or Update/Verify Contact Name Day Time Phone After Hours Phone Hueng Danny (714)608-8882 After Hours Phone? Attributes: Fire Protection Equipment Type Description Comments Fire Protection System Cert Expiration Date Knox Box 9' high to the right of main Clean ?? entrance Fife Prnta�.4Gn ..`vQfpm - *o Fire Alarm System Annual Insp Report Alarm F Fire Protection System ; Cect Ez iration Date Sprinkler F 11/13/2012 Permits / State Mandated Insp Issued Expires Required Activities Assigned Units/Inspector AssignedDate Completed Status Fire Operations Inspection NT63C 4/1/2014 Open P� rf H /J r 2- Cf t, C� X / F FPO P17k ` l (SG C �-� l CU f� IL v-' $6 7 /\/, A 11v s 'q q�---/d S Attributes: ❑ Elevator(s) ❑ Knox Box ❑ Electric gate access ❑ Bi Directional Amplifier ❑ Swimming Pool QTY. ❑ AED ❑ Photovoltaic System _ ❑ Fire Protection System ❑ Yes Cert Date ❑ No ❑ Hood Last Serviced ❑ Fire Pump Service Date Printed: 08/20/2014 09:51:10 N NFPA Fire Alarm Inspection & Test Form SCI CK0 Q101W i CID: 155 5()t �XAoq Date: O • 1t� • 90'4 Time:(JIM09 ' 33 SERVICE ORGANIZATION PROPERTY NAME (USER) Name: Stanley Security Solutions Name: Address: 751 N. Todd Ave, Azusa CA 91702 Address: Representative: Owner Contact: License No.: C-10: 848019 ACC# 6055 Telephone: f Telephone: (877) 476- 4968 opt.:4 MONITORING ENTITY Contact: Stanley CSS LINES TESTED Primary iyes ■ \• Telephone: 1877-476-4968 I Secondary >e1Yes ❑ No Monitoring Account Ref. No.: T E TRANSMISSION SERVICE Digital ❑ Weekly ❑ Monthly n aF n nwirterly n Semiannually ❑ Other (Specify) rnntrnl I ]nit ManiifnrtiirAr- ALARM -INITIATING DEVICES AND CIRCUIT INFORMATION Qty Devices (V) Qty Devices (T) Device Type Supervising Station Monitoring Yes No _ FACP Alarm Signal W ❑ y/ Manual Fire Alarm Boxes Alarm Restoration 91 ❑ Smoke Detector Trouble Signal id ❑ Duct Detector Trouble Signal Restoration' ❑ Heat Detector Supervisory Signal ❑ Waterflow switches Supervisory Restoration ❑ Supervisory Switches _OSY_PIV Notification Horns —Strobe —Bell — Ground -Fault Monitoring Other (Specify): System Power Supplies (a) Primary (Main): Normal Voltage tnf Amps Location . (b) Secondary (Standby): - Storage Batter: Amp-HR Ratin Calculated capacity in Amp-Hrs to operate system hours. The following did not operate correctly: N 1 K System restored to normal operation: Date:__ Time: THIS TESTING WAS PERFORMED IN ACCORDANCE WITH, APPLICABLE NFPA STANDARDS. � Name ofinspector:,Y VL l AVtt/4 Date: �' U `° Time: 0 Vv i Signature: Badge: Name of Owner or Representative: Date: Time: Signature: Technician: ID #: ✓�-' 11/ 1 /i ZU14 W'.J: dbAM 1 114bd1`J41 ! PAGE r93/07 25.7S INSpECMON, TESTING, AND MAENTENANCE of wATm-BAsED F= PILOT C nON SYSTEMS noun u, T *13 Mallare-na'ace over IRoet NlE'1?'A ZS as xateAded A T# 19 _ ,C.CL ANur+r 1 p�'0A1 Property InforMagon: Name: �1� Ltd .T 'ktrM�oPCcoupency /Use: Address: s3.�...�. -��1aae/Vo Coru trnetwn Type: & _,....._ City: ,/J No. Stories: ZIP: Year Constructed: , J CY 7. S Contact: Telephone: Contractor Information: Number of System Risers Name: Lee Fire PI'gSt g t Copy sent to: Address: 1188 N. Ow + . #B n Owner pate City: Anehillm___ r3 Fire AHJ. Data - State: Ga ftmis Now a Contractor "hats Telephone: a 14 0 - 9 # 1) For specifto insper ttoa,1140 1, Rud CA Lfrense# 919 682.771 _ _ walateaaace requirements and infuation, see .-4Fp A. 25, 2002 Edl!ou as Job # California Code of R,agrelstiane, itle to 19ft Perthormed by: P R Smit (print) zj inspection Yteme may be performed -by the owner In accordance wltb CAtiforalx Cast of Kote; Contrxctor information m! be re. rioted Regladow Title 19 MIW Forte Included with thb report Automatic Sprinkler System REP ter Chap 6 Number of Forns . K/A FAIR* PASS o Standpipe and Hose Systems t3 o Private Wertar supply System 7 o Fire Pump $ o Water Storage Tank o Water Spray System 10 m Foam Water Sprinkler Syftm 19 Sea `Deficiencies and Comme' n " section at end of each respeckivee torn, State Fire Marshal AES 1 Mar& 21, 2006 and Maintenance I�MVC. V�1I .�f i Page! f 4 Date of 1nation, TeratHnQ,lNaintenance: system Riser ID: Property information: p Nam /i 4rFfr4�.w..r�� 7'y Sy Pipe e C a �eW'4t e �t ET pry Pipes ^� Adctnsae_ �� M 0 p'reaation 13 Deluge Main gratin Test Results: AbtwovWftn Key: A initial Static Pressure: , ,r+� (psq 10 Inspection T ■ Teat Residual Pressure: ,,. (psi) M = Maintenance' A-b=After Operation Restored Static Pressure: (psi) MI = Per Metnutacturer s instructions Item Activity Frequency D, 1pgon RNFPAefer+eftre xbncet pail NIA Pass 1.1 I Derlly F;w mOQuge Valves - Enclosure 12.4.3.1 " VVab tam raturs 1.2 1 _ V1kxl+kl Dry Pipe Valves - Enclosure trrmarature 12.4.4.1.1 ..- ._ 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge SyaWms) 5.2.4. .2.4.3 1.4 1 Quarterly _ Control Valves 12.3.2.1 1.6 1 Quarterly Alarm Devion $.2.6 1.6 1 Quarterly Gauges (Wet Pipe Systems) 52.4.1 1.7 1 Quarterly Hydraulic nameplate 5.2.7 1.8 I Owtarly Sprinklers 6,2.1 , �+ 5.2.1.3 1.9 I Quarterly Spare Sprinklers —�� I Quarterly Fire Department +Connections! 12.7A 1.11 I Quarterly Alarm Valves -» Exterior Inspection 12.4.1.1 1.12 1 Quarterly Preaclior0oluge Valves - EAeriar Inspection 12.4-3.1.6 1' 13 I Quarterly Priessure Reducing Valves 17,5.1.1 V 101, 1.14 1 Quarterly Dry Pipe Valves - Exterior Inspection ; 12.4.4.1 A 101, V 1.16 l Quarterly Bacmw Proventerrs 12.8.1 1.1 I Annually Pipit and Fittings 8.2.2 Li17 I annually Sulldingli 5.2.6 State Fire Marshal AES 2 June 17, 2008 11f 1 ! t 6U1Y UZI. J0"-1 1 !1`t07L 7'�1 f • Inspection, Teaf aq, and4ftintenance Fire Sprinkler System NFPA 25 Chit terfi-es-amended b CC TRIO 19 Date of lr►spectlon, Testing, Maintenance: /t" ! Syatortn Riser ID: Prcperty information: Typed system: . Name: D wet pipe d Dry Piped Address � g �LM1.a�-1�,> s lt� 0 Preactlon 0 oaiuge rMuc VLI Uf Page 2 of 4 U items Activity Frequency Description w xA 25 RAM Fait WA Pass 1.18 1 Annually bangers 5.2.3 1.19 1 Annually 69ismic swas 5.2.3 1.20 1 5 Years ace Hangers (Accessible concealed sps} ti.2.3.3 5 Years seismic BreCes Okki bie concealed 6.2.3.3 1.22 1 5 Years Pipe and Fittings (Accessible concealed 5.2.2.3 _ Gee 1.23 1 5 Years Sprinkiars (Accessible concealed Spaces) 1.24 1 5 Years Aiarrn Valves •- Interior lnspectidn 12.4,1.2 1.28 .1 5 Years Alarm Valves - Strainers. filters, Orifices 12.4.1.2 1.26 1 5 Years Check Valves - Interior insp$Cticn 12.4.2.1 1.2'7 1 5 ywm FreactfonlDeiuge Valves- Interior Inspection 124.3.1.7 1 5 years Preactlon/Deluge Valves - Strainers, titers, 12.4.3.1.8 � 1.28 orifices _ 1.29 1 5 Years Dry Pipe Valves •- Interior Inspection 12.4.4.1.6 1.30 1 5 Years Dry Pipe Valves - Strainers, filters, orifrcds 12.4.4.1.6 2A T Annually Alarm Devices (90 Sec) 2.3.3 12.2.7 - i2.2,6 - 12.2.6.1 2.2 T Annually Main Drain feat (Enter data oft Page 1) i✓ 12.3.3.4 2.3 T Annually Antifrsexe Test 2.4 T Annually Control Volvo - Position 2.5 T Annually Control Valve - Operation 12.3.3.1 2.5 T Annually Supervisory 12.3.3-5 2.7 T Annually Presctiort Valve - Priming Water 12.4.3.2.1 2.8 T Annually Presction Valve - Low Air PresBure Alarm 12.4.3.2.10 State Fire Marshal AE9 2 June 17, 2008 01 .L.L? .L t f 4U14 U7. '7V"'/ 1 r.L-901&;„11 r r HVL 'JG1' U r _ Inspection, SYStern Date of Inspectlon, Testing, Maintenance: 1 / �iy�Sydem Near IM Property Information: Type of SYetarn: o+` C� Name: ,c idyars;�.,r..Ms W*� tPlps 13 pry pipe oo Address: Ci Pt+sectlon Cl Deluge " aw. L V{ Item Acbvity Freency qu Description NFPA 25 Reference Flail PIA Pass 2.9 T Annually Preac5on Valve -- Full Flow Trip Test 12.4.3.2.2 2.10 T Annually Dry Pipe Valve - Pruning lAktor 12,4.4.2.1 2.11 T Annually pry Pipe Valve — Low Air Pn►esure Alarm 12AA-2.6 2.12 T Annually Dry Pipe Valve — Quick -Opening Devba 12A.4.2.4 2.13 T Annually Dry Pipe Valve — Trip Test 12.4,4.2.2 2.14 T Annually 6wcidkrw Preventer Aesemblks 12.6.2 2.16 T 3 Years 01Y Pipe Valves »- Fult Flow Trip Test 12AA.2.2.2 2.1E T 5Years pauyee w 5.3.2 2.17 T 5 Years Fressure Reducing Valve 12.6.1.2 2.18 T b Years Fires DePrkrant Connection Back lush 12.7.4 2.19 T 5 Years Sprinkkn— E** High Temperature 2.20 T 5 Years Sprinklers — Corrosive envtrot►ment or corrosive water 2.21 T 10 Yams Sprinklers - Dry 2.22 T 20 Years Sprinkler: - Fnst Response 2.23 T 50 Years $prinkien 5.3.1.1.1 2.24 T 75 Years Sprinklers 76 years in service 5.3.1.1.1 A 2.25 T p—d M manui�ectared prior to 920 — 513.1-1-1.1 3.1 M Annually Ccntroi VAW44 12.3.4 3.2 M Annually Pres"WDekw Vraives 12.4.3.3.2 3.3 M Annually Dry pips VaivesQuick-Opening Devices 12.4.4.3.2 3.4 M Annually pry Pipe Valve — Low Point Drains 12.4-4.3.3 1 3.5 M 5 Years tr Utaeut�ion invasiigation Chapter 13 State Fire Marshal AES 2 aune i r, zum .:1rlrr.colY u�.avr-u•� lii`fOJG�Ylf rr�uc. vrrur Inspection, Thing, and M>3 m*12enance Firs Sprinkler 8ystam NFPA 26, Cha r f.`..._ endQd b CC!!,TMO 19 Page 4-of 4 GAtli of tnspeCt#on, Testing. 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ON m mrnrnrn } ur oo W aQ c>3 3 N N uOf E U cn n O0 4` o c Z aZooW ON W CL mvUmmmmLLLLm a oC: c0) ai0 O z Wa c v o -o o -o a ovO o N 3v L av L oTvv o oo I —C OQ a ¢¢ LL UF- OQ¢zzLLm m N L� Alcaraz, Debbie From: Morris, Nadine Sent: Wednesday, September 16, 2015 6:42 AM To: Alcaraz, Debbie Subject: Invoice Attachments: chld-01@newportbeachca.gov_20150916_064047_000Oa85d00lb.pdf Good morning Debbie, Please invoice ORR for an off hours inspection. 09/16/2015 6AM-7AM Thank you, Nadine n O 5 _ O rn U W � 1 U ap to a0 0] co MN cm t Z oa 0 > N 3 oa m Z U U O O •� O O 1CiE 6�" 4 UdSt� n ' O O O :ia :4 49 a a ttp » U J (a W fn Q J N ZCO LO N to � W < 9 YUU� z3�(� o: 1-wmm a�i m rn a� ai ° ¢Q a w¢ a o¢ a v c 0 U m 'U U N z LU Nw Z Q Z M O J �- F U m— U co 1- I1) C 0: W W N O co o W oo N (D (0 lC 3aM(o N U Q N O N C. 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I CITY OF NEWPORT BEACH .., REVENUE DIVISION 100 CIVIC CENTER DRIVE P.O.BOX 1768, NEWPORT BEACH, CA 92658-8915 E-Mail Address: RevenueHelp@newportbeachca.gov . OI NN AG & S .ECIAL>PERM TS ...I . NV. #BWNKJHD #AR00000185520# ORR PROTECTION SYSTEMS INC 16 TECHNOLOGY DRIVE #134 IRVINE, CA 92618 NUMBER: 0000018552 INVOICE: FS54004459 INV DATE: 12/11/13 DUE DATE: 01/10/14 NBID: 510987 Description Qty Unit Price Tax Extension ------------------------------------------------------------- ---- ------------- OFF HOURS INSPECTION 1.00 290.00 0.00 290.00 INSP DATE: 09-18-13 @ 6AM LOCATION: 3501 JAMBOREE RD STE 1 ---------------------------------------------------------------------------------- TOTAL INVOICE: $ 290.00 PAYMENTS/ADJUSTMENTS: $ 0.00 PAST DUE: $ 0.00 PENALTIES/INTEREST: $ 0.00 TOTAL AMOUNT DUE: $ 290.00 BILLING QUESTIONS SHOULD BE DIRECTED TO THE FIRE DEPARTMENT AT (949) 644-3106. THANK YOU. :. . 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W N g m m o._c cgm LvLOj y Q Y cm233a�'i -YmCc>w ti 0c> ca AstW c N E` p �00No N '00N ;0No m w o00ww tq a .0 i» c y v m Z Z$ 'c o 'Q •_ •�_ •� N N N W Q N N N C CC U C N O 7 N N '� '_ 'a to V m'm m m LL LL U- LL V O. c CL 0 0 0 _ O � 5 0Q a QQ a UF'1000zzU-m a a a Q C9 z Z N O ti W ii 7 Z J t L Q L = W ru mt 7 c1,,0 a J > w a a Q W LL lY 1 lb)h f � AN AIcaraz, Debbie From: Morris, Nadine Sent: Tuesday, April 07, 2015 9:46 AM To: Alcaraz, Debbie Subject: Invoice Attachments: 3501 Jamboree Rd #500.pdf Hi Debbie, Please invoice ORR Protection Systems: 04/07/2015 Off hours inspection 6AM — 7AM = 1 hour Thank you, Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net ,n z o m Do G? m mmmm S.� m a c a c 0 M -0 D O 0 j DQa= j c to CD co co co co %U Oo m 3.n5 m0-D o r ni D i -i O •m (D o m 77m, = 3 m c .. m = m -i m m o' -n o 0 " :3 m 0 7 r" -n m -n CD m Fll\ W y -�'�-�il►_ -Ga iA iH EH EA O O A O p p p &AH� 0 0 0 0 0 0 0 0 -o vv vv�n N Q cr N n A 2. 3. 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Am .- 621G COUNTY OF ORANGE CONEXANT SYSTEM INC c/o BOB WARREN 1901 MAIN STREET STE 200 IRVINE, CA 92614 ORANGE COUNTY HEALTH CARE AGENCY ENVIRONMENTAL HEALTH PA08 1241 EAST DYER ROAD, SUITE 120 SANTA ANA, CA 92705-5611 (714)433-6000 INVOICEM IN0946735 Owner: CONEXANT SYSTEM INC SITE: CONEXANT SYSTEM INC 4311 JAMBOREE RD NEWPORT BEACH, CA 92660 County of Orange Tax ID# 95-6000928 District : EE0000360 AIR # Facility # Invoice Date Due Date Billing Period AR1327187 FA0024224 08/02/2013 09/02/2013 07/01/13 to 06/30/14 Related Date PE PE Program # Site ID Description Amount 08/02/2013 5215 5215 PR0025027 4849 RCRA HW LQG 101-250 EMPLOYEES 08/02/2013 5865 5865 PR0053246 NPB000221 HAZARDOUS MATERIALS - NEWPORT BEACH 08/02/2013 6210 6210 CUPA- STATE SERVICE CHARGE BASE FEE $1,418.00 S 0!6Nr $35.00 Total Due: $2,132.00 PAYMENTS RECEIVED AFTER THE DUE DATE MAY BE SUBJECT TO A MAXIMUM 25% PENALTY. WE RECOMMEND THAT DISPUTES BE RESOLVED OR PAYMENT MADE PRIOR TO THE DUE DATE TO AVOID LATE FEES. FEES ARE DUE FROM ESTABLISHMENTS WHICH OPERATE AT ANY TIME DURING THE BILLING PERIOD. IF THERE HAS BEEN A CHANGE IN OWNERSHIP PRIOR TO THE BILLING PERIOD, PLEASE RETURN THIS INVOICE WITH THE NEW OWNER'S NAME, MAILING ADDRESS AND THE CHANGE OF OWNERSHIP DATE PLEASE DO NOT SUBMIT POSTDATED CHECK (CHECK DATED LATER THAN THE ACTUAL DATE SUBMITTED) IN PAYMENT OF THIS OBLIGATION. ALL CHECKS WILL BE PROCESSED UPON RECEIPT. FORANY CHECKS RETURNED UNPAID, THE MAKER WILL BE CHARGED AN ADDITIONAL FEE. --? l._L-'vAS C fZ;F ! N V O A CE 7174-1 C J A A -2-w1 V--t Retain top portion for your records — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Return this bottom portion with payment ` — Write invoice number on check CONEXANT SYSTEM INC 4311 JAMBOREE RD NEWPORT BEACH, CA 92660 Billing CONEXANT SYSTEM INC Address : c/o BOB WARREN 1901 MAIN STREET STE 200 IRVINE, CA 92614 PLEASE REMIT TO: ORANGE COUNTY HEALTH CARE AGENCY ENVIRONMENTAL HEALTH 1241 EAST DYER ROAD, SUITE 120 SANTAANA, CA 92705-5611 Billing Period: Facility #: FA0024224 07/01/13 to 06/30/14 F Invoice #: IN0946735 Due Date: 09/02/2013 Total Due: $2,132.00� Payment Type: Check Credit Card (see reverse) FOR OFFICE USE ONLY DATE RECEIVED BATCH/HSO # CHECK DATE CHECK NUMBER AMOUNT PAID INITIALS MAKE CHECKS PAYABLE TO: ""'* BRING THIS INVOICE WHEN PAYING IN PERSON COUNTY & ORANGE *IN09467352,132.00* 09/17/2013 �55'1UOw51 I 7 O 9fl9 q q Dgfl •)•J q q ] ] 3 J 1 A t J N i N )': a N I N Ln r O LO O V J U J O W Q/ LL c s •- w° wo a>Q J Q U a r CO to J a' N W UM N Y Z E o L o Zia �wtno U O O W W wo 5co CL LL a_ _ (n�V)mn o �- C 3 C cow •� U to r i U pp co .� N CO M U Mai O.mO W O) t Z 0 O ? 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E EoIL n wC 0) 0) m c cc 0 O a) Uxa)a) N N ZN9m Sm .LL U` LL LL LLm co N v t CITY OF NEWPORT BEACH 3300 NEWPORT BLVD NEWPORT BEACH, CA 92663 PHONE: 949 644-3141 CUSTOMER0000011922 PYRO-COMM SYSTEMS, INC. 15531 CONTAINER LANE HUNTINGTON BEACH, CA 92649 INVOICE: FS54003794 PAGE 1 DATE: Feb 17, 2012 OF 1 SERVICE: ANNUAL & SPECIAL PERMITS CUSTOMER PO: CUSTOMER PH: 714-902-8000x TERMS: DUE IN 30 DAYS DUE DATE: Mar 18, 2012 SERVICE ADDRESS: PYRO-COMM SYSTEMS, INC. 15531 CONTAINER LANE HUNTINGTON BEACH, CA 9'2649 ---------- DESCRIPTION --------------- QTY---- UNIT PRICE -TOTAL PRICE- TAX OFF HOURS INSPECTION 2.00 290.00 580..00 N INSPECTION DATE: 2/13/12 LOCATION: 800 NEWPORT CTR DR NEWPORT BEACH, CA TIME: 5 PM-7PM (NON-CONTIGUOUS) P� TOTAL CHARGES: TOTAL TAX: TOTAL INVOICE: PAYMENTS: ADJUSTMENTS: TOTAL DUE: 58'0.00 0.00 580.00 0.00 0.00 580.00 t r- ,C r N N Mrt T L W w Z o Lj Z L a E W 0 O O U)n. 0 O °. = :z m � C O U V 0 a W rn c LL co M v v rn IT m N C 0 L a a� i ho- O E C a m COO, to to N 0) ca 0 U L U to t� m � o m 3 V z O to CL d o Z 00 V- O O U INSPECTOR. 1 M `00 � i O co U co T (� g C� cn azx =� U Z W W 'J �Zm t a0 4 J0ZN Co L0 le c -o 0 rn a 0 to �o 0 ii c ¢¢ a w¢ a o¢ a a c 0 U m to m U CL T U) 0 X_ � v (14 Z rn W L z V Wig=T ood �zm tuWa a. 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U J v w Z W 0 a. a Q .. � J m � o a 0 Q a w z°- a M O a a N u. ■ CITY OF NEWPORT BEACH 3300 NEWPORT BLVD' NEWPORT BEACH, CA_ 9.2663 PHONE: 949 644-3141 CUSTOMER0000019086 HCI SYSTEMS INC 1354 S PARKSIDE PLACE ONTARIO, CA 91761 INVOICE: FS50001082 PAGE 1 DATE: Mar 27, 2012 OF 1 SERVICE: FIRE PREV SVC REIM CUSTOMER PO: CUSTOMER PH: (909) 628-7773 TERMS: DUE IN 30 DAYS DUE DATE: Apr 26, 2012 SERVICE ADDRESS: HCI SYSTEMS INC 1354 S PARKSIDE PLACE ONTARIO, CA 91761 --------- -DESCRIPTION --------------- QTY---- UNIT PRICE -TOTAL PRICE- TAX OFF HOURS INSPECTION 1.00 290.00 290.00 N INSPECT DATE: '3/26/12 LOCATION:700 NEWPORT CTR DR NEWPORT BCH, CA 92660 TOTAL CHARGES: 290.00 TOTAL TAX: 0.00 ------------- TOTAL INVOICE: 290.00 PAYMENTS: 0.00 ADJUSTMENTS: 0.00 TOTAL DUE: 290.00 o� to N to C. Q CO V NNv N � W 9 Om Z � o Z Q W N aW O a. cr m � G 0 O U L) C. w �' t% co N o? co a rn 0) c 0 o. N = F� O �N E a M� 0) W co Cb LO cu E O U U .0 a) C1 m tv o m 9 '-' Z O co o Z in 4- O n. 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D w N O O O O N CDC N r0000e-oomm000mao.wt o09,vsur4AO4neRN � 4' 40 b 0 0 La M 49. ai Li CD 0 W a) a) N LL CDV' LL ALL 0+=_LL J UocLLE€'Q J m .- N c °) as cum cc~ Q - o a0LU C A E O o o a) W L �m�� (D a a'v oU U�� pa Q tl V mmmCaLLLLLLLL O Z W a N LL 06S CITY OF NEWPORT BEACH 3300 NEWPORT BLVD NEWPORT BEACH, CA 92663 PHONE: 949 644-3141 CUSTOMER0000018552 ORR PROTECTION SYSTEMS INC 16 TECHNOLOGY DRIVE #134 IRVINE, CA 92618 INVOICE: FS54003750 PAGE 1 DATE: Jan 20, 2012 OF 1 SERVICE:- ANNUAL & SPECIAL PERMITS CUSTOMER PO: CUSTOMER PH: (877) 265-970'5 TERMS: DUE IN 30 DAYS DUE DATE: Feb 19, 2012. SERVICE ADDRESS: ORR PROTECTION SYSTEMS INC 16 TECHNOLOGY DRIVE #134 IRVINE, CA 92618 ---------- DESCRIPTION --------------- QTY---- UNIT PRICE -TOTAL PRICE -.TAX OFF HOURS INSPECTION 1.00 290.00 290-00 N INSPECTION DATE: 1/12/12 INSPECTION LOCATION: 840 NEWPORT CTR DR TOTAL CHARGES: TOTAL TAX: TOTAL INVOICE: PAYMENTS: ADJUSTMENTS: TOTAL DUE: 290:00 0.00 290.00 0.00 0.00 290.00 1 JW Is . o Ln T N_! T u) m . ww� W _y m C!I Z 2 O Z n E U� W awa) Dam M a W � c 0 U U a LL! U) O r' m C9 W Ln CD N O (D E 0 U U N O m 3 at Z 0 00 � o Z m O V 00 et C1{ U) 1� cU Nc 2 en E x ® P L 0 0 o' U t' • ® r D m� ^' W ® `' N U tq N 0 N cn Ct i C c c m L O in LL QQ 0. 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U �UV W�a a`' No z ai a) aoi at oW a r- U =a (..(D LLOOLL O� W U- OLL ai,-LLLL W LL 2 0- J O Zam �aUaao rn o aU- cLL 8 E mta- GZ W Za- ZI? o QmU LL 0 =LoiW UnOm o c U > m oav F-LaZ >M_1t 2 o 0'a� o a,OW c E E y Q N cU 3 3 m Y mmcmm o a�'i ayi w o 0 ai a Lo cN �UcZZo'E0' CL c as=a2E22 Q a0i N N c Co N C N O CAN o io V mU]mmIL I.L LL I.L 0 y 3: s Q� s o�o,07000000-0 c 0Q 0- QQ a UL-�•000ZZLim CITY OF NEWPORT BEACH 3300 NEWPORT BLVD NEWPORT BEACH, CA 92663 PHONE: 949 644-3141 CUSTOMER0000002126 GREATER ALARM COMPANY 3750 SCHAUFELE AVE LONG BEACH, CA 90808-1778 INVOICE: FS54003706 PAGE 1 DATE: Dec 07, 2011 OF 1 SERVICE: ANNUAL & SPECIAL PERMITS CUSTOMER PO: CUSTOMER PH: 949-474-0555x TERMS: DUE IN 30 DAYS DUE DATE: Jan 06, 2012 SERVICE ADDRESS: GREATER ALARM COMPANY 3750 SCHAUFELE AVE LONG BEACH, CA 90808 ---------- DESCRIPTION --------------- QTY---- UNIT PRICE -TOTAL PRICE- TAX OFF HOURS INSPECTION 3.00 282.00 846.00 N 999 NEWPORT CNTR DR 11/30/11 - 1.5 HRS 12/01/11 - 1.5 HRS TOTAL CHARGES: TOTAL TAX: TOTAL INVOICE: PAYMENTS: ADJUSTMENTS: TOTAL DUE: 846.00 0.00 846.00 0.00 0.00 846.00 LO LO LO M 0 V' 4 r rn CNC LL a tC r to O a) L tT a Z° c ui 0 .6 CL U- n`_ N ��,��ni nnn nn nn nn o n n n n n n n n r n n n in) cs a) a) N UA o cn Q cn z N Y _ C Z N LLI a)m 02Q�- Z J U N p _O0099 U)=o �vQ4 U w Y W rn c ` ) c S c L c Q Q dWa Q dw O Q S U H w J Y Z a. � Z w � et Z FL T O L W N o O CO a W J Z N z o a a �f=co NWN 00T M N a 5 w U N 0 E z w m a o U to TNT -It E—mT N-co U W o W _ O N N TOMr' C W o N N Y U�aI-T Qto ZT Cl) !Q CN co C�OI� OwCD +-'>MO� m o TQr- vTmo y W in a o 0 o Q Q. _0 U N N 0 m n Q OE O U Z U to a) C fn X J X y N >+ Q C "p O 'O C w N W U U ` C U X O I_-O UQ O a) (6 O XUa w J in Z w 0 z w w � o0 U O m h Z 04 N > > m a m wo U a d W O> Q T Z w V N ? U O U M 0029 =�N=T T �Z/N LL�LLQI 2Tai� N N v Q a 0 W L Q O U d a N C . N OQ N U N o �a •o a ¢¢ m c 0 r a ui CD . m CD 0 Cl O O O � ff► tH � O M 6F� 1 � "O )I c o 0 o � C �J 11017 4 U m U a) O_ L7 ui LU LL T a � N M N N 0 C (6 � L �LL�2 CD Jof � Y U a) CO L o U T o } v � o m C7 M U Q� � T � 0 6 � 0 � N U N C U 0 0� +N-' C C O pUcZZ9'c0 O (p\\ 0 a) O Q) O 0 0 0 m 0 0 0 o UHOQQZZLL00 O O O O O a� E a) m Cc m 'o 0 U a) Cc 000 00 000 00 000 00 u> sR yr v> vs N L Y N U LL L U d R m E>�w oo c- LL f-- C O C Y Y 0 � U N � m m O m 7 7 LLan. an. 0 O (D ti yr a 000000a c 0000000 0 o(3ootct�o r` yr vs to yr r- rn �n r` . T N � LL LL a� o EL LL o aami a) .cu .. O C LL c :C. o m a)i - c �'0 m am• > U aa)�LLLE U > > U , m o dO W c c EI- U mmmmma m ` C C C C a C N :2'2'0 a D aim= CO mmmmtitim w W LL J I o w > CL N Q (1) a U Z a. o Z W a N LL. i Alcaraz, Debbie From: Morris, Nadine Sent: Monday, October 06, 201410:55 AM To: Alcaraz, Debbie Subject: Invoice - 1400 Newport Center Drive Hi Debbie, Please invoice as follows: Weekend Inspection Saturday, 10/4/2014 9AM —11AM = 2 hours 1400 Newport Center Drive — underground hydro & flush Sean Kelly Kelly Fire Protection Inc 10141 Theseus Dr Huntington Beach, CA 92646 714-907-7586 Thank you, Nadine From: Tony Furnari[mailto:tfurnari@irvinecompany.com] Sent: Monday, October 06, 2014 8:44 AM To: Morris, Nadine Subject: RE: 1400 Newport Center Drive Please send the invoice to Kelly Fire and Thanks for All Your Help and Have a Great Day Tony Furnari Chief Portfolio Engineer Irvine Company Office Properties 620 Newport Center Drive, Suite 150 1 Newport Beach, California 192660 Phone 949.729-1475 1 Fax 949.759.1319 1 tfurnarl(W ryinecompany.com 0 JBVINE COMPA 1NX I OFF ICI -rIES Please considerthe environment before pnMing From: Morris, Nadine [mailto:NMorris@NBFD.net] Sent: Monday, October 06, 2014 7:19 AM To: Tony Furnari Subject: RE: 1400 Newport Center Drive Good morning Tony, I witnessed the inspection on Saturday and all went well. Operations has been advised that the system is back in service. Sean said he'll get a set of plans in for approval this week. ��ce5i �l Who should the City invoice the 2 hours to - Irvine Company or Kelly Fire? If it's the IC, should the invoice go to the address in your signature block? Thank you, Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net nN 1) -4 C) Q 0 co C, 0 00 LO 401). 40 4& 0 LO 04 Cl) r I 0 'IT 4 0) 0 ca co C� z LL Ile a) CD a) cc E cu cr 0 a) U) (L Z '2 0 LLIV z 0 D ca 0 C4 0 a) co a) in a) a) U) 6 r I . . LL 1: :L-- S; 2 (1) �i 2 L) C: 9)2 C: = 2 -o 0 CF),D 0 U) _0 0 �o = C: -0 J-5 (15-0 _r_ 0 41 < < 0- w < 0- 0 < IL 0 C! C! C� C, C, C, LLI 0 C) CD 00 0 CL c\1 co w LL Q U- C14 Ck w C) UJ o CM LU 04) a- < >- Cw E > LL LL fa a) C.) 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L 2.Q mLL�JO' pY p o 0 a c Nw o o 0 o co o x a 0 U a a-U J m J ,W U a w a)Cc cu 0 N m o 0 0 o 0 rn o o J (n OOOONIt00 LO f % fA fH NT O Hi iR 04 U) V! O � O 0 0 h O N N to N M 44!k 0) co c J U >-CD W o0 J as �U jw 0 rxr �; LU W Lu �O W FLU LL ALL N= LLJ IL m to?iF- JU) QOZ'n ai 0) c) o aLL E' EQ 0Z0 UQZ�� m .0 j aLL oU m o n n n- F- 0 w O IL Y-tea' a O aD E rn0 co •� •i _i a ll. O p W N U) ? w dam'' O m .0 a�� t6 c LLB N y N j .. id 0 U)Nz �v, n.'c� o r E o �6 o E E a0pw c E E Q a 0� c C�C�c o a`�i m w na w 3 3 0 0 o m a`) aiY c o v v v U U Of W cA a a O 0 U) C N a U c Z Z � U 'c O c "." OL V) C a) a) a) m 7 7 � -. -- w U, Q, C. C C V C N 7 N N p p 0 V CommmLLLLLLLL O Z w U) 3a t CL.o � o TcO'D'a 0 0 ov O Oa a ¢a a UF- OaazZwm a N M l oo! psa M�' L1 STATF_ 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 REQUEST DATE PROGRAM Health Facilities Inspection Division (626) 569 3965 9/9/2014 EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Shirley Singleton, RN, Supervisor 7A CODES 1. ORIGINAL A. FIRE CLEARANCE � — LICENSING I Department of Public Health 2. RENEWAL B. LIFE SAFETY AGENCY Health Facilities Inspection Division NAME AND Acute and Ancillary Unit South 3. CAPACITY CHANGE ADDRESS 3400 Aerojet Avenue, Suite 323 4. OWNERSHIP CHANGE El Monte, California 91731 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVOUS CAPACITY FACILITY NAME LICENSE CATEGORY Keck Hospital of USC STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 1500 San Pablo CITY RESTRAINT Los Angeles, CA 90033 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Charles "Chip" G. Riddle III Adm Director 1(323) 442-8924 SPECIAL CONDITIONS The facility is requesting licensure for outpatient services of a Newport Beach Healthcare Clinic located at 300 Old New Port Blvd, Newport,Beach CA 92663. Request fire clearance TO BE COMPLETED BY INSPECTING AUTHORITY Newport Beach Fire Department FIRE 100 Civic Center Drive AUTHORITY Newport Beach, CA 92660 NAME AND Fire Inspector: Steve Michael ADDRESS Direct: (949) 644-3108 Fax:(949) 723-3552 L INSPECTOR'S NAME (Typed orPmrted) S-eve WckaeL INSPECTIgN DATE INSPECTOR' 91�I5/1y I lak EXPLAIN DENIAL OR LIST SPECIAL CONC 01 C/L/q_ 67y-' toe 1 3co55 CLEARANCE MENIAL CODE cvues ;• FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM OCCUPANCYCLASS D. SPRINKLERS E. HOUSEKEEPING 13 F. SPECIAL HAZARD G. OTHER M STATE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 4.20M) See instructions on reverse. AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM Health Facilities Inspection Division (626) 569 3965 9/9/2014 EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Shirley Singleton, RN, Supervisor 7A CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING Department of Public Health 2 RENEWAL B. LIFE SAFETY AGENCY Health Facilities Inspection Division 3. CAPACITY CHANGE NAME AND Acute and Ancillary Unit South ADDRESS 3400 Aerojet Avenue, Suite 323 4. OWNERSHIP CHANGE El Monte, California 91731 5. ADDRESS CHANGE L S. NAME CHANGE T OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPAC4TY FACILITY NAME LICENSE CATEGORY Keck Hospital of USC STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 1500 San Pablo CITY RESTRAINT Los Angeles, CA 90033 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Charles "Chip" G. Riddle III Adm Director (323) 442-8924 SPECIAL CONDITIONS The facility is requesting licensure for outpatient services of a Newport Beach Clinic located at 520 Superior Avenue, Suite 300 Newport,Beach CA 92663. Request fire clearance TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE MENIAL CODE f CODES Newport Beach Fire Department FIRE 100 Civic Center Drive 01FIRE CLEARANCE GRANTED AUTHORITY Newport Beach, CA 92660 NAME AND 2. FIRE CLEARANCE DENIED Fire Inspector. Steve Michael ADDRESS Direct: (949) 644-3108 Fax:(949) 723-3552 A. EXITS —J L I S. CONSTRUCTION C. FIREALARM D. SPRINKLERS INSPECTOR'S NAME (Typed orPdnted) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS �� / 9 y9- 6`/`/- 31 � � 3 DOSS • 'Q E. HOUSEKEEPING /� �' ( (' G �A e v Steve D F. SPECIAL HAZARD G. OTHER INSPECTION DATE INSPECTOR'S SIGNATUREd orPaMed) —_�—� DENIAL OR LIST SPECIAL CONDITIONS #BWNKJHD #AR00000216845# KECK HOSPITAL OF USC UNIVERSITY OF CALIFORNIA 1500 SAN PABLO STREET LOS ANGELES, CA 90033 Description STATE FIRE CLEARANCE INSPECTION DATE: 09.15.14 LOCATION: NB HEALTHCARE CLINIC ADDRESS: 300 OLD NEWPORT BLVD CUST#: 0000021684 NBID: 57084 INVOICE: FS54004743 INV DATE: 10/02/14 DUE DATE: 11/01/14 Qty Unit Price Tax Extension 1.00 75.00 0.00 75.00 TOTAL INVOICE: $ 75.00 PAYMENTS/ADJUSTMENTS: $ 0.00 PAST DUE: $ 0.00 PENALTIES/INTEREST: $ 0.00 TOTAL AMOUNT DUE: $ 75.00 BILLING QUESTIONS SHOULD BE DIRECTED TO THE FIRE DEPARTMENT AT (949) 644-3106. THANK YOU. Wow: ANNUAL & SPECIAL PERMITS - INVOICE KECK HOSPITAL OF USC UNIVERSITY OF CALIFORNIA 1500 SAN PABLO STREET LOS ANGELES, CA 90033 TOTAL AMOUNT DUE: $ CUST NBR: 0000021684 NBID: 57084 INVOICE: FS54004743 INV DATE: 10/02/14 DUE DATE: 11/01/14 75.00 AR 0000021684 7500 Ii Keck Medical CHARLEs " Bdminis CHIP" G, RIDD LE 1. j trativeDirectar C Center f USC Keck No Facilitie of(jSC Norris Cancer ),cer f jospital University ofsouthe Q f r sc dJ rn 1500 San Pabl�orne , Los Street eles, a if, - y g C 0033 ' Tel: 323 442 8924 Fax:323 442 8430 e'rnazl: 909 957 d chazleM ie' 6081 Camed.usc.edu vir -� 5 ov_ Alcaraz, Debbie From: Morris, Nadine Sent: Tuesday, February 16, 2016 1:57 PM To: Alcaraz, Debbie Subject: Scanning - 4225 MacArthur Blvd Attachments: SCAN0322.pdf; Newport Place Test results.pdf; Newport Place.doc Categories: SCAN Hi Debbie, Please scan these documents into 4225 MacArthur Blvd. They are fire alarm & fire sprinkler acceptance test reports. Thank you, Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net FORM 2-J Automatic Sprinkler Systems Contractor's Material and Test Certificate for Aboveground Piping Date: Name: PAD A Building E2/16/1Property Propeess• 4225 Mcarthur Newport Beach CA Procedure Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and the system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authori- ties, owners, and contractors. it is understood that the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. Plans Accepted by [approving authority's name(s)] City of Newport Beach Fire Address 100 Civic Center Newport Beach CA Installation conforms to accepted plans? O Yes ❑ No Equipment used is approved? ED Yes ❑ No If no, explain deviations. Instructions Has person in charge of fire equipment been instructed as to location of control valves ❑O Yes ❑ No and care and maintenance of this new equipment? If no, explain. Have copies of appropriate instructions and care and maintenance charts and NFPA 13 (] Yes ❑ No been left on premises? if no, explain. Location of System Supplies building(s) North East Side of Building Sprinklers Year of Orifice Temperature Make Model Manufacture Size Quantity Rating Globe GL5615 2015 1/2 34 200 Globe GL5601 2015 1/2 2 155 Pipe and Fittings Pipe conforms to NFPA 13 2013 standard. D Yes ❑ No Fittings conform to NFPA 13 2013 standard. 121 Yes ❑ No If no, explain. PAGE 1 of 3 Copyright© 2000 National Fire Protection Association FORM 2-J Automatic Sprinkler Systems Contractor's Material and Test 1AJ] Certificate for Aboveground Piping (coat.) Alarm Valve or Flow Indicator Alarm Device Maximum Time to Operate Through Test Pipe Type Make Model Min. Sec. Flow Switch System Sensor WFD25A 60 Dry Pipe Operating Test Dry Valve Q.O.D. Make Model Serial No. Make Model Serial No. Time to Trip Through Test Pipe* Water Pressure Air Pressure Trip Point Air Pressure Time Water Reached Test Outlet* Alarm Operated Properly Min. Sec. Psi (Bar) Psi (Bar) Psi (Bar) Min. Sec. 'Yes No Without Q.O.D. With Q.O.D. If no, explain. Deluge and Preaction Valves Operation ❑ Pneumatic ❑ Electric ❑ Hydraulic Piping supervised? ❑ Yes ❑ No Detecting media supervised? ❑ Yes ❑ No Is there an accessible facility in each circuit for testing? ❑ Yes ❑ No If no, explain. Does each circuit operate supervision loss alarm? Does each circuit operate valve release? Maximum Time to Operate Release Yes No Yes No Make Model Min. sec. Test Description HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for two hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for two hours. Differential dry pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. FLUSHING: Flow the required rate until water is clear as indicated by no collection of foreign material in burlap bags at outlets such as hydrants and blow -offs. Flush at flows not less than 400 gpm (1514 L/min) for 4-in. (102-mm) pipe, 600 gpm (2271 L/min) for 5-in. (127-mm) pipe, 750 gpm (2839 L/min) for 6-in. (152-mm) pipe, 1000 gpm (3785 L/min) for 8-in. (203-mm) pipe, 1500 gpm (5678 L/min) for 10-in. (254-mm) pipe and 2000 gpm (7570 L/min) for 12-in. (305-mm) pipe. When supply cannot produce stipulated flow rates, obtain maximum available. *Measured from time inspector's test pipe is opened. PAGE 2 of 3 Copyright © 2000 National Fire Protection Association Automatic Sprinkler Systems FORM 2-J Contractor's Material. and Test %91 Certificate for Aboveground Piping (cons.) Test Description (cont.) PNEUMATIC: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 11/2 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 11/2 psi (0.1 bar) in 24 hours. Tests All piping hydrostatically tested at 200 psi (bar) for 2 hrs. Dry piping pneumatically tested? ❑ Yes ❑ No Equipment operates properly? ❑ Yes ❑ No If no, state reason. Drain test —Reading of gauge located near water supply test pipe: Static pressure: 100 psi (bar) Drain test —Residual pressure with valve in test pipe open wide: 90 psi (bar) Underground mains and lead-in connections to system risers flushed before connections made to sprinkler piping Verified by copy of the U Form No. 85B ❑ Yes ❑ No ❑ Other Flushed by installer of underground sprinkler piping O Yes ❑ No ❑ Other If other, explain. Blank Testing Gaskets Number used Locations Number removed Welding Welded piping? ❑ Yes El No If yes, Do you certify as the sprinkler contractor that welding procedures comply with the requirements of at least AWS D10.9, Level AR-3? ❑ Yes 121 No Do you certify that the welding was performed by welders qualified in com- pliance with the requirements of at least AWS D10.9, Level AR-3? ❑ Yes M No Do you certify that welding was carried out in compliance with a documented quality control procedure to insure that all discs are retrieved, that openings in piping are smooth, that slag and other welding residue are removed, and that the internal diameters of piping are not penetrated? ❑ Yes O No Hydraulic Data Nameplate Nameplate provided? O Yes ❑ No If no, explain. Remarks Date left in service with all control valves open: 2/16116 Sprinkler Contractor: Rice Fire Protection Signatures of Test Witnesses For property owner (signed) Title Date For sprinkler contractor (signed) — " Title cfir �l�. Date 9 167 /2 PAGk 3 of 3 Copyright © 2000 National Fire Protection Association 02116/2016 11:22:26 CS#A1527473 toA1527473 Name to Date Operator Zone Area State Event History Page 1 of 1 02/1612016 to 0211151201a Site# to to Primary city to State to Sewndary Sort Event 10 Zonecommerd User Name U_riD A1527473 - Newport Place 021162016 09A2:37 501 R 20DOf2ESTORE 'fast PIV VALVETAMPER ZrrType: Supervisory Zn_Desc: PIV VALVE TAMPER Sent via CELL Path: 01 (Primary) 02/162016 09A2:11 501 A 511-FIRE TROUBLE- NTFY *Test PIV VALVE TAMPERDelay:20.00 Ztt_Deso: PIV VALVE TAMPER Sent via CELL Path: 01 (Primary) 02116/2016 09:37*23 9 R 200D-RESTORE `Test SMOKE OVER FACP Zn_Type: Par Zn_Desc SMOKE OVER FACP Sent via CELL Path: Ot (Primary) 02/16/2016 09:37:05 $34 A DM113-ALARM BELL SILENCED 'Test Sent via CELL Path: 01 (Primary) 021161201609:36:47 9 A I01-FIRE-DISP IST 'Test SMOKE OVER FACP Zn Dasc SMOKE OVER FACP Sent via CELL Path: Of (Primary) O21162016 09:36:22 10 R 2000-RESTORE 'Tost WATERFLOW Zr Type: Piro Zn Desc.WATERFLOWSentviaCELLPath:01(Primary) 021162016 09:36:03 S34 A DM113•ALARM BELL SILENCED 'Test Sent via CELL Path: Ot (Primary) 021162016 09:35:55 10 A 101-FIRE- DISP 1ST 'Test WATERFLOW Zrt_Desa WATERFLOW Sent via CELL Path: 01 (Primary) Page 1 of FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION 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. 1. PROPERTY INFORMATION Name of property: Newport Place Address: 4225 Macarthur Blvd. Newport Beach CA. Description of property: Occupancy type: Name of property representative: Address: Phone: Fax: Authority having jurisdiction over this property: Phone: Fax: E-mail: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: Troy Alarm Inc. Address: 5981 Republic Street Riverside, CA 92504 License or certification number: 792133 Phone: 951.352.7589 Fax: 951.352.7763 E-mail: Service organization for this equipment: Troy Alarm Inc. Address: 5981 Republic Street Riverside, CA. 92504 License or certification number: 792133 Phone: 951.352.7589 Fax: 951.352.7763 E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of - Contracted testing company: Address: Phone: Fax: E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. DESCRIPTION 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):- NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12) Copyright ©2009 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. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2013 Additional description of system(s): 3.1 Control Unit Manufacturer: Digital Monitoring Products 3.2 Mass Notification System 3.2.1 System Type: ❑ In -building MNS—combination Model number: XR150FC-R ® This system does not incorporate an MNS ❑ In -building MNS—stand-alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ❑ An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: 3.4 System Software ® This system does not have alterable site -specific software. Operating system (executive) software revision level: Site -specific software revision date: Revision completed by: ❑ A copy of the site -specific software is stored on site. Location: 3.5 Off -Premises Signal Transmission ❑ This system does not have off -premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: National Monitoring Center Phone: 800.662.1711 Supervisory: National Monitoring Center Phone: 800.662.1711 Trouble: National Monitoring Center Phone: 800.662.1711 Entity to which alarms are retransmitted: Phone: Method of retransmission: If Chapter 26, specify the means of transmission from the protected premises to the supervising station: If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12) Copyright 0 2009 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. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: Survivability level: Quantity: 0 (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: Description: 4.1.3 Device Power Pathways ® No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: Quantity: 2_ (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: Description: 4.2.3 Device Power Pathways ® No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: Survivability level: Quantity: (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: Description: 4.3.3 Appliance Power Pathways ❑ No separate power pathways from the notification appliance pathway ❑ Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12) Copyright © 2009 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. 0 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes Type and number of devices: Addressable: Other (specify): 5.1.2 Other Alarm Boxes Description: Type and number of devices: Addressable: Other (specify): 5.2 Automatic Initiating Devices ® This system does not have manual fire alarm boxes. Conventional: Coded: Transmitter: ® This system does not have other alarm boxes. Conventional: Coded: Transmitter: 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area Other (specify): Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): OVER FACP 5.2.2 Duct Smoke Detectors ® This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors ® This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: 5.2.4 Gas Detectors ® This system does not have gas detectors. Type of detector(s): Number of devices: Addressable: Conventional: Type of coverage: 5.2.5 Heat Detectors ® This system does not have heat detectors. Type and number of devices: Addressable: Conventional: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ❑ Rate -of -rise ❑ Rate compensated NPPA 72, Fig. 10.18.2.1.1 (p. 4 of 12) Copyright © 2009 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. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules ® This system does not have monitoring modules. Number of devices: 5.2.7 Waterflow Alarm Devices Type and number of devices: Addressable: 5.2.8 Alarm Verification Number of devices subject to alarm verification: 5.2.9 Presignal Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: 5.2.11 Other Initiating Devices Describe: ❑ This system does not have waterflow alarm devices. Conventional: 1 Coded: Transmitter: ® This system does not incorporate alarm verification. Alarm verification set for seconds ® This system does not incorporate pre -signal. ® This system does not incorporate PAS. ® This system does not have other initiating devices. 6. SUPERVISORY SIGNAL -INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: Conventional: Coded: Transmitter: 1 Other (specify): PIV 6.2 Fire Pump Description and Supervisory Devices ® This system does not have a fire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): _ 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) ® This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: _ Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: NFPA 72, Fig. 10.18.2.1.1 (p. 5 of 12) Copyright © 2009 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. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Other (specify): 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: FACP Location 2: Location 3: ® This system does not have a generator. ❑ Selector switch not in auto ❑ Low fuel ® This system does not monitor special hazard systems. ® This system does not monitor other systems. ❑ This system does not have annunciators. 9. ALARM NOTIFICATION APPLIANCES 9.1 In -Building Fire Emergency Voice Alarm Communication System ® This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound -processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 9.2 Nonvoice Notification Appliances ® This system does not have nonvoice notification appliances. Horns: With visible: Bells: With visible: Chimes: With visible: Visible only: Other (describe): 9.3 Notification Appliance Power Extender Panels ❑ This system does not have power extender panels. Quantity: Locations: NFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12) Copyright © 2009 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. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ®This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: _ Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other (describe): Supervision class: 10.3.1 Special Hazard Notification ❑ This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ❑ This system does not have a two-way telephone system. Number of telephone jacks installed: Number of warden stations installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ❑ This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: _ Radio system monitor panel location: 0 NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright © 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ❑ This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: _ Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ❑ This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two -Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ❑ Hold -open door releasing devices ❑ Smoke management ❑ HVAC shutdown ❑ F/S dampers ❑ Door unlocking ❑ Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules ® This system does not have control modules. Number of devices: Other (specify): _ 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120VAC Overcurrent protection: Type: Breaker Location (of primary supply panel board): Disconnecting means location: 13.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: Control panel amps: Amps: 20 ® This system does not have a generator. Type of fuel: NFPA 72, Fig. 10.18.2.1.1 (p. 8 of 12) Copyright © 2009 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. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: FACP Type: Nominal voltage: 12VDC Amp/hourrating: _17.0 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 ❑ Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ® This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: Overcurrent protection: Type: Amps: Location (of primary supply panel board): _ Disconnecting means location: 13.2.2 Engine -Driven Generator ❑ This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.2.3 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): 13.2.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): ❑ Batteries are marked with date of manufacture ❑ Battery calculations are attached NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) Copyright 0 2009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power Input voltage of power extender panel(s): Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: ® This system does not have power extender panels. Power extender panel amps: Amps: 13.3.2 Engine -Driven Generator IN "i Ins system does not nave a generator. Location of generator: Location of fuel storage: Type of fuel: 13.3.3 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): 13.3.4 Batteries Location: Type: Nominal voltage: Amp/hour raring: Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): ❑ Batteries are marked with date of manufacture ❑ Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. This is a: ® New system ❑ Modification to an existing system Permit number: F201_6001'0 The system has been installed in accordance with the following requirements: (Note any or all that apply.) ® NFPA 72, Edition: 2013 ® NFPA 70, National Electrical Code, Article 760, Edition: 2013 ❑ Manufacturer's published instructions Other (specify): System deviations from referenced NFPA standards: Signed: Printed name: Leo A. Najera Date: 2/16/2016 Organization: Troy Alarm Inc. Title: Operation's Manager Phone: 951.352.7589 NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright 0 2009 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. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ® New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ❑ Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: ® NFPA 72, Edition: 2013 ® NFPA 70, National Electrical Code, Article 760, Edition: 2013 ❑ Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: Printed name: Leo A. Najera Date: 2/16/2016 _ Organization: Troy Alarm Inc. Title: Operation's Manager Phone: 951.352_7589 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Alfred Tovar Date: 2/16/2016 Organization: Troy Alarm Inc. Title: Installer Phone: 951.352.7589 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Leo A. Najera Date: 2/16/2016 Organization: Troy Alarm Inc. Title: Operation's Manager Phone: _ 951.352.7589 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Organization: Printed name: Title: Date: Phone: NFPA 72, Fig. 10.18,2.1.1 (p. 11 of 12) Copyright © 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: -Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: J NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright © 2009 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. Alcaraz, Debbie From: Morris, Nadine Sent: Friday, January 29, 201612:43 PM To: Alcaraz, Debbie Subject: Scan & Invoice Attachments: Zoning Clearance Letter for Outpatient Office .pdf; chid-01@newportbeachca.gov_ 20160129_123549_000023cc001b.pdf Categories: SCAN Hi Debbie, Please scan the attached documents into 4299 MacArthur Blvd #200. No need to mail. And invoice the facility $76.00 for a fire clearance inspection. Thanks! Nadine 1 R�p 5�5a�a �'d95� 1, 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.ngMMortbeachca.gov January 8, 2016 Kevin Robertson Krobert6(cDsan.rr.com RE: 4299 MacArthur Blvd, Suite 200, Newport Beach, CA 92660 427-181-01 Dear Mr. Robertson: The above referenced property is located within Newport Place Planned Community (PC11) Zoning District and is designated within the Land Use Element of the General Plan as Mixed Use Horizontal (MU-H2). Within the PC11 Zoning District, the site is designated as Professional and Business Office Site 6, which 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 therapeutic counseling with a maximum of 10 clients per group and a maximum of 15 clients on -site at one time, one-on-one counseling and the related office use has been determined to be within the MU-H2 Land Use Category and is a permitted use in the PC11 Zoning District. However, the following changes in the operation as provided in the attachment would constitute a change in use, 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 imurillo(a)newportbeachca.gov. Sincerely, Kimberly Brandt, AICP, Community Development Director By: •r J e Murillo Senior Planner Enclosures: Description of outpatient program use for 4299 MacArthur Blvd, Suite 200 January 5, 2016 Jaime Murillo, AICP Senior Planner City of Newport Beach 100 Civic Center Drive Newport Beach, CA 92660 Re: The DBT Center of Orange County Zoning Approval Jaime, Thank you for taking the time yesterday to explain the process for obtaining a zoning approval for our outpatient drug and alcohol program located at 4299 MacArthur Blvd, Suite 200, Newport Beach, CA '92660. We are completing the final steps on our application to obtain State Certification and your help is very much appreciated. Along with the documentation you requested (program description, schedule of activities and floor plan), I have included the DHCS 5115 form the state provides to zoning departments for this approval. If you have any questions, you may reach me at krobert6@san.rr.com or by cell at 858-705- 1778. Sincerely, Kevin Robertson Senior Consultant The DBT Center of Orange County k Proaram Description The DBT Center of Orange County drug and/or alcohol rehabilitation program will provide intensive outpatient counseling services to clients suffering from substance abuse. All of the counseling services offered will be conducted in an office setting, either individually or in small groups three times per week for three hours per day. The services will be provided to approximately 10-15 clients per week. The program.will be offered at 4299 MacArthur Blvd., Suite #200 which is a 3,311 square foot office suite consisting of 11 separate rooms along with a kitchenette. The program and it's participants will be contained within the suite for the 9-10 hours of program activity each week. Schedule of Activities As mentioned in the program description, the program will operate three times per week for three hours per day. The proposed schedule is below: Monday 9:00-12:00 Wednesday 9:00-12:00 Friday 9:00-12:00 For the three hours each day, clients will receive services in the traditional office/counseling setting. Floor Plan The floor plan for 4299 MacArthur Blvd., Suite #200 is attached, showing the office layout. I 4C> col N 0 CD 1 In C"r Newport Beach Fire Department Life Safety Services 100 Civic Center Drive Newport Beach, CA 92660 (949) 644-3106 FIRE CLEARANCE Newport Beach Fire Department - Life Safety Services Division (Fire Authority Name) 100 Civic Center Drive, Newport Beach, CA 92660 (Address) (949) 644-3106 (Telephone Number) DBT Center of Orange County (Name of program) was inspected this date for compliance with local requirements and is hereby granted a fire clearance to operate an outpatient drug and/or alcohol rehabilitation program at: q1141141W (Address of program -please include suite numbers if applicable) Nadine Morris (949) 644-3105 (Inspector's name'p- typed or printed) (Telephone number) M- L� f v � Uo-/t-i1 "6 Life Safety Specialist (Signature and Rank of Inspector Granting Clearance) January 29 2016 (Inspection Date) r t4 FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time ofsystem acceptance and approval. 1. Protected Property Information Name of property: BANK OF THE WEST - PHASE 2 T.I. Address: 4400 MACARTHUR BLVD. #100 NEWPORT BEACH, CA 92660 Description of property: BANK Occupancy type: B Name of property representative: HOWARDS CONSTRUCTION _ Address: Phone: Fax: E-mail: Authority having jurisdiction over this property: Phone: Fax: E-mail: 2. Fire Alarm System Installation, Service, and Testing Information Installation contractor for this equipment: VFS FIRE & SECURITY SERVICES Address: 1011 EAST LACY AVE. ANAHEIM, CA 92805 Phone: 714-778-6070 Fax: 714-778-6090 E-mail: Service organization for this equipment: Address: Phone: Fax: E-mail: Location of as -built drawings: OWNER 1 PANEL Location of Historical Test Reports: Location of system operation and maintenance manuals: OWNER A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: ........... Address: Phone: Fax: E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. Type of Fire Alarm System or Service NFPA 72® Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers (if applicable): Alarm: Supervisory: Trouble: Phone: Phone: Phone: _ Entity to which alarms are retransmitted: PUBLIC TELEPHONE NETWORK , Phone: Method of retransmission of alarms to that organization or location: PUBLIC TELEPHONE NETWORK NFPA 72, Fig. 4.5.2.1 (p. 1 of 5) a Copydght ©2009 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. It If Chapter 8, note the means of transmission from the protected premises to the central station: ❑ Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2-way radio ❑ 1-way radio ❑ N/A If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: Site -specific software revision date: v _� 4. Signaling Line Circuits Revision completed by: Characteristics ofsignaling line circuits connected to this system (see NFPA 72 ® Table 6.6.1): Quantity: Style: Class: 5. Alarm -Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system (see NFPA 72® Table 6.5): Quantity: Style: Class: 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: 4 Tvoe of coverage: Type of devices: ® Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.4 Sprinkler Wateflow Detectors Number of waterflow detectors: _ Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for seconds 6. Supervisory Signal -Initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ,❑ N/A NFPA 72, Fig. 4.5.2.1 (p. 2 of 5) Copyright ©2009 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. 01 6.2 Fire Pump Type of fire pump: ❑ Electric ❑ Diesel Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine -Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: 7. Annunciators 7.1 Annunciator 1 ❑ Local ❑ Remote Type: p Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.2 Annunciator 2 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 8. Alarm Notification Devices and Circuits 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of speakers: 4 8.2 Telephone Jacks Number of multiple voice alarm channels: Number of speaker zones: Number of telephone jacks installed: — Number of telephone handsets stored.on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFPA 72® Table 6.5): Quantity: �- -- - - -- Style: Class: 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device: Chimes: With visual device: Visual devices without audible devices: 5 Horns: Bells: Other (describe): With visual device: With visual device: NFPA 72, Fig. 4.5.2.1 (p. 3 of 5) Copyright © 2009 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. 9. Emergency Control Functions Activated ❑ Hold -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑ Elevator recall ❑ Other 10. System Power Supply 10.1 Primary Power Nominal voltage: 120 Overcurrentprotection: Type: _ _._ _____._ Location (of primary supply panelboard): _ Disconnecting means location: __ 10.2 Secondary Power Location: PANEL Type: Number of standby batteries: Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: _24 HOURS.------------ In alarm mode: 5 MINUTES Amps: 20 Amps: Nominal voltage: 12 Amp hour rating: 7 Current rating: 11. Record of System Installation Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) ® NFPA 720 ® NFPA 70® Article 760 ® Manufacturer's published instructions ❑ Other (please specify): v� System deviations from referenced NFPA standards: Signed: Organization: VFS FIRE & SEC. Title: Printed name: ALARM TECH Date: Phone: 714-778-6070 12. Record of System Operation All operational features and functions of this system were tested by or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of. ® NFPA 720 ® NFPA 70®, Article 760 ® Manufacturer's published instructions ❑ Other (please specify): _ ❑ Documentation in accordance with Inspection and Testing Form (Figure 10.6.2.3 of NFPA 72) is attached Signed: —� Printed name: C � Q � o Date: OY-3 0 —! 1 Organization: VFS FIRE & SEC..----,- Title: ALARM TECH Phone: 714-778-6070 NFPA 72, Fig. 4.5.2.1 (p. 4 of 5) Copyright © 2009 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. 13. Certifications and Approvals 13.1 System Installation Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed. / Printed name:cc p �(tt,�„ekf>� Date: Odf-3 a Organization: VFS FIRE & SEC. Title: . ALARM TECH. _ Phone: 714-778-6070 13.2 System Service Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signe Printed name: "w `0©a/ � Date: p cf—3a /Y Organization: VFS FIRE & SEC Title: ALARM TECH Phone: 714-778-6070 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: _ Printed name: Date: Organization: Title: Phone: 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: _ _ Printed name: Date: Organization: Title: Phone: 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, its approved sequence nof` operations, and with all NFPA standards cited herein. �Lf Signed: r v �ILPrinted name: i' V I LP M 0 _ 5 Date: ✓3() Organization: N l� �� Title: J Q5PL-2-(-0)2 Phone: NL_7_(ptl q-3l05 NFPA 72, Fig. 4.5.2.1 (p. 5 of 5) Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sate or distribution. U 4 s FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. 1. Protected Property Information Name of property: BANK OF THE WEST --PHASE 1 T.I. Address:4400MAARlHUR=BL`VD #fONEWPORT BEACH, CA 92660 Description of property: —BANK Occupancy type: B Name of property representative: HOWARDS CONSTRUCTION Address: Phone: Fax: E-mail: Authority having jurisdiction over this property: — Phone: Fax: E-mail: 2. Fire Alarm System Installation, Service, and Testing Information Installation contractor for this equipment: _ VFS FIRE & SECURITY SERVICES Address: 1011 EAST LACY AVE. ANAHEIM, CA 92805 Phone: 714-778-6070 Fax: 714-778-6090 E-mail: Service organization for this equipment: Address: Phone: Fax: E-mail: Location of as -built drawings: OWNER i PANEL Location of Historical Test Reports: Location of system operation and maintenance manuals: OWNER — A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Address: Phone: Fax: E-mail: M Contract expires: Contract number: Frequency of routine inspections: 3. Type of Fire Alarm System or Service NFPA 72®, Chapter Reference of System Type:_ - Name of organization receiving alarm signals with phone numbers (f applicable): Alarm: Phone: Supervisory: - _ ----- _ Phone: Trouble: - -- - - - ----- --- --- Phone: Entity to which alarms are retransmitted: PUBLIC TELEPHONE NETWORK Phone: Method of retransmission of alarms to that organization or location: PUBLIC TELEPHONE'NETWORK -NFPA 72, ,Fig. 4.5.2.1 (p. 1 of 5) Copyright © 2009 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. t s If Chapter 8, note the means of transmission from the protected premises to the central station: ❑ Digital alarm communicator ❑ McCulloh ❑ Multiplex .❑ 2-way radio .❑ 1-way radio ❑ N/A If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: Site -specific software revision date: Revision completed by: 4. Signaling Line Circuits Characteristics of signaling line circuits connected to this system (see NFPA 72 ® Table 6.6.1): Quantity: Style: Class: 5. Alarm -Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system (see NFPA 72®, Table 6.5): Quantity: —_-� -_ Style: Class: 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: 6 Type of coverage: _ Type of devices: ® Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for seconds 6. Supervisory Signal -initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A NFPA 72, Fig. 4.5.2.1 (p. 2 of 5) Copyright ©2009 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. 4 6.2 Fire Pump Type of fire pump: ❑ Electric ❑ Diesel Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter 0 N/A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal .❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine -Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: 7. Annunciators 7.1 Annunciator 1 ❑ Local ❑ Remote Type: o Addressable ❑ Directory ❑ Graphic ❑ N/A 7.2 Annunciator 2 ❑ Local ❑ Remote Type: o Addressable ❑ Directory ❑ Graphic ❑ N/A 7.3 Annunciator 3 ❑ Local ❑ Remote Type: o Addressable ❑ Directory ❑ Graphic ❑ N/A 8. Alarm Notification Devices and Circuits 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of speakers: 6_ 8.2 Telephone Jacks Location: Location: Location: Number of multiple voice alarm channels: Number of speaker zones: Number of telephone jacks installed: Number of telephone'handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFP,4 72® Table 6.5): Quantity: _- -- - Style: Class: 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device: Horns: With visual device: Chimes: With visual device: Bells: With visual device: Visual devices without audible devices: 12 Other (describe): NFPA 72, Fig. 4.5.2.1 (p. 3 of 5) Copyright © 2009 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. l 9. Emergency Control Functions Activated ❑ Hold -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑ Elevator recall ❑ Other 10.System Power Supply 10.1 Primary Power Nominal voltage: 120 Overcurrent protection: Type: Location (of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power - - --- Amps: 20 - - -- Amps: Location: PANEL _ Type: _— Nominal voltage: 12 Number of standby batteries: 2 Amp hour rating: _7 Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: 24 HOURS Current rating: In alarm mode: 5 MINUTES 11. Record of System Installation Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) ® NFPA 720 ® NFPA 70® Article 760 ® Manufacturer' 4blished*ons ❑ Other (please speciSystem devi froPA standards:Signed:_ _Printed name: Organiz ion: VFS FIRE & SEC. Title: ALARM TECH Phone: 714-778-6070 12. Record of System Operation All operational features and functions of this system were tested by or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of- ® NFPA 72® ®NFPA 70®, Article 760 ® Manufactu er's published instru ons ❑Other (please speci ) ❑ Docum t on in accor an with Insypection and Testing Form • rre� 10..2.3 of NFPA4 72') is attached Signed: 1, Printed name: t✓ �4/ n/ V Date: Organiz on: VF IRE & SECT Title: ALARM TEC Phone: 714-778-6070 — NFPA 72, Fig. 4.5.2.1 (p. 4 of 5) Copynght ©2009 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. 13. Certifications and Approvals 13.1 System Install on Contract This system as s ified herein s been installed and tested a c rdi g to al A standards cited herein. Signed: Printed name: ` �� Date: Organization: VFS FI E & SEC. itle: ALARM CH. ry Phone: 714-778-6070 _ 13.2 System Servi C tractor This system as s ci ed herei s been installed and tested accordi all NFP standards cited herein. Signed: _ _ _ _ Printed name: (7E+ Date: Organizatio VFS FIRE & SEC Title: ALARM TECH Phone: 714-778-6070 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: _ Printed name: Date: Organization: — ----- Title: Phone: 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: _ _ Date: Organization: _ _ Title: Phone: _ 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, its approved sequence of operations, and with- all NFPA standards cited herein. Signed: Printed name: Date: Organization: _ _ Title: Phone: NFPA 72, -Fig. 4.5.2.1 (p. 5 of 5) Copynght ©2009 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. NEWPORT BEACH FIRE DEP'i LIFE SAFETY SERVICES DIV AUG 13 20155 BY. � ,, RECEIVE�Yk/ rptARAdjlnv14 0 REEASURtR-TAX COOLLLAE�CTOR REVENUE RECOVERY - AIR UNIT P.O. BOX 4005 SANTA ANA, CA 92702-4005 Newport Beach Fire Department - Project ATTN: Fire Department 475 32nd Street Newport Beach, CA 92660 (949) 644-3377 INVOICE NO. SC089255 DATE August 11, 2015 REFERENCE THIS NUMBER ON YOUR REMITTANCES FOR PROPER CREDIT M Put "X" in the box if Government FUND DEPT BGT CTRL UNIT REV SUB REV DEPT REV OBJ SUB OBJ DEPT OBJ BSA SUB BSA DEPT BSA JOB AMOUNT Agency 100 060 055 9393 7665 M140 GCCO076 $0.00 100 060 056 93i6(v 7330 M140 GCCO076 $440.00 P.O. THIS INVOICE PREPARED BY: OCSD/Communications & Technology PHONE# (714) 704-7924 QUANTITY DESCRIPTION PRICE AMOUNT BDA testisupport 4450 MacArthur Blvd., Newport Beach. See work order #291321. AGENCY CODE: 2NB Total Parts: $0.00 Total Labor: $440.00 .t APPROVED BY: TOTAL $440.00 .,. ^ r-. r �-OeVe aao avz K ',� -77 4t� )- ORIGINAL INVOICE i�i��UiC� C,f. p phi ew'�� ac ac Orange County Sheriff 0 Communications & Technology 840 N. Eckhoff St. Suite 104 Orange, CA 92868-1021 DF— /71AN 7nAJ000 Gar /71A\ 7nA-7on1 • • - m��u�mmuo 291321 Agency 2NB Asset# Bill to: 2NB Newport Beach Fire Depa Newport Beach Fire Depart Model# Date in 2015-07-24 Date out 2015-08-07 Due b 2015-07-27 Service Location Address 100 Civic Center Serial# Customer PO/Ref: Svc. DSU Code ID Proiect Newport Beach, CA 92660 Vehicle Grou 01 - Manual Bill Contact Art Torres Phone 562-673-3606 Hat E-Number Svc. Required: BDA isolation test at: 4450 MacArthur Blvd., Newport Beach Action Taken: BDA isolation testfauto dialer. BDA isolation test documentation. q '+!a ;9• .• A j^ y Aw � 'w ��''.N y'F� ''S"AN C1�•1, 0 n,misMs nro� nrr+e lt�Fi°�Datefi�T �: � "��`i�.s��Filleil:h"t�-'"cci tion'��:�,�.�:.�`�, � S�"! R'�Il �'4m� ,fr"Naicpr,�` ,'N,�'� �n C�jMM ��ti`Gl.,ry, "'N�g •mraC � � � w=� ��,..��i�:�;a,��i`�'b�'.,:..�',�;'IPL�'E�.. n, d 2015-07-24 1.00 1.00 236 Prep for BDA isolation tests 195 0.00 0.00 2015-07-30 2.00 2.00 234 BDA isolation test 195 88.00 176.00 2015-07-30 2.00 2.00 238 BDA isolation test 149 0.00 0.00 2015-07-30 1.00 1.00 234 BDA isolation test results documentation 195 88.00. 88.00 2015-07-30 2.00 2.00 234 BDA isolation test 181 88.00 176.00 Work Order Totals _Parts 0.00 Labor 440.00 Sub -Total 440.00 TOTAL 440.00 rptlN0Wo14,RSW FIRE ALARM TEST & SENSITIVITY +f COVER SHEET $60drrty BRANCH 434 I SERVICE -CUSTOMER NUMBER 34177090 PASS / FAIL PASS INSPECTION DATE 1 11/19/15 INSPECT. TYPE ANNUAL ARRIVAL DATE 11/19/2015 I COMP DATE 11/20/2015 I NON -BILL X SVC. CODE 050 - NAME: Our Lady Queen of Angels Church TESTING LOCATION: SAME ADDRESS: 2046 Mar Vista Dr CUSTOMER NAME: Kathleen D Jensen CITY: STATE: ZIP: Newport Beach CA 92660 PHONE NUMBER: 949-219-1403 MANUFACTURER: Sim lex MODEL NO: SERIAL NO. (IF AVAILABLE): POWER SOURCE: Fire Control / 41000 N/A Panel L6 CKT6 LOCKED CIRCUIT BREAKER: Rl Y ❑ N SYSTEM REVISION INFORMATION (IF AVAILABLE): N/A DEDICATED CIRCUIT' E] Y ❑ N TYPE OF SIGNALING: SIGNALS SOUNDED PER CUSTOMER REQUEST: SYSTEM MONITORED: aGENERALALARM []SELECTIVE SIGNALS []CODED ❑PRESIGNAL ❑� Y ❑ N ❑ NA OUST. [NIT. ❑J Y ❑ N BATTERIES: BATT. INSTALL DATE: Sep-14 X NORMAL FIRE ALARM LICENSE NO. / STATE CERTIFICATION NO.: NOTE BATT. QUANTITY: 2 LOW 986047 CUSTOMER SIGNATURE: x TECHNICIAN NAME: Ste hen McCoy PRINT NAME: x TECHNICIAN SIGNATURE: PHONE NO.: x 562-405-3800 %i V':`.: 0 '1i F l~ # I Ali is RECALL TO PRIMARY FLOOR: RECALL TO ALTERNATE FLOOR: YIN ELEVATOR RECALL VERIFIED ❑ NORMAL NOTE # N/A 0 NORMAL NOTE # N/A 21 L(ORFiOLDI=:' DOOR RELEASE DEVICES INCLUDING CLOSERS AND LATCHES: _Y/N_NORMAL QTY ❑ NOTE # N/A P� ANNUNCIATOR LOCATION: N/A MV.' � n UT.0AIAt# s s: ; ; : ;i i AIR HANDLER SHUTDOWN Y/N AIR HANDLER SHUTDOWN Q NORMAL NOTE # N/A VERIFIED ANNUNCIATOR MFGR. Simplex MODEL #: N/A RESPONSE TO: ZONE/ADDR. TROUBLE ❑ NORMAL NOTE# SIGNAL TROUBLE Q NORMAL NOTE# AC POWER LOSS Q NORMAL NOTE# EARTH GROUND ❑ NORMAL NOTE# BATTERY TROUBLE NORMAL NOTE# i?A1JFUIC1 IQNS ... TYPE NIA VOLTAGE N/A #ZONES # USED NIA N/A RESET P�ANl=). CtNtg--It�H':,I oo-ii ACK ✓ -NORMAL DRILL SW Li LAMP TEST ::::::::'tNtJMEC3PRI?Flli3V1�4T'S1')=13E'sli i O o TTALNof DEVICES NUMBER NM TESTED DEFE T C S= D N N ES- i`iil;lJd1C?4NI:#VIS:tI;4LIEVICBS'':`i' CENTRAL STATION MANUALPULLSTATIONs 50 SIG TYPE: (CHECK ALL THAT APPLY) OPERATION VERIFIED MASTERBOX LEASE LINE x SMOKES 70 BELLS Y N BELLS 2 HORN ONLY JY Lj N Lj MONITORING COMPANY SIMPLEX HORN STROBES S5 STROBE ONLY IYE N LJ STROBES 15 SPEAKERS ONLY I Y N Lj PHONE NO. HORN/STROBE IYE N LJ SPEAKER/STROBE ❑ Y 0 N LINE NO. Customer Provides CHIME ONLY Lj Y Ll N 0 CHIME/STROBE ❑ Y Ll N n ACCOUNT NO. I Customer Provides BELUSTROBE Lj Y Ll N Lj <.. �: Isi • I .P :p. • ' . �•::::.. � �::: �t�i��€€€€ilss€ F,s �o L WS 0 I;cl� . . ADDITIONAL INSPECTOR(S): Matt Schmitt INSPECTION TYPE: ANNUAL FIlME ALARM INSPECTION CLOSE DATE 11/20/2015 SERV. COMP. Y Page 1 of 1 cl -V D5 FIRE ALARM TEST / ACKNOWLEDGE FORM Awe & DEVICE TEST RESULT SHEET $ecyiiry Sirnplete6rinriei! .:....:.......................................................................................................................................................................... DEVICE TYPE ADDRESS DEVICE DESCRIPTION AND LOCATION ALARM SUPERV PASS FAIL. DEFECTS NOTES Parish Center PSD Hall YES PASS PSD Hall YES PASS PSD Hall YES PASS PSD Corridor By Pastoral Admin YES PASS PSD Voluteer Rm YES PASS PSD Corridor Across from staff lounge YES PASS PSD Staff Lounge YES PASS PSD Corridor Main Hall YES PASS PSD Hall YES PASS PSD Hail YES PASS PSD Hall YES PASS PSD Kitchen YES PASS PSD Kitchen YES PASS PSD Electrical Rm YES PASS PSD Annex Rm YES PASS PSD Faculty Rm YES PASS PSD Corridor by Assistant Principal YES PASS PSD Supply Rm in Faculty Rm YES PASS MPS Front Reception Area YES PASS MPS Corridor Across from elevator YES PASS MPS Corridor by Faculty Room YES PASS MPS Rear Reception Area YES PASS MPS Corridor Across from staff lounge YES PASS MPS Hail YES PASS MPS Hall YES PASS MPS Hall YES PASS MPS Rear exit of Annex Rm YES dNO PASS STS Backflow System Side A5 k; i -f , 7-0 L�Wp FAIL STS Backflow City Side 11Ie, FAIL STS PIV f l� NO FAIL School Buildings Building C PSD M1-1 Electrical Rm Above FACP YES PASS PSD M1-2 Server RM 126 YES PASS MPS M1-3 Computer Lab C101 East YES PASS PSD M1-4 Computer Lab C101 North YES PASS PSD M1-5 Computer Lab C101 South YES PASS MPS M1-6 Computer Lab C101 West YES PASS PSD M1-7 Sciece Lab C102 West YES PASS Page 1 of TEST RESULTS 0ma FIRE ALARM TEST / ACKNOWLEDGE FORM Fire fi Secufiiy DEVICE TEST RESULT SHEET Siniiplex6rinnel,! DEVICE TYPE ADDRESS DEVICE DESCRIPTION AND LOCATION eLeani SUFERV PASS Feu, DEFECTS NOTES PSD M1-8 Sciece Lab C102 North YES PASS PSD M1-9 Sciece Lab C102 South YES PASS MPS M1-10 Sciece Lab C102 South YES PASS PSD M1-12 East Janitor Rm C103 YES PASS PSD M1-13 East Girls RestRoom YES PASS PSD M1-14 East Boys RestRoom YES PASS MPS M1-15 Conference Rm D101 YES PASS PSD M1-16 Conference Rm D101 YES PASS HD M1-17 Maintainance RM YES PASS MPS M1-18 Rm C105 6A East YES PASS PSD M1-19 Rm C105 6A YES PASS MPS M1-20 Rm C105 6A West YES PASS PSD M1-21 Student Study Between 6A-613 YES PASS MPS M1-22 C106 6B East YES PASS PSD M1-23 C106 6B YES PASS MPS M1-24 C106 6B West YES PASS PSD M1-25 West Girls RestRoom YES PASS PSD M1-26 West Janitor Rm YES PASS PSD M1-27 West Boys RestRoom YES PASS MPS M1-28 Rm C107 5A East YES PASS PSD M1-29 Rm C107 5A YES PASS MPS M1-30 Rm C107 5A West YES PASS PSD M1-31 Student Study Between 5A-513 YES PASS MPS M1-32 Rm C108 5B East YES PASS PSD M1-33 Rm C108 5B YES PASS MPS M1-34 Rm C108 5B West YES PASS MPS M1-35 Rm C109 4A East YES PASS PSD M1-36 RmC1094A YES PASS MPS M1-37 Rm C109 4A West YES PASS PSD M1-38 Student Study Between 5A-5B YES PASS MPS M1-39 Rm C110 4B East YES PASS PSD M1-40 Rm C110 4B YES PASS MPS M1-41 Rm C110 4B West YES PASS PSD Ml-42 Girls RestRoom West YES PASS PSD Ml-43 Boys RestRoom West YES PASS PSD M144 Janitor Rm West YES PASS MPS M1-45 Rm C111 3A East YES PASS PSD M1-46 Rm C111 3A YES PASS MPS M1-47 Rm C111 3A West YES PASS PSD M148 Student Study Between 3A-3B YES PASS MPS M1-49 Rm C112 36 East YES PASS PSD M1-50 Rm C112 3B YES PASS MPS M1-51 Rm C112 3B West YES PASS MPS M1-52 Rm C1131A East YES PASS PSD M1-53 Rm C1131A YES PASS Page 2 of 4 TEST RESULTS ecaQ FIRE ALARM TEST I ACKNOWLEDGE FORM fire & DEVICE TEST RESULT SHEET Security Siriipl�x6ri�ne/! l::PR 4 NCT171 ..?.$.................................................................................................................................. DEVICE TYPE ADDRESS DEVICE DESCRIPTION AND LOCATION ALARM SDPERV PASS FAIL DEFECTS NOTES MPS M1-54 Rm C113 1A West YES PASS Building B MPS M1-55 Rm B108 1B South YES PASS PSD M1-56 Rm B108 1B YES PASS MPS M1-57 Rm B108 1B North YES PASS MPS M1-58 Rm B107 2B South YES PASS PSD M1-59 Rm B107 2B YES PASS MPS M1-60 Rm B107 2B North YES PASS PSD M1-61 Student Study Between 2A-2B YES PASS MPS M1-62 Rm B106 2A South YES PASS PSD M1-63 Rm B106 2A YES PASS MPS M1-64 Rm B106 2A North YES PASS MPS M1-65 Kindergarten Rm B105 South YES PASS PSD M1-66 Kindergarten Rm B105 YES PASS MPS M1-67 Kindergarten Rm B105 North YES PASS PSD M1-68 RestRooms Between Kindergarten B105 YES PASS PSD M1-69 Kindergarten Rm B105 YES PASS MPS M1-70 Kindergarten Rm B104 South YES PASS PSD M1-71 Kindergarten Rm B104 YES PASS MPS M1-72 Kindergarten Rm B104 North YES PASS MPS M1-73 Music / Extnded Day Rm B103 South YES PASS PSD M1-74 Music / Extnded Day Rm B103 YES PASS MPS M1-75 Music / Extnded Day Rm B103 North YES PASS MPS M1-76 Spanish / Art B102 South YES PASS PSD M1-77 Spanish / Art B102 YES PASS MPS M1-78 Spanish /Art 13102 North YES PASS PSD M1-79 Tutoring Rm B101 YES PASS MPS M1-80 Library Rm B101 South YES PASS PSD M1-81 Library Rm B101 West YES PASS PSD M1-82 Library Rm B101 West YES PASS MPS M1-83 Library Rm B101 North YES PASS PSD M1-84 Library / Reading Rm B YES PASS PSD M1-85 Library / Reading Rm A YES PASS Building D MPS M1-86 Junior High Rm D104 7B West YES PASS PSD M1-87 Junior High Rm D104 7B YES PASS MPS M1-88 Junior High Rm D104 7B East YES PASS PSD M1-89 Student Study Between 7A-7B YES PASS MPS M1-90 Junior High Rm D103 7A West YES PASS PSD M1-91 Junior High Rm D103 7A YES PASS MPS M1-92 Junior High Rm D103 7A East YES PASS MPS M1-93 Junior High Rm D103 8B South YES PASS PSD I M1-94 Junior High Rm D103 8B YES PASS Page 3 of 4 TEST RESULTS 'qco FIRE ALARM TEST 1 ACKNOWLEDGE FORM fire & DEVICE TEST RESULT SHEET sea* sy SimFp/exGriane!! DEVICE TYPE ZONE/ ADDRESS DEVICE DESCRIPTION AND LOCATION ALARM SUPERV PASS FAIL DEFECTS NOTES MPS M1-95 Junior High Rm D103 8B North YES PASS PSD M1-96 Student Study Between 8A-86 YES PASS MPS M1-97 Junior High Rm D103 8A South YES PASS PSD M1-98 Junior High Rm D103 8A YES PASS MPS M1-99 Junior High Rm D103 8A North YES PASS WF M1-103 Storage Rm YES PASS Page 4 of 4 TEST RESULTS v dire �ecurity� FIRE ALARM TEST / INSTALLATION DISCREPANCY/DEFECTS SHEET 1 I Parish Building PIV not Reporting to panel when testing. Model: PIBV2 2 Parish Building Backflow (2) OS&Y Tampers not Reporting to panel when tested. Page 1 of 1 DISCREPANCY PAGE FIRE ALARM TEST & SENSITIVITY Fiev & NOTES I RECOMMENDATIONS SHEET Parish Center Panel Batteries: (2) Power Sonic PS-1270 12V 7AH - Good 90% - Dated 9/2014 School Buildings Panel Batteries: (2) Casil CAI 2330 12V 33AH - Good 90% - Dated 7/2013 ------- --- - - Page 1 of 1 DISCREPANCY PAGE tcfAMo 3lmptexarin0e/1 SERVICE REQUEST FORWARD TO YOUR ACCOUNTS PAYABLE DEPARTMENT License # I TR# 172535 NGUYEN, HUNG THAI Project# 1 99999996 1 Task/SR# 1 50197974 1 34907858 NAME Our Lad uecn Of Angels Churc CUSTOMER PURCHASE ORDER ADDRESS ATTENTION OF) (OR 2046 MarVista Dr NEWPORT BEACH, CA 92660-0000 LABOR-REG LABOR-OT LABOR-DT 5 0 0 TR ARRIVAL DATE BILL NON- BILL SERV. COMPL CUSTOMER NUMBER NAT. ACCT. PHONE INSP-MONTH 12-FEB-2016 15:22:39 434-01386422 N NAME(BILL TO) Our Lady Queen Of Angels Chute ADDRESS 2046 Mar Vista Dr CITY STATE ZIP NEWPORT BEACH CA 1 92660-0000 LABOR-REG = ARRIVAL .5 10 12-FEB-201615:22:39 MILES DEPART 12-FEB-201615:40:12 I authorize SimplexGrinnell to proceed with the work as agreed to and outlined below: 12-FEB-201615:40:12 Signature will be obtained at completion (Preauthorization Customer Signature) Date PAYMENTTERMS TIME AND MATERIAL PRICE NTE FIXED PRICE DEPOSIT (S) BALANCE DUES) BILLABLE SCOPE OF WORK/PROBLEM CODE T-repair WORK PERFORMED/RESOLUTION CODE -Rciground Deficiency Repaired Removed both street OS&Y per Fire Dept. Approval. Deficiency have complete. KATHLEEN D. jENSEN PASTORAL ADMINISTRATOR -�- OUR LADY QUEEN OF ANGELS CHURCH 2046 MAR VISTA DRIVE NEWPORT BEACH, CA 92660 (949) 219-1403 FAX: (949) 644-1349 kjensen@olga.org Simp/exGrfnnel/ J PRODUCT ID QTY DESCRIPTION UONI S1'su.11 TYPE CON'rA('T NANIF. IMPORTANT NOTICE TO TBE CUSTOMER Customer acknowledges and agrees to the terms and conditions on the reverse side of this Service Request , agrees that the services have been completed to Customer's satisfaction and the system is in good working order and repair, unless services performed were of a temporary nature, in which case Customer acknowledges that part of customer's system may have been bypassed or is otherwise Inoperable until service can be completed . CUSTOMER'S ACTION IS DIRECTED TO THE LIMITATION OF LIABILITY, WARRANTY, INDEMNITY AND OTHER CONDITIONS ON THE REVERSE SIDE. CUSTOMER ACCEPTANCE (Customer Acceptance) j A FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION 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 1. PROPERTY INFORMATION Name of property: Our Lady Queen of Angels -Newport Beach Address: 2100 Mar Vista Drive, Newport Beach, CA Description of property: House of Worship Occupancy type: A-3 Name of property representative: Address: Phone: Fax: E-mail: Authority having jurisdiction over this property: Newport Beach FD Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: Safeway Security Systems Address: 1474 N Miller Drive License or certification number: ACO-3998 Phone: 909-824-7980 Fax: 909-824-0571 E-mail: Service organization for this equipment: Safeway Security Systems Address: 1474 N Miller Drive License or certification number: ACO-3998 Phone: 909-824-7980 Fax: 909-824-0571 E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Safeway Security Systems Address: 1474 N Miller Drive Phone: 909-824-7980 Fax: 909-824-7980 E-mail: Contract expires: 2015 Contract number: Frequency of routine inspections: Anually 3. DESCRIPTION OF SYSTEM OR SERVICE ❑ Fire alarm system (nonvoice) ® Fire alarm with in -building fire emergency voice alarm communication system (EVACS) 0 Mass notification system (MNS) ❑ Combination system, with the following components: ❑ Fire alarm ❑ EVACS ❑ MNS ❑ Two-way, in -building, emergency communication system ❑ Other (specify): Copyright 0 2OD9 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial 3819 or distribution. 11 3. DESCRIPTION OF SYSTEM OR SERVICE (congnueag NFPA 72 edition: 2010 3.1 Control Unit Manufacturer: Silent Knight 3.2 Mass Notification System 3.2.1 System Type: ❑ In -building MNS--combination ❑ In -building MNS—stand-alone ❑ Other (specify): Additional description of system(s): Model number: SK5808 ® This system does not incorporate an MNS ❑ Wide -area MNS ❑ Distributed recipient MNS 3.2.2 System Features: (] Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS interface 0 Other (specify): 3.3 System Documentation ® An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: At FACP 3.4 System Software ® This system does not have alterable site -specific software. Operating system (executive) software revision level: Site -specific software revision date: Revision completed by: [7 A copy of the site -specific software is stored on site. Location: 3.5 Off -Premises Signal Transmission ❑ This system does not have off -premises -transmission. Name of organization receiving alarm signals with phone numbers: Alarm: CMS Phone: 1-800-482-9800 Supervisory: CMS Phone: 1-800-482-9800 Trouble: CMS Phone: 1-800-482-9800 Entity to which alarms are retransmitted: Newport Beach FD Phone: Method of retransmission: Dispatch If Chapter 26, specify the means of transmission from the protected premises to the supervising station: If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sate or distribution. t 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: N/A Quantity: 9 (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: 0 Description: 4.13 Device Power Pathways ❑ No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ® Power pathways are separate and different classification from the signaling line pathway 4.1A Isolation Modules Quantity: 0 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: N/A Survivability level: NIA Quantity: 0 (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: 0 Description: N/A 4.2.3 Device Power Pathways ® No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: N/A Survivability level: NIA Quantity: 0 (See NFPA 72, Sections 1Z.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: 0 Description: N/A 4.3.3 Appliance Power Pathways ® No separate power pathways from the notification appliance pathway 0 Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway Copyright 0 2009 National Fire Protection Association. Thls form may be copied for individual use other than for resale, it may not be copied for owmerciai Sale or doldbution. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ❑ This system does not have manual fire alarm boxes. Type and number of devices: Addressable: 6 Conventional: 0 Coded: 0 Transmitter: 0 Other (specify): 5.1.2 Other Alarm Boxes ® This system does not have other alarm boxes. Description: Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: 1 Conventional: 0 Other (specify): Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area Other (specify): Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): 5.2.2 Duct Smoke Detectors ® This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: 0 Ionization ❑ Photoelectric i] Aspirating p Beam 5.2.3 Radiant Energy (Flame) Detectors ® This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: 5.2.4 Gas Detectors ® This system does not have gas detectors. Type of detector(s): Number of devices: Addressable: Conventional: Type of coverage: 5.2.5 Heat Detectors ® This system does not have heat detectors. Type and number of devices: Addressable: Conventional: Type ofcoverage: ❑ Complete area r-1 Partial area ❑ Nonrequired partial area ❑ Linear [3 Spot Type of heat detector sensing technology: 13 Fixed temperature ❑ Rate -of -rise ❑ Rate compensated Copyright 02009 National Fire Protection Association. This form maybe copied for individual use other then forresale. It may not be copied for commercial sale or distribution. 5. ALARM INITIATING DEVICES (continued} 5.2.6 Addressable Monitoring Modules Number of devices: 6 5.2.E Waterflow Alarm Devices Type and number of devices: Addressable: 1 5.2.8 Alarm Verification Number of devices subject to alarm verification: 5.2.9 Presignal Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: 5.2.11 Other Initiating Devices Describe: [1 This system does not have monitoring modules. ❑ This system does not have waterflow alarm devices. Conventional: Coded: Transmitter: 6. SUPERVISORY SIGNAL -INITIATING DEVICES ® This system does not incorporate alarm verification. Alarm verification set for seconds 0 This system does not incorporate pre -signal. ® This system does not incorporate PAS. ® This system does not have other initiating devices. 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: 1 Conventional: Coded: Transmitter: Other (specify): 6.2 Fire Pump Description and Supervisory Devices ® This system does not have a fire pump. Type fire pump: ❑ EIectric pump ❑ Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running p Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble I] Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) ❑ This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: 2 Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ® Ionization 6.4 Other Supervisory Devices Describe: ❑ Photoelectric ❑ Aspirating D Beam ® This system does not have other supervisory devices. Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sate or distAbution. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator 7.1.I Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Other (specify): 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: Front Entry Location 2: Location 3: 9. ALARM NOTIFICATION APPLIANCES ® This system does not have a generator. ❑ Selector switch not in auto ❑ Low fuel ® This system does not monitor special hazard systems. ® This system does not monitor other systems. ❑ This system does not have annunciators. 9.1 In -Building Fire Emergency Voice Alarm Communication System ❑ This system does not have an EVACS. Number of single voice alarm channels: 1 Number of multiple voice alarm channels: 0 Number of speakers: 15 Number of speaker circuits: 4 Location of amplification and sound -processing equipment: FACP Room Location of paging microphone stations: Location 1: FACP Room Location 2: Location 3: 9.2 Nonvoice Notification Appliances Horns: 0 With visible: 0 Chimes: 0 With visible: 0 Visible only: 17 Other (describe): 9.3 Notification Appliance Power Extender Panels Quantity: Locations: ❑ This system does not have nonvoice notification appliances. Bells: 0 With visible: 0 ® This system does not have power extender panels. Copyright *2009 National FireProtection Association. This form may be copied for individual use other titan for resale. it may not be copied for commercial sate or distribution. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ® This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other (describe): Supervision class: 10.3.1 Special Hazard Notification ❑ This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ® This system does not have a two-way telephone system. Number of telephone jacks installed: Number of warden stations installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ® This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: Copyright 0 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (Continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two -Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: C7 Hold -open door releasing devices 0 Smoke management ® HVAC shutdown ❑ F/S dampers ❑ Door unlocking ❑ Elevator reealI ❑ Fuel source shutdown ❑ Extinguishing agent release ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules ❑ This system does not have control modules. Number of devices: 8 Other (specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120V Control panel amps: 2.5 A Overcurrent protection: Type: Breaker Amps: 20 A Location (of primary supply panel board): Main Electric Room Disconnecting means location: Breaker 13.1.2 Engine -Driven Generator ® This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: Copyright 0 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial We or distribution. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: FACP Type: Lead Acid Nominal voltage: 24 Amp/hour rating: 18h Calculated capacity of batteries to drive the system: In standby mode (hours): 24 In alarm mode (minutes): 15 ® Batteries are marked with date of manufacture ❑ Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ❑ This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: 120 V EVACS or MNS panel amps: 1.2 A Overcurrent protection: Type: Breaker Amps: 20 A Location (of primary supply panel board): Main Electrical Room Disconnecting means location: Breaker 13.2.2 Engine -Driven Generator ® This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.2.3 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): 13.2.4 Batteries Location: FACP Type: Lead Acid Nominal voltage: .24 Amp/hour rating: 7 Ah Calculated capacity of batteries to drive the system: In standby mode (hours): 24 In alarm mode (minutes): 15 ® Batteries are marked with date of manufacture ❑ Battery calculations are attached Copyright 0 2009 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. 13. SYSTEM POWER (continued 13.3 Notification Appliance Power Extender Panels 133.1 Primary Power Input voltage of power extender panel(s): Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: 133.2 Engine -Driven Generator Location of generator: Location of fuel storage: 13.3.3 Uninterruptible Power System Equipment powered by a UPS system: Location of UPS system: 0 This system does not have power extender panels. Power extender panel amps: Amps: ® This system does not have a generator. Type of fuel: ® This system does not have a UPS. Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): 133.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ® Batteries are marked with date of manufacture 14. RECORD OF SYSTEM INSTALLATION Nominal voltage: In alarm mode (minutes): ❑ Battery calculations are attached Amp/hour rating: Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. This is a: ® New system ❑ Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: 2010 ❑ Manufacturer's published instructions Other (specify): System deviations from referenced NFPA standards: Signed: Organization: Printed name: Date: Title: Phone: Copyright 02009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for oommerclal sale or distribution. IS. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST 0 New system A11 operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ❑ Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: 0 NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: 2010 ❑ Manufacturer's published instructions Other (specify): 0 Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: Printed name: Date: Organization: Title: Phone: 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: t +%> Printed name: u «Y+ Date;� Z Organization. �L ` c ��. �� Title: btr� �^�•tn.. Phone: 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Date: Organization: Title: Phone: 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: Copyright 0 2009 National Fire Protection Association. This form may be copied for Individual use other than for resale. It may not be copied for oommerciai sale or distribufion. 16. CERTIFICATIONS AND APPROVALS (conUnuetp 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: r� ` Printed name: �y JDate: J ��a Organization: s ' Title: �� . 9-,�11� Phone: 16.5 Authority Having Jurisdiction: / I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: 1f ) tA,(Jl -,C A�WLA/� Printed name: �l�i 01pr Date: t ( I rIq J f c1 Organization: � Title: �� us Phone: QL1q-rl�4Lt-,3 I ��--- C hs�r-t�v- ` I Copyright 0 2009 National Fire Protection Association. This form may be copied for Individual use other that for resale. It may not be copied for eommerdai sale or distnbution. STATEOF CALIFORNIA FIRE SAFETY INSPECTION REQUEST � STD.850 (REV. 10-94) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONENUMBER REQUESTDATE PROGRAM BARREN ORLOFF 949 324-6495 TBD A/DRF EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUESTCODE TBD - Upon Receipt of Application Approval LA CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING DEPARTMENT OF HEALTH CARE SERVICES 2. RENEWAL B. LIFE SAFETY AGENCY SUBSTANCE USE DISORDER DMSION NAME AND LICENSING AND CERTIFICATION BRANCH 3. CAPACITY CHANGE ADDRESS MS-2600 4. OWNERSHIP CHANGE P.O. BOX 997413 5. ADDRESS CHANGE �SACRAMENTO, CA 95899-7413 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 6 0 0 0 0 0 6 FACILITYNAME LICENSECATEGORY PILLARS RECOVERY ALCOHOL/DRUG FACILITY STREETADDRESS (ActualLocatlon) NUMBER OF BUILDINGS 304 MARGUERITE A V E' , 1 CITY RESTRAINT CORONA DEL MAR None FACILITY CONTACT PERSON'S NAME HOURS DARREN ORLOFF 24/7 SPECIALCONDITIONS r. .,h :+�" � � i.4.. ?'%lam �"x,`�o,.'?o- • .-,? . � ., . _. K.i �� . r•; y^ • � 'TO BE COMPLETED',BY:;INSP.ECTING'AUTHORITY. - .;,•,;�. �� • - - __t._ , _.... . _. _. .. . ............ � _..:� .-,. :.......»..._ _ -*.., :. _.� �NEWPORT BEACH FIRE DEPARTMENT FIRE LIFE SAFETY AUTHORITY 100 CIVIC CENTER DRIVE NAME AND NEWPORT BEACH, CA 92660 ADDRESS INSPECTOR'S NAME(TypedorPitted) NADINE MORRIS, LSS II INSPECTIONDATE INSPECTgl f l - lq - [ L4 I C�A N TELEPHONENUMBER 949 ) 64'4-3105 &'vW I 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM CFIRS NUMBER OCCUPANCYCLASS D. SPRINKLERS E. HOUSEKEEPING 30055 R 3.1 F. SPECIAL HAZARD G. OTHER Ll _ m >� UJo M r� (J-1 20 m QN ()z o �� m 4z c.n z � >� X zul = —# --i > > ALLEY T I� I MARGUERITE AVENUE ►l Morris, Nadine From: Murillo, Jaime Sent: Monday, November 10, 2014 11:25 AM To: Morris, Nadine Subject: RE: Fire Inspection Yes, they are okay as a 6 or fewer with a license. From: Morris, Nadine Sent: Monday, November 10, 2014 11:20 AM To: Murillo, Jaime Subject: FW: Fire Inspection Hi Jaime, I just received the below email. Are they okay with Planning? Thanks, Nadine From: Darren Orloff, Owner fmailto:darren@piIlarsrecove[y.com] Sent: Monday, November 10, 2014 11:14 AM To: Morris, Nadine Subject: Fire Inspection Hi Nadine, This is Darren Orloff from over at 304 Marguerite in Corona Del Mar. We have been approved by the city and are ready for our fire inspection. Attached is the 850 fire inspection form. The department of health no longer sends them out as I mentioned before, so you get them from their website. My consultant filled out the form in its entirety in this pdf with all of the required information. I'm sending you a copy and will have a hard copy with me at the the time of the inspection if that would help as well. Once again thank you for all of you help and assistance with our project. I know you have a busy schedule and we are available for the inspection starting Wednesday. Thanks again Darren Orloff Sent from my Verizon Wireless 4G LTE smartphone 4GUIDELINES & STANDARDS GUIDELINE A.09 — Residential Group R-3.1 Occupancies A.09.1 PURPOSE The purpose of this guideline is to provide the minimum requirements necessary for review and approval of residentially based 24-hour care facilities. The regulations regarding a residentially based 24-hour care facility is found in the California Code of Regulations Title 19, California Fire Code (CFC), and California Building Code (CBC). A.09.2 SCOPE This guideline shall apply to residentially based 24-hour care facilities providing accommodations for six or fewer clients of any age. Clients may be classified as ambulatory, nonambulatory, or bedridden. Such residentially based 24-hour care facilities may include adult residential facilities, group homes, and residential care facilities for the elderly. 1. Permits shall be secured from the Building Department for any structural, electrical, mechanical, or plumbing modifications. Any Building Department vA' permits shall be finaled prior to the Fire Department fire clearance inspection. P �\O Upon Fire Department approval, a Fire and Life Safety form will be completed �j and forwarded to the governmental licensing agency. A Zoning Compliance letter is required to be obtained from the City's Planning Division. They can be contacted at (949) 644-3200. The following information is required: a. A copy of your state license or your pending state license. Q� p� b. A statement responding to each of the applicable requirements required by Section 20.48.170 to show compliance with this section: http://www codepublishing com/CA/NewportBeach/htmI/newportbeach2O/NewportBeach 2048.html#20.48.170 C. A statement explaining that the operation will not be defined or classified as an integral facility per our Zoning Code as they are not permitted within the Zoning District. Definition from the Zoning Code: A.09 - Residential Group R-3.1 Occupancies Page 1 of 10 Revised: 11 in 2011 95-95-13 03-03 2014 LIFE SAFETY SERVICES DIVISION GUIDELINES & STANDARD. Integral facilities (land use)" means any combination of two or more residential care (small licensed, small unlicensed, or general) facilities that may or may not be located on the same or contiguous lots, that are under the control and management of the same owner, operator, management company or licensee or any affiliate of any of them, and are integrated components of one operation shall be considered one facility for purposes of applying Federal, State, and local laws to its operation. Examples of integral facilities include, but are not limited to, the provision of housing in one facility and recovery programming, treatment, meals, or any other service or services to program participants in another facility or facilities or by assigning staff or a consultant or consultants to provide services to the same program participants in more than one licensed or unlicensed facility. Residential Group R-4 Occupancy - Facilities providing accommodations for more than six clients shall begin by applying for a Use Permit at the Newport Beach Planning Department. If the Use Permit is approved, a code analysis shall be submitted to the Fire Department evaluating the request for a change in occupancy. Once reviewed, plans may be required to be submitted to the Building Department if alterations to the building are required due to the change in occupancy. A.09.3 PROCEDURE Prior to requesting a fire and life safety inspection, new and existing facilities shall submit a site plan to the fire department. Please submit the drawing at least two weeks prior to requesting an inspection. The plan shall include the occupancy classification, number of clients and staff, building address, location of smoke alarms and fire extinguisher, exit doors, hallway widths, stairs, and gates. Include furniture layout for each client bedroom. Furniture shall be in place for the fire department inspection. Use this guideline to ensure that your plans have at least the minimum amount of information required to begin a review. Depending on the project, it may be necessary to provide additional information beyond what is initially requested in this guideline. A.09 - Residential Group R-3.1 Occupancies Page 2 of 10 Revised: 2011 85-05 13 03-03 2014 LIFE SAFETY SERVICES DIVISION GUIDELINES & STANDARDS . P 11 GENERAL REQUIREMENTS Address numbers shall be posted on the residence and shall be visible from the street. The numbers shall not be less than 4 inches in height and contrast with their background. In new construction, the numbers shall be illuminated for viewing the numbers at night. Illumination may be either internal or external. A fire extinguisher with a minimum classification of 2A:10BC is required and shall be mounted in a conspicuous and unobstructed location. The top of the extinguisher shall not be more than 5 feet above finished floor level. A current service tag shall be attached to the fire extinguisher at all times. The extinguisher shall be visually inspected annually and serviced every six years by a licensed company. Single or multiple station smoke alarms shall be installed and maintained regardless of occupant load at all of the following locations: a. On the ceiling or wall outside of each, separate sleeping area in the immediate vicinity of bedrooms. b. In each room used for sleeping purposes. C. In each story within a dwelling unit, including basements but not including crawl spaces and uninhabitable attics. In dwellings or dwelling units with split levels and without an intervening door between the adjacent levels, a smoke alarm installed on the upper level shall suffice for the adjacent lower level provided that the lower level is less than one full story below the upper level. d. Smoke alarms shall be provided throughout the habitable areas of the dwelling unit except kitchens. The smoke alarms shall be interconnected in such a manner that the activation of one alarm will activate all of the alarms in the individual unit. A.09 - Residential Group R-3.1 Occupancies Page 3 of 10 Revised: h in 2044� 85-05-13 03-03 2014 LIFE SAFETY SERVICES DIVISION y .,GUIDELINES & STANDARDS In new construction and in newly classified R-3.1 occupancies, required smoke alarms shall receive their primary power from building wiring where such wiring is served from a commercial source and shall be equipped with a battery backup. There shall be a minimum of two exits from the dwelling. Exterior doors shall be 36 inches with a 32 inch clear opening. (Interior doors are not regulated by the code unless required to meet accessibility requirements in Chapter 11 of the California Building Code.) A sliding glass door may be used as a bedroom exit however in order to provide a 32 inch clear opening a 6 foot or larger door will be necessary. Exits shall not pass through kitchens, garages, storerooms, or closets and shall not pass through more than one intervening room. Bedrooms used by nonambulatory clients shall have access to at least one of the required exits, which conform to one of the following: (i.e. diagrams attached) a. Egress through a hallway or area into a bedroom in the immediate area which has an exit directly to the exterior and the corridor/hallway is constructed consistent with the dwelling unit interior walls. The hallway shall be separated from the common areas by a solid wood door not less than 1 3/8 inch in thickness, maintained self closing or shall be automatic closing by actuation of a smoke detector. b. Egress through a hallway which has an exit directly to the exterior. The hallway shall be separated from the rest of the house by a wall constructed consistent with the dwelling unit interior walls and opening protected by a solid wood door not less than 1 318 inch in thickness, maintained self -closing or shall be automatic closing by actuation of a smoke detector. C. Direct exit from the bedroom to the exterior shall be 3 feet in width and not less than 6 feet 8 inches in height. A minimum of 32 inches clear exit width shall be provided. d. An exit that passes through an adjoining bedroom that exits to the exterior. Corridors and hallways on floors serving clients shall be a minimum of 36 inches in width. A.09 - Residential Group R-3.1 Occupancies Page 4 of 10 Revised: 3uR 2914 05 05-13 03-03 2014 LIFE SAFETY SERVICES DIVISION GUIDELINES N.� Existing stairways (except winding and spiral stairways) may be used as a means of egress provided the stairs have a maximum rise of 8 inches with a minimum run of 9 inches. The minimum stairway width may be 30 inches. N� Provide a nonfire resistance constructed floor separation at stairs to prevent smoke migration between floors. Such a floor separation shall equivalent construction of 0.5 inch gypsum wallboard on one side of wall framing. Exceptions: a. Occupancies with at least one exterior exit from floors occupied by clients. b. Occupancies provided with automatic fire sprinkler systems. Doors within such floor separations shall be tight fitting solid wood at least 1 3/8 inches in thickness. Door glazing shall not exceed 1,296 square inches with no dimension greater than 54 inches. Such doors shall be positive latching, smoke gasketed and shall be automatic -closing by smoke detection. Interior ramps are required in facilities housing nonambulatory clients when changes in level exceed 0.50 inches. If exterior ramps, handrails, or guardrails are installed, they shall meet the requirements of the California Building Code Chapter 10 or Chapter 11 for accessibility. Plans shall be submitted to the Building Department for review and approval. IeA If the garage is attached to the dwelling, the door between the dwelling and the garage shall be maintained to be self closing and self latching. The door shall be a minimum of a 1 3/8 inch thick, solid wood door. The garage shall not be used for sleeping purposes. There shall be no openings from the garage into any of the sleeping areas. Maintain the garage in a neat, orderly fashion with minimal combustible storage. Clearance around the water heater shall be maintained in accordance with manufacturer's specifications and the heater's listing. Typically, 18 inches is the required minimum clearance. A.09 - Residential Group R-3.1 Occupancies Page 5 of 10 Revised: `'�;=' 85-05-12 03-03 2014 LIFE SAFETY SERVICES DIVISION Provide an evacuation sign in a central location. The sign shall be properly framed and mounted. Show paths of travel to evacuate the building and include the statement "In Case of Emergency Dial 911". All drapes, hangings, curtains, drops, and all other decorative material, including Christmas trees, shall be made from a nonflammable material or shall be treated and maintained in a flame-retardant condition by means of a flame-retardant solution or process approved by the State Fire Marshal. Exception: Individual patient room window curtains and drapes. Good housekeeping shall be maintained. The storage of flammable and combustible liquids shall not be permitted. Chimneys shall be equipped with a spark arrestor. REQUIREMENTS FOR BEDRIDDEN CLIENTS In gr&RR-3.1 occupancies housing a bedridden client, all of the folio�g shall apply. 1. Bedri en clients shall not be located above or below e first story except as a result of temporary illness as defined in the alth and Safety Code. A temporary ill s is an illness that persists for 1 days or less. A bedridden client may be retained ' excess of the 14 days on approval by the Department of Social Services. 2. Licensees admitting or retal g a edridden resident shall, within 48 hours of the resident's admission Jr reten ' n in the facility, notify fire department of the estimated length of time th clien ill retain his or her bedridden status in the facility. 3. Where clients are used above the first s , having more than two stories in height, or having more than 3,000 square feet floor area above the first story, shall not be loss than one -hour fire -resistance -rate construction throughout. 4. ExitingAquirements shall be as follows: A direct exit to the exterior of the residence shall be rovided from the client sleeping room. A.09 - Residential Group R-3.1 Occupancies Page 6 of 10 Revised: jUa 2014 95-05-13 03-03 2014 LIFE SAFETY SERVICES DIVISION State Fire Marshall 1. Request Date 2. Program ;Are S,-,-Iety Inspection Request STD 850 JUNE 10, 2013 CCL 3. Agency Contact 4. Telephone 5. Evaluator (714) 703-2800 Fax (714)703-2831 CONG-HUYEN / ES E2138 Department of Social Services 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request. Code 300610624 1A 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 750 The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change 6. Name Change 7. Hours: Monday - Friday 6:45am-6:OOpm Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap Lj I Care? 36 Care? �A6 18. Facility Code - 16 - CCC No 0 No 0 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC MARINERS YMCA 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 2100 MARINERS DRIVE NONE 4. APH, 12. ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under NEWPORT BEACH, CA. 92660 24 HRS. 6. SNF 14. CCF 7. ICF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special JOANNA DENNERY (949) 548-6770 NONE 8. ICF/DD 16. Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name hh�ne # CFiRS iD# T-19 OCC 1. Fire Clear/Granted I v A,bj NE I `1 D 2fZA S (gI �jq (pLf Lf -310 2. Fire Clear/Denied 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code Explanation of Denial or Special Conditions: Denial Code Fire Agency Denial Codes 1. Exits NEWPORT BEACH FIRE DEPARTMENT 2.Construct. 3300 NEWPORT BLVD. 3.Fire Alarm NEWPORT BEACH, CA. 92663 4.Sprinklers 5.Housekeeping ATTN: NADINE 6.Special Hazard 7.Other 40 , I $TATE OF CALIFORNIA - HEALTH AND KUMAN SERVICES AGENCY CALIFCF" 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 U UC 909 (7/99) Lf Lf D SF PC) CORPORATE OFFICE 60 BERRY DRIVE • PACHECO CA, 94553 DIRECT: 925-935-1100 • FAX: 925-947-1020 9/9 October 03, 2012 NEWPORT BEACH FIRE DEPARTMENT 3300 NEWPORT BLVD NEWPORT BEACH, CA 92658 Attention: Fire Marshal HEARST COMMUNICATIONS INC 1499 MONROVIA AVE NEWPORT, BEACH, CA 92663 Account #: 2995170 Dear Chief, A Family Business Since 1946 Cal Lic. ACO 28 CCL #880138 www.baValarm.com Sales: (800) 610-1000 Service: (800) 470-1000 Pursuit to Section 901.7 and 907.7.5 of the California Fire Code, this letter is to inform you that effective 10/02/12, Bay Alarm Company will no longer be monitoring the fire alarm system at the above referenced address due to the following reason(s): ® Customer requested cancellation ❑ System not communicating ❑ Temporarily cancelled monitoring due to remodel ❑ Customer does not have a valid contract If the system is Underwriters Laboratories certified, the certificate may also be cancelled. Bay Alarm Company will assume no responsibility in regard to any fire emergency that may occur after the above mentioned date. -- --- ------ - --- If circumstances should change, we will inform you. If you have any questions regarding this matter, please call (800) 470-1000. Sincerely, Bay Alarm Company a - CC: HEARST COMMUNICATIONS INC Greater Los Angeles • Martinez • Oakland • Ontario • Orange County • Peninsula • Petaluma • Redding • Sacramento • San Diego • Santa Clara • Soutfi Bay Stockton • Ventura What Have You Got To Lose?TM Cancelled Fire Monitoring ` Newport Beach Fire Department All Inspection Data P.O. Box 1768 Newport Beach, CA 92658-8915 (949) 644-3106 I Address: Grid: Assigned To: Data ID: Inspection Cycle: 180 NEWPORT CENTER DR Suite: 4728Z NE64B 37705 12 Months 255 Building Type: Inspection Type: Sq Ft. Occ Type: Occ Load: Next Inspection: TYPE III - 1HR Tenant 1271 B 0 Apr 1, 2013 Business Name: Business Phone: Preplan Hazmat: Last Action: PACE Recovery Center (714) 274-9239 Yes No Action: Inspect Date: Apr 25, 2012 By: Rick Zaccaro Building Name: Owner /Responsible Party: Owner /Responsible Party Phone: 180 Newport Center Drive Lenny Segal (520) 390-5017 E-Mail: Mobile Phone: lsegal@pacerecoverycenter.com N/A Hood. Dry Chem: CO2: Other System(s): Knox Box Loc: No No No N/A South Side of Front Door Notes: PACE Recovery Center is a new business as of 2/11/2013. Reqd Permits: Sprinkler System: Standpipe System: Alarm System: Full Class 3 - Domestic Partial - Monitored Sprinkler S Year Date: Standpipe 5 Year Date: Alarm Panel Location: Apr 29, 2008 Apr 29, 2008 Main FA panel in garage electrical room. Annunciator panel by entrance to Suite 140. *Only suite 158 has a fire alarm system.* Riser Location: Standpipe Location: Highrise: Fire Pump: Fire Lanes: In parking garage on East wall. N/A No No No Insp Test Valve Location: FDC Location: Emergency Generator: Archive: Inside parking garage to the right. 50 yards north of Farallon on No No Anacapa Issued Status Inspector Descriptibn US Printed: 02/11/2013 Newport Beach Fire Department All Inspection Data P.O. Box 1768 • Newport Beach, CA 92658-8915 (949) 644-3106 h14 q� i- qZ - ys-/3 I Address: Grid: Assigned To: Data ID: Inspection Cycle: 180 NEWPORT CENTER DR Suite: 4728Z NE64B 37705 12 Months 255 Building Type: Inspection Type: Sq Ft: Occ Type: Occ Load: Next Inspection: TYPE III -1HR Tenant 1271 N/A 0 Apr 1, 2013 Business Name: Business Phone: Preplan Hazmat. Last Action: N/A Yes No Action: Inspect Date: Apr 25, 2012 By: Rick Zaccaro Building Name: Owner /Responsible Party: Owner /Responsible Parry Phone: 180 Newport Center Drive Occupant N/A E-Mail: Mobile Phone: N/A N/A Hood: Dry Chem: CO2: Other System(s): Knox Box Loc: No No No N/A South Side of Front Door Notes: Reqd Permits: c� -A , A Sprinkler System: Full Sprinkler 5 Year Date: Apr 29, 2008 Standpipe Syste, Class 3 - Dom, Standpipe 5 Year Apr 29, 2008 Riser Location: Standpipe Location In parking garage on East wall. N/A Insp Test Valve Location: FDC Location Inside parking garage to the right. 50 yards nor xh of �jD LLB YJ�r r, it electrical ny ly suite Lanes: ergency Generator: Archive: anonI No No Printed: 02/08/2013 FIRE INSPECTION CLEARANCE` THIS ENTIRE FORM MUST BE COMPLETED BY THE INSPECTIW, AUTHORITY. Name of Nonpublic, Nonsectarian School: Address: 180 Newport Center Drive #255 City: Newport Beach County: Orange State: CA Zip: 92660 Total Classroom occupant Load Based Upon California Building Code (CCR, Title 24): Number of Classrooms: This facility is approved to service (check appropriate one): % a. ambulatory ❑ b. non -ambulatory ❑ c. both This facility co m lies with all applicable standards related to fire and life safety (check one): Yes No ❑ This facility is in violation of standards; the following corrections are needed (use back of form for more violations) 1. 2. 3. 4. Nothing contained herein shall be construed as encompassing the structural stability of any building, or as abrogating any more restrictive requirements by other agencies having jurisdiction. For answers to anv questions regarding the above clearance contact: Inspector (print n . aymi Wun Title: LifeS-.Afe_tyfSpegieist II Signature: Name of In m enc : Newport Beach Fire Dept. Telephone: ( 949 ) 644-3110 Date of Inspection: 11 February, 2013 Contact the local city or county fire department of the fire district providing tire protection services to arrange for this clearance. If you cannot obtain a local fire clearance, your fire inspection can be ordered through the State Fire Marshal. Contact our office for this form. All sites MUST have individual fire clearances. It is a requirement of certification that a fire inspection clearance be issued by the appropriate city, county, fire district or state fire official not less that once each calendar year. Other documentation provided by your local fire department (i.e., STD 850) may be utilized and attached to the CDE fire clearance form that provides the same information, location, and name of the nonpublic, nonsectarian school. r• -n m N '0 z O v O m m 0 O -0m v 03 oc r m 3 y X rn n° 'n a 0 ^i m c0ou00 0 c o i.ucigoo u) O a O 00 O a cz O O 00 O O 0 '�O 0 O 6m O a Oe6OG ;aZOc m O OLOCco 0 .y D r m m Of, -0 '(on �aec W < 0 � �-a c C m a t. • � c <m -Z'-1 n z 71 Tt 7I ?I W W W W 0 cnCDCDCD:3 no as cn mEr m 0 0 S2 m 3 30(n�ca a o: m 0 0 0 �m m CD CD n M E cc CD E� O D D m -0 CD . 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N N A w 0 z 0 O 0 m z ,--I m X v X z W CD 0 a o' 7 ._. L 0 �o i IJ 3 O W � m D N3 Cn S m M 0 �m V' ci +o 3 -00 �Z D M m O WiTTy o �± CD 0 . C) o ' O -h '(D Z N cD 0 v 0 .a CD m co Z 0 CA 0 N O o 1 T b aN cD v O 3 u, 0. c C m 0 m O cD -� CD 3 0 N fD w O co to W A p W '_` N W cn s ,. FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION 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. 1. PROPERTY INFORMATION Name of property: The Irvine Company Address: 450 Newport Center drive. Newport Beach, CA 92660 _ Description of property: 6tn Story Building with penthouse m_ Occupancy type: B Name of property representative: The Irvine Company LLC.- Address: 111 Innovation Irvine, CA 92617 Phone: 949-279-2492 Fax: N/A E-mail: tfurnari@irvinecompany.com Authority having jurisdiction over this property: Newport Beach Fire Department �v Phone: 949-644-3106 Fax: E-mail: nmorris@nbfd.net 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: TRL systems Inc Address: 800 W Doran Street Suite 200 .Glendale, CA 91203 License or certification number- C10- 413747 Phone: 800-266-1392 Fax: E-mail: www.trisystems.com Service organization for this equipment: TRL systems Inc Address: 800 W Doran Street Suite 200.Glendale,CA91203 License or certification number: C10- 413747 Phone: 800-266-1392 Fax: E-mail: www.trlsystems.com A contract for test and inspection in accordance with NFPA standards is in effect as of N/A Contracted testing company: N/A Address: N/A Phone: N/A Fax: N/A - - -- ^-- — — E-mail: N/A_ _ Contract expires: N/A Contract number: N/A _ A Frequency of routine inspections: N/A 3. DESCRIPTION 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): — -- NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12) Copyright © 2009 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. 0 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2010 Additional description of system(s): 3.1 Control Unit Manufacturer: Edwards 3.2 Mass Notification System 3.2.1 System Type: ❑ In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Other (specify): N/A 3.2.2 System Features: Model number: EST-3 ® This system does not incorporate an MNS ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): _ N/A _ _ ^-- 3.3 System Documentation ❑ An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: Fire Control Room 3.4 System Software ❑ This system does not have alterable site -specific software. Operating system (executive) software revision level: Version 5.12 Site -specific software revision date: 03/21/2014 _ Revision completed by: Noe Gonzalez (TRL) ® A copy of the site -specific software is stored on site. Location: _Fire Control Panel 3.5 Off -Premises Signal Transmission ❑ This system does not have off -premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: UPS Services Phone: 800-463-6885 Supervisory: UPS Services Phone: 800-463-6885------ Trouble: UPS Services Phone: 800-463-6885 Entity to which alarms are retransmitted: CSM - — _ Phone: 800-463-6885 Method of retransmission: _Via Internal Central Station (Dialer) If Chapter 26, specify the means of transmission from the protected premises to the supervising station: Central Station monitoring via internal dialer If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12) Copyright © 2009 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. a 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: B _ Survivability level (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: N/A _ _ Description: N/A 1 Quantity: 2 4.1.3 Device Power Pathways ® No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: N/A 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: _B_ _ Survivability level: (See NFPA 72, Sections 12.3 and 12.4)v 4.2.2 Pathways Utilizing Two or More Media Quantity: N/A Description: _N/A 1 Quantity: 2 4.2.3 Device Power Pathways ® No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: N/A Survivability level: N/A (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: N/A Description: N/A Quantity: _ N/A 4.3.3 Appliance Power Pathways ❑ No separate power pathways from the notification appliance pathway ❑ Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10,18.2.1.1 (p. 3 of 12) Copyright © 2009 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. t 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes Type and number of devices: Addressable: Other (specify): ® This system does not have manual fire alarm boxes. 2 Conventional: Coded: Transmitter: 5.1.2 Other Alarm Boxes ®This system does not have other alarm boxes. Description: N/A Type and number of devices: Addressable: N/A Conventional: Other (specify): N/A _ 5.2 Automatic Initiating Devices N/A Coded: N/A Transmitter: NIA 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: 23 Conventional: Other (specify): _ N/A Type of coverage: ❑ Complete area ❑ Partial area ® Nonrequired partial area Other (specify): N/A Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): ___N/A —_----- 5.2.2 Duct Smoke Detectors ❑ This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: 7 Conventional: Other (specify): Type of coverage: Supply Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors ® This system does not have radiant energy detectors. Type and number of devices: Addressable: N/A Conventional: N/A Other (specify): N/A Type of coverage: N/A 5.2.4 Gas Detectors ® This system does not -have gas detectors. Type of detector(s): N/A Number of devices: Addressable: N/A Conventional: N/A Type of coverage: N/A--------�...---_ __� _ 5.2.5 Heat Detectors ❑ This system does not have heat detectors. Type and number of devices: Addressable: 1 Conventional: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ❑ Rate -of -rise ❑ Rate compensated NFPA 72, Fig. 10.18.2.1.1 (p. 4 of 12) Copyright © 2009 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 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules Number of devices: N/A 5.2.7 Waterflow Alarm Devices Type and number of devices: Addressable: 7 5.2.8 Alarm Verification Number of devices subject to alarm verification: 5.2.9 Presignal Number of devices subject to presignal: Describe presignal functions: N/A 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: N/A 5.2.11 Other Initiating Devices Describe: N/A N/A ® This system does not have monitoring modules. ❑ This system does not have waterflow alarm devices. Conventional: Coded: Transmitter: ® This system does not incorporate alarm verification. N/A Alarm verification set for N/A seconds ® This system does not incorporate pre -signal. ® This system does not incorporate PAS. ® This system does not have other initiating devices. 6. SUPERVISORY SIGNAL -INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: 7 Conventional: Coded: Transmitter: Other (specify): N/A 6.2 Fire Pump Description and Supervisory Devices ❑ This system does not have a fire pump. Type fire pump: ® Electric pump ❑ Engine Type and number of devices: Addressable: 1 Conventional: Coded: _ _ Transmitter: Other (specify): N/A 6.2.1 Fire Pump Functions Supervised ® Power ® Running ❑ Phase reversal ® Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): N/A 6.3 Duct Smoke Detectors (DSDs) ® This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: N/A Conventional: _ N/A Other (specify): N/A Type of coverage: N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: N/A NFPA 72, Fig. 10.18.2.1.1 (p. 5 of 12) Copyright © 2009 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. e 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Other (specify): N/A 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): N/A 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: N/A Location 2: N/A Location 3: N/A ❑ This system does not have a -generator. ❑ Selector switch not in auto ❑ Low fuel ® This system does not monitor special hazard systems. ® This system does not monitor other systems. ❑ This system does not have annunciators. 9. ALARM NOTIFICATION APPLIANCES 9.1 In -Building Fire Emergency Voice Alarm Communication System ❑ This system does not have an EVACS. Number of single voice alarm channels: 2_ Number of multiple voice alarm channels: Number of speakers: 87 Number of speaker circuits: 8 Location of amplification and sound -processing equipment: Fire Control Room v Location of paging microphone stations: Location 1: Fire Control Room Location 2: N/A Location 3: N/A 9.2 Nonvoice Notification Appliances ❑ This system does not have nonvoice notification appliances. Horns: With visible: Bells: With visible: Chimes: With visible: Visible only: 124 Other (describe): _ 9.3 Notification Appliance Power Extender Panels Quantity: 7 Locations: Electrical rooms ❑ This system does not have power extender panels. NFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12) copyright © 2009 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. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ® This system does not have an MNS. 11 10.1 MNS Local Operating Consoles Location 1: N/A Location 2: N/A Location 3: N/A 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: N/A Location 2: N/A Location 3: N/A 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: N/A _ MNS-only visible appliances: N/A Textual signs: N/A Other (describe): Supervision class: N/A 10.3.1 Special Hazard Notification ® This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ❑ This system does not have a two-way telephone system. Number of telephone jacks installed: 20 Number of warden stations installed: Number of telephone handsets stored on site: 6 Type of telephone system installed: ® Electrically powered ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ® This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: _ % General building areas: o Amplification component locations: N/A Inbound signal strength: N/A dBm Outbound signal strength: N/A dBm Donor antenna isolation is: N/A dB above the signal booster gain Radio frequencies covered: N/A Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright © 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: N/A Location of central control point: N/A� Days and hours when central control point is attended: N/A Location of alternate control point: N/A _ __,.-_..___.__ Days and hours when alternate control point is attended: N/A 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: N/A ---- Location of central control point: Days and hours when central control point is attended: N/A Location of alternate control point: N/A Days and hours when alternate control point is attended: N/A 11.5 Other Two -Way Communication Systems Describe: N/A 12. CONTROL FUNCTIONS This system activates the following control fuctions: N/A ® Hold -open door releasing devices ❑ Smoke management ® HVAC shutdown ❑ F/S dampers ® Door unlocking ® Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules Number of devices: 9 Other (specify): -- - -- - 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power ❑ This system does not have control modules. Input voltage of control panel: 120VAC Control panel amps: Overcurrent protection: Type: BREAKER _ Amps: 20AMP Location (of primary supply panel board): Fire Control panel _ Disconnecting means location: 120VAC Sub panel 13.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: 3.5 ❑ This system does not have a generator. Type of fuel: NFPA 72, Fig. 10.18.2.1.1 (p. 8 of 12) Copyright ©2009 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. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: FACP Type: AGM Calculated capacity of batteries to drive the system: Nominal voltage: 12V __ Amp/hour rating: 55 In standby mode (hours): 24 Hours _ In alarm mode (minutes): _ ® Batteries are marked with date of manufacture ® Battery calculations are attached 15 Minutes 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ❑ This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: 120VAC EVACS or MNS panel amps: Overcurrent protection: Type: Breaker Amps: 20Amps Location (of primary supply panel board): Fire Control Panel Disconnecting means location: Electrical room sub panel 13.2.2 Engine -Driven Generator Location of generator: Location of fuel storage: 3.5 ❑ This system does not have a generator. Type of fuel: 13.2.3 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): 13.2.4 Batteries Location: FACP Type: AGIM Nominal voltage: 12V Amp/hour rating: 55 Calculated capacity of batteries to drive the system: In standby mode (hours): 24 Hours In alarm mode (minutes): _ ❑ Batteries are marked with date of manufacture ❑ Battery calculations are attached 15 minutes NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) Copyright ©2009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power Input voltage of power extender panel(s): 120VAC Overcurrent protection: Type: Breaker Location (of primary supply panel board): Power Expander Disconnecting means location: electrical, room sub panel 13.3.2 Engine -Driven Generator Location of generator: ❑ This system does not have power extender panels. Power extender panel amps: 4.0 Amps: 20Amps ❑ This system does not have a generator. Location of fuel storage: Type of fuel: 13.3.3 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): 13.3.4 Batteries Location: Power Expander Type: AGM Nominal voltage: 12V Calculated capacity of batteries to drive the system: In standby mode (hours): 24 Hours In alarm mode (minutes): ® Batteries are marked with date of manufacture ® Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Amp/hour rating: 10 15 minutes Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. This is a: ❑ New system ❑ Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) ❑ NFPA 72, Edition: ❑ NFPA 70, National Electrical Code, Article 760, Edition: ❑ Manufacturer's published instructions Other(specify): System deviations from referenced NFPA standards: Signed: G�^---^ ... _ Printed name: /tifj�1J �T/� MDR Date: Organization: 72 Y-��p7j_-_-_- Title: _ P�Q�L ci All 6 �/Z Phone: _�- �� Z t O G V_6 NFPA 72, Fig. 10.18:2.1.1 (p. 10 of 12) Copyright © 2009 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. 16. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST It New system All operational features and fimctions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ❑ Modifications to an existing system All newly modified operational features andjunctions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: ,i `NFPA 72, Edition: 10 1 (:) 21 NFPA 70, National Electrical Code, Article 760, Edition: ❑ Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: �jv.�' Printed name: (A_IAX416 #A Date: 9 j L1 Organization:( �`�S ih��' _ Title: poi __��b�� Phone: 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: _ Printed name: T /W)�, C, Date: 3— Organization: 7PL S-yS r- A^, V Title: y��Q��C i �ApA6 'L. Phone: 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: ...-- � Printed name: jA 0"C CA VIA N-4 � y Date: — 2Z - -- - - - - - - --- - ------- Organization: 71L �g-ym5`-s _ Title: �%� �Gi 1 N/�____ Phone: 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. 1. . Signed: =% _� Printed name: �t,�, A <rA- A4�o Date: Organization: L Sy S'r(`� 'S _ Title: P701 -c f, _ fl/IP� n�A 64,,,— Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 11 of 12) Copyright© 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: _._ -, Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. C (� � �t Printed name: N' \ !>j 0C -� (OVZi2i.S Date: 3�_� Signed: �2.. � �� t .. . ----------- c� _I_�----- Organization: iJ1 Title: Phone: L( NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright ©2009 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. 3 FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time ofsystem 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 amused lines. Attach additional sheets, data, or calculations as necessary to provide a complete record. 1. PROPERTY INFORMATION Name of property: The Irvine Company _ Address: 500 Newport Center drive. Newport Beach, CA 92660w Description of property: 91h Story Building with penthouse & basement level _ Occupancy type: B Name of property representative: The Irvine Company LLC Address: 111 Innovation Irvine, CA 92617 Phone: 949-279-2492 Fax: N/A E-mail: tfurnari@irvinecompany.com Authority having jurisdiction over this property: Newport Beach Fire Department _ Phone: 949-644-3106 Fax: E-mail: nmorris@nbfd.net 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: TRL systems Inc Address: 800 W Doran Street Suite 200 .Glendale, CA 91203 License or certification number: C10- 413747 Phone: 800-266-1392 Fax: E-mail: www.trisystems.com Service organization for this equipment: TRL systems Inc Address: 800 W Doran Street Suite 200 .Glendale, CA 91203 License or certification number: C10- 413747 Phone: 800-266-1392 Fax E-mail: www.trlsystems.com A contract for test and inspection in accordance with NFPA standards is in effect as of N/A Contracted testing company: N/A Address: N/A Phone: N/A Fax: N/A E-mail: N/A Contract expires: N/A Contract number: N/A Frequency of routine inspections: N/A 3. DESCRIPTION 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): _..__ . _ _ _ _ _ NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12) Copyright © 2009 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. I 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2010 Additional description of system(s): 3.1 Control Unit Manufacturer: Edwards Model number: EST-3 3.2 Mass Notification System ® This system does not incorporate an MNS 3.2.1 System Type: ❑ In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): N/A 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS-interface ❑ Other (specify): N/A 3.3 System Documentation ❑ An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: _ Fire Control Room 3.4 System Software ❑ This system does not have alterable site -specific software. Operating system (executive) software revision level: Version 5.12 Site -specific software revision date: _03121/2014 _ Revision completed by: _.Noe Gonzalez (TRL)Y ® A copy of the site -specific software is stored on site. Location: _ Fire Control Panel 3.5 Off -Premises Signal Transmission ❑ This system does not have off premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: UPS Services Phone: 800-463-6885 Supervisory: UPS Services Phone: 800-463-6885 Trouble: UPS Services Phone: 800-463-6885 Entity to which alarms are retransmitted: CSM Phone: 800-463-6885 Method of retransmission: Via Internal Central Station (Dialer) If Chapter 26, specify the means of transmission from the protected premises to the supervising station: Central Station monitoring via internal dialer. If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12) Copyright © 2009 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. t 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: _B _ Survivability level (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: _N/A _ Description: N/A 1 Quantity: 2 4.1.3 Device Power Pathways ® No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: N/A - - - - 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: _ 1 (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: N/A Description: N/A Quantity: 2 4.2.3 Device Power Pathways ® No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: N/A Survivability level: N/A _ _ Quantity: N/A (See NFPA 72, Sections 12.3 and 12.4) _ T 4.3.2 Pathways Utilizing Two or More Media Quantity: N/A Description: _ N/A 4.3.3 Appliance Power Pathways ❑ No separate power pathways from the notification appliance pathway ❑ Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12) Copyright 0 2009 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. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ® This system does not have manual fire alarm boxes. Type and number of devices: Addressable: 2 Conventional: Coded: Transmitter: Other (specify): 5.1.2 Other Alarm Boxes ® This system does not have other alarm boxes. Description: N/A Type and number of devices: Addressable: N/A Conventional: N/A Coded: N/A Transmitter: N/A Other (specify): N/A 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: 83 Conventional: Other (specify): N/A Type of coverage: ❑ Complete area ❑ Partial area ® Nonrequired partial area Other (specify): NIA Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): __N/A 5.2.2 Duct Smoke Detectors ❑ This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: 8. Conventional: — Other (specify): Type of coverage: Supply Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors ® This system does not have radiant energy detectors. Type and number of devices: Addressable: N/A Conventional: N/A Other (specify): N/A Type of coverage: N/A 5.2.4 Gas Detectors ® This system does not have gas detectors. Type of detector(s): N/A Number of devices: Addressable: N/A Conventional: N/A Type of coverage: _N/A 5.2.5 Heat Detectors ❑ This system does not have heat detectors. Type and number of devices: Addressable: 7 Conventional: _ Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ❑ Rate -of -rise ❑ Rate compensated NFPA 72, Fig. 10.18.2.1.1 (p. 4 of 12) Copyright © 2009 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. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules Number of devices: N/A 5.2.7 Waterflow Alarm Devices Type and number of devices: Addressable: 13 5.2.8 Alarm Verification Number of devices subject to alarm verification: 5.2.9 Presignal Number of devices subject to presignal: N/A Describe presignal functions: N/A 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: N/A 5.2.11 Other Initiating Devices Describe: N/A ® This system does not have monitoring modules. ❑ This system does not have waterflow alarm devices. Conventional: Coded: Transmitter: ® This system does not incorporate alarm verification. N/A Alarm verification set for N/A seconds ® This system does not incorporate pre -signal. 6. SUPERVISORY SIGNAL -INITIATING DEVICES ® This system does not incorporate PAS. ® This system does not have other initiating devices. 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: 12 Conventional: Coded: Transmitter: Other (specify): N/A 6.2 Fire Pump Description and Supervisory Devices ❑ This system does not have a fire pump. Type fire pump: ® Electric pump ❑ Engine Type and number of devices: Addressable: 1 Conventional: _ Coded: Transmitter: Other (specify): N/A 6.2.1 Fire Pump Functions Supervised ® Power ® Running ❑ Phase reversal ® Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): N/A 6.3 Duct Smoke Detectors (DSDs) ® This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: N/A Conventional: N/A Other (specify): N/A Type of coverage: N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: N/A NFPA 72, Fig. 10,18.2.1.1 (p. 5 of 12) Copyright © 2009 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. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Other (specify): N/A 7.2 Special Hazard Suppression Systems Description of special hazard system(s): N/A _ 7.3 Other Monitoring Systems Description of special hazard system(s): NSA 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: N/A Location 2: N/A Location 3: N/A ❑ This system does not have a generator. ❑ Selector switch not in auto (] Low fuel ® This system does not monitor special hazard systems. ® This system does not monitor other systems. ❑ This system does not have annunciators. 9. ALARM NOTIFICATION APPLIANCES 9.1 In -Building Fire Emergency Voice Alarm Communication System ❑ This system does not have an EVACS. Number of single voice alarm channels: 2 Number of multiple voice alarm channels: Number of speakers: 116 v _ Number of speaker circuits: 11 Location of amplification and sound -processing equipment: Fire Control Room Location of paging microphone stations: Location 1: Fire Control Room Location 2: NIA Location 3: N/A 9.2 Nonvoice Notification Appliances ❑ This system does not have nonvoice notification appliances. Horns: With visible: Bells: With visible: Chimes: With visible: Visible only: 275 Other (describe): 9.3 Notification Appliance Power Extender Panels ❑ This system does not have power extender panels. Quantity: 13 Locations: Electrical Closet NFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12) Copyright © 2009 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. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS 10.1 MNS Local Operating Consoles Location 1: N/A Location 2: N/A Location 3: N/A 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones Location 1: N/A Location 2: N/A Location 3: N/A N/A ® This system does not have an MNS. 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: N/A —__._._—..... MNS-only visible appliances: N/A Textual signs: N/A Other (describe): N/A Supervision class: N/A 10.3.1 Special Hazard Notification ® This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ❑ This system does not have a two-way telephone system. Number of telephone jacks installed: 33 _ Number of warden stations installed: Number of telephone handsets stored on site: 6 Type of telephone system installed: ® Electrically powered ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ® This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: _ _ % General building areas: % Amplification component locations: Inbound signal strength: N/A dBm Outbound signal strength: N/A dBm Donor antenna isolation is: N/A dB above the signal booster gain Radio frequencies covered: N/A Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright © 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: N/A Location of central control point: N/A_ ___. ___._- Days and hours when central control point is attended: N/A Location of alternate control point: Days and hours when alternate control point is attended: N/A 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: NIA _ Location of central control point: N/A Days and hours when central control point is attended: N/A Location of alternate control point: N/A Days and hours when alternate control point is attended: 11.5 Other Two -Way Communication Systems Describe: N/A 12. CONTROL FUNCTIONS This system activates the following control fuctions: ® Hold -open door releasing devices ❑ Smoke management ® HVAC shutdown ❑ F/S dampers ® Door unlocking ® Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules Number of devices: 12 Other (specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120VAC Overcurrent protection: Type: BREAKER _ Location (of primary supply panel board): Fire Control panel Disconnecting means location: 120VAC Sub panel 13.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: ❑ This system does not have control modules. Control panel amps: 3.5 Amps: 20AMP ❑ This system does not have a generator. Type of fuel: NFPA 72, Fig. 10.18.2.1.1 (p. 8 of 12) Copyright 0 2009 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. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: FACP Type: AGM Nominal voltage: _ 12V Calculated capacity of batteries to drive the system: In standby mode (hours): 24 Hours ® Batteries are marked with date of manufacture In alarm mode (minutes): _ ® Battery calculations are attached Amp/hour rating: 55 15 Minutes 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ❑ This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: 120VAC _ EVACS or MNS panel amps: 3.5 Overcurrent protection: Type: _Breaker Amps: 20Amps Location (of primary supply panel board): Fire Control Panel Disconnecting means location: Electrical room sub panel 13.2.2 Engine -Driven Generator ❑ This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.2.3 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): 13.2.4 Batteries Location: FACP Type: _ AGM Nominal voltage: 12V Calculated capacity of batteries to drive the system: In standby mode (hours): 24 Hours In alarm mode (minutes): _ ❑ Batteries are marked with date of manufacture ❑ Battery calculations are attached Amp/hour rating: 55 15 minutes NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) copyright © 2009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power Input voltage of power extender panel(s): 120VAC Overcurrent protection: Type: Breaker Location (of primary supply panel board): Power Expander _ Disconnecting means location: electrical room sub panel ❑ This system does not have power extender panels. Power extender panel amps: Amps: 20Amps - - 4.0 13.3.2 Engine -Driven Generator This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.3.3 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): 13.3.4 Batteries Location: Power Expander Type: AGM _ Nominal voltage: 12V Amp/hour rating. 10 Calculated capacity of batteries to drive the system: In standby mode (hours): 24 Hours In alarm mode (minutes): 15 minutes ® Batteries are marked with date of manufacture ® Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. This is a: +New system ❑ Modification to an existing system Permit number: r The system has been installed in accordance with the following requirements: (Note any or all that apply.) NFPA 72, Edition: ❑ NFPA 70, National Electrical Code, Article 760, Edition: _ ❑ Manufacturer's published instructions Other (specify): System deviations from referenced NFPA standards: Signe&--- �' Printed name: CA SSA N CO : Date: 3 — Z Z _ ) q Organization: Sy SriffA—S Title: __ PIZO} C-Cr AJ A NAU� Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright © 2009 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. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ❑ New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ❑ Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: ❑ NFPA 72, Edition: ❑ NFPA 70, National Electrical Code, Article 760, Edition: ❑ Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: �.� -�'"— Printed name: Xd'4 CAS-ANF,OA Date: 3 - Organization: `% SyS1'�s''S Title: P120jr, C,f Phone: — 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed.—, Printed name: A1% (A$-)7WV O4, Date: 1 [ z - -- — Organization: Title: Pns j 4 C r MAMA 6 411- Phone: 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Printed name: ✓" -. �A $'1A ��4 Date: Organization: L S\? S-rt—s Title: Bln g c r h1,1n/y! KL- Phone: 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: '`�G G� Printed name: /U44< CAP-A-,4,04,. Date: Organization: 'X l Title: _ _ v _ Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 11 of 12) Copyright © 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: _ Date: Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: �� ,(`�11 V�-L�Vi Printed name: (IvE Date: Organization: (� 1 in S � G�U � Phone: �.� L( et i (�� _ Title: �- ��_-- NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright © 2009 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. Morris, Nadine Full Name: Kelly Fire - Sean Last Name: Sean First Name: Kelly Job Title: Owner Company: Kelly Fire Protection Inc Business Address: Kelly Fire Protection Inc I N vOkCF f A 10141 Theseus Dr Huntington Beach, CA 92646 LO �.��_ I N & P r _ Business: (714) 907-7586 E-mail: kellyfireprotection@verizon.net E-mail Display As: Sean Kelly SSU MUD U t)I�. vevtC,f2x)U � L> 4 1 1 Alcaraz, Debbie From: Morris, Nadine Sent: Monday, January 25, 2016 10:54 AM To: Alcaraz, Debbie Subject: Invoice - Weekend Inspection Hi Debbie, Please invoice the following contractor for a weekend inspection: Kelly Fire Protection Inc Attn: Sean Kelly 10141 Theseus Dr Huntington Beach, CA 92646 714-907-7586 Inspection @ 550 Newport Center Drive (underground fire line - hydro & flush) Sunday, 1/24/2016 9:00 AM — 11:00 AM = 2 hours Thank you, Nadine NADINE MORRI5 I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net avo5l m m 0— m90 O D Z 0 mmm_n W W Wm 0 � N GD N N Q Q. a N > � Dv m Q. o m o o �> >' =' c N T. co cQ (n cn c� y W mmB3<m0n 0 F_ O < -- �� a 3 0 0 m 17 < M. 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O "I 0 3 N -n CD try 1 O CD y V.81caraz, Debbie From: Morris, Nadine Sent: Friday, July 31, 2015 7:25 AM To: Alcaraz, Debbie Subject: Invoice - After Hours Inspection Attachments: chid-01@newportbeachca.gov_20150731_063637_000Oa42e001b.pdf Good morning, Please invoice HCI as follows: 07/31/2015 1.5 hours — 5:30AM-7AM Non-contiguous after hours inspection @ $156.00/hour Thank you, Nadine (10 0) N 0 t o04 IL N CD O 0) O a z W ti a`. a O 3 L. O 0 to m U t 1 U 00 Co .0 o N � m M M Q(D W Z m 0 a) c C' O .c 7' 4- d 0 Z aa) c 4- U =1 0 ° c0 co U- m Z a w H z w U O (L w z 0 In w U U ¢ .o 0 n J N U N d O � � uj N ti cQdUr. J N o N a zT to a) m m C, C) a) U m U U U C U a) .... C C N C C V -d t m-0 L a) v -C= C ° ¢¢ a w<t au o r 0 U 'U a) CL U) U z CO 2 w U J CL o Ul _ HQrn vzw ¢ O h rco cq N z o LO ?tea fo vM Oo r_Q C O U ai'-m �c�IchN oaU o tit z � zoom coiomo NciO N C u) C C2 V Q. = 0 ai 2 `) Q 0 z dj o N N m u ro m nii n. 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J a aa. 0 LLJ a 0- m a U a. z a o Z w W a N W ' Alcaraz, Debbie From: Morris, Nadine Sent: Monday, November 02, 2015 10:35 AM To: Alcaraz, Debbie Subject: 650 NCD DUCT DET SUPERVISORY (F2015-0003) Attachments: PIMCO BLDG 650 DUCT CORRELATION.pdf, PIMCO SMOKE CORRELATION.pdf Categories: SCAN Debbie, Please scan into 650 Newport Center Dr. Thank you, Nadine From: Jim MontoyarmailtoJmontoyagbhcisystems.net] Sent: Friday, October 30, 2015 9:26 AM To: Morris, Nadine Subject: 650 NCD DUCT DET SUPERVISORY Hello Nadine, I just found this in my draft folder from last week so I guess you haven't seen it yet. It is the duct detector change to supervisory for 650 Newport Center Drive. Please let me know if you have any questions on it. Thank you, Jim Montoya (219Systems J �*�•.Inc. ONTARIO - IRVINE - SAN DIEGO - NORTHERN CALIFORNIA 1354 S. Parkside Place Ontario, Ca. 91761 Office: 909-628-7773 Fax: 909-628-7774 Cell: 562-999-6052 NICET Certified From: Absalon Soriano [mailto:asoriano a hcisystems.netI Sent: Friday, October 23, 2015 12:09 PM To: Jimmy Montoya Subject: PIMCO DUCT DET SUPERVISORY Jim, I also attached 2 smoke det correlation Correlation Report EST3 System Definition Utility Version 05.12.00 Project: 650 NCD Version: 05.00.00 Logical Address: 01020014 Device Type: SUPERVISORY Label: 2014 L2 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302014" 650_NCD(01050001)[-SEND]"320302014" Logical Address: 01020018 Device Type: SUPERVISORY Label: 2018_L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302018" 650_NCD(01050001)[-SEND]"320302018" Logical Address: 01020019 Device Type: SUPERVISORY Label: 2019_L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302019" 650_NCD(01050001)[-SEND]"320302019" Logical Address: 01020027 Device Type: SUPERVISORY Label: 2027_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302027" 650_NCD(01050001)[-SEND]"320302027" Logical Address: 01020030 Device Type: SUPERVISORY Label: 2030_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302030" 650_NCD(01050001)[-SEND]"320302030" Logical Address: 01020032 Device Type: SUPERVISORY Label: 2032_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302032" 650_NCD(01050001)[-SEND]"320302032" Logical Address: 01020033 Device Type: SUPERVISORY Label: 2033 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302033" 650_NCD(01050001)[-SEND]"320302033" Logical Address: 01020034 Device Type: SUPERVISORY Label: 2034 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302034" 650_NCD(01050001)[-SEND]"320302034" Logical Address: 01020035 Device Type: SUPERVISORY Label: 2035_1-2_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120302035" 650_NCD(01050001)[-SEND]"320302035" Logical Address: 01020037 Device Type: SUPERVISORY Label: 2037_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302037" 650_NCD(01050001)[-SEND]"320302037" 1 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM Logical Address: 01020038 Device Type: SUPERVISORY Label: 2038_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302038" 650_NCD(01050001)[-SEND]"320302038" Logical Address: 01020046 Device Type: SUPERVISORY Label: 2046 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302046" 650_NCD(01050001)[-SEND]"320302046" Logical Address: 01020047 Device Type: SUPERVISORY Label: 2047_1-2_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120302047" 650_NCD(01050001)[-SEND]"320302047" Logical Address: 01020048 Device Type: SUPERVISORY Label: 2048_1-2 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302048" 650_NCD(01050001)[-SEND]"320302048" Logical Address: 01020049 Device Type: SUPERVISORY Label: 2049_L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302049" 650_NCD(01050001)[-SEND]"320302049" Logical Address: 01020057 Device Type: SUPERVISORY Label: 2057_1-3_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302057" 650_NCD(01050001)[-SEND]"320302057" Logical Address: 01020058 Device Type: SUPERVISORY Label: 2058_1-3_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302058" 650_NCD(01050001)[-SEND]"320302058" Logical Address: 01020059 Device Type: SUPERVISORY Label: 2059_1-3_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302059" 650_NCD(01050001)[-SEND]"320302059" Logical Address: 01020060 Device Type: SUPERVISORY Label: 2060_1-2_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120302060" 650_NCD(01050001)[-SEND]"320302060" Logical Address: 01020068 Device Type: SUPERVISORY Label: 2068_1-4 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302068" 650_NCD(01050001)[-SEND]"320302068" Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM Logical Address: 01020069 Device Type: SUPERVISORY Label: 2069 L4 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302069" 650_NCD(01050001)[-SEND]"320302069" Logical Address: 01020070 Device Type: SUPERVISORY Label: 2070_1-4 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302070" 650_NCD(01050001)[-SEND]"320302070" Logical Address: 01020078 Device Type: SUPERVISORY Label: 2078_1-5_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302078" 650_NCD(01050001)[-SEND]"320302078" Logical Address: 01020079 Device Type: SUPERVISORY Label: 2079_1-5 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302079" 650_NCD(01050001)[-SEND]"320302079" Logical Address: 01020080 Device Type: SUPERVISORY Label: 2080_1-5 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302080" 650_NCD(01050001)[-SEND]"320302080" Logical Address: 01020088 Device Type: SUPERVISORY Label: 2088_1-6 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302088" 650_NCD(01050001)[-SEND]"320302088" Logical Address: 01020089 Device Type: SUPERVISORY Label: 2089_1-6_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302089" 650_NCD(01050001)[-SEND]"320302089" Logical Address: 01020090 Device Type: SUPERVISORY Label: 2090_1-6_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302090" 650_NCD(01050001)[-SEND]"320302090" Logical Address: 01020091 Device Type: SUPERVISORY Label: 2091_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302091" 650_NCD(01050001)[-SEND]"320302091" Logical Address: 01020121 Device Type: SUPERVISORY Label: 2121_L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302121" 650_NCD(01050001)[-SEND]"320302121" Logical Address: 01020122 Device Type: SUPERVISORY Label: 2122 L1 DUCT 3 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM 4 Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120302122" 650_NCD(01050001)[-SEND]"320302122" Logical Address: 01020123 Device Type: SUPERVISORY Label: 2123 L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302123" 650_NCD(01050001)[-SEND]"320302123" Logical Address: 01020124 Device Type: SUPERVISORY Label: 2124 L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302124" 650_NCD(01050001)[-SEND]"320302124" Logical Address: 01020125 Device Type: SUPERVISORY Label: 2125_L1_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120302125" 650_NCD(01050001)[-SEND]"320302125" Logical Address: 01020298 Device Type: SUPERVISORY Label: 2298_1-14 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302298" 650_NCD(01050001)[-SEND]"320302298" Logical Address: 01020299 Device Type: SUPERVISORY Label: 2299_1-14 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302299" 650_NCD(01050001)[-SEND]"320302299" Logical Address: 01020300 Device Type: SUPERVISORY Label: 2300_1-14 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302300" 650_NCD(01050001)[-SEND]"320302300" Logical Address: 01020308 Device Type: SUPERVISORY Label: 2308_1-15 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302308" 650_NCD(01050001)[-SEND]"320302308" Logical Address: 01020309 Device Type: SUPERVISORY Label: 2309_1-15_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302309" 650_NCD(01050001)[-SEND]"320302309" Logical Address: 01020310 Device Type: SUPERVISORY Label: 2310_1-15_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302310" 650_NCD(01050001)[-SEND]"320302310" Logical Address: 01020318 Device Type: SUPERVISORY Label: 2318_1-16_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302318" 650_NCD(01050001)[-SEND]"320302318" Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM 5 Logical Address: 01020319 Device Type: SUPERVISORY Label: 2319 L16 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302319" 650_NCD(01050001)[-SEND]"320302319" Logical Address: 01020320 Device Type: SUPERVISORY Label: 2320_1-16 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302320" 650_NCD(01050001)[-SEND]"320302320" Logical Address: 01020328 Device Type: SUPERVISORY Label: 2328_1-17 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302328" 650_NCD(01050001)[-SEND]"320302328" Logical Address: 01020329 Device Type: SUPERVISORY Label: 2329 L17 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302329" 650_NCD(01050001)[-SEND]"320302329" Logical Address: 01020330 Device Type: SUPERVISORY Label: 2330_1-17_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302330" 650_NCD(01050001)[-SEND]"320302330" Logical Address: 01020338 Device Type: SUPERVISORY Label: 2338_1-18_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120302338" 650_NCD(01050001)[-SEND]"320302338" Logical Address: 01020339 Device Type: SUPERVISORY Label: 2339_1-18_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302339" 650_NCD(01050001)[-SEND]"320302339" Logical Address: 01020340 Device Type: SUPERVISORY Label: 2340_1-18_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302340" 650_NCD(01050001)[-SEND]"320302340" Logical Address: 01020348 Device Type: SUPERVISORY Label: 2348_1-19_DUCT Response., SUPERVISORY 650_NCD(01050001)[+SEND]"120302348" 650_NCD(01050001)[-SEND]"320302348" Logical Address: 01020349 Device Type: SUPERVISORY Label: 2349_1-19_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302349" 650_NCD(01050001)[-SEND]"320302349" Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM 0 Logical Address: 01020350 Device Type: SUPERVISORY Label: 2350_1-19_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302350" 650_NCD(01050001)[-SEND]"320302350" Logical Address: 01030011 Device Type: SUPERVISORY Label: 1011_G_DUCT 011 Response. SUPERVISORY 1131_G_SHUTD_131(01030131) 1132_G_SHUTD_132(01030132) 650_NCD(01050001)[+SEND]"120301011" 650_NCD(01050001)[-SEND]"320301011" Logical Address: 01030013 Device Type: SUPERVISORY Label: 1013_G DUCT 013 Response. SUPERVISORY 1131_G_SHUTD_131(01030131) 1132_G_SHUTD_132(01030132) 650_NCD(01050001)[+SEND]"120301013" 650_NCD(01050001)[-SEND]"320301013" Logical Address: 01030014 Device Type: SUPERVISORY Label: 1014 G DUCT 014 Response: SUPERVISORY 1131_G_SHUTD_131(01030131) 1132_G_SHUTD_132(01030132) 650_NCD(01050001)[+SEND]"120301014" 650_NCD(01050001)[-SEND]"320301014" Logical Address: 01030016 Device Type: SUPERVISORY Label: 1016_G_DUCT 016 Response. SUPERVISORY 1131_G_SHUTD_131(01030131) 1132_G_SHUTD_132(01030132) 650_NCD(01050001)[+SEND]"120301016" 650_NCD(01050001)[-SEND]"320301016" Logical Address: 01030017 Device Type: SUPERVISORY Label: 1017_G_DUCT 017 Response: SUPERVISORY 1131_G_SHUTD_131(01030131) 1132_G_SHUTD_132(01030132) _ 65CNCD(01050001)[+SEND]"120301017" 650_NCD(01050001)[-SEND]"320301017" Logical Address: 01030019 Device Type: SUPERVISORY Label: 1019 G_DUCT 019 Response: SUPERVISORY 1131_G_SHUTD_131(01030131) 1132_G_SHUTD_132(01030132) 650_NCD(01050001)[+SEND]"120301019" 650_NCD(01050001)[-SEND]"320301019" Logical Address: 01030020 Device Type: SUPERVISORY Label: 1020_G_DUCT 020 Response: SUPERVISORY 1131_G_SHUTD_131(01030131) 1132_G_SHUTD_132(01030132) 650_NCD(01050001)[+SEND]"120301020" 650_NCD(01050001)[-SEND]"320301020" Logical Address: 01030022 Device Type: SUPERVISORY Label: 1022_G_DUCT 022 Response: SUPERVISORY 1131_G_SHUTD_131(01030131) 1132_G_SHUTD_132(01030132) 650_NCD(01050001)[+SEND]"120301022" 650_NCD(01050001)[-SEND]"320301022" Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM 7 Logical Address: 01030023 Device Type: SUPERVISORY Label: 1023 G_DUCT 023 Response: SUPERVISORY 1131_G_SHUTD_131(01030131) 1132_G_SHUTD_132(01030132) 650_NCD(01050001)[+SEND]"120301023" 650_NCD(01050001)[-SEND]11320301023" Logical Address: 01040028 Device Type: SUPERVISORY Label: 2528 L9 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302528" 650_NCD(01050001)[-SEND]"320302528" Logical Address: 01040029 Device Type: SUPERVISORY Label: 2529_1-9 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302529" 650_NCD(01050001)[-SEND]"320302529" Logical Address: 01040038 Device Type: SUPERVISORY Label: 2538_L10_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302538" 650_NCD(01050001)[-SEND]"320302538" Logical Address: 01040039 Device Type: SUPERVISORY Label: 2539_L10_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302539" 650_NCD(01050001)[-SEND]"320302539" Logical Address: 01040040 Device Type: SUPERVISORY Label: 2540_1-10_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302540" 650_NCD(01050001)[-SEND]"320302540" Logical Address: 01040048 Device Type: SUPERVISORY Label: 2548_1-11_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302548" 650_NCD(01050001)[-SEND]"320302548" Logical Address: 01040049 Device Type: SUPERVISORY Label: 2549_1-11_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302549" 650_NCD(01050001)[-SEND]"320302549" Logical Address: 01040050 Device Type: SUPERVISORY Label: 2550_L11_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302550" 650_NCD(01050001)[-SEND]"320302550" Logical Address: 01040058 Device Type: SUPERVISORY Label: 2558_1-12 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302558" 650_NCD(01050001)[-SEND]"320302558" Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM Logical Address: 01040059 Device Type: SUPERVISORY Label: 2559 L12_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302559" 650_NCD(01050001)[-SEND]"320302559" Logical Address: 01040060 Device Type: SUPERVISORY Label: 2560_1-12_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302560" 650_NCD(01050001)[-SEND]"320302560" Logical Address: 01040065 Device Type: SUPERVISORY Label: 2568_1-13_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302568" 650_NCD(01050001)[-SEND]"320302568" Logical Address: 01040069 Device Type: SUPERVISORY Label: 2569 L13 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302569" 650_NCD(01050001)[-SEND]"320302569" Logical Address: 01040070 Device Type: SUPERVISORY Label: 2570_1-13_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302570" 650_NCD(01050001)[-SEND]"320302570" Logical Address: 01040098 Device Type: SUPERVISORY Label: 2508_1-7_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120302508" 650_NCD(01050001)[-SEND]"320302508" Logical Address: 01040099 Device Type: SUPERVISORY Label: 2509_1-7_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302509" 650_NCD(01050001)[-SEND]"320302509" Logical Address: 01040100 Device Type: SUPERVISORY Label: 2510_1-7_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302510" 650_NCD(01050001)[-SEND]"320302510" Logical Address: 01040108 Device Type: SUPERVISORY Label: 2518_1-8_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302518" 650_NCD(01050001)[-SEND]"320302518" Logical Address: 01040109 Device Type: SUPERVISORY Label: 2519 L8_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120302519" 650_NCD(01050001)[-SEND]"320302519" Logical Address:01040120 Device Type: SUPERVISORY Label: 2530 L9 DUCT 8 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302530" 650_NCD(01050001)[-SEND]"320302530" Logical Address: 01080004 Device Type: SUPERVISORY Label: 4004 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304004" 650_NCD(01050001)[-SEND]"320304004" Logical Address: 01080069 Device Type: SUPERVISORY Label: 4069 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304069" 650_NCD(01050001)[-SEND]"320304069" Logical Address: 01080070 Device Type: SUPERVISORY Label: 4070_L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304070" 650_NCD(01050001)[-SEND]"320304070" Logical Address: 01080071 Device Type: SUPERVISORY Label: 4071_L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304071" 650_NCD(01050001)[-SEND]"320304071" Logical Address: 01080072 Device Type: SUPERVISORY Label: 4072_L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304072" 650_NCD(01050001)[-SEND]"320304072" Logical Address: 01080073 Device Type: SUPERVISORY Label: 4073 L1_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304073" 650_NCD(01050001)[-SEND]"320304073" Logical Address: 01080074 Device Type: SUPERVISORY Label: 4074 L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304074" 650_NCD(01050001)[-SEND]"320304074" Logical Address: 01080075 Device Type: SUPERVISORY Label: 4075 L1_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304075" 650_NCD(01050001)[-SEND]"320304075" Logical Address: 01080076 Device Type: SUPERVISORY Label: 4076_L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304076" 650_NCD(01050001)[-SEND]"320304076" Logical Address: 01080077 Device Type: SUPERVISORY Label: 4077_L1_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304077" 650_NCD(01050001)[-SEND]"320304077" 9 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM Logical Address: 01080078 Device Type: SUPERVISORY Label: 4078_L1_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304078" 650_NCD(01050001)[-SEND]"320304078" Logical Address: 01080079 Device Type: SUPERVISORY Label: 4079 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304079" 650_NCD(01050001)[-SEND]"320304079" Logical Address: 01080080 Device Type: SUPERVISORY Label: 4080_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304080" 650_NCD(01050001)[-SEND]"320304080" Logical Address: 01080081 Device Type: SUPERVISORY Label: 4081_1-2 DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304081" 650_NCD(01050001)[-SEND]"320304081" Logical Address: 01080082 Device Type: SUPERVISORY Label: 4082_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304082" 650_NCD(01050001)[-SEND]"320304082" Logical Address: 01080083 Device Type: SUPERVISORY Label: 4083_1-2 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304083" 650_NCD(01050001)[-SEND]"320304083" Logical Address: 01080084 Device Type: SUPERVISORY Label: 4084 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304084" 650_NCD(01050001)[-SEND]"320304084" Logical Address: 01080085 Device Type: SUPERVISORY Label: 4085 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304085" 650_NCD(01050001)[-SEND]"320304085" Logical Address: 01080086 Device Type: SUPERVISORY Label: 4086_1-2 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304086" 650_NCD(01050001)[-SEND]"320304086" Logical Address: 01080087 Device Type: SUPERVISORY Label: 4087_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304087" 650_NCD(01050001)[-SEND]"320304087" 10 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM Logical Address: 01080088 Device Type: SUPERVISORY Label: 4088 L2 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304088" 650_NCD(01050001)[-SEND]"320304088" Logical Address: 01080089 Device Type: SUPERVISORY Label: 4089 L2 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304089" 650_NCD(01050001)[-SEND]"320304089" Logical Address: 01080090 Device Type: SUPERVISORY Label: 4090_1-2_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304090" 650_NCD(01050001)[-SEND]11320304090" Logical Address: 01080091 Device Type: SUPERVISORY Label: 4091_1-2 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304091" 650_NCD(01050001)[-SEND]"320304091" Logical Address: 01080092 Device Type: SUPERVISORY Label: 4092_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304092" 650_NCD(01050001)[-SEND]"320304092" Logical Address: 01080093 Device Type: SUPERVISORY Label: 4093_1-2 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304093" 650_NCD(01050001)[-SEND]"320304093" Logical Address: 01080094 Device Type: SUPERVISORY Label: 4094_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304094" 650_NCD(01050001)[-SEND]"320304094" Logical Address: 01080095 Device Type: SUPERVISORY Label: 4095_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304095" 650_NCD(01050001)[-SEND]"320304095" Logical Address: 01080096 Device Type: SUPERVISORY Label: 4096 12_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304096" 650_NCD(01050001)[-SEND]"320304096" Logical Address: 01080097 Device Type: SUPERVISORY Label: 4097_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304097" 650_NCD(01050001)[-SEND]"320304097" Logical Address: 01080098 Device Type: SUPERVISORY Label: 4098 12 DUCT 11 Correlation Report Project: 650_NCD Version: 05.00.00 Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304098" 650_NCD(01050001)[-SEND]"320304098" Logical Address: 01080099 Device Type: SUPERVISORY Label: 4099 L2 DUCT Response., SUPERVISORY 650_NCD(01050001)[+SEND]"120304099" 650_NCD(01050001)[-SEND]"320304099" Logical Address: 01080101 Device Type: SUPERVISORY Label: 4101_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304101" 650_NCD(01050001)[-SEND]"320304101" Logical Address: 01080103 Device Type: SUPERVISORY Label: 4103_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304103" 650_NCD(01050001)[-SEND]"320304103" Logical Address: 01080104 Device Type: SUPERVISORY Label: 4104 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304104" 650_NCD(01050001)[-SEND]"320304104" Logical Address: 01080105 Device Type: SUPERVISORY Label: 4105 L2 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304105" 650_NCD(01050001)[-SEND]"320304105" Logical Address: 01080106 Device Type: SUPERVISORY Label: 4106_1-2_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304106" 650_NCD(01050001)[-SEND]"320304106" Logical Address: 01080107 Device Type: SUPERVISORY Label: 4107_1-2 DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304107" 650_NCD(01050001)[-SEND]"320304107" Logical Address: 01080108 Device Type: SUPERVISORY Label: 4108_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304108" 650_NCD(01050001)[-SEND]"320304108" Logical Address: 01080109 Device Type: SUPERVISORY Label: 4109_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304109" 650_NCD(01050001)[-SEND]"320304109" Logical Address: 01080110 Device Type: SUPERVISORY Label: 4110_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304110" 650_NCD(01050001)[-SEND]"320304110" 12 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM Logical Address: 01080111 Device Type: SUPERVISORY Label: 4111_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304111" 650_NCD(01050001)[-SEND]"320304111" Logical Address: 01080112 Device Type: SUPERVISORY Label: 4112 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304112" 650_NCD(01050001)[-SEND]"320304112" Logical Address: 01080113 Device Type: SUPERVISORY Label: 4113_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304113" 650_NCD(01050001)[-SEND]"320304113" Logical Address: 01080114 Device Type: SUPERVISORY Label: 4114 L2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304114" 650_NCD(01050001)[-SEND]"320304114" Logical Address: 01080115 Device Type: SUPERVISORY Label: 4115_1-2_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304115" 650_NCD(01050001)[-SEND]"320304115" Logical Address: 01080116 Device Type: SUPERVISORY Label: 4116_1-3 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304116" 650_NCD(01050001)[-SEND]"320304116" Logical Address: 01080117 Device Type: SUPERVISORY Label: 4117_1-3_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304117" 650_NCD(01050001)[-SEND]"320304117" Logical Address: 01080118 Device Type: SUPERVISORY Label: 4118_1-3_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304118" 650_NCD(01050001)[-SEND]"320304118" Logical Address: 01080119 Device Type: SUPERVISORY Label: 4119_1-3_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304119" 650_NCD(01050001)[-SEND]"320304119" Logical Address: 01080120 Device Type: SUPERVISORY Label: 4120_1-3_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304120" 650_NCD(01050001)[-SEND]"320304120" 13 Correlation Report Project:650_NCD Version: 05.00.00 Logical Address: 01080122 Device Type: SUPERVISORY Label: 4122 L3 DUCT Response., SUPERVISORY 650_NCD(01050001)[+SEND]"120304122" 650_NCD(01050001)[-SEND]"320304122" Logical Address: 01080123 Device Type: SUPERVISORY Label: 4123_1-3 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120304123" 650_NCD(01050001)[-SEND]"320304123" Logical Address: 01080124 Device Type: SUPERVISORY Label: 4124 L3 DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304124" 650_NCD(01050001)[-SEND]"320304124" Logical Address: 01080125 Device Type: SUPERVISORY Label: 4125 1-3_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120304125" 650_NCD(01050001)[-SEND]"320304125" Logical Address: 01080351 Device Type: SUPERVISORY Label: 3351_1.4 DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120303351" 650_NCD(01050001)[-SEND]"320303351" Logical Address: 01080352 Device Type: SUPERVISORY Label: 3352_1-4 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303352" 650_NCD(01050001)[-SEND]"320303352" Logical Address: 01080353 Device Type: SUPERVISORY Label: 3353 L4 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303353" 650_NCD(01050001)[-SEND]"320303353" Logical Address: 01080354 Device Type: SUPERVISORY Label: 3354_1-5_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303354" 650_NCD(01050001)[-SEND]"320303354" Logical Address: 01080355 Device Type: SUPERVISORY Label: 3355 1-5_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303355" 650_NCD(01050001)[-SEND]"320303355" Logical Address: 01080356 Device Type: SUPERVISORY Label: 3356 L6 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303356" 650_NCD(01050001)[-SEND]"320303356" Logical Address: 01080357 Device Type: SUPERVISORY Label: 3357 L6 DUCT 14 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:18 AM Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303357" 650_NCD(01050001)[-SEND]"320303357" Logical Address: 01080358 Device Type: SUPERVISORY Label: 3358 L6 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303358" 650_NCD(01050001)[-SEND]"320303358" Logical Address: 01080359 Device Type: SUPERVISORY Label: 3359_1-7_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303359" 650_NCD(01050001)[-SEND]"320303359" Logical Address: 01080360 Device Type: SUPERVISORY Label: 3360_L7_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303360" 650_NCD(01050001)[-SEND]"320303360" Logical Address: 01080361 Device Type: SUPERVISORY Label: 3361_1-3_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303361" 650_NCD(01050001)[-SEND]"320303361" Logical Address: 01080362 Device Type: SUPERVISORY Label: 3362 L3 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303362" 650_NCD(01050001)[-SEND]"320303362" Logical Address: 01080363 Device Type: SUPERVISORY Label: 3363_1-3 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303363" 650_NCD(01050001)[-SEND]"320303363" Logical Address: 01080364 Device Type: SUPERVISORY Label: 3364 L3_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120303364" 650_NCD(01050001)[-SEND]"320303364" Logical Address: 04140071 Device Type: SUPERVISORY Label: 8071_1-8_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308071" 650_NCD(01050001)[-SEND]"320308071" Logical Address: 04140072 Device Type: SUPERVISORY Label: 8072_1-8_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308072" 650_NCD(01050001)[-SEND]"320308072" Logical Address: 04140073 Device Type: SUPERVISORY Label: 8073_1-9_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308073" 650_NCD(01050001)[-SEND]"320308073" 15 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:19 AM Logical Address: 04140074 Device Type: SUPERVISORY Label: 8074 L9 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308074" 650_NCD(01050001)[-SEND]"320308074" Logical Address: 04140075 Device Type: SUPERVISORY Label: 8075_L10_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308075" 650_NCD(01050001)[-SEND]"320308075" Logical Address: 04140076 Device Type: SUPERVISORY Label: 8076_1-10_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308076" 650_NCD(01050001)[-SEND]"320308076" Logical Address: 04140077 Device Type: SUPERVISORY Label: 8077 L11_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308077" 650_NCD(01050001)[-SEND]"320308077" Logical Address: 04140078 Device Type: SUPERVISORY Label: 8078_L11_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308078" 650_NCD(01050001)[-SEND]"320308078" Logical Address: 04140079 Device Type: SUPERVISORY Label: 8079 L12 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308079" 650_NCD(01050001)[-SEND]"320308079" Logical Address: 04140080 Device Type: SUPERVISORY Label: 8080_1-12_DUCT Response., SUPERVISORY 650_NCD(01050001)[+SEND]"120308080" 650_NCD(01050001)[-SEND]"320308080" Logical Address: 04140081 Device Type: SUPERVISORY Label: 8081_1-13_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308081" 650_NCD(01050001)[-SEND]"320308081" Logical Address: 04140082 Device Type: SUPERVISORY Label: 8082_1-13 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308082" 650_NCD(01050001)[-SEND]"320308082" Logical Address: 04140083 Device Type: SUPERVISORY Label: 8083_1-13_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308083" 650_NCD(01050001)[-SEND]"320308083" 16 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:19 AM Logical Address: 04140084 Device Type: SUPERVISORY Label: 8084 L14 DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120308084" 650_NCD(01050001)[-SEND]"320308084" Logical Address: 04140085 Device Type: SUPERVISORY Label: 8085_1-14 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308085" 650_NCD(01050001)[-SEND]"320308085" Logical Address: 04140086 Device Type: SUPERVISORY Label: 8086 L15_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308086" 650_NCD(01050001)[-SEND]"320308086" Logical Address: 04140087 Device Type: SUPERVISORY Label: 8087 L15 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308087" 650_NCD(01050001)[-SEND]"320308087" Logical Address: 04140088 Device Type: SUPERVISORY Label: 8088_1-15_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308088" 650_NCD(01050001)[-SEND]"320308088" Logical Address: 04140089 Device Type: SUPERVISORY Label: 8089 L16 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308089" 650_NCD(01050001)[-SEND]"320308089" Logical Address: 04140090 Device Type: SUPERVISORY Label: 8090_1-16_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120308090" 650_NCD(01050001)[-SEND]"320308090" Logical Address: 04140091 Device Type: SUPERVISORY Label: 8091_1-17_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308091" 650_NCD(01050001)[-SEND]"320308091" Logical Address: 04140092 Device Type: SUPERVISORY Label: 8092_1-17_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308092" 650_NCD(01050001)[-SEND]"320308092" Logical Address: 04140093 Device Type: SUPERVISORY Label: 8093_1-18_DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120308093" 650_NCD(01050001)[-SEND]"320308093" Logical Address: 04140094 Device Type: SUPERVISORY Label: 8094 1-18 DUCT 17 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:19 AM Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308094" 650_NCD(01050001)[-SEND]"320308094" Logical Address: 04140095 Device Type: SUPERVISORY Label: 8095_1-18_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308095" 650_NCD(01050001)[-SEND]"320308095" Logical Address: 04140096 Device Type: SUPERVISORY Label: 8096_1-19 DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120308096" 650_NCD(01050001)[-SEND]"320308096" Logical Address: 04140097 Device Type: SUPERVISORY Label: 8097 L19 DUCT Response. SUPERVISORY 650_NCD(01050001)[+SEND]"120308097" 650_NCD(01050001)[-SEND]"320308097" Logical Address: 04140098 Device Type: SUPERVISORY Label: 2520_1-8_DUCT Response: SUPERVISORY 650_NCD(01050001)[+SEND]"120302520" 650_NCD(01050001)[-SEND]"320302520" 18 Correlation Report Project: 650_NCD Version: 05.00.00 2/21/2015 9:08:19 AM Correlation Report EST3 System Definition Utility Version 05.12.00 Project: 650 NCD Version: 05.00.01 Logical Address: 01020001 Device Type: SMOKE Label: 2001_L1_SMK Response. ALARM [DELAYACTIVATE]/10\ L1 AMP(03020000)<Evac> L2_AMP1(03030000)<Evac> L2_AMP2(03040000)<Evac> L1 AMP(03020000)<Page> L2 AMP1(03030000)<Page> L2_AMP2(03040000)<Page> L3_AMP(03050000)<Page> L4 AMP(03060000)<Page> L5_AMP(03070000)<Page> L6_AMP(03090000)<Page> L7 AMP(03100000)<Page> L8_AMP(03110000)<Page> L9 AMP(03120000)<Page> L10_AMP(04020000)<Page> L11 AMP(04030000)<Page> L12_AMP(04040000)<Page> L13 AMP(04050000)<Page> L14_AMP(04060000)<Page> L15_AMP(04070000)<Page> L16 AMP(04090000)<Page> L17 AMP(04100000)<Page> L18_AMP(04110000)<Page> L19_AMP(04120000)<Page> L20 AMP(04130000)<Page> L1 VIS2(01080136) L1_VIS(03020001) L2_VIS2(01080137) L2_VIS3(01080138) L2 VIS(03030001) L2_VIS1(03040001) L20 AMP(04130000)<Evac> 2450_L23_SPKCAB(01020450) 2451_L20_SPKPH(01020451) 2630_L22_SPKST2(01040130) 2631_L21_SPKST1(01040131) 3127_L1_DOOR(01080128) 2144_L2_DOOR(01020144) 2152_L2_DOOR(01020152) 2138_L2_DSHUT(01020138) 2139_L2_DSHUT(01020139) 2140_L2_DSHUT(01020140) 2141_L2_DSHUT(01020141) 2142_L2_DSHUT(01020142) 2143_L2_DSHUT(01020143) 2151_L2_DSHUT(01020151) 2155_L2_STRDRS(01020155) 2223_L2_STRDRS(01020223) 2224_L2_STRDRS(01020224) 2225_L2_STRDRS(01020225) 2626_L10_STRDRS(01040126) 2627_L10_STRDRS(01040127) 2628_L10_STRDRS(01040128) 2629_L10_STRDRS(01040129) 2198_L1_SMKCNTRL(01020198) 3126_L1 AV SHUT(01080126) 3129_L2 AV SHUT(01080129) 3131_L2 AV SHUT(01080131) 3133_L2_AV SHUT(01080133) 3160_L2 AV SHUT(01080160) 3127 L1_HEATPUMP_SHUT(01080127) 3130_L2_HEATPUMP_SHUT(01080130) 3132_L2_HEATPUMP_SHUT(01080132) 2132_L1_DAMP(01020132) 2167_L1_DAMP(01020167) 2137_L2_DAMP(01020137) 2150_12_DAMP(01020150) 2145_ACCESS_RELAY(01020145) 3159_L1_SEC _DOORS(01080159) 650_NCD(01050001)[+SEND]"111102001" 650_NCD(01050001)[-SEND]"311102001" Logical Address: 01020002 Device Type: SMOKE Label: 2002_L1_ESMK Response: ALARM [DELAYACTIVATE]/10\ L1_AMP(03020000)<Evac> L2_AMP1(03030000)<Evac> L2 AMP2(03040000)<Evac> EVAC_MESSAGE(01070005)<EVAC_CH> L1 AMP(03020000)<Page> L2_AMP1(03030000)<Page> L2 AMP2(03040000)<Page> L3_AMP(03050000)<Page> L4_AMP(03060000)<Page> L5_AMP(03070000)<Page> L6_AMP(03090000)<Page> L7 AMP(03100000)<Page> L8_AMP(03110000)<Page> L9_AMP(03120000)<Page> L1 C_AMP(04020000)<Page> L11 AMP(04030000)<Page> L12_AMP(04040000)<Page> L13_AMP(04050000)<Page> L14 AMP(04060000)<Page> L15_AMP(04070000)<Page> L16_AMP(04090000)<Page> L17 AMP(04100000)<Page> L18_AMP(04110000)<Page> L19_AMP(04120000)<Page> L20 AMP(04130000)<Page> L1 VIS(03020001) L2 VIS2(01080137) L2 VIS3(01080138) L2_VIS(03030001) L2 VIS1(03040001) 2445_L20_ALT(01020445) L20_AMP(04130000)<Evac> 2450_L23_SPKCAB(01020450) 2451_L20_SPKPH(01020451) 2630_L22_SPKST2(01040130) 2631_L21_SPKST1(01040131) 3127_L1_DOOR(01080128) 2144_L2_DOOR(01020144) 2152_L2_DOOR(01020152) 2138_L2_DSHUT(01020138) 2139_L2_DSHUT(01020139) 2140_L2_DSHUT(01020140) 2141_L2_DSHUT(01020141) 2142_L2_DSHUT(01020142) 2143_L2_DSHUT(01020143) 2151_L2_DSHUT(01020151) 2155_L2_STRDRS(01020155) 2223_L2_STRDRS(01020223) 2224_L2_STRDRS(01020224) 2225_L2_STRDRS(01020225) 2626_L10_STRDRS(01040126.) 2627_L10_STRDRS(01040127) 2628_L10_STRDRS(01040128) 2629_L10_STRDRS(01040129) 2198_L1_SMKCNTRL(01020198) 3126_L1 AV_SHUT(01080126) 3129_L2_AV SHUT(01080129) 3131_L2_AV_SHUT(01080131) 3133_L2_AV SHUT(01080133) 3160_L2_AV SHUT(01080160) 3127_L1_HEATPUMP_SHUT(01080127) 3130_L2_HEATPUMP_SHUT(01080130) 3132_L2_HEATPUMP_SHUT(01080132) 2132_L1_DAMP(01020132) 2167_L1_DAMP(01020167) 2137_L2_DAMP(01020137) 2150_L2_DAMP(01020150) 2145_ACCESS_RELAY(01020145) 650_NCD(01050001)[+SEND]"111102002" 650_NCD(01050001)[-SEND]"311102002" Correlation Report Project: 650_NCD Version: 05.00.01 10/23/201512:03:45 PM Correlation Report Project: 650_NCD Version: 05.00.01 10/23/2015 12:03:45 PM Alcaraz, Debbie From: Morris, Nadine Sent: Thursday, May 14, 2015 2:17 PM To: Alcaraz, Debbie Subject: Scan Item Attachments: 72-2010 Harbor Justice CompletionForm 05-13-15.doc Categories: SCAN Please scan into 4601 Jamboree Rd. Thanks! Nadine --- FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time ofsystem 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. 1. PROPERTY INFORMATION Name of property: HARBOR JUSTICE Address: 4601 JAMBOREE RD Description of property: COMM FIRE FACP CPU UPGRADE Occupancy type: B Name of property representative: COUNTY OF ORANGE Address: 1143 E. FRUIT STREET, SANTA ANA, CA 92701 Phone: Fax: Authority having jurisdiction over this property: Phone: 949-644-3255 Fax: E-mail: CITY OF NEWPORT BEACH E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: SimplexGrnnell Address: 12728 Shoemaker Ave., Sante Fe Springs, CA 90625 License or certification number: Phone: 562-405-3800 Fax: 562-405-3801 E-mail: darcaro@simplexgrinnell.com Service organization for this equipment: SimplexGrinnell Address: 12728 Shoemaker Ave., Sante Fe Springs, CA 90625 License or certification number: Phone: 562-405-3800 Fax: 562-405-3801 E-mail: darcaro@simplexgrinnell.com A contract for test and inspection in accordance with NFPA standards is in effect as of: Contracted testing company: SimplexGrinnell Address: 12728 Shoemaker Ave., Sante Fe Springs, CA 90625 Phone: 562-405-3800 Fax: 562-405-3801 E-mail: darcaro@simplexgrinnell.com Contract expires: NA Contract number: Frequency of routine inspections: _ 3. DESCRIPTION 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 alann ❑ EVACS ❑ MNS ❑ Two-way, in -building, emergency communication system ❑ Other (specify): NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12) Copyright 0 2009 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. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2010 Additional description of system(s): NA 3.1 Control Unit Manufacturer: SimplexGrinnell Model number: 4100ES 3.2 Mass Notification System ® This system does not incorporate an MNS 3.2.1 System Type: ❑ In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ® An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: ON -SITE 3.4 System Software ❑ This system does not have alterable site -specific software. Operating system (executive) software revision level: 3.02 REV 7 Site -specific software revision date: 5/11/15 Revision completed by: Clarence Tolsen ®A copy of the site -specific software is stored on site. Location: SIMPLEXGRINNELL 3.5 Off -Premises Signal Transmission Name of organization receiving alarm signals with phone numbers: Alarm: TROYALARM Supervisory: TROYALARM Trouble: TROYALARM Entity to which alarms are retransmitted: NEWPORT BEACH Method of retransmission: SILENT KNIGHT 5104 ❑ This system does not have off -premises transmission. Phone: 877-876-9252 Phone: 877-876-9252 Phone: 877-876-9252 Phone: UNKNOWN If Chapter 26, specify the means of transmission from the protected premises to the supervising station: If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12) Copyright 0 2009 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. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: B Quantity: 12 (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: NA Description: 4.1.3 Device Power Pathways ❑ No separate power pathways from the signaling line pathway ® Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: 0 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: B Quantity: 16 (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: NA Description: 4.2.3 Device Power Pathways ❑ No separate power pathways from the initiating device pathway ® Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: B Quantity: 12 (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: NA Description: 4.3.3 Device Power Pathways ❑ No separate power pathways from the notification appliance pathway ® Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12) Copyright © 2009 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. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ❑ This system does not have manual fire alarm boxes. Type and number of devices: Addressable: Conventional: 13 Coded: Transmitter: Other (specify): 5.1.2 Other Alarm Boxes ® This system does not have other alarm boxes. Description: Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: Conventional: 63 Other (specify): Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area Other (specify): Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): 5.2.2 Duct Smoke Detectors ❑ This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: Conventional: 4 Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors ® This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: 5.2.4 Gas Detectors ® This system does not have gas detectors. Type of detector(s): Number of devices: Addressable: Conventional: Type of coverage: 5.2.5 Heat Detectors ❑ This system does not have heat detectors. Type and number of devices: Addressable: 3 Conventional: Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ® Rate -of -rise ❑ Rate compensated NFPA 72, Fig. 10.18.2.1.1 (p. 4 of 12) Copyright © 2009 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. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules ❑ This system does not have monitoring modules. Number of devices: 0 5.2.7 Waterflow Alarm Devices Type and number of devices: Addressable: 5.2.8 Alarm Verification Number of devices subject to alarm verification: 5.2.9 Presignal Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: 5.2.11 Other Initiating Devices Describe: ® This system does not have waterflow alarm devices. .Conventional: Coded: Transmitter: ® This system does not incorporate alarm verification. Alarm verification set for: seconds ® This system does not incorporate pre -signal. ® This system does not incorporate PAS. ® This system does not have other initiating devices. 6. SUPERVISORY SIGNAL -INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ® This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2 Fire Pump Description and Supervisory Devices ® This system does not have a fire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) ® This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: _ NFPA 72, Fig. 10.18.2.1.1 (p. 5 of 12) Copyright © 2009 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. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Other (specify): 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: Sheriff Dept Location 2: Location 3: ® This system does not have a generator. ❑ Selector switch not in auto ❑ Low fuel ® This system does not monitor special hazard systems. ® This system does not monitor other systems. ❑ This system does not have annunciators. 9. ALARM NOTIFICATION APPLIANCES 9.1 In -Building Fire Emergency Voice Alarm Communication System ® This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound -processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 9.2 Nonvoice Notification Appliances ❑ This system does not have nonvoice notification appliances. Horns: With visible: Bells: 13 With visible: Chimes: With visible: Visible only: Other (describe): 9.3 Notification Appliance Power Extender Panels ® This system does not have power extender panels. Quantity: Locations: NFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12) Copyright © 2009 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. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ® This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: _ Location 2: Location 3: _ 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other (describe): Supervision class: 10.3.1 Special Hazard Notification ❑ This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ® This system does not have a two-way telephone system. Number of telephone jacks installed: Number of warden stations installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ❑ This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright 0 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: _ 11.5 Other Two -Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ® Hold -open door releasing devices ® Smoke management ® HVAC shutdown ® F/S dampers ❑ Door unlocking ® Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release ® Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules ® This system does not have control modules. Number of devices: Other (specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120 VAC Control panel amps: 8 amps Overcurrent protection: Type: CB Amps: 15 _ Location (of primary supply panel board): ELECTRIC /FACP ROOM -1 PB Disconnecting means location: Electric Rm 13.1.2 Engine -Driven Generator ® This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: NFPA 72, Fig. 10.1-8.2.1.1 (p. 8 of 12) Copyright 0 2009 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. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: Control Rm Type: LEAD ACID Nominal voltage: _ 24 V Amp/hour rating: 33 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 ® Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ® This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: Overcurrent protection: Type: Amps: Location (of primary supply panel board): _ Disconnecting means location: 13.2.2 Engine -Driven Generator ® This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.2.3 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): 13.2.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): ❑ Batteries are marked with date of manufacture ❑ Battery calculations are attached NPPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) Copyright 0 2009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power Input voltage of power extender panel(s): Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: ❑ This system does not have power extender panels. Power extender panel amps: Amps: 13.3.2 Engine -Driven Generator ® This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.3.3 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): 13.3.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): ❑ Batteries are marked with date of manufacture ❑ Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before confifcting operational acceptance tests. This is a: ❑ New system ® Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: ® Manufacturer's published instructions Other (specify): System deviations from referenced NFPA standards: Signed: Printed name: Jason Lapa Date: 05/13/15 Organization: SimplexGrinnell Title: Superintendant Phone: 909-801-4381 NFPA 72, Fig. 10,18.2.1.1 (p. 10 of 12) Copyright © 2009 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. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ❑ New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ® Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: ® Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: Organization: SIMPLEXGRINNELL 16. CERTIFICATIONS AND APPROVALS Printed name: DAVID ARCARO Date: 05/13/15 Title: ELECTRONIC SYSTEMS TECH Phone: 714-493-5977 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Jason Lapa Organization: Simplexgrinnell Title: SUPERINTENDENT 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: DAVID ARCARO Organization: SIMPLEXGRINNELL Title: ELECTRONIC SYSTEMS TECH 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: Organization: Troy Alarm Title: Date: 05/13/15 Phone: 909-801-4381 Date: 05/13/15 Phone: 714-493-5977 Date: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 11 of 12) Copyright © 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printed name: Nadine Morris Date: 05/13/2015 Organization: Newport Beach Fire Dept Title: Life Safety Specialist Phone: 949-644-3105 NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright 0 2009 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. Alcaraz, Debbie From: Morris, Nadine Sent: Thursday, May 14, 2015 2:17 PM To: Alcaraz, Debbie Subject: Scan Item Attachments: 72-2010 Harbor Justice CompletionForm 05-13-15.doc Categories: SCAN Please scan into 4601 Jamboree Rd. Thanks! Nadine FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION 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. 1. PROPERTY INFORMATION Name of property: HARBOR JUSTICE Address: 4601 JAMBOREE RD Description of property: COMM FIRE FACP CPU UPGRADE Occupancy type: B _. Name of property representative: COUNTY OF ORANGE Address: 1143 E. FRUIT STREET, SANTA ANA, CA 92701 Phone: Fax: E-mail: Authority having jurisdiction over this property: CITY OF NEWPORT BEACH Phone: 949-644-3255 Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: SimplexGmnell Address: 12728 Shoemaker Ave., Sante Fe Springs, CA 90625 License or certification number: Phone: 562-405-3800 Fax: 562-405-3801 E-mail: darcaro@simplexgrinnell.com Service organization for this equipment: SimplexGrinnell Address: 12728 Shoemaker Ave., Sante Fe Springs, CA 90625 License or certification number: Phone: 562-405-3800 Fax: 562-405-3801 E-mail: darcaro@simplexgrinnell.com A contract for test and inspection in accordance with NFPA standards is in effect as of - Contracted testing company: SimplexGrinnell Address: 12728 Shoemaker Ave., Sante Fe Springs, CA 90625 Phone: 562-405-3800 Fax: 562-405-3801 E-mail: darcaro@simplexgrinnell.com Contract expires: NA Contract number: Frequency of routine inspections: 3. DESCRIPTION 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): NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12) Copyright © 2009 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. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2010 Additional description of system(s): NA 3.1 Control Unit Manufacturer: SimplexGrinnell Model number: 4100ES 3.2 Mass Notification System ®This system does not incorporate an MNS 3.2.1 System Type: ❑ In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ® An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: ON -SITE 3.4 System Software ❑ This system does not have alterable site -specific software. Operating system (executive) software revision level: 3.02 REV 7 Site -specific software revision date: 5/11/15 Revision completed by: Clarence Tolsen ® A copy of the site -specific software is stored on site. Location: SIMPLEXGRINNELL 3.5 Off -Premises Signal Transmission Name of organization receiving alarm signals with phone numbers: Alarm: TROYALARM Supervisory: TROYALARM Trouble: TROYALARM Entity to which alarms are retransmitted: NEWPORT BEACH Method of retransmission: SILENT KNIGHT 5104 ❑ This system does not have off -premises transmission. Phone: 877-876-9252 Phone: 877-876-9252 Phone: 877-876-9252 Phone: UNKNOWN If Chapter 26, specify the means of transmission from the protected premises to the supervising station: If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12) Copyright © 2009 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. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: B (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: NA Description: Quantity: 12 4.1.3 Device Power Pathways ❑ No separate power pathways from the signaling line pathway ® Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: 0 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: B (See NFPA 72, Sections 12.3 and 12.4) Quantity: 16 - _ 4.2.2 Pathways Utilizing Two or More Media Quantity: NA Description: 4.2.3 Device Power Pathways ❑ No separate power pathways from the initiating device pathway ® Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: B Quantity: 12 (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: NA Description: 4.3.3 Device Power Pathways ❑ No separate power pathways from the notification appliance pathway ® Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12) Copyright © 2009 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. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ❑ This system does not have manual fire alarm boxes. Type and number of devices: Addressable: Conventional: 13 Coded: Transmitter: Other (specify): 5.1.2 Other Alarm Boxes ® This system does not have other alarm boxes. Description: Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: Conventional: 63 Other (specify): Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area Other (specify): Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): 5.2.2 Duct Smoke Detectors ❑ This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: Conventional: 4 Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors ® This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: 5.2.4 Gas Detectors ® This system does not have gas detectors. Type of detector(s): Number of devices: Addressable: Conventional: Type of coverage: 5.2.5 Heat Detectors ❑ This system -does not have heat detectors. Type and number of devices: Addressable: 3 Conventional: Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ® Rate -of -rise ❑ Rate compensated NFPA 72, Fig. 10.18.2.1.1 (p. 4 of 12) Copyright © 2009 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. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules ❑ This system does not have monitoring modules. Number of devices: 0 5.2.7 Waterflow Alarm Devices ® This system does not have waterflow alarm devices. Type and number of devices: Addressable: Conventional: Coded: Transmitter: 5.2.8 Alarm Verification ® This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for: seconds 5.2.9 Presignal ® This system does not incorporate pre -signal. Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) ® This system does not incorporate PAS. Describe PAS: 5.2.11 Other Initiating Devices ® This system does not have other initiating devices. Describe: 6. SUPERVISORY SIGNAL -INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ® This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2 Fire Pump Description and Supervisory Devices ® This system does not have afire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) ® This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: NFPA 72, Fig. 10.18.2.1.1 (p. 5 of 12) Copyright © 2009 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. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Other (specify): 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: Sheriff Dept Location 2: Location 3: 9. ALARM NOTIFICATION APPLIANCES ® This system does not have a generator. ❑ Selector switch not in auto ❑ Low fuel ® This system does not monitor special hazard systems. ® This system does not monitor other systems. ❑ This system does not have annunciators. 9.1 In -Building Fire Emergency Voice Alarm Communication System ® This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound -processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 9.2 Nonvoice Notification Appliances Horns: With visible: Chimes: With visible: Visible only: Other (describe): 9.3 Notification Appliance Power Extender Panels Quantity: Locations: ❑ This system does not have nonvoice notification appliances. Bells: 13 With visible: ® This system does not have power extender panels. NFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12) Copyright © 2009 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. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ® This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other (describe): Supervision class: 10.3.1 Special Hazard Notification ❑ This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ® This system does not have a two-way telephone system. Number of warden stations installed: ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ❑ This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright © 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two -Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ® Hold -open door releasing devices ® Smoke management ® HVAC shutdown ® F/S dampers ❑ Door unlocking ® Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release ® Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules Number of devices: Other (specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120 VAC Overcurrent protection: Type: CB Location (of primary supply panel board): Disconnecting means location: Electric Rm 13.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: ® This system does not have control modules. Control panel amps: 8 amps Amps: 15 ELECTRIC /FACP ROOM -1 PB ® This system does not have a generator. Type of fuel: NFPA 72, Fig. 10.18.2.1.1 (p. 8 of 12) Copyright © 2009 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. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: Control Rm Type: LEAD ACID Nominal voltage: 24 V Amp/hour rating: 33 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 ® Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ® This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: 13.2.2 Engine -Driven Generator Location of generator: Location of fuel storage: EVACS or MNS panel amps: Amps: ® This system does not have a generator. Type of fuel: 13.2.3 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): 13.2.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture Nominal voltage: In alarm mode (minutes): ❑ Battery calculations are attached Amp/hour rating: NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) Copyright © 2009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power Input voltage of power extender panel(s): Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: 13.3.2 Engine -Driven Generator Location of generator: Location of fuel storage: ❑ This system does not have power extender panels. Power extender panel amps: Amps: ® This system does not have a generator. Type of fuel: 13.3.3 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): 13.3.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture 14. RECORD OF SYSTEM INSTALLATION Nominal voltage: In alarm mode (minutes): ❑ Battery calculations are attached Amp/hour rating: Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before confitcting operational acceptance tests. This is a: ❑ New system ® Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: ® Manufacturer's published instructions Other (specify): System deviations from referenced NFPA standards: Signed: Printed name: Jason Lapa Date: 05/13/15 Organization: SimplexGrinnell Title: Superintendant Phone: 909-801-4381 NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright © 2009 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. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ❑ New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ® Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operatingproperly in accordance with the requirements of the following: ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: ® Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: Printed name: DAVID ARCARO Date: 05/13/15 Organization: SIMPLEXGRINNELL Title: ELECTRONIC SYSTEMS TECH Phone: 714-493-5977 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Jason Lapa Organization: Simplexgrinnell Title: SUPERINTENDENT 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: DAVID ARCARO Organization: SIMPLEXGRINNELL Title: ELECTRONIC SYSTEMS TECH 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: Organization: Troy Alarm Title: Date: 05/13/15 Phone: 909-801-4381 Date: 05/13/15 Phone: 714-493-5977 Date: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 11 of 12) Copyright © 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printed name: Nadine Morris Date: 05/13/2015 Organization: Newport Beach Fire Dept Title: Life Safety Specialist Phone: 949-644-3105 NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright © 2009 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. STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST bl"LY 850 (REV.10-94) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONENUMBER REQUESTDATE PROGRAM Substance Use Disorder Compliance Branch 916 327-3091 7/22/15 Residential EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUESTCODE Joanne Howard 300330BP 1A CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING Department of Health Care Services 2. RENEWAL B. LIFE SAFETY AGENCY Licensing and Certification SECTION NAME AND Substance Use Disorder Compliance Division 3. CAPACITY CHANGE ADDRESS PO Box 997413, MS 2600 4. OWNERSHIP CHANGE Sacramento, CA 95899-7413 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 6 0 0 0 0 0 6 FACILITYNAME LICENSECATEGORY AFFINITY RECOVERY RES-DETOX STREETADDRESS (Actual Location) NUMBER OF BUILDINGS 1911 KINGS ROAD 1 CITY RESTRAINT NEWPORT BEACH, CA 92663 N/A FACILITY CONTACT PERSON'S NAME HOURS Evan Rabinowitz, CEO 949-531-6530 24 SPECIAL CONDITIONS NONE FIRE:; AUTHORITY NAME AND ADDRESS l.� TO BE COMPLETED .BY INSPECTING AUTHORITY` Newport Beach Fire Department PC Box 1768.100 Civic Center Dr. Ne'tdpr; Beach CA 92660 J LIFE SAFETY SERVICES INSPECTOR'SNAME (TjpedorPrinted) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCYCLASS INSPECTION DATE INSPECTOR'S SIGNATURE a q-'q-1. -1 3 ICA N ct&L v� K( &A& 6 EXPLAIN DENIALOR LISTSPECIAL CONDITIONS 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER ,r7_505,19 Kk 533av5 �aa�a � q t 0 1C4o-� (-Isiz-> C-1 T� Ball KtN61S2b 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 August 10, 2015 RE: Affinity Recovery, LLC 1911 Kings Road, Newport Beach, CA 92663 049-222-04 Dear Mr. Lewis: The above referenced property is located within the Single -Unit Residential Zoning District (R-1) and is designated as Single -Unit Residential Detached within the'Land Use Element of the General Plan (RS-D). This Zoning District allows for single-family dwellings. Residential Care Facilities, Limited (6 or fewer beds) Licensed by the State of California are a permitted use within the R-1 Zoning District. Based on the pending State License and the documents provided, found attached, the proposed Residential Care Facility, Limited (6 or fewer beds) is found to be a use in compliance with the R-1 Zoning District. However, operation of the facility shall not commence until the State license is received as well as the Fire Clearance from the Fire Department. Please submit a copy of the license once received from the State for confirmation. Staff will maintain the contact number for Affinity Recovery, 949-531-6530 for public and/or City contact. Thank you. Should you have any further questions, please contact me at 949-644-3221 or mwhelan(a)-newportbeachca.gov Sincerely, Kimberly Brandt, AICP, Community Development Director By: Melinda Whelan Assistant Planner Enclosures: Operation information for 1911 Kings Rd. DHCS Application Letter from Affinity Group Compliance Officer t 1 Written Request Form for Zoning Clearance Please provide the requested information below. Upon review of this completed form, staff will provide a Zoning Clearance letter as to whether the request is in compliance with the Zoning Code and if occupancy can be pursued. 1. Property address including unit if occupying one unit in a duplex. 2. Provide the Zoning of proposed property.. 3. Proposed bed count per unit or address, Male (M) or Female (F). 4. ADP License Pursued (Y or N). Provide copy of license. If no, provide lease or rental agreement. 5. Requested date of Occupancy. 6. As a courtesy if you could provide the operation manager information to assist staff in making contact if we get calls from the neighbors or the public. Thank you for taking the time to speak with me earlier this week. Below, I have responded to the questions on the Written Request Form in connection with Affinity Group LLC's request for a Zoning Clearance letter. Also, I have attached the amended license application for the Department of Health Care Services showing that the proposed bed count is six (6) beds. 1. The property address is 1911 Kings Road, Newport Beach, California 92663. 2. The house is located in the R-1 (Single -Unit Residential) Zoning -District. 3. The proposed bed count for this house is six (6) beds. Affinity Group LLC's license application is for both males and females at the home, although the company expects the home to be used for females only. 4. 1 have attached an executed copy of the lease. 5. The requested date of occupancy is August 15, 2015. 6. The contact person for Affinity Group LLC is Evan Rabinowitz. His phone number is (949) 531-6530, and his email is evana-affinityrecovery.com. ` PO Bu9r,,413 TIP 1. Target Population (check all that apply) General Populallon (co-ed) E] Go-Ed[Ch Wren Co-Ed1Ch[1d?M21 0109nosIS Ej- Dual DfagrIQ34 Z Services to So Provided (check all that apply) nVEducational Sessions (ES) oRecavetycrTmobwntPlannIN(RFIlorTi$) Is water used for human consumption suppliod by municipality? jyj yes' E] If yes, give thtt name of ft munlclpaff�r Mesa Water DIsVict If no, gWe the source of water ... 4. Occupancy indicate the bed capacity for which you are applytng[Xbrther VHCS- NOTE,, License capacl!y shall never excacti total capacltyapproved-by-thdll� �authwd —1— Indicate numbet of staff beft If any; 0,00 Number -of TOTAL CAPAWY includes treatment. dependent children of restdents, WW slaff beft and $hpfl nbt-iixteed t&ALtapc-ay approved, by the fita authqmy 6. Fire Authority Information LOCAL FIRE INSPECTION AUT*40PJTY INFORMATION PLIZA613 FULLY COMPLETETHIS SECTION process, Nve are reqWring that you identify the total *e PWectiog,1690 Is" Tospof5fbILi, 14 lnsp6d Your faciffty '1rWfy and Issue a fire. clearance. DHCS Wit submit the fim clearandd d; -to yaw 164'al LOCAL FIRE INVECTION AUTHORITY PHONE ADDRESS CITY zo opoe W August 2, 2015 VIA EMAIL City of Newport Beach Attention: Melinda Whelan MGondreziir�,newportbeachca.gov Ile: 1911 Kings Road, Newport Beach Dear Ms. Whelan: Pursuant to your request, I am writing to undeniably confirm that Affinity Group = understands that it will not be permitted to have more than six (6} beds ai its 1911: Kings Road location. The application we submitted to the Department of Health. Cam SerN ices, as well as the, fire clearance request, was for a total of six beds. Please do not hesitate to call me at 916-704-4279 should you have any Airther questions ds issue. Lewis Compliance Officer Affinity Group LLC 1 STATE OF CALIFORNIA �Y�� QEVt1 opmai� DEPARTMENT OF HOUtING AND COMMUNITY ["F� DM$iON OF CODES AND STANDARDS P'RiVATE FIRE HYDRANT TEST AND CERTIFICATION REPORT ALL PARKS MUST RETURN THIS FORM TO THE ENFORCEMENT AGENCY FOP. THE PARK (SEE THE REVERSE SIDE FOR INSTRUCTIONS ON COMPLETING THIS I:ORM Part 1 - iDENTIFICATION Park ID# 30-0167 Park Name: Lido Park Address: 710 N. Lido Park Dr. City. Newport Beach CA ZIP: 92663 Park Operator Name Bessire & Casenhiser Phone Number (909) 594-0501._ Park Operator Address and city 430 $. San Dimas Blvd. Sant Dimas CA 91773 Part 2 - CERTIFICATION EXCEPTIONS - You do not need certlficaUon, but must comptate this section if any of tite following applies: ❑ Hydrants are publicly owned and maintainad - Water Company Name ❑ No hydrants and park was built before September 1, 1968 - List Tate of Construction: ! � ❑ No hydrants ,arm park has 14 or less total lots - Enter Number of Lots: ❑ No private hydrants and park was built after September 1, 1968, (SpeGifiic exception at the time of construction.) Part 3 - ANNUAL FIRE HYDRANT OPERATION TEST (initial verification in the appropriate column) (Standpipes are considered hydrants for these requirements) YES NO CORRECTED 1, Hydrant stems and valves operate fully, freely, and are properly lubricated. _A_ - - —. 2. All hydrant threads and raps are undamaged. X ----�—------T S. Where subject to vehicular damage, hydrants are physically protected. X- 4. Around all hydrants is a minimum of 36 inches of unobstructed access, __X — 5. All hydrants outlets are 14 inches to 24 inches above grade. X — (Standpipe outlets need not be a specific height, but must be readily accessible.) 6. Each hydrant is clearly identified or marked. --— h d t h a raved hose in a marked enclosure, N/A -- 7. Each 1 /Z -inch y ran as an rapp -- AH'Wnre mnQw,arc arp violations and will Prohibit the issuance of the pant Permit to Operate. Verification: I verify under penalty of perjury that either this park is exempt from testing requirements or the hydrant operation is in compliance. Dark owner or operator Part 4 — FIVE -YEAH FIRE HYDRANT WATER FLOW TEST I one eomplewa ay aulnur Ixeu cep a m lirm i . Barrel Size Flow Pressure Space Barrel Size Flow Presssu're Space (inches) to (GPM) 905 (PSi) 70..._._ FH1 (inches) 4 6 1 (GPM) (7 I) F�4 1 8 100Q._.... 70 FH2 5 6 .990 70 FH5 3 6 985 70 FH3 9 6. _. 970 72 FH6 FOR lNORE THAN HYDRANTS IN THE PARK, ATTACH AN ADDITIONAL, LIST USING THE FORMAT ABOVE. (GPM) -GALLONS PER MINUTE. (PSI) - RESIDUAL PRESSURE IN POUNDS PER SQUARE INCH. PART a — CERTIFICATION OF TEST RESULTS Certifier Name Meterman, Inc. ....,-License Class and No: C-16 #729180 Address PMB# 367 - 40485 Murrieta Hot Springs load - Murrieta, CA 92563-6406 Telephone Number (951) 672-6909 E-Mail Address randy@metermanine.com Printed e h Morgan Title Field Operations Signatur Date of Test Part 6 — AAR6VAL FOR CONTINUED'U'SE or- EXISTING SYSTEM To 8B COMPLETED BY LOCAL FIRE_ AGENCY ONLY Agent Name 110) MI' 53Z (i;ov 1147) Sido I Title .'C'Ainuation sheet: Additional hydrants Name of Facility: Lido Address: 710 N. Lido Park Dr., Newport Beach, GA 92063 Hydrant Number Barrel size (inches) Flaw (GPM) 7. FH7 6 1000 8. FH8 6 980 9. FH9 6 _ 1000 10. — 11. 12. 13. - 14. _ - 15. - 16. 17. _ - 18. 20. 21. 22. Park la# 30-018 Pressure (PSI) 70 70 72 NEWPORT BEACH FIRE DEPARTMENT - P.O. Box 1768, 3300 NEWPORT BLVD., NEWPORT BEACH, CA 92658-8915 PHONE: (949) 644-3104 FAX: (949) 644-3120 WEB: WWW.NBFD.NET SCOTT L. POSTER FIRE CHIEF DATE: 07-11-2012 VFS FIRE & SECURITY SVCS 1011 E LACY AVE ANAHEIM CA 92805 SUBJECT: NOTICE OF EXPIRED PERMIT ADDRESS: 230 LILLE LN NB St: 1 FI: 3 Unit: 313 Our records indicate that permit # F2010-0314 issued on 08110/2010, is expired effective 07/3112012, based on limitations set forth in Section Section 105.3.1 of the 2010 California Fire Code. If the work has begun and intended to continue, a new permit shall be obtained. The permit fee shall be one-half the amount required for a new permit for such work, provided no changes have been made or will be made in the original construction documents, and provided it has not exceeded one year. The new permit is required prior to beginning work. Please contact Fire Inspector Nadine Morris in the Fire Prevention Division at nmorris nbfd.net or (949) 644-3105 within two weeks from the date of this letter regarding the status of the project. Thank you for your prompt attention to this important matter. Sincerely, NEWPORT BEACH FIRE DEPARTMENT Kevin Kitch, Assistant Chief, Life Safety Services Nadine Morris Fire Inspector Morris, Nadine 14 From: Morris, Nadine Sent: Monday, August 27, �012 10:19 AM To: 'Linda Maiocchi' Subject: RE: 230 Lille Lane # 1.13, Newport Beach Good morning Linda, The Building Department has expired their permits for this project. Since I have not received a status from your agency, permit no. F2010-0314 will be expired effective July 31, 2012, as per the notice sent on July 11, 2012. Thank you, Nadine .Nadine Morris Fire Inspector Newport Beach Fire Department (949) 644-3105 1 (949) 723-3505 Fax I nmorris@nbfd.net 1'R Safety, Service, Professionalism From: Linda Maiocchi [mailto:Linda. MCabvfsfire.coml Sent: Friday, August 17, 2012 8:51 AM To: Morris, Nadine Subject: RE: 230 Lille Lane #313, Newport Beach Hi Nadine, 1 apologize for the delay and thank you for letting me know that this has not been taken care of. I have followed upon the request that was sent on 8/3/12 and I hope to have an answer for you today. Thank you for your patience. Linda Maiocchi VFS Fire & Security Services 1011 East Lacy Avenue Anaheim, California 92805 714-778-6070 x21 714-778-6090 fax lnda. m (a)-vfsfire. com `A Save Trees: Don't print this e-mail unless necessary. CONFIDENTIALITY NOTICE This message and any attached documents are confidential and intended only for the use of the addressee. Access to this message by anyone else is unauthorized. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action or omission taken by you in reliance on the contents of this information„ is strictly prohibited and may be unlawful. If you received this transmission in error, immediately contact the sender. Thank you. From: Morris, Nadine [mailto:NMorrisC NBFD.net Sent: Friday, August 17, 2012 8:33 AM To: Linda Maiocchi Subject: RE: 230 Lille Lane #313, Newport Beach Good morning Linda, I'm following-i _p with you since I haven't heard back from anyone at VFS. Thank you for your assistance, Nadine Nadine .Morris Fire Inspector Newport Beach Fire Department (949) 644-3105 1 (949) 723-3505 Fax I nmorris@nbfd.net Safety, Service, Professionalism From: Linda Maiocchi [mailto:Linda. M@vfsfire.com] Sent: Friday, August 03, 2012 10:18 AM To: Morris, Nadine Subject: RE: 230 Lille Lane #313, Newport Beach Hi Nadine, I have forwarded your email to the necessary individuals and hopefully we can get this resolved. If you do not receive a reply please let me know. Linda Maiocchi VFS Fire & Security Services 1011 East Lacy Avenue Anaheim, California 92806 714-778-6070 x21 714-778-6090 fax linda.m(a),vfsfire.com `A Save Trees! Don't print this e-mail unless necessary. CONFIDENTIALITY NOTICE This message and any attached documents are confidential and intended only for the use of the addressee. Access to this message by anyone else is unauthorized. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action or omission taken by you in reliance on the contents of this information is strictly prohibited and may be unlawful. If you received this transmission in error, immediately contact the sender. Thank you. From: Morris, Nadine [mailto:NMorris@NBFD.netl Sent: Friday, August 03, 2012 10:10 AM To: Linda Maiocchi Subject: 230 Lille Lane #313, Newport Beach Good morning Linda, Attached is a copy of the front and back of the sprinkler permit along with the expiration letter sent on July 11, 2012. Though the letter states that the permit expired on 7/31/2012, 1 have not processed the expiration. If the project is nearing completion, I'll keep the permit open so that a final inspection can be conducted. The rough piping inspection was conducted on the original permit, F2007-0387, on 1/9/2008. But this permit was expired effective 8/19/2009. I'm in the office today until 3:00 PM, returning back to the office on Tuesday, August 7, 2012. Thank you for your assistance, Nadine Nadine .Morris Fire Inspector Newport Beach Fire Department (949) 644-3105 i (949) 723-3505 Fax i nmorris@nbfd.net Safety, Service, Professionalism c FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. 1. Protected Property Information F:901 a - b 3- Name of property: FIRST REPUBLIC BANK Address: 3991 MACARTHUR BLVD. SUITE 300 NEWPORT BEACH, CA 92660 Description of property: BANK Occupancy type: B Name of property representative: Address: Phone: Fax: E-mail: Authority having jurisdiction over this property: NEWPORT BEACH FIRE DEPT Phone: 949-644-3106 Fax: 949-644-3120 E-mail: 2. Fire Alarm System Installation, Service, and Testing Information Installation contractor for this equipment: VFS FIRE & SECURITY SERVICES Address: 1011 EAST LACY AVE. ANAHEIM, CA 92805 Phone: 714-778-6070 Fax: 714-778-6090 E-mail: Service organization for this equipment: Address: Phone: Fax: E-mail: Location of as -built drawings: OWNER / PANEL Location of Historical Test Reports: Location of system operation and maintenance manuals: OWNER A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: _ Address: VFS Phone: Fax: E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. Type of Fire Alarm System or Service NFPA 72® Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers (if applicable): Alarm: HONEYWELL Supervisory: HONEYWELL Trouble: HONEYWELL Entity to which alarms are retransmitted: Method of retransmission of alarms to that organization or location: Phone: 800-836-6691 Phone: 800-836-6691 Phone: 800-836-6691 Phone: NFPA 72, Fig. 4.5.2.1 (p. 1_ of 5) Copyright© 2009 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. i If Chapter 8, note the means of transmission from the protected premises to the central station: []Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2-way radio ❑ 1-way radio ❑'N/A If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: Site -specific software revision date: Revision completed by: 4. Signaling Line Circuits Characteristics of signaling line circuits connected to this system (see NFPA 72 ® Table 6.6.1): Quantity: Style: Class: 5. Alarm -Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system (see NFPA 72® Table 6.5): Quantity: _ V Style: — Class: 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: 1 Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: 10 (NEW & EXISTING) Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: 0 Type of coverage: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: [:]Ionization ®Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: 0 — Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for seconds 6. Supervisory Signal -Initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: 0 Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A NFPA 72, Fig. 4.5.2.1 (p. 2 of 5) Copyright ©2009 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. 6.2 Fire Pump Type of fire pump: ❑ Electric ❑ Diesel Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter '❑ N/A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine -Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter -❑ N/A ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: 7. Annunciators 7.1 Annunciator 1 ❑ Local ❑ Remote Type: o Addressable []Directory ❑ Graphic ❑ N/A 7.2 Annunciator 2 ❑ Local ❑ Remote Type: o Addressable ❑ Directory ❑ Graphic ❑ N/A 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A 8. Alarm Notification Devices and Circuits 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of speakers: 8.2 Telephone Jacks Location: Location: Location: Number of multiple voice alarm channels: Number of speaker zones: Number of telephone jacks installed: _—_ Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFPA 72® Table 6.5): Quantity: -- ----------- Style. ------- --------- Class: 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device: Chimes: With visual device: Visual devices without audible devices: 3 Horns: 4 With visual device: 4 Bells: With visual device: Other (describe): NFPA-72, Fig. 4.5.2.1 (p. 3 of 5) Copyright © 2009 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. 9. Emergency Control Functions Activated ❑ Hold -open door releasing devices ❑ Door unlocking 10.System Power Supply 10.1 Primary Power Nominal voltage: 120 Overcurrent protection: Type: _ Location (of primary supply panelboard): Disconnecting means location: _ 10.2 Secondary Power ❑ Smoke management or smoke control ❑ Elevator recall ❑ Other Amps: 20 Amps: Location: PANEL Type: Nominal voltage: 12 Number of standby batteries: 2 Amp hour rating: 7 Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: 24 HOURS Current rating: In alarm mode: 5 MINUTES• 11. Record of System Installation Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) ® NFPA 720 ® NFPA 70® Article 760 ® Manufacturer's published instructions ❑ Other (please specify): System deviations from referenced NFPA standards: Signed: _ --� �' Printed name: GA -AP w Aaigv,v +4Qa Date: _jj ( _j Organization: VFS FIRE & SEC. Title: ALARM TECH Phone: 714-778-6070 12. Record of System Operation All operational features and functions of this system were tested by or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of: ® NFPA 720 ® NFPA 70®, Article 760 ® Manufacturer's published instructions ❑ Other (please specify): ❑ Documentation in accordance with Inspection and Testing Form (Figure 10.6.2.3 of NFPA 72') is attached Signed: l Printed name: �e f p �✓ a1-}� 2� Date: 61— Z - /3 Organization: VFS FIRE & SEC. Title: ALARM TECH Phone: 714-778-6070 NFPA 72, Fig. 4.5.2.1 (p. 4 of 5) Copyright © 2009 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. 13. Certifications and Approvals 13.1 System Installation Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: --rc — _ Printed name: /1_4wo Jhwy Date: 121 Z,�"/ Organization: VFS FIRE & SEC. Title: ALARM TECH. Phone: 714-778-6070 13.2 System Service Contractor This system as specified herein has been installed and tested according to all NFPA, standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: _ Title: Phone: 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: �T Printed name: Date: Organization: Title: Phone: 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig. 4.5.2.1 (p. 5 of 5) Copynghl © 2009 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. 6210 * ' COUNTY OF ORANGE ORANGE COUNTY HEALTH CARE AGENCY ifl ENVIRONMENTAL HEALTH 1241 EAST DYER ROAD, SUITE 120 SANTAANA, CA 92706-6611 (714) 433-6000 M 1Lt t S IZE fqL ,TLC. r PA08 1 INVOICEM IN0946750I 51r V-V I.0 D F C. W I 97M h15-S PFA LT`/ O fjS*'1 L� it t�fZVCTOfZ Owner: Conexant Syste nc SITE: V 1 C E S O G 111 Lb c/o BOB EN 3 1 (D ( yL( I, 64-I j"LSDN b(Z 4000-MbcArthur BLVD 1901 IN STREET STE 200# d DO NEWPORT BEACH, CA 92660 INE, CA 92614 7 I fzq I lut / L 1,+ �f a cc I County of Orange Tax ID# 95-6000928 District A/R # Facility # Invoice Date Due Date Billing Period AR1339164 FA0035849 08/02/2013 09/02/2013 07/01/13 to 06/30/14 Related Date PE PE Program # Site ID Description Amount 08/02/2013 5865 5865 PR0037979 NPB000095 HAZARDOUS MATERIALS - NEWPORT BEACH 08/02/2013 6210 6210 CUPA- STATE SERVICE CHARGE BASE FEE $583.00 $35.00 Total Due: $618.00 PAYMENTS RECEIVED AFTER THE DUE DATE MAY BE SUBJECT TO A MAXIMUM 25% PENALTY. WE RECOMMEND THAT DISPUTES BE RESOLVED OR PAYMENT MADE PRIOR TO THE DUE DATE TO AVOID LATE FEES. FEES ARE DUE FROM ESTABLISHMENTS WHICH OPERATE AT ANY TIME DURING THE BILLING PERIOD. IF THERE HAS BEEN A CHANGE IN OWNERSHIP PRIOR TO THE BILLING PERIOD, PLEASE RETURN THIS INVOICE WITH THE NEW OWNER'S NAME, MAILING ADDRESS AND THE CHANGE OF OWNERSHIP DATE. PLEASE DO NOT SUBMIT POSTDATED CHECK (CHECK DATED LATER THAN THE ACTUAL DATE SUBMITTED) IN PAYMENT OF THIS OBLIGATION. ALL CHECKS WILL BE PROCESSED UPON RECEIPT. FOR ANY CHECKS RETURNED UNPAID, THE MAKER WILL BE CHARGED AN ADDITIONAL FEE. aD )lon N / --3-�l Retain top portion for your records _ _ _ Return this bottom portion with payment **** Write invoice number on check Conexant SPO § Inc - 4000 Ma ur BLVD / Billing Period: F Facility #: FA0035849 NE RT BEACH, CA 92660 5� Ov �, 07/01/13 to 06/30/14 Invoice #: IN0946750 Billing Conexant Sy s Inc Address : c/o BOB RREN 190 AIN STREET STE 200 Due Date: 09/02/2013 Total Due: $618.00 I INE, CA 92614 PLEASE REMIT TO: ORANGE COUNTY HEALTH CARE AGENCY ENVIRONMENTAL HEALTH 1241 EAST DYER ROAD, SUITE 120 SANTAANA, CA 92705-5611 **** MAKE CHECKS PAYABLE TO: **** COUNTY of ORANGE Payment Type: 0 Check Credit Card (see reverse) FOR OFFICE V DATE RECEIVED BATCH/HSO# CHECK DATE SIN KN M R - AMOUNT PAID - INITIALS BRING THIS INVOICE WHEN PAYING IN PERSON 09/17/2013 *IN0946750618.00* M, � �nq� Aj b d Alcaraz, Debbie From: Lunde, Ty Sent: Saturday, May 23, 2015 3:17 PM To: Alcaraz, Debbie Subject: FW: Fire Inspection Attachments: Scan0352.pdf Categories: SCAN Debbie, Please add the attached file to inspection #28363. Thanks, Ty From: Kimberly Foreman [mailto:kim nbaor.com] Sent: Friday, May 22, 2015 8:52 AM To: Lunde, Ty Subject: Re: Fire Inspection Hello Captain Lunde — I'm terribly sorry for the delay in getting this to you, we've had some issues with receiving the data from our monitoring company Sonitrol. I had them come in yesterday to re -do what they needed so that we'll be compliant. I've attached their report for your review and had them post it in the fire riser room as well. Please let me know if you need anything additional. Thank you. Kimberly Foreman of� NEWPo PO T BEACH r � ASSOCIATION CIF REALTOR5O 401 Old Newport Blvd., Suite 100, Newport Beach, CA 92663 (949) 722-2300 www.nbaor.com From: tricia [mailto:tricia@nbaor.com] Sent: Friday, May 01, 2015 3:51 PM To: Kimberly Foreman Subject: Fw: Fire Inspection Sent from my BlackBerry 10 smartphone. 1 From: Lunde, Ty <TLunde(cbNBFD.net> Sent: Friday, May 1, 2015 2:57 PM To: 'tricia@nbaor.com' Subject: Fire Inspection Hello Tricia, I completed a fire inspection at 401 Old Newport Boulevard on April 21, 2015. The fire alarm system is required to be inspected annually. The most recent record that I observed indicated the last test was September 29, 2012. Please provide a record of annual inspection within the last year. If it has not been done, the company that services your alarm system should be able to fulfill the requirement. Please let me know if you have questions. Respectfully, Ty Lunde Fire Captain Newport Beach Fire Department 949-644-3372 - Fire Station 2 949-644-3104 - Fire Administration tiunde()-nbfd.net 2 30 Fairbanks, Suite 114 e , I , Irvine, CA 92618 (949) 768-1414 License No. 006394 SONITROL VERIFIED ELECTRONIC SECURITY Fire Testing & Inspection CL No. 902077 UL Cert. No. UUFX S24707-1 Name: {. Contact: Telephone: Address City Sate Zip r+tq",�: ph�p'y� ,y-� -p�.g ry ..,F-. •; - _ ,h .Ci�': Quarter: 1 21°, 3rd 01 Date: /' `• / Operator Name: Monthly Quarterly Start Time: a.m. p.m. End Time: a.m, p.m. Semi -Annual _AnnuuaP System #: y` " `? i Panel Type: Other: Notes: .9€ 'ZI! i �� $e9" •.. t;; , Device Quantity Notes Device Quanti Notes Manual Stations Supervisory Switches Photo Detectors PIV Duct Detectors OS & y r Heat Detectors Butterfly Valve Waterflow Switches Other: Pull Station Other: Type Visual Functional Comments Battery Condition fl a ' r • s• f- I "' ` ! r ' '4�' Load Voltage ❑ �7 ; ?,I v ^� ,� L Discharge Test ❑ ❑ l� ; Charger Test ❑ ❑ PeOP��t��'� Type Visual Functional Comments i Audible ❑ ,CQ I Visual :❑ ❑ Speakers, ❑ ❑ Comments „- f System Restored to Normal Operation: Date: _ _ / - I / ' `? Time: _ _ a.m. p.m ! i THIS TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS CUSTOMER SIGNATURE TECHNICIAN SIGNATURE ; f ` CUSTOMER PRINT NAME i TECHNICIAN PRINT NAME g i NFPN Apmo rw Alcaraz, Debbie From: Morris, Nadine Sent: Wednesday, October 15, 2014 3:02 PM To: Alcaraz, Debbie Subject: Invoice for State Fire Clearance . Attachments: chld-01@newportbeachca.gov_20141015_145846 OOOOba2e00lb.pdf Hi Debbie, Please invoice the attached facility $75.00 for a State Fire Clearance and scan into Laserfiche. No need to mail the form, they already have a copy. Thanks, Nadine State Fire Marshall 1. Request Date 2. Program FirSafety Inspection Request STD 850 SEPTEMBER 17, 2014 CCL 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714)703-2831 M. MALEK/WT E203 6. SFM' Region 7. SFM I.D. # 8. Facility # 9. Request Code 370 304370526 3A 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 6. Name Change NOTE: PRESCHOOL= 20 7. TOTAL CAPACITY= 20 Hours: Monday -Friday 8:45am-1:15pm Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date 7/10/2009 Capacity Medical Prev.Cap Capacity Medical Prev.Cap 18. Facility Code - 16 - CCC Care? Care? 20 20 No 18 0 No 0 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC PACIFIC SHORES DAY SCHOOL 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 2900 PACIFIC VIEW DRIVE NONE 4. APH 12. ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under CORONA DEL MAR, CA 92625 24 HRS. 6. SNF 14. CCF 7: ICF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special CONZELMAN, COURTENAY 949- 351-5744 NONE 8. ICF/DD 16. Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Telephone # CFI ID# T-19 OCC 1. Fire Clear/Granted 2. Fire Clear/Denied M o ��k S qqq-&LfL4_3)j .3 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code Lj Explanation of Denial or Special Conditions: Denial Code Fire Agency Denial Codes 1.Exits 2.Construct. NEWPORT BEACH FIRE PREVENTION BUREAU 3.Fire Alarm F-Bt:fB. 100 CIVIC CeKTI�-n- �52 4.Sprinklers NEWPORT BEACH, CA. 42663 5.Housekeeping q at��o 6.Special Hazard 7.Other 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 S2 V `s • 11 �/. V OR IT t � -I I i 4 i 1�-(f�� •� } ( 'jt �.1/�, ... t r I i •I` f i i- - - - - --- --, - -- — - - - - - - -- t LIC 999 (3199) -W N EW Fl-N� CqgbUNb 4 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. e�l �L2f�2� • .i .. 11 I �- x — .1. , i - �. I.L.. , 1 �.1.� � - i I ••�•..i.,•`+:�� } t I !. 111 1 � ..i.a-- r !__F_....{_. It I.... _i_ __i t ..I •—I_.i,._.-- — f--F -1;_ ;_�_7 --I---,ice, T —'r---T��';V?t/ _�.'�—,•�—, .c.._.>_—.l_,�..;—: , _� —I , t ,_;_�T I i , t ; .j , : t �-4-1 x I ' I 1 -- — ! �..: ' i 1 ! i FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time ofsystem 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. 1. PROPERTY INFORMATION Name of property: PARK NEWPORT APPARTMENTCBL`OG: 3 p Address: �,__I PARK-N. EWPORT yNEWPORT BEACH. CA 92660 Description of property: RESIDENTIAL Occupancy type: R-2 Name of property representative: JIM DIAZ Address: 1 PARK NEWPORT. NEWPORT BEACH, CA 92660 Phone: 949-644-2622 Fax: E-mail: jdiaz@gb-a.com Authority having jurisdiction over this property: NEWPORT BEACH FIRE DEPARTMENT Phone: 949-644-3611 Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: NUTECH Address: 11223 OLD RIVER SCHOOL RD. SUITE A. DOWNEY CA 90241 License or certification number: Phone: 562-946-3473 Fax: E-mail: INFO@SNOWDENELECTRIC.COM Service organization for this equipment: SIMPLEXGRINNELL Address: 12728 SHOEMAKER AVE. SANTA FE SPRINGS, CA 90670 License or certification number: CA986047 Phone: 562-405-3800 Fax: 562-405-3801 E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of: Contracted testing company: SIMPLEXGRINNELL Address: 12728 SHOEMAKER AVE. SANTA FE SPRINGS, CA 90670 Phone: 562-405-3800 Fax: 562-405-3801 E-mail: Contract expires: Contract number: Frequency of routine inspections: ANUALLY 3. DESCRIPTION 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): NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12) Copyright 0 2009 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. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2010 Additional description of system(s): 3.1 Control Unit Manufacturer: TYCO SAFETY PRODUCTS 3.2 Mass Notification System 3.2.1 System Type: ❑ In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Other (specify): 3.2.2 System Features: Model number: 4100-9114 ® This system does not incorporate an MNS ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS interface ❑ Other (specify):-- 3.3 System Documentation ® An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: DOCUMENT CONTROL 3.4 System Software ❑ This system does not have alterable site -specific software. Operating system (executive) software revision level: 2.02.01 Site -specific software revision date: 10/29/2013 ® A copy of the site -specific software is stored on site. Location: 3.5 Off -Premises Signal Transmission Name of organization receiving alarm signals with phone numbers: Alarm: Supervisory: Trouble: Entity to which alarms are retransmitted: Method of retransmission: Revision completed by: MARTIN GAGNON INSIDE FIRE ALARM CABINET ® This system does not have off -premises transmission. Phone: Phone: Phone: Phone: If Chapter 26, specify the means of transmission from the protected premises to the supervising station: If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12) Copyright 0 2009 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. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 0 Quantity: 1 (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: 0 Description: 4.1.3 Device Power Pathways ® No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: 0 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 0 Quantity: 0 (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: 0 Description: 4.2.3 Device Power Pathways ❑ No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 0 Quantity: 0 (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: 0 Description: 4.3.3 Device Power Pathways ❑ No separate power pathways from the notification appliance pathway ❑ Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12) Copyright © 2009 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. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ❑ This system does not have manual fire alarm boxes. Type and number of devices: Addressable: 60 Conventional: Coded: Transmitter: Other (specify): 5.1.2 Other Alarm Boxes ® This system does not have other alarm boxes. Description: Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: 24 Conventional: Other (specify): Type of coverage: ❑ Complete area ❑ Partial area ® Nonrequired partial area Other (specify): Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): _ _ 5.2.2 Duct Smoke Detectors ® This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: _ Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors ® This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: 5.2.4 Gas Detectors ® This system does not have gas detectors. Type of detector(s): Number of devices: Addressable: Conventional: Type of coverage: 5.2.5 Heat Detectors ❑ This system does not have heat detectors. Type and number of devices: Addressable: 1 Conventional: Type of coverage: ❑ Complete area ❑ Partial area ® Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ® Rate -of -rise ❑ Rate compensated NFPA 72, Fig. 10.18.2.1.1 (p. 4 of 12) Copyright 0 2009 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. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules Number of devices: 5.2.7 Waterflow Alarm Devices Type and number of devices: Addressable: 5.2.8 Alarm Verification Number of devices subject to alarm verification: 5.2.9 Presignal Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: 5.2.11 Other Initiating Devices Describe: ® This system does not have monitoring modules. ® This system does not have waterflow alarm devices. Conventional: Coded: Transmitter: ® This system does not incorporate alarm verification. Alarm verification set for: seconds ® This system does not incorporate pre -signal. ® This system does not incorporate PAS. ® This system does not have other initiating devices. 6. SUPERVISORY SIGNAL -INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ® This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2 Fire Pump Description and Supervisory Devices ® This system does not have a fire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) ®This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: _ Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: NFPA 72, Fig. 10.18.2.1.1 (p. 5 of 12) Copyright © 2009 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. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Other (specify): 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: 1ST FLOOR LOBBY Location 2: Location 3: ® This system does not have a generator. ❑ Selector switch not in auto ❑ Low fuel ® This system does not monitor special hazard systems. ® This system does not monitor other systems. ❑ This system does not have annunciators. 9. ALARM NOTIFICATION APPLIANCES 9.1 In -Building Fire Emergency Voice Alarm Communication System ® This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound -processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 9.2 Nonvoice Notification Appliances ❑ This system does not have nonvoice notification appliances. Horns: With visible: Bells: 45 With visible: Chimes: With visible: Visible only: Other (describe): 9.3 Notification Appliance Power Extender Panels ® This system does not have power extender panels. Quantity: Locations: IVFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12) Copyright © 2009 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. 0 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ®This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other (describe): Supervision class: 10.3.1 Special Hazard Notification ® This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ® This system does not have a two-way telephone system. Number of telephone jacks installed: Number of warden stations installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ® This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright 0 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two -Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ® Hold -open door releasing devices ❑ Smoke management ❑ HVAC shutdown ❑ F/S dampers ❑ Door unlocking ® Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules ❑ This system does not have control modules. Number of devices: 3 Other (specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120 VAC Control panel amps: 9A Overcurrentprotection: Type: SELF RESTORING Amps: 3.5A Location (of primary supply panel board): TOP BAY OF CAN 1 Disconnecting means location: GARAGE ELECTRICAL ROOM 13.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: ® This system does not have a generator. Type of fuel: NFPA 72, Fig. 10.18.2.1.1 (p. 8 of 12) Copyright 0 2009 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. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: FACP/XPNDRS Type: Nominal voltage: 24 Amp/hour rating: 3.5 Calculated capacity of batteries to drive the system: In standby mode (hours): 24 In alarm mode (minutes): 15 ® Batteries are marked with date of manufacture ® Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ❑ This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: BUILT INTO FACP EVACS or MNS panel amps: Overcurrent protection: Type: Amps: _._ _ _ _ __ _ _ Location (of primary supply panel board): Disconnecting means location: _ 13.2.2 Engine -Driven Generator ® This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.2.3 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): 13.2.4 Batteries Location: FACP Type: Nominal voltage: 24 Amp/hour rating: 33 Calculated capacity of batteries to drive the system: In standby mode (hours): 24 In alarm mode (minutes): 15 ® Batteries are marked with date of manufacture ❑ Battery calculations are attached NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) Copyright © 2009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels ® This system does not have power extender panels. 13.3.1 Primary Power Input voltage of power extender panel(s): Power extender panel amps: Overcurrent protection: Type: Amps: Location (of primary supply panel board): Disconnecting means location: 13.3.2 Engine -Driven Generator ® This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.3.3 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): 13.3.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): ❑ Batteries are marked with date of manufacture ❑ Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before confucting operational acceptance tests. This is a: ❑ New system ® Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: 2010 ® Manufacturer's published instructions Other (specify): System deviations from referenced NFPA standards: Signed: Jessld Hervtiawdez Printed name: JESSY HERNANDEZ Date: 10/29/2013 Organization: NUTECH Title: FOREMAN Phone: 562-307-1743 NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright 0 2009 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. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ❑ New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ® Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in thepresence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: 2010 ® Manufacturer's published instructions Other (specify): _ ® Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: MartLv. cagw.ow Printed name: MARTIN GAG -NON Date: 10/29/2013 Organization: SIMPLEXGRINNELL Title: TECHNICIAN Phone: 714-493-1045 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: jessd I-ter"MQZ Printed name: JESSY HERNANDEZ Organization: NUTECH Title: FOREMAN 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Mart%w cagwow Printed name: MARTIN GAGNON Organization: SIMPLEXGRINNELL Title: TECHNICIAN 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: N/A Organization: Printed name: Title: Date: 10/29/2013 Phone: 562-307-1743 Date: 10/29/2013 Phone: 714-493-1045 Date: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 11 of 12) Copyright © 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright 0 2009 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. ltycrr Fire & Security Cfi•�sa1a>.rl�rlsnw!! FIRE ALARM PRE - TEST FORM F-a_D1-3 oC)`f(oi CUSTOMER INFORMATION' SITE INFORMATION BRANCH 434 f CUSTOMER NUMBER PROJECT NUMBER NAME: PARK NEWPORT APPARTEMENTS BUILDING 3 NAME: NUTECH ADDRESS:- - ADDRESS (OR'ATTN: OF): 11223 0LD RIVER_ SCHOOL RD.. ADDRESSi 1 PARK NEWPO.RT ADDRESS; SUITE' A CITY: - 'STATE: -, ZIP: - - - NEWPORT BEACH CA 92660 CITY:STATE: ZIP: DOWNEY CA 90241 .SERVICEAODE 'LBR.=REG "' TRAV REG "" LBR.. OT, TRAV.-OT; MILES - CONTROL PANEL FOR MANUFACTURER: MODEL NO.: TYCO SAFETY PRODUCTS 4100ES ADDITIONAL PANEL INFORMATION•A SERIAL NO. NODE POWERSOURCE: LOCKED CIRCUIT BREAKER: nV Y ON GARAGE7ELECTRICAL.ROOM TYPE OF SIGNALING: QGENERALALARN❑SELECTIVE -]CODED ❑NONE EXECUiNE SOFTWARE REVISION LEVEL 2.02.01 - CFIG (JOB) REVISION LEVEL b� P REVISION# ^^ _ 5mr DEDICATED CIRCUIT: � Y ON BATTERIES: NOTE# AMP HOUR RATING 2 33 PROGRAMMING TECHNICIAN STATE CERTIFICATION/ OTHERCERTIFICATION Martin Gagnon CAFLS# 140969 TR# 175794 TESTING TECHNICIAN/STATE CERTIFICATION OTHER CERTIFICATION' Martin Gagnon, _ CAFLS# 140959 TR# ' 175794,_ , TECHNICIAN SIGNATURE: DATE 10/29/2013, TECHNICIAN SIGNATURE: .' - "lWmta zn ` n osv : DATE 10/29/2013 TROUBLE• I, • •• TO: ZONE TROUBLE Ej NORMAL NOTE# SIGNAL TROUBLE Q NORMAL NOTE# AC POWER LOSS Q NORMAL NOTE# EARTH GROUND NORMAL NOTE# •- I OAC FUNCTIONS•- MFGR. ACK NORMAL NOTE# SILENCE, NORMAL' NOTE#TYPE VOLTAGE• RESET NORMAL NOTE# NORMAL NOTE# MODEL#: • • • FIRE,DO.ORS' • Y ,r NOTE# NOTE # DEVICE TYPE TOTAL NO. DEVICES F SMOKE DETETOR 24 NUMBER 10 TESTED % SEEN07E 24 OK ELEVATOR RECALLS Y NOTE# PULLSTATION 60 60 OK ELEVAT,OR,HELMET LIGHT Y-0 NOTE# • • . HEAT DETECTOR WATERFLOW 1 _ 0 1 0 OK Y NOTE# Y Lj NOTE# • • TAMPER SWITCH VESDASYSTEM 0 0 0 0 Y Lj NOTE# Y Lj NOTE# • DUCT DETECTOR AIR HANDLER CONTROL RELAY 0 0 0 0 Y NOTE# Y NOTE# • • _ MAINTENANCE POINT INPUT MONITORING POINT 0 0 0 0 _ Y NOTE# Y NOTE# • - INPUT ALARM POINT ELEVATOR CONTROL RELAY 0 3 0 3 OK _ _ Y ❑ NOTE# Y ❑ NOTE# PRIMARY ELEVATOR CONTROL RELA • ALTERNATE ELEVATOR CONTROL REI - • • DAMPER CIRCUIT El NO FIRE DOOR CIRCUIT (FACP RELAY CA1 0 0 0 0 0 0 1 OK Y ❑ NOTE# NOTE# Y Y NOTE# ly Y NOTE# NOTE# • • • -• • NOTIFICATION CIRCUIT Y Q NOTE# FIRE ALARM 24VBELL 0 6 45 0 6 45 OK OK Y Y NOTE# Y NOTE# 0 0 Y NOTE# 0 0 Y NOTE# 0 0 Y NOTE# 0 0 Y NOTE# 0 0 CUSTOMER SIGNATURE: _ DATE 0 0 0 0 CUSTOMER NAME ('PRINT): WARRANTY START'DATE - 0 0 0 0 FAILURES/ INFORMATION: SEE NOTE(S) PAGE 13NONE AS FOLLOWS (DESCRIBE FULLY): Page 1 of 1 Cover Page ot L'z> f IF7 L; C' 5-Qt u-; N/ ^--s b6CE Tel: (949) 644.3110 QA-tj (A " 1, J../ rwun@nbfd.net . Rayrnf Wun Life Safety Specialist 11 Newport Beach 100 Civic Center Drive Fire Department F.O. Box 1768 www.nbfd.net Newport Beach, CA 92658-8915 October 28, 2015 Park Newport Apartments 1 Park Newport Newport Beach, CA 92660 ATTN: Ryan Dean QcL --P� f%q'?q® Location: Park Newport Apartments Building # 4 1 Park Newport Newport Beach, CA 92660 5: X'6 VeC4610U tle� Subject: (5) Year Certification Test Report Class 1 - 2 1/" Standpipes 015�7 V""Z'6v' NEWPORT BEACH FIRE DEP`I LIFE SAFETY SERVICES DIV JAN ® 4 zli 1s3 l RECEIVED f� SY: All deficiencies have been corrected as per N.F.P.A. 13 and the local fire codes. Action Fire Protection has certified the (52) Standpipe Systems at the addresses listed above. FIRE DEPT. CONNECTION — OK CONTROL VALVES — OK Note: Per agreement with Inspector Raymi Wun of Newport Beach Fire Department, Standpipe and Fire Hose Stations will demand separate inspections and Certifications. This certification is only in regard to standpipes and does not include hose stations. This concludes the 2015 5 Year Standpipe Certification report. Thank you for choosing Action Fire Protection to take care of your fire protection needs! Sincerely, Joe Rodriguez Service Department Manager Action Fire Protection FIRE SPRINKLER CONTRACTORS • Engineering • Installation • Repairs • Testing 7602 Anthony, Garden Grove, CA 92841 (714) 260-0101 • Fax (714) 823-4623 • Lic. C-16 #848831 • www.actionfp.com ANNEX B 25-83 Inspection, Testing, and Maintenance Standpipe System Page 1 of 3 NFPA 25, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 10/26/15 System Riser ID: 1 Type of System: of CA4 �- Property Information: ❑ Manual Wet ❑ Manual Dry ` Name: PARK NEWPORT 0 Automatic Wet ❑ Automatic Dry Address: 1 PARK NEWPORT- BUILDING # 4 ❑ Semiautomatic Dry ARE NtP�' Class of System: 0 Class I ❑ Class II City: NEWPORT BEACH, CA 92660 Z Class III Combination Sprinkler/Standpipe E Yes ❑ No Main Drain Test Results: Abbreviation Key: Initial Static Pressure: 55 (psi) I = Inspection T = Test Residual Pressure: 15 (psi) M = Maintenance A-O = After Operation Restored Static Pressure: 55 (psi) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Fail N/A PassReference 1.1 1 Quarterly Control Valves 12.3.2.1 12.5.2.112.5.3.1 1.2 I Quarterly Pressure Regulating Devices 1.3 I Quarterly Backflow Preventers 12.6.1 x - 1.4 I Semiannually Piping 6.2.1 x 1.5 I Semiannually Hose Connections Chapter 12 X 1.6 I Semiannually Cabinet NFPA 1962 x 1.7 I Semiannually Hose NFPA 1962 x 1.8- I Semiannually Hose Storage Device NFPA 1962 2.1 T Annually Alarm Device (90 Sec.) 12.2.7 fix/ X 2.2 T Annually Hose Nozzle NFPA 1962 x 2.3 T Annually Main Drain Test (Enter data on'Page 1) 12.2.E 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 2.7 T Annually Backflow Preventer Assemblies 12.6.2 X �Aor�h 71 )nnr 25-84 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Standpipe System Page 2 of 3 NFPA 25, Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 10/26/15 System Riser ID: 1 Type of System:' of cq Property Information: ❑ Manual Wet ��, ❑ Manual Dry ? Name: PARK NEWPORT [E Automatic Wet D ❑ Automatic Dry Address: 1 PARK NEWPORT- BUILDING # 4 ❑Semiautomatic D A�`r' City: NEWPORT BEACH, CA 92660 ry E M Class of System: E Class I ❑ Class II 9 Class III Combination Sprinkler/Standpipe N Yes ❑ No Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.8 T Annually Pressure Reducing Valve - Partial Flow 12.5.2.3 Test 12.5.3.3 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. 12.5.3.2 .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 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 `.:Late Fire Marshal AES 3 March 21, 2006 . • ANNEX B 25-85 Inspection, Testing, and Maintenance Standpipe System Page 3 of 3 NFPA 25, Chapter 6 as amender( by CCR, Title 19 Date of Inspection, Testing, Maintenance: 10/26/15 System Riser ID: 1 Type of System: p CA4" Property Information: ❑ Manual Wet ❑ Manual Dry ai v Name: PARK NEWPORT p Automatic Wet ❑ Automatic Dry Address: 1 PARK NEWPORT- BUILDING # 4 ❑ Semiautomatic Dry ARE .- City: NEWPORT BEACH, CA 92660 Class of System: E Class 1 ❑ Class II 0 Class III Combination Sprinkler/Standpipe .0 Yes ❑ No Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above: THIS SYSTEM DOES NOT CONFORM TO NFPA 14 THEREFORE THE REQUIREMENTS FOR FLOW TESTARE OUTLINED NFPA 25 TABLE 6.3.1 6 WHICH REQUIRES 100 GPM MAX FRICTION LOSS NOT TO EXCEED 15PS1. THIS SYSTEM PASSED CRITERIA FOR FLOW TESTING. ONLY THE CLASS I PORTION OF THE SYSTEM WAS INSPECTED. THE CONTROL VALVES ARE OF THE NON INDICATING TYPE, VALVES HOWEVER ARE LOCKED IN THE OPEN POSITION. All repairs have been made. The Class I Standpipe System is Certified. Z See Continuation Page(s) 1 (Indicate the number of continuation pages) EI PASS ❑ FAIL 10/26/15 Signature Date State Fire Marshal AES 3 March 21, 2006 1'caraz, Debbie From: Morris, Nadine Sent: Tuesday, December 22, 2015 7:57 AM To: Alcaraz, Debbie Subject: SCANNING Attachments: chld-01@ newportbeachca.gov_20151222_080248_00000290001b.pdf Categories: SCAN Please scan, no invoice necessary. Thank you. 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 Orange County District Office 714-567-2906 11/30/15 L&C EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 630016414 LA CODES 1. ORIGINAL A. FIRE CLEARANCE (� LICENSING f CA Department of Public Health 2. RENEWAL B. LIFE SAFETY AGENCY Orange County District Office NAME AND 681 So. Parker Street, Suite 200 3. CAPACITY CHANGE ADDRESS Orange, Ca 92868 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE L 6. NAME CHANGE T OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 'f . n/a I n/a n/a n/a n!a /I,, FACILITY NAME LICENSE CATEGORY SOS Beauchamp Dental Center Primary Care Clinic STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 307 Placentia Avenue, Suite 202, 1 CITY RESTRAINT Newport Beach, Ca 92663 None FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Vanessa Rodriguez 949-270-2199 M-F 8a-5p SPECIAL CONDITIONS TO BE COMPLETED BY INSPECTING AUTHORITY FIRE N ew eoiL 1 cA-A AUTHORITY O NAME AND i� ADDRESS �j� 1 L C 1 A- �1 �acoCc 0 INSPECTOR'S NAME (Typed orPnnted) TELEPHONE UMBER l t LA � NvE T\A S lo-t\A-31Ds INSPECTION DATE INSPECTOR'S SIGNATURE FypedorPrinted) , Q- a t-15 "'-& N CL-CU-vuc- Uri cv\- .0 EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS CFIRS NUMBER 3a0 S OCCUPANCY CLASS CLEARANCE CODE 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIREALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIALHAZARD G. OTHER State Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request ST September 28, 2012(OCFA in error) FCCH October 11, 2012 (OCFA in error) November 27, 2012 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714)703-2831 CONG-HUYEN/vd E2138 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 370 304205646 3A 10. Response Required: Codes 1. Original A.Fire Clearance 6. Name Change Department of Social Services 2. Renewal B. Life Safety Previous Name Community Care Licensing 3. Capacity Change 7. 750 The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change Hours: Monday - Friday 7:30am - 6:00pm Date of Original Request: 11. Ambulatory Nonambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap 18. Facility Code -16 - FCCH Care? Care? 14 14 No 8 0 "No 0 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC MARTIN, KATE 1 2. GACH/R 10. Clinic 3. SH I.I. Jail 14. Street Address (Actual Location) 15. Restraint 613 POPPY AVENUE None 4. APH 12. ICF/DDN 6. PHF 13, RCF City Zip Code 16. Under CORONA DEL MAR, CA 92625 24 hrs. 6. SNF 14. CCF 7. -ICF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special MARTIN, KATE 849-721-0422 None 8. ICF/DD 16. Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Telephone # � CFIRS ID# 1. Fire Clear/Granted ]T-190CC �r- i 2. Fire Clear/Denied 3. Fire Clear/Withh.eld Inspection Date Inspector's Signature Clearance Code j 01 Q j{� ( Explanation of Denial- or Special Conditions: �P Denial Code Re- L-� Zt� 1 N a C u ►rn PLi A13L.t111--2 . Denial Codes 1.Exits NEWPORT BEACH FIRE DEPARTMENT 2. Construct. 3300 NEWPORT BEACH BLVD. 3.Fire Alarm NEWPORT BEACH, CA. 92663 4.Sprinklers ATTN: NADINE 5.Housekeeping 6.Special Hazard 7,Other r" E • November 2T 2012 COMMUNITY DEVELOPMENT DEPARTMENT PLANNING DIVISION 3300 Newport Boulevard, Building C, Newport Beach, CA 92663 (949) 644-3200 Fax: (949) 644-3229 www.iiewportbeachca.gov ZONING COMPLIANCE Reference No. PA2012-127 Although licensed by the State for a large child day care, Kate Martin has committed to the City of Newport Beach to maintain the existing child day care home with a maximum of 8 children as provided in the attached letter. In the future, if she decides that she would like to exceed the maximum 8 children, then she would need to obtain a minor use permit from the Planning Division. Sincerely, Melinda Whelan Assistant Planner Enclosures: Withdrawal Letter 0 1 0 l Vhelan, Melinda From: Whelan, Melinda Sent: Tuesday, November 27, 2012 3:37 PM To: Whelan, Melinda Subject: FW: Kate Martin's application to withdraw request for the Use Permit No. 2012-021 11/27/12 Dear Melinda Whelan, I would like to formally withdraw my application for a Use Permit No. 2012-021 as I understand that this is no longer a necessity as I agree to care for a maximum of eight children a day, four of whom will be infants, at my childcare facility. I fully understand that if I exceed the amount of eight children then I would be required to reapply for another Use Permit from the City of Newport Beach. I also understand that I am no longer required to provide -two parking spaces in my carport for the parents to use when they bring their children to my home at 613 Poppy Avenue, in Corona del Mar. In conclusion, I would like to take this opportunity to thank you for your all your help and guidance. Yours sincerely, Kate Martin. 1 sTATE of cAUFORHIA • HEALTH AND WELFARE AGENCY '--'ZO�VN[n� - ' FAdRLITY SKETdH (Floor Plan) ��E�,�,H� - 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 12). Keep close to scale. Use the space below_ See back for yard sketch. FACILITY NAME. ADDRESS- k31 114 k.k� ti w HIM 15- R R I OUND NOTIFICATION FAX RECEIVED SUCCE FULLY TIME RECEIVED REMOTE CSID DLON PAGES STATUS November 30, 2012 1:48:15 PM PST 949 721 0422 57 2 Received • Nov.30.2012 03:47 PM LAIC lvi La n Ad 949 721 0422 PAGE. 1/ 2 NOV.30.2012 03:48 PM 1 949 0422 PAGE. 2/ 2 YWWI } a + �� ff 9 a Momis,'Nadine , From: Whelan, Melinda Sent: Friday, December 07, 2012 8:55 AM To: Morris, Nadine Subject: RE: 613 Poppy Ave Attachments: PA2012-127 Condition for fire clearance.pdf; Email.pdf Please attach these to the fire clearance. Thank you so much. Melinda Whelan Assistant Planner City of Newport Beach From: Morris, Nadine Sent: Tuesday, December 04, 2012 12:50 PM To: Whelan, Melinda Subject: 613 Poppy Ave Hi Melinda, I have scheduled a fire clearance inspection for Friday, 12/7, at 10:00 AM. Attached is a copy of the form I received from DSS. Prior to signing and sending it back, I will need the letter outlining the City's conditions of approval. Thank you, Nadine Nadine Aorris Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 (949) 723-3505 Fax I nmorris@nbfd.net Safety, Service, Professionalism State Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request STD 850 September 29, 2014 FCCH ( REVISED) 2nd REQUEST 3. Agency Contact 4. Telephone 5. Evaluator CONG-HUYEN, JANE / ES' E268 Department of Social Services (714) 703-2800 Fax (714) 703-2831 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 370 304312720 SA 10. Response Required: Codes 1. Original A. Fire Clearance 6. Name Change Department of Social Services 2. Renewal B. Life'Safety Previous Name Community Care Licensing 3. Capacity Change 7. 750 The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change O'D A.18 GARAGE APPROVED FOR DAY CARE USE? B. IF'THIS fS A TWO STORY DWELLING IS UPSTAIRS/2No FLOOR -APPROVED FOR DAY CARE USE? Hours: Monday - Friday 7:30 AM - 5:30 PM Date of Original Request: 11. Ambulatory Nonambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap 14 ` Care? Care? 18. Facility Code -16 - FCCH 14 No 14 0 No 0 12. Facility Name 13. # of Bldgs. 1. GACH 9.ADHC MARTIN, KATE 1 2. GACH/R 10. Clinic 3. SH 11. Jail' 14. Street Address (Actual Location) 15. Restraint 613 POPPY AVENUE None 4. APH 12. ICF/DDN 5. PHF ^ 13: RCF City Zip Code 16. Under CORONA DEL MAR, CA 92625 24 hrs. 6. SNF 14. CCF 7. ICF/OT 15. DAF 17. Facility Contact Person Telephone # (A 16a. Special KATE MARTIN 949-721-?76 None 8. ICF/DD 16.Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Teleph ne # CFIRS ID# T-19 OCC 1. Fire Clear/Granted Cg4Q) 2. Fire Clear/Denied l , �f �i NE �v` OrZ(Z1 S (oL4+3t OS 3 0D S S 3, Fire Clear/Withheld Inspection Date Inspector's Signature Clear///a//�n/)) a Code r .- D 1 �I 1 �{ �( } (• Q GL C� V ��. t`/ `' �/ `� J 7 Explanation of Denial or special Conditions Denial Code I' L. I T`( /N 0 i1 0 e W) AX t M 11 A P C.I n S C E `ib C, t M 1 N 0 rz Se FLEA 12,e6o 1 Z "ql3-vS U N PrGLt�_ TO 1 Fire Agency Denial Codes 1.Exits NEWPORT BCH FIRE DEPARTMENT 2. Construct. 3.Fire Alarm P 0 BOX 1768 4.Sprinklers NEWPORT BCH, CA 92658-8915 5.Housekeeping ATTN: NADINE MORRIS 6.Special Hazard 7.Other STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY FACILITY SKETCH (Floor Plan) - Family Child Care Home CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING 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. Please identify areas which will be "off limits" to children. Doorand 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 12). Keep dlose to -scale. Use the space below. See back for yard sketch. FACILITY NAME: p � i ! 7 � ,� 1 ,� -r1/� ADDRESS: /�©)0Py 4Vr—. ,y n r E r(ct; g - f T�.ALN:t1U�Ncs � _0 ' • «-----•-__._ i ` t +-- - ---+ � _gip-o--2_ . _F _, _. _ �_ , . _. _._.._ .:- '-�----- ----�= A.D 0-1 ? r --, -T- -a -r- --�j�yl� .G ..-- - , 1 AL r LIC 999A (2/05) I 4J /. tW1,:3 a �U q° Grit tFO �tgth . mEACH AMD YdELrfv�£ ;GEMG� CAUF[hR:NIA0'-FART) bfrofSOCIALSE VMES [3rttiY C+lii`cl1GENStK{ . SVIETC T.d sketch should shOVIIv all buildings in the yard inc€Luting the home (vAlt2 no detail). garage and storage building- _.s waiks, driveways, play area. fences, gates- Shout any potential hazardous area such as pools, garbage starage. .;mat pens, etc. Show the overail yard size. Try to keep the sizes close to scale. 'l_€se the spcice below. r.GORESS ,q �� iiviurn� �.a�r �- �„ g 9'� tJ !� �+ ^_ _ — } {•" a �-- �i�;I'� � �� o .sue � of ta.�- ��i � �t� 7 � (�. ( f v tl s�i"^ � J�"'rd'4• G.�.+ {Jj�.,j"��` - =c $ d d% . (ham_ • - - 4 c I Morris, Nadine From: Morris, Nadine Sent: Wednesday, September 24, 20141:32 PM To: 'Cong-Huyen, Jane@DSS' Subject: RE: KATE MARTIN - 613 Poppy Ave CDM Hi Jane, Thank you for the update. Yes, Chief Kitch and I have spoken. I will await the revised fire clearance form. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net From: Cong-Huyen, Jane@DSS [mailto:Jane.Cong-Huyen(abDSS.ca.gov] Sent: Wednesday, September 24, 2014 12:29 PM To: Morris, Nadine Subject: KATE MARTIN - 613 Poppy Ave CDM Hi Nadine, I recently received an email from Kate Martin and I also spoke to her today regarding her current situation. She stated that she will not be able to start construction to her front house until December 2014 or later. Therefore, she will remain at her front house (613 Poppy Ave.) and will continue to do daycare there. We have taken her fire clearance for a large daycare at that address before, so at this time, our office will be sending you another request for a fire clearance for that current address for the record to be a large license. Kate will be sending me something in writing to withdraw her current pending request for a change of location to the 613 Y2 Poppy Ave address. Please disregard the fire clearance that we have just sent and faxed to you yesterday for that 613 Y2 Poppy address. Kate explained to me that she spoke to Kevin Kitch and he has approved her to have a large license at the 613 Poppy Ave address and for her to contact you to ask that you give her a fire clearance. Have you heard from Kevin? At this time, I just want to keep you posted of what is going on with this licensee. If you need anything, please contact me. Thank you again for all of your help. Jav,&Cv"-Hwye v Licensing Program Analyst DSS - Orange County Child Care (714) 703 - 2818 (714) 703 - 2800 (Main Office) �. 'I GUIDELINES & STANDARDS GUIDELINE A.17 — Large Family Day Care Home A.17.1 PURPOSE The purpose of this guideline is to provide the minimum requirements necessary for review and approval of a large family day care in a residence. The regulations regarding this type of facility are found in the California Code of Regulations Title 19, California Fire Code (CFC), and California Building Code (CBC). A.17.2 SCOPE The guidelines will address single-family residences that are licensed to provide day care for periods less than 24 hours per day for nine to 14 persons, including children under the age of 10 years who reside at the home. A.17.3 PROCEDURE Prior to beginning the process for a fire clearance inspection, contact the Community Development Department for zoning approval. They can be reached at (949) 644-3200. Once approval is obtained, provide a copy to the fire department along with site and floor plans. Allow 10 days for plan review prior to a fire clearance inspection. Provide a Site Plan on 11" x 8 Y/2" paper and include the following: 1. Address 2. Exterior structure exits 3. Landings and ramps for "non -ambulatory" applications 4. Fence lines 5. Gates 6. Pathways to a public way 7. Swimming pool and/or other water features Provide a Floor Plan on 11" x 8 Y2" paper and include the following: 1. Wall layout 2. Room descriptions 3. Exit doors 4. Garage location Any Building Division permits for modifications, such as structural changes, room conversions, electrical work, door landings, ramps, windows and/or doors, shall be inspected and finaled prior to obtaining a fire clearance. LIFE SAFETY SERVICES DIVISION A.17 — Large Family Day Care Home Page 1 of 3 New: March 3, 2014 A.17.4 GENERAL REQUIREMENTS � () �' 5 �1� Room Location Rooms used for child care purposes shall not be located above the first story unless the building is equipped with an approved fire sprinkler system and the exit from the floor provides access directly to the exterior. Premises Identification Address numbers not less than 4" in height shall be posted on the house and visible from the street. Exiting Every story or basement shall have two exits which are remotely located from each other. Every required exit shall not be less than 6' 8" in height and have 32" clear width. Exits shall not pass through kitchens, garages, storerooms, or closets. Door Hardware Doors shall be readily openable from the egress side without the use of a key or special knowledge or effort. Fire Extinguisher One portable 2A10BC rated fire extinguisher shall be provided. • Readily available in a centralized location • Mounted so that the top is not higher than 5' above the floor • Monthly visual inspections are required in addition to annual maintenance Fire Alarm One wall -mounted, manually operated device shall be provided in a centralized location to produce a distinctive alarm when activated. The alarm shall be audible throughout the facility at a minimum level of 15 db above ambient noise level. Smoke Alarms Single -station residential -type smoke alarms shall be provided. Smoke alarms shall be installed and maintained per manufacturer's instructions in the following areas: • Inside all sleeping and/or napping rooms/areas • Outside of each sleeping and/or napping areas • On each floor, including basements Carbon Monoxide Alarms Carbon monoxide alarms shall be installed per manufacturer's recommendations. A.17 — Large Family Day Care Home Page 2 of 3 New: March 3, 2014 LIFE SAFETY SERVICES DIVISION { Gas -fired Water Heaters or Furnaces Heating equipment shall be protected to keep children from coming in contact with the appliances. vo—qK Garage i�� VU The door shall be a solid door not less than 1 3/8" in thickness or a 20-minute fire -rated door. The garage door between the dwelling and the garage shall be self -closing and self -latching. Floor Elevation & Landings A floor or landing shall be provided on each side of a door. Landings shall be level except exterior landings may have a slope not to exceed 0.25 unit vertical in 12 units horizontal. Landings shall have a width matching the width of the door. Thresholds shall not exceed W in height for sliding doors or Y2" for other doors. Thresholds at doorways greater than Y4" shall be beveled. Ramps and Handrails Ramps, when used as a component of a means of egress, shall comply with the following: • Ramps shall not have a slope greater than 12 units horizontal for every 1 unit vertical • Minimum ramp width shall be 36" • Ramps shall be built of materials consistent with the type of construction of the building. • The surface of the ramp shall be of slip resistant materials that are securely attached. • Outdoor ramps shall be designed so that water will to accumulate on walking surfaces. Accessibility Accessibility requirements for persons with disabilities are located in Chapter 11A & 11B of the California Building Code. A.17 — Large Family Day Care Home Page 3 of 3 New: March 3, 2014 LIFE SAFETY SERVICES DIVISION Morris, Nadine From: Cong-Huyen, Jane@DSS [Jane.Cong-Huyen@DSS.ca.gov] Sent: Wednesday, September 24, 2014 12:29 PM To: Morris, Nadine Subject: KATE MARTIN - 613 Poppy Ave CDM Hi Nadine, I recently received an email from Kate Martin and I also spoke to her today regarding her current situation. She stated that she will not be able to start construction to her front house until December 2014 or later. Therefore, she will remain at her front house (613 Poppy Ave.) and will continue to do daycare there. We have taken her fire clearance for a large daycare at that address before, so at this time, our office will be sending you another request for afire clearance for that current address for the record to be a large license. Kate will be sending me something in writing to withdraw her current pending request for a change of location to the 613 Y2 Poppy Ave address. Please disregard the fire clearance that we have just sent and faxed to you yesterday for that 613 %2 Poppy address. Kate explained to me that she spoke to Kevin Kitch and he has approved her to have a large license at the 613 Poppy Ave address and for her to contact you to ask that you give her a fire clearance. Have you heard from Kevin? At this time, I just want to keep you posted of what is going on with this licensee. If you need anything, please contact me. Thank you again for all of your help. Jane Cong-Huyen Licensing Program Analyst DSS - Orange County Child Care (714) 703 - 2818 (714) 703 - 2800 (Main Office) Morris, Nadine r From: Morris, Nadine Sent: Tuesday, October 14, 20141:00 PM To: 'Katesrn@earthlink.net' Subject: 613 Poppy Ave Attachments: chld-01@newportbeachca.gov_20141014_130117_000041d4001b.pdf Good afternoon Kate, Attached is the approved fire clearance. The original will be mailed to Jane today. Please ensure that the exit door hardware is changed to single-action hardware devices. Also, provide a date on the fire extinguisher. Thank you and I'll be in touch regarding the 613 %Z Poppy Ave address. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net State Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request STD 850 September 23, 2014 FCCH 2nd REQUEST 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714) 703-2831 CONG-HUYEN, JANE / ES E2138 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 370 304312720 5A 10. Response Required: Codes 1. Original A. Fire Clearance 6. Name Change Department of Social Services 2. Renewal B. Life Safety Previous Name Community Care Licensing 3. Capacity Change 7. 750 The City Drive #250 Orange, CA 92868 4. Ownership Change \ 5. Address Change A." IS:"GARAGE APPROVED FOR DAY CARE USE. B"s IF THIS=IS'ATWO, STORY G7WELLING IS"UPSTAIRS/2ND FLOOR APPROVED FOR DAY CARE USE? Hours: Monday - Friday 7:30 AM - 5:30 PM Date of Original Request: 11. Ambulatory Nonambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap 14 Care? Care? 18. Facility Code - 16 - FCCH 14 No 14 0 No 0 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC MARTIN, KATE 1 2. GACH/R 10. Clinic 14. Street Address (Actual Location) 15. Restraint 3. SH 11. Jail 613'/2 POPPY AVENUE None 4. APH 12. ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under CORONA DEL MAR, CA 92625 24 hrs. 6. SNF 14. CCF 7. ICF/OT 1"5. DAF 17. Facility Contact Person Telephone # 16a. Special KATE MARTIN 949-721-2720 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 2. Fire Clear/Denied 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code Explanation .of Cienial or Special, Conditions: Denial Code Fire Agency Denial Codes 1. Exits NEWPORT BCH FIRE DEPARTMENT 2. Construct. 3. Fire Alarm P 0 BOX 1768 4.Sprinklers NEWPORT BCH, CA 92658-8915 5.Housekeeping Roy? 6.Special Hazard VI(?7.Other COMMUNITY DEVELOPMENT DEPARTMENT PLANNING DIVISION 3300 Newport Boulevard, Building C, Newport Beach, CA 92663 (949) 644-3200 Fax: (949) 644-3229 www.new-oortbeachca.gov ZONING COMPLIANCE LETTER November 27, 2012 Reference No. PA2012-127 Kate Martin 613 Poppy Avenue Corona Del Mar, CA 92625 RE: 613 Poppy Avenue, Newport Beach, CA 92625 APN 459-231-16 Dear Mrs. Kate Martin The above referenced property is currently located within the Two -Family Residential Zoning District (R-2) of Corona Del Mar and designated as Two -Unit Residential (R-T) within the Land Use Element of the General Plan. These allow for residential uses including child day care homes within the primary residence of a care provider. The Zoning Code defines a small child daycare home as having 8 or fewer children and a large child day care home as having 9 to 14 children. A small daycare is permitted by right within the R-2 Zoning District and a large daycare home requires a minor use permit. Initially, you had applied for a minor use permit to enlarge your existing small child day care home. However, since the application was submitted, you have decided to commit to maintaining the existing child day care home with a maximum of 8 children as provided in the attached letter. In the future, if you decide that you would like to exceed the maximum 8 children, then you would need to obtain a minor use permit from the Planning Division. Sincerely, Kimberly Brandt, AICP, Community Development Director -A" I-, , " A k -, x Melinda Whelan Assistant Planner Enclosures: Withdrawal Letter Page 2 Zoning Compliance - Oroject_File_No>> Tmplt: 06-07-12 Morris, Nadine From: Cong-Huyen, Jane@DSS (Jane.Cong-Huyen@DSS.ca.gov) Sent: Wednesday, June 13, 2012 11:10 AM To: Morris, Nadine Subject: RE- Kate Martin - Large Family Day Care Home Hi Nadine, Thank you for the updated on Kate Martin. I spoke to her and she has turned in her application for a decrease in capacity from 14 to 8. We will be processing her application today and in our system she will be a small license effective 6/4112. If you have any questions, please contact me. Jane Cong-Huyen Liceh§ing Program Analyst (71 et) 703 - 2818 Fax: (714) 703-2831 Community Care Licensing Orange County Child Care Regional Office 7$0 The City Dr. # 250 Orange, CA 9286$ (714)703-2800 Main Office ----Original Message ---- From: Morris, Nadine [mailfo.NMorrisc&NBFD.netj Sent:-Mohday, June 04, 2012 4:01 PM To: Cong-Huyeri, Jane@DSS Cc: Mufillo, Jaime Subject: Kate Martin - Large. Family Day Care Home Good afternoon Jane, This email Is to inform bommunity Care Licensing that the Newport Beach Fire Department is"withdrawing 'the fire clearance issued for a Large Famfly Day Care Home"located at.613 Poppy Avenue, Corona del Mar effective June 4, 2012, In early March. Ms. Martin indicated to Community Development that she did not wish to pursue obtaining, a use permit for a Large Family Day Care and that she would modify her operations to a Small Family Day Care, An extension -was granted to May 31, 2012, in order for Ms. Martin to find accommodations for her clients. Feel free to contact me if you have any questions. Thank you, Nadine Nadine Morris Fire Inspector Newport Beach Fire Department (949) 644-31051 (949) 723.3505 Fax I nmorris cD-nbfd.net Safety, Service, Professionalism Morris, Nadine From: Morris, Nadine Sent: Wednesday, February 22, 2012 11:37 AM To: 'Cong-Huyen, Jane@DSS' Cc: Murillo, Jaime Subject: 613 Poppy Ave, Corona del Mar Good morning Jane, The Fire Department was informed that the facility operator is requesting the withdrawal of the fire clearance for a Large Family Day Care be effective March 6, 2012. This would allow time for placement of current children for which they are providing care. Their request is approved and therefore the facility may operate as a Large Family Day Care until March 6, 2012. After such time, the facility may only operate as a Small Fanifly Day Care Home. Regarding the fire clearance form I received from your office last week —did you heed tome complete the form by choosing "3. Fire ClearMjithheid"? Please clarify the proper completion of the form. Thank you, Nadine 'Ni2t.�INC? :hfOrt is Pyre Inspector Newport $each Piro Department (949) 044-3td51(949) 723-3505 Fax I Prr.0I s@nbitl 1191 a Safety, Sorvire, Profossion0ltsnt February 15. 2012 Kate Martin 613 Poppy Avenue Corona del ANIar, CA 92623 Subject: Large Family Day Care Fire Clearance: 613 Poppy Ave, Corona del Mar, CA Dear Ms. Martin - This letter is ciineerning a complaint received by the City of Newpext Beach reg'rd'uig the operation of a Large Fairiily.Day Care at the al)60 subjectfocation. I2esaarch roncin!cted by the Planning Division revealed that the facility was operating with6ut a A inorUw Permit, which is required for barge Family Day Care facilities. Though a fire clearance was issued on Mgy 28, 2009, at the time of the imInd-ion-1 was �not aware that the City required a Minor Use.Pehnit for a single family rrsidencas to provide day care for 9 to 14 children. Therefore, the Fire Department has withdrown thLTire C:lenwice issued on May 28, 2U09, for a Large Family Day Care Nome at the above subject facility. The residence may only continue to operate as a Small Family Day Care Home providing day [are lot 8 or fewer children. Please contact Jarnie Mu rillu in the Planning Division regardin}; obtaining a Minor Use Permit. He can be reached at (949) 644-3209 or imuriill> +c:it�.iictiti,}�cicl l;�a�h.c l;uti. Feel free to contact me if you have additiprua questions. I can be reached at (949) 6..- 3103 or n�lpuri <inUi.(.nyt. Thank you. SLu:erely, }Nadine Morris Fire Inspector CC: Jane Cong-1-luym, DSS. Cormnunity Care Licensing SAFETY + SERVICE + PROFESSIONALISM State Fire Marshall 1. Request Date 2. Program Fire`Safety Inspection Request STD 850 May 6, 2009 FCCH 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714)703-2831 J. CONG-HUYEN/vd E202 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 370 304205646 3A 10. Response Required: Codes 1. Original A.Fire Clearance 6. Name Change Department of Social Services 2. Renewal B. Life Safety Previous Name Community Care Licensing 3. Capacity Change 7. 750 The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change A. IS GARAGE APPROVED FOR DAY CARE USE? Nlfl B. IF THIS IS A TWO STORY DWELLING IS UPSTAIRS/2No FLOOR APPROVED FOR DAY CARE USE? A Hours: Monday - Friday 7:30am - 6:00pm Date of Original Request: 11. Ambulatory Nonambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap 18. Facility Code - 16 -FCCH Care? Care? 14 No 8 0 No 0 14 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC MARTIN, KATE 1 2. GACH/R 10. Clinic 14. Street Address (Actual Location) 15. Restraint 3. SH 11. Jail 613 Poppy Avenue None 4. APH 12. ICF/DDN City Zip Code 1.6. Under 5. PHF 13. RCF CORONA DEL MAR 92625 24 hrs. 6. SNF 14. CCF 17, Facility Contact Person Telephone # 168. Special 7. ICF/OT 15. DAF Martin, Kate (949) 721-0422 None 8. ICF/DD 16. Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Telephone # 6q ( CFIRS ID# T-19 OCC 1. Fire Clear/Granted 2. Fire Clear/Denied N Di oiE pkD1212 j S t-f 3�U5S � -3 DS 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code S 1 ,DS''/Dq i�Gt Gt✓t �v� I �''-�-D U Explanation of Denial or Special Conditions: 0-0 Denial Code C2� IS WO CA-V- E D20 MVZV , Fire Agency Denial Codes 1.Exits NEWPORT BEACH FIRE DEPARTMENT 2. Construct. 3300 NEWPORT BLVD. 3.Fire Alarm NEWPORT BEACH, CA. 92663 4.Sprinklers 5.Housekeeping 6.Special Hazard 7.Other Morris, Nadine From: Cong-Huyen, Jane@DSS [Jane.Cong-Huyen@DSS.ca.gov] Sent: Friday, August 29, 2014 8:53 AM To: Morris, Nadine Subject: RE: 613 1/2 Poppy Ave Hi Nadine, Thank you for your information and for returning the fire clearance document "Denied Fire Clearance". Now we have proof and a reason to not grant her a large daycare license. If you need anything else from me, please feel free to contact anytime. Have a nice day. Jane Cong-Huyen Licensing Program Analyst DSS - Orange County Child Care (714) 703 - 2818 (714) 703 - 2800 (Main Office) From: Morris, Nadine [mailto:NMorris@NBFD.net] Sent: Thursday, August 28, 2014 4:15 PM To: Cong-Huyen, Jane@DSS Cc: Murillo, Jaime Subject: 613 1/2 Poppy Ave Good afternoon Jane, I've discussed the issue with our Fire Marshal and we are unable to issue a Large Family Day Care license to a facility unless they've obtained a Minor Use Permit from the Community Development Department. I've attached the completed fire clearance for your records. Thank you. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department 100 Civic Center Dr, Newport Beach, CA 92660 (949) 644-3105 1 (949) 723-3505 FAX I nmorris@nbfd.net Safety, Service, Professionalism Morris, Nadine From: Morris, Nadine Sent: Thursday, August 28, 2014 4:15 PM To: 'Cong-Huyen, Jane@DSS' Cc: Murillo, Jaime Subject: 613 1/2 Poppy Ave Attachments: ch1 d-01@newportbeachca.gov_20140828_161602_00001089001 b.pdf Good afternoon Jane, I've discussed the issue with our Fire Marshal and we are unable to issue a Large Family Day Care license to a facility unless they've obtained a Minor Use Permit from the Community Development Department. I've attached the completed fire clearance for your records. Thank you. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department 100 Civic Center Dr, Newport Beach, CA 92660 (949) 644-3105 1 (949) 723-3505 FAX I nmorris@nbfd.net Safety, Service, Professionalism `State Fire Marshall 1. Request Date 2. Program Fiii r Safety Inspection Request STD 850 August 22, 2014 FCCH 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714) 703-2831 CONG-HUYEN, JANE / ES E268 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 304312720 5A 370 10. Response Required: Codes 1. Original A. Fire Clearance 6. Name Change Department of Social Services 2. Renewal B. Life Safety Previous Name Community Care Licensing 3. Capacity Change 7. 750 The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change A. IS-GARAOE.APPROVED FOR DAY CARE USE? B.1F THIS IS A i %NO�- S T-ORY GVvELLING iS UPSTAIRS/R"D FLOOR APPROVED FOR DAY CARE'USE? Hours: Monday - Friday 7:30 AM - 5:30 PM Date of Original Request: 11. Ambulatory Nonambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap 14 Care? Care? 18. Facility Code - 16 - FCCH 14 No 14 0 No 0 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC MARTIN, KATE 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 613'/2 POPPY AVENUE None 4. APH 12. ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under CORONA DEL MAR, CA 92625 24 hrs. 6. SNF 14. CCF 7. ICF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special KATE MARTIN 949-721-2720 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 �v 2. Fire Clear/Denied 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code N I 1�L v� IlL1� �0 Explanatio pf Denial .oq r-Sjpe%ci{a�h'.'Gonditions' Denial Code j % ��% C �//�� )///� �'/! TY IRO Fire Agency Denial Codes 1.Exits NEWPORT BCH FIRE DEPARTMENT 2. Construct. FirP 0 BOX 1768 4.Spri klarm ers NEWPORT BCH, CA 92658-8915 5.Housekeeping 6.Special Hazard 7.Other STrCALIFORNIA •HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING t FACILITY SKETCH (Floor Plan) I Sf �L©a1Q 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 12) Keep close to scale. Use the space below. See back for yard sketch. / {fit} may{ //�� t� S /� i tom,✓' FACILITY NAME:, L^- ! LllA��,I F 2 ! �/ f d / v %QON �1:-k �^ _)0_ ALT } �.,�-l��•6.([C �� V I .T- r '- 3- � ; • - "i- �--� j' _'--� i _i. 1 y i , _I .__ I-.F. :. ! �., I._ _ ' ,7�*►JM1-t ''" � N.tJ J �rr...- -f t } � t r P r t _ .. .. u • .. ,. r- .r-_rwt«,..,t "rwilmvae„ • v... _ _ ' !- , - i - - - . C .• F - jf'�TE•fB(GIF � .a 1 _ [ -_i i .1. _ - }. j - .i _..i _ , . •.1�© -i .. j- k 1 . - t ,, ti( ij _ r. .. _.}. � .i j ,J.-t __.i _1 : ; , . ... .. V. , ._. t...-r •r. ..».�....-..._i..___..,._ --} - i-. 1 .; _ f , A , r i . , r k. , ' f .L._ ' •y'(� j i } _5. _//)p®{�(y]r : i ;. . I F a , 1 v - . . 1 . ! .. . < s. _ . • .. :. ,� �Tw - _. S w •i r • F I- i t t : M1 • , , . .} • • r - t-t-. .. r-. � .• f _ "}_ r ' _' t -i ..[_ i -; - ^i . I ' t a L� v I i • j i * ' }�{ . F ,-"__} i'" !' I 1 - ' , I ! t e " 4 •}_.} [. ..� ._ i 1. _! 't"-'- __ f' i- 71.. F_ , - f1!i y _[ _I _ _ x _ i._• .f.. { - - i ' } _q i e ' i . I i 1 'i}^ i {' • • + i ' ' ! 1 • i } _ ! .1 < • t . r a .__ ? - 1, i _. ..i .._ } ,.. i, i l � I ! .I i � =_ P A -fH - - LIC 999 (3199) (• /1 /1 FYI f /CA ALIFORNIA-HEALTHANDHLWMSERVICESAGENCY CALIFORNIADEPARTMENTOFSOCIALSERVICES COMMUNMYCARELICENSI N9LITY SKETCH (Floor Plan) ,""t ��ooR 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/clientslchikiren. Door and window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Shoyl room sizes (e.g. 8.5 x 47\ Cm hark fnr var i ckatM *T4 tf,+Arlm ORESS: ►'4 vLrk C+ 714A1-'62S" ft s I /`-FACILITY W COMMUNITY CARELICENSINO OFCALIFORNIA-HEALTHANDHUMANSERVICESAGENCY CALIFORNLADEPARTMENTOFSOC.SERVICES SKETCH (Floor Plan) 3R y tav R 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 12). Keep close to scale. Use the space below. See back for vard sketch. FACILITY NAME: ADDRESS: !! y -' Lt/ \ Al �. Wr P1 jj ' -� i I (' ' (- - �r • i . 'iki y� i s , y a 1 ...�..,a �.,.+t•— , a , } - t _ ._:. , a , -- jr 4 t• 1 ' t t i } F . r J. mt.,ud w�Q-:•.axr-.•x? --ar-.dwy-...3-,.._ t_ t � 4^-i..--r...t..... ,.-.k.,...... t I , , : E 1 LIC 999 (3m) I N dy Q L Morris, Nadine From: Murillo, Jaime Sent: Monday, July 28, 2014 4:07 PM To: Morris, Nadine Subject: 613 1/2 Poppy Ave- Daycare Facility Attachments: PA2012-127%20Zoning%20Compliance%20Letter.pdf Hi Nadine, Just an FYI... Kate Martin is rebuilding her front unit where she currently operates a daycare and wants to operate the daycare from the back unit during construction. I just received a call from Jane at the Department of Social Services and she said that Mrs. Martin will need to apply for a new license and will need a new fire inspection. This is that case where they have a large daycare license from the State in order to have more infants, but really only operate with a maximum of 8 children. As such, she meets the definition of a small daycare per of Zoning Code and will did not require a minor use permit. See attached letter. Jane recommended that when we issue her a new fire clearance for the back unit, that we make a note stating that we are only authorizing a maximum of 8 children at any one time. Thanks, Jaime NEWPORT BEACH FIRE DEPARTMENT P.O. BOX 1768, 3300 NEWPORT BLVD., NEWPORT BEACH, CA 92658-8915 PHONE: (949) 644-3104 FAX: (949) 644-3120 WEB: WWW.NBFD.NET SCOTT L. POSTER FIRE CHIEF November 20, 2012 Barbara Pliha Pliha Speech & Learning Center 1000 Quail Street, Suite 120 Newport Beach, CA 92660 Subject: Fire Clearance 1000 Quail Street, Suite 120 Newport Beach, CA 92660 Dear Barbara: The above subject location was inspected on November 20, 2012, for compliance with local fire code requirements. At this time no violations of the California Fire Code were found. A fire clearance has been granted. An invoice in the amount of $83.00 will be processed and mailed to the above address. If you have any questions, I can be reached at (949) 644-3105. Thank you. Sincerely, Nadine Morris Fire Inspector V5�t�1UI I 3 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 1 October 25, 2013 Barbara Pliha Pliha Speech & Learning Center 1000 Quail Street, Suite 120 Newport Beach, CA 92660 Subject: Fire Clearance 1000 Quail Street, Suite 120 Newport Beach, CA 92660 Dear Barbara: The above subject location was inspected on October 24, 2013, for compliance with local fire code requirements. At this time no violations of the California Fire Code were found. A fire clearance has been granted. An invoice in the amount of $83.00 will be processed and mailed to the above address. 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 11 R T ' California Department of Education Special .Education Division Interagency -Nonpublic Schools/Agencies Unit FIRE INSPECTION CLEARANCE* THIS ENTIRE FORM MUST BE COMPLETED BY THE INSPECTING AUTHORITY. Name of Nonpublic Nonsectarian School or Agency: A-CCA-AA-0 M C SC.;P Address: j Lf S ( V.@�i t_ IST- 4#! DS City NI=W Icbarr g L--* - A County: O RA-O C E" State: C.1,0zip: Q ,-.;J to (,v a For Schools Only: Total Classroom Occupant Load: (Based Upon The California Building Code [CCR, Title 241) Number of Classrooms: This facility is approved to serve (check appropriate one): ❑ a. ambulatory ❑ b. non -ambulatory c. both This facility complies with all applicable standards related to fire and life safety (check one): Yes X No ❑ This facility is in violation of standards; the following corrections are required (use back of form if more space is needed.) 1. 2. 3. 4. Nothing contained herein shall be construed as encompassing the structural stability of any building, or as abrogating any more restrictive requirements by other agencies having jurisdiction. For answers to any questions regarding the above clearance contact: Inspector (print name): I " D 9 9 X.5 Title: LICg 5 LI W S l Signature: ft .. :p Name of Inspecting Agency: uwCow-vinAtkA �i I , Telephone:(iJLq (oLJ%4,3 (p,5 Date of Inspection: (0 a`F 113 Contact the local city or county fire department or the fire district providing fire protection services to arrange for this clearance. If you cannot obtain a local fire clearance, your fire inspection can be ordered through the State Fire Marshal. Contact our office for this form. All sites MUST have individual fire clearances. It is a requirement of certification that afire inspection clearance be issued by the appropriate city, county, fire district or state fire official not less than once each calendar year. *Other documentation provided by your local fire department (e.g., STD 850) may be utilized and attached to the CDE fire clearance form if it provides the same information.. I Alcaraz, Debbie From: Morris, Nadine Sent: Friday, December 05, 20141.43 PM To: Alcaraz, Debbie Subject: Invoice Attachments: chld-01@newportbeachca.gov_20141205_134710_00006f88001b.pdf Hi Debbie, Please invoice the attached facility for a State Fire Clearance at $75.00. Thank you, Nadine California Department of Education Special Education Division Interagency -Nonpublic Schools/Agencies Unit FIRE INSPECTION CLEARANCE* THIS ENTIRE FORM MUST BE COMPLETED BY THE INSPECTING AUTHORITY. Name of Nonpublic nonsectarian School or Agency: : jZA-C- ;w,,. i AQ &A-H e Address:.(�hU/kjlq- City: NEVO >D�- g .l- County: S•tate:(,R-- Zip:QQ(,04p o For Schools Only Total Classroom Occupant road:. _ (Basest Upon The California Building Code (CCR, Title 24J) Number of Classroorns: This facility is approved to serve (check appropriate one): El a, ambulatory C b. non -ambulatory c. both This facility complies with all applicable standards related to fire and life safety (check one); Yes lei No 0 This facility Is In violation of standards; the following corrections are required (use ,back of farm if more space is needed.) 2. 3. 4. .vv«r,rrly L.—oLurrrzu r,tzrerrr anuar ve cunsrrNea as encompassing the structura►stawity of any building, or as abrogating any more restrictive requirements by other agencies having!lurisdiction. For answers to any auestions reLyardina thu ahnWek rlranranra rnn+�r4. inspector (print name): ___ �PS�t N C M D (21►2.i�..y` Title: Lk "" � "itif ' 21.A'l`.t S,` Signature: Name of Inspecting Agency: tQt::a�(ja;r- j-.,ps-t Telephone: qgq &H 4 _-3 i C)Date of Inspection: I a, �6— p i e4__ Contact the local city or county fire department or the fire district providing fire protection'services to arrange for this clearance. if you cannot obtain a local fire clearance, your fire Inspection can be ordered through the State lire Marshal. Contact our office for this form. All sites MUST have Individual fire clearances. It is a requirement of certification that a Fire Inspection clearance be issued by the appropriate city, county, fire district or state fire official not less than once each calendar year. -9LF INXn 4 4' Alcaraz; Debbie From: Morris, Nadine . Sent: Monday, October 13, 2014 3:57 PM To: Alcaraz, Debbie Subject: Fire Clearance Invoice Attachments: chld-01@newportbeachca.gov_20141013_155814_0000fa4b001b.pdf Hi Debbie, Please invoice $75.00 State Fire Clearance fee. Thank you, Nadine A I NEWPORT BEACH FIRE DEPARTMENT 100 CIVIC CENTER DRIVE, P.O. BOX 1766,. NEWPORT BEACH, CA 92660 PHONE: (949) 644-3104 FAX: (949) 644-3120 WEB: www.nbfd.net SCOTT L. POSTER Fire Chief October 14, 2014 Barbara Pliha Pliha Speech & Learning Center 1000 Quail Street, Suite 120 Newport Beach, CA 92660 Subject: Fire Clearance 1000 Quail Street, Suite 120 Newport Beach, CA 92660 Dear Barbara: The above subject location was inspected on October 13, 2014, 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 c[�r.nbfd.net. Thank you. Sincerely, Nadine Morris Life Safety Specialist C%�'4 11V&'a Fire Safety Firs December 16, 2015 Barbara Lakin CRYSTAL COVE CLUBHOUSE c/o Keystone Pacific 16845 Von Karman, Suite 200 Irvine, CA 92606 fvk � rl Re: Title 19, 5-Year, Reports and Repair Quotation Crystal Cove Community Association Dear Barbara: 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, cP;��-tc� Brandon Bridgford FIRE SAFETY FIRST C 10/C 16/C36-599761 JAWPDOCS\Sprinkler Department\Sprinkler\00_Keystone Pacific\Crystal Cove Clubhouse 2\2015\Re�e Pomt_22828_SYrCertLtr 121615.doc 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 YES NO N/A N/1 ® ❑ ❑ ❑ 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 Z ❑ ❑ ❑ 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? Z ❑ ❑ ❑ 1. Are all sprinkler system control valves open? N ❑ ❑ ❑ 2. Are all other control valves open? (Main, Sectionals and Standpipe Controls) Control ® ❑ El ❑ 3. Are all control valves in good condition, operate freely, locked open and/or supervised? Valves N ❑ ❑ ❑ 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? ® ❑ ❑ ❑ 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 Z ❑ ❑ ❑ 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? N ❑ ❑ ❑ 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 ❑ I. 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 ''/z" Outlet ❑ ❑ Z ❑ I. 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 ❑ ❑ Z ❑ 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 ❑ ❑ Z ❑ 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? ❑ ❑ N ❑ 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 Place N/I Not -Ins ected-ai thislime 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 92 - 158 158 140 158 Inspection & Testing Performed By: B. Bridgford, K. Saia Inspection Date: 12/16/2015 (4" Qtr.) 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 Location: 22828 Reef Point, Newport Coast Date: December 16, 2015 Type: 5 Year (4"' Quarter) ITEM # I EXPLANATION OF DEFICIENCIES I * I No deficiencies found at this inspection I 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 Fire Safety Fire Alarm Inspection and Test First � CUSTOMER NAME 'TEST'DATE Keystone Pacific 12/16/2016 ❑ Monthly ❑ Quarterly ❑ Semi -An ® Annual JOBSIT,E 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 CONTROL.PANEL 'MODEL LOCATION OF FIRE<ALARM.C,ONTROL PANEL . 'MISC. INFORMATION- MANUF. - Radionics 7412G Barbara Lakin's Office CIRCUIT BREAKERLOCATION"".PANEL'#. ,__ '- BREAKER#. -'L`O.CKED='CIRCUIT' DEDICATED CIRCUIT; 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 El12.2 4 12V x 7AH ( ) Without Charger: 12.5 Note #: GENERAL ZONE'TROUBLE, NO Lost, GROUND FAULT EMERG. GENERATOR' :TROUBLE- TROUBLE. C6NDITI6N8 Normal ® Normal: ® Normal: ® Normal ® Normal: ❑ N/A CK Note #: Note #: Note #: Note #: Note #: `MONITORING COMPANY'' . - _ PHONE:_ ' AC•COUNT........ ' .,, : ',. _. -' P.RIMARY=LINE• 'SEC;ONDARY- LINE NMC % Fire Safety First (800) 259-0047 L30-1414 1 (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 Yz" 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 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 Property Information: Name: Crystal Cove Clubhouse Occupancy/Use: A-3 oF cq�,�o n Address: 22828 Reef Pointe Construction Type III � City: Newport Beach No. Stories: 1 E MPS Zip; Year Constructed: 2005 Contact: Barbara Lakin Telephone: 949-376-4551 Ext.- 230 Contractor Information: 4 No. of System Risers Name: Fire Safety First Copy sent to: Address: 1170 E. Fruit Street ❑ Owner Date: ❑ 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 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 (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: Type Of System: F ca Name: Crystal Cove Clubhouse ® Wet Pipe ° (i,�o� Address: 22828 Reef Point ❑ Dry Pipe co v ❑ Preaction ct�, ❑ Deluge 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 1 Daily Weekly Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.3 5.2.4. 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: Pavillion #1 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 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 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 j T j Annually I 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: Crustal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #1 Type Of System: F Cq ° L�'�c ® Wet Pipe ❑ Dry Pipe ❑ Preaction 9� ❑ Deluge c F/RE MP� 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 of4] 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: p Cq Name: Crustal Cove Clubhouse ® Wet Pipe �° 0�2 Address: 22828 Reef Point ❑ Dry Pipe Co ❑ Preaction cry ❑ Deluge q�F,� p.5� ARE MP City: Newport Beach 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: 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) 5.2.4.2 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: 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 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 I 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: Crustal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach System Riser ID: Pavillion #2 Type Of System: o F ca ® Wet Pipe Dry Pipe ❑y v ❑ Preaction gn q��FIRE ❑ Deluge 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 FNFPA 26, 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: Crvstal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Type Of System: of Cq4/ ® Wet Pipe �� c ❑ Dry Pipe y ❑ 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: 12/16/2015 1 System Riser ID: Pool Property Information: Name: Crustal 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 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: Pool 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.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 Tj 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: Pool Property Information: Type Of System: Name: Crystal Cove Clubhouse ® Wet Pipe Address: 22828 Reef Point ❑ Dry Pipe ❑ Preaction ❑ Deluge 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 I System Riser ID: Pool Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Type Of System: F Cq ® Wet Pipe ��f° C. ❑ Dry Pipe yl ❑ Preaction c!� ❑ Deluge 9� g FjRE 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 1 System Riser ID: Clubhouse 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 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: ® 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: 12/16/2015 Property Information: Name: Crustal 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 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 I 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: Clubhouse Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Type Of System: F Cq ® Wet Pipe°c Q ❑ Dry Pipe i ❑.Preaction ❑ Deluge R State Fire Marshal AES 2 March 21, 2006 Fire Safety First January 21, 2016 Fire Prevention Department NEWPORT BEACH FIRE DEPARTMENT 3300 Newport Blvd. Newport Beach, CA 92663 RE: Crystal Cove Clubhouse 22828 Reef Pointe, 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. 139. Sincerely, Brandon Bridgford, Inspector FIRE SAFETY FIRST C10/16/36- 599761 N'E vP0,E _ - -:sir i3E�'S LIFE SAFE`i Y SERVICES D9V JAN 2, A 2016 a'- -1 0 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 of ca<�,�o �2 Address: 22828 Reef Pointe Construction Type III �P 7 N City: Newport Beach No. Stories: 1 �� F 5 FARE Zip: Year Constructed: 2005 MPS Contact: Barbara Lakin Telephone: 949-376-4551 Ext.- 230 Contractor Information: 4 No. of System Risers 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 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 (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: 12/16/201.5 Property Information: Name: Crystal Cove Clubhouse Address: 22828 Reef Point City: Newport Beach Main Drain Test Results: Initial Static Pressure: Residual Pressure: Restored Static Pressure System Riser ID: Clubhouse Type Of System: ® Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge Abbreviation Key: 155 (PSI) I = Inspection T =Test 110 (PSI) M = Maintenance A-O = After Operation 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 Weekl Dry Pipe Valves — Enclosure 12.4.4.1.1 X 1.3 I 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 I Quarterly Spare Sprinklers 5.2.1.3 X 1.11 I Quarterly Fire Department Connections 12.7.1 X 1.12 I 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 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 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 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 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) 12.2.6 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: Clubhouse 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 Annually Control Valves 12.3.4 X 3.2rqm Annually Preaction/Deluge Valves 12.4.3.3.2 X 3.3Annually 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 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: Pool Property Information: Type Of System: p Cq Name: Crystal Cove Clubhouse ® Wet Pipe ° �i,�o� ❑ Dry Pipe co 7 Address: 22828 Reef Point ❑ Preaction cn;.A ❑ Deluge 9��FiRE MP�Sz 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 Fail N/A PassReference 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 I Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4. 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 I Quarterly Pipe and Fittings 5.2.2 X 1.9 I Quarterly Sprinklers 5.2.1 X 1.10 I Quarterly Spare Sprinklers 5.2.1.3 X 1.11 I 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 March 21, 2006 State Fire Marshal AES 2 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 I System Riser ID: Pool Property Information: Type Of System: OF Cp'L/,c Name: Crystal Cove Clubhouse ® Wet Pipe opt � Address: 22828 Reef Point ❑ Dry Pipe co ❑ Preaction cn� ❑ 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 AnnuallyAlarm 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 I System Riser ID: Pool Property Information: Type Of System: of Cq4/R Name: Crystal Cove Clubhouse ® Wet Pipe opt ❑ Dry Pipe 00 7 Address: 22828 Reef Point ❑ Preaction_ ❑ Deluge '�/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 I System Riser ID: Pool Property Information: Type Of System: OF CAS/,� Name: Crystal Cove Clubhouse ® Wet Pipe 0�2' � Address: 22828 Reef Point ❑ Dry Pipe v ❑ Preaction u ❑ Deluge E MPQ'y�� 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: Pavillion #1 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 I 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 1 Quarterly Sprinklers 52.1 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 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 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 t_�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, Tittle 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 Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.18 I Annually Hangers 5.2.3 X 1.19 I Annually Seismic Bracing 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 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 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 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 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 #1 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 12.44.4.3.2 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. Cp</Pc ®Wet Pipe opt ❑ Dry Pipe v ❑ Preaction (P� � ❑ Deluge ARE MP 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 ® PASS ❑ FAIL Pages) Signature vni wand 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: 12/1,6/2015 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 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 1 Daily Weekly Dry Pipe Valves — Enclosure 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 I Quarterly Alarm Devices 5.2.6 X 1.6 I 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 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 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: 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 F 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 System Riser ID: Pavillion #2 Property Information: Type Of System: Name: Crystal Cove Clubhouse ® Wet Pipe 0� CA4/,copy Address: 22828 Reef Point ❑ Dry Pipe co v ❑ Preaction ❑ Deluge q��'cIRE MP�Sz City: Newport Beach 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 guodm vz&,d Pnd Date 12/16/2015 State Fire Marshal AES 2 March 21, 2006 r Alcaraz, Debbie Morris, Nadine Sent: Friday, April 25, 2014 1:16 PM To: Alcaraz, Debbie Subject: Invoice - 360 San Miguel Dr #301 Attachments: ch1 d-01@newportbeachca.gov_20140425_131409_00004e21001 b.pdf Hi Debbie, Please invoice the attached business as follows: State Fire Clearance $75.00 4/25/2014 Thanks, Nadine From: Morris, Nadine Sent: Friday, April 25, 2014 1:12 PM To: '19497599164@fax.cnb' Subject: 360 San Miguel Dr #301 Attached is the 2014 fire clearance inspection report. Thank you. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department 100 Civic Center Dr, Newport Beach, CA 92660 (949) 644-3105 1 (949) 723-3505 FAX I nmorris@nbfd.net Safety, Service, Professionalism Newport Beach Fire Department Life Safety Services 1 Civic Center Drive Newport Beach, CA 92660 Facsimile Cover Sheet To: Company: Phone: Fax: START Physical Therapy 949-759-0300 949-759-9164 From: Nadine Morris Company: Life Safety Services Phone: (949) 644-3105 Fax: (949) 723-3505 Email: nmorris(@,,`nbfd.net Date: April 25, 2014 Pages including this cover page: 2 Comments: Attached is the inspection report for 2014. There were no violations noted. Thank you. ' High Priority/Deliver Immediately Normal Processing Addressee Phone After Review X Pursuant to Your Request Confidential --Addressee Eyes -Only! Phone Verification - Receipt For Your Information Original to Follow via US Mail t� Newport Beach Fire Department All Inspection Data j PO Box 1768 Newport Beach, CA 92658-8915 (949) 644-3106 Address: Grid.- Assigned To: Data ID: Inspection Cycle: 360 SAN MIGUEL DR Suite: 301 4729W NT63C 2986 12 Months Building Type. Inspection Type: Sq Ft: Oce Type: Occ Load: Next Inspection: TYPE I - FR Tenant 4525 B 0 Apr 1, 2015 Business Name: Business Phone: Preplan Hazmat.- Last Action: START Physical Therapy (949) 759-0300 Yes No Action: Reassign Date: Apr 25, 2014 By: Nadine Morris Building Name: Owner /Responsible Party: Owner /Responsible Party Phone: Medical Tower #4 Melinda Hansen (949) 759-0300 E-Mail: Mobile Phone: N/A (949) 759-9164 FAX Hood: Dry Chem: CO2: Other System(&): Knox Box Loc: No No No N/A Above FCR wset side Notes: Reqd Permits: 1 Sprinkler System: Standpipe System: Alarm System: NIA Full - Wet Full - Monitored Sprinkler S Year Date: Standpipe S Year Date: Alarm Panel.Location: Feb 10, 2010 Feb 10, 2010 FCR Riser Location: Standpipe Location: Highrise: Fire Pump. Fire Lanes: N/A Both stairwells Yes Yes No Insp Test Yalve Location: FDC Location: Emergency Generator: Archive: 7th floor south stairwell on San Miguel No No Issued Status Inspector Description 4/28/99 Cleared Middlebrough, Rich Remove combustible storage in boiler, mechanical, or electrical rooms. 4/28/99 Cleared Middlebrough, Rich Exit signs shall be illuminated. 6/2/00 Cleared Middlebrough, Rich Service and tag each extinguisher annually and after each use. Printed: 04/25/2014 ►i Newport Beach Fire Department Life Safety Services 100 Civic Center Drive Newport Beach, CA 92660 (949) 644-3106 FIRE CLEARANCE Healing Path Recovery (Name of program) was inspected this date for compliance with local requirements, and is hereby granted a fire clearance to operate an outpatient alcohol and/or other drug treatment program at: 366 San Miguel Drive, Suite 310, Newport Beach, CA 92660 % (Address of program -please include suite numbers if applicable) Nadine Morris (949) 644-3105 Inspector's name (typed or printed), telephone number (Signature and rank of inspector granting clearance) July 22, 2014 (Inspection date) n 2t STDCi -FDO 41 - 0--- �55�wua��1 �t� 5�p�la�b Ted Abrudan, Administrator 2209 Alta Vista Drive A S T O R I A Newport Beach, CA 92660 Tel 949.719-7718 QUALM, PMORT-STYLE ASSISTED LIVING Cell 714.306.2253 Oana Abrudan, MBA, Administrator www.AstoriaRetirement.coin E info@AstoriaRetirement.com 4 --)qo P-0- a JH 1a S A70 T1 A--(51 () 6 'z ��v 537�a5 Xow F55�I�wo STAR OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST E�b. aso (REV. I0-94) See Instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DEPARTMENT OF SOCIAL SERVICES 714 703-2840 April 4, 2013 CCL-R EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Lucy Adams (T524) 306004545 1A CODES t. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL S. LIFE SAFETY LICENSING Department Of Social Services, CCLD7 AGENCY 3. CAPACITY CHANGE NAMEAND 770 The City Drive, Suite 7100 ADDRESS 4. OWNERSHIP CHANGE Orange, CA 92868 6. ADDRESSCHANGE L— 6. NAMECHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY D 0 _0.� � 0 0 6 FACILITY NAME LiC'cNScvATrGrR`f ASTORIA RETIREMENT AT DOVER SHORES RCFE STREET ADDRESS (Aatud Loation) NUMBER OF BUILDINGS 1412 SANTIAGO DRIVE 1 CITY RESTRAINT NEWPORT BEACH, CA 92660 NO FACILITY CONTACT PERSONS NAME OANA ABRUDAN (714) 306-2253 7/24 Hrs. SPECIAL CONDITIONS NEWPORT BEACH FIRE DEPT. FIRE AUTHORITY P.O. BOX 1768 NAME AND ADDRESS NEWPORT BEACH, CA 92658-8915 L_ INSPECTORS NAME (T)pd orPrhld) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS N AD) t, E mFj rze 041 3C)DSs INSPECTION DATE INSPECTORS SIGNATURE (Typd or Pdntd) D(P AN DEMAL OR LIST SPECIAL CONDITIONS 01. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIALHAZARD G. OTHER A (2--1�-- NOT HP -.OV t 1L A-1- T2,1) S 'EJ M G - N CALIFORNIA EPARYMENT C.OMMUNITSGiRF!1.IC8NSING STATP of oAUFORNIA-M HEALTH AND HUM AAI SE_RVICFS AG3-NQY FACILITY SKETCH (Floor Flan)or plan of the homO Qr itY and outside yard. Tb-, oor sketch must label rQ0lA Applicants are required to provide aivsi ketch o it he the names of khe rcaams th�tilw 11 be e flo used by $ afF/residenits/clients/chi dren- Dwrr an such as the Kitchen, bath, living room, set-, Emergency Di%aster Plan). Show room sizes {e, , $.S x window exits from the roams must be shown in case of an emergency w . Kee Gloto scale. Use the space below. see e back for yard sketch. •--'�" AC6R2ss;q 9i6a r.AC.lt.rYNAME! 44.12 $�fttlago L)r(VG, NewRotk Beach, _ --- Astoria Retirement at Dover Shores -- S Ted Abrudan, Adminkmwtor 2209 Alta Vista Drive AS T O R I A Newport Beach, CA 92660 �. rENO owl u Tel 949.719.7718 QUALrrY, RUSORT•STYLU ASSWTUD LIVING Cell 714.306.2253 : x 4ti Oana Abrudan, MBA, h r A. ' ' ��.,•.ti Arinrrnrstrrrtor www.AstoriaRetirement.com ' � •, q��, �. E in£o@AstoriaRetirement.coxn } 4OL1DPb Spa tZ 10 WAIcaraz, Debbie From: Morris, Nadine Sent: Monday, October 05, 2015 9:01 AM To: Alcaraz, Debbie Subject: Invoice Attachments: chld-01@newportbeachca.gov_20151005_090415_000044be001b.pdf Hi Debbie, Please invoice Interface Security Systems for an off -hours inspection: 10/05/2015 6:30 AM (1 hour minimum) Thanks, Nadine fra:r ao oa cr n oon 44 < n a (7 :i ri a to � a o •T 7 :9 r f ^f •r '} r2 rF a O (r R r.oa n o n n•tn O O O O O M 9 7 ', U ; '? 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Z (1) o m t7 `fa aoi c c�S �= LL �p� Z N '�-� q O ��LL E h ro �LOz ry�� CO M-jh o O'o N N 0 a.0 S r C y Q. N .,N_, N C C C C—IL COL C ' a 0 c aUcZZ Qco, ov`o a) fu u ui o naa .•-0(� m W W W L.L.(n N c •o GO a. -oo D .0 CL U .0 .00 0 0 o 0 . ..'�. O 3 o r o.v o> o�� o o,_ n c O¢ m ¢¢ 0. UI- O¢¢zZLLtq P . , III w m N a .0 o o i a i g IL a o n a Alcaraz, Debbie From: Morris, Nadine Sent: Monday, August 24, 2015 4:15 PM To: Alcaraz, Debbie Subject: Invoice Attachments: chld-01@newportbeachca.gov_20150824_162049 00001441001b.pdf Hi Debbie, Please invoice the attached as highlighted in yellow the following fee: 1-4 chemicals $128.00 Thank you. Nadine NADINE MORRIS 1 Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net NEWPORT BEACH FIRE DEPARTMENT Qn� FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION I. IDENTIFICATION BEGINNING DATE: 01/01/2015 ENDING DATE: 12/31/2015 BUSINESS NAME: MERIDIAN NEWPORT BEACH SITE ADDRESS: 1001 SANTA BARBARA DR NEWPORT BEACH- CA -92660 , BUSINESS PHONE: 9492190110 BUSINESS FAX: 9492190111 DUN & BRADSTREET: I PRIMARY NAICS: BUSINESS OPERATOR NAME: Joshua Ramirez BUSINESS OPERATOR PHONE: 9099690053 BUSINESS EMAIL: joshuaramirez@actionlife.com 11. MAILING INFORMATION BUSINESS NAME: ATTN: ATTN ANGIE TROUNSON CONTACT PHONE: MAILING ADDRESS: 1001 SANTA BARBARA DR CITY: NEWPORT BEACH STATE: CA ZIP CODE: 92660 III. BUSINESS OWNER OWNER NAME: MERIDIAN NEWPORT BEACH PHONE: 9492190110 NUMBER: STREET: CITY: Newport Beach STATE: CA ZIP CODE: IV. ENVIRONMENTAL CONTACT NAME: Angie Trounson EMAIL: atrounson@actionlife.com PHONE: 9492190110 EXT: 201 MAILING ADDRESS: 1001 Santa Barbara Drive CITY: I STATE: CA ZIP CODE: 92660 -Primary- V. EMERGENCY CONTACTS -Secondary- NAME: Angie Trounson NAME: Joshua ramirez TITLE: General Manager TITLE: Building Engineer BUSINESS PHONE: 9492190110 EXT: 201 BUSINESS PHONE: 9492190110 EXT: 24-HOUR PHONE: 9492190110 24-HOUR PHONE: 9492190110 CELL/PAGER#: I CELL/PAGER#: 9099690053 VI. CERTIFICATION Certification based on my inquiry of those individuals responsible for obtaining the information. I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe that the information is true, accurate, and complete. Package Preparers _ _ Joshua Ramirez - fication CertiDate: _ 07/1'3/2015—----- y-" NBFD (Rev.03/2010) Sea Island Community Association January 28, 2016 Raymi K. Wun Life Safety Specialist Newport Beach Fire Department 100 Civic Center Drive Newport Beach, California 92660 inspector Raymi Wun, Per your request, we are providing an outline of the initial phases of selecting a contractor to complete the obstruction investigation and subsequent 5 year certification of the fire protection systems at Sea Island. • Currently a Special Committee is in the process of reviewing proposals provided by contractors. Pending interviews with each contractor and any clarifications, this committee with.provide a recommendation to the Board; • On or before February 15th, the Board will select a contractor and authorize that contractor to proceed with the repair process; • The Board and the chosen contractor, will establish a homeowner notification and coordination process that will start as soon as possible, following approval to proceed; • The chosen contractor Will be requested to provide a timeline for repairs and this will be communicated to you for review; We understand the importance of resolving the issues and recertification of the fire protection systems. We welcome your input as we move forward with the repair process. Sincerely, ON BEHALF OF THE BOARD OF DIRECTORS Chris Nelson CN CONSTRUCTION & MANAGEMENT 714-757-5948 LIC #997966 cc: Lynn Wyatt, Community Manager Board of Directors Chris Nelson FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION 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. 1. PROPERTY INFORMATION Name of property: Sea Island Address: 40 Sea Island Drive Newport Beach, CA Description of property: Apartments Occupancy type: Existing Name of property representative: Address: Phone: Fax: Authority having jurisdiction over this property: Phone: 949-644-3288 Fax: City of Newport Beach E-mail: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: KOR Fire and Security Address: 26812 Vista Terrace, Lake Forest Ca. 92630 License or certification number: 857710 Phone: 949-273-8340 Fax: 949-951-6922 E-mail: Service organization for this equipment: KOR Fire and Security Address: 26812 Vista Terrace, Lake Forest Ca. 92630 License or certification number: 857710 Phone: 949-273-8340 Fax: 949-951-6922 E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of: Contracted testing company: KOR Fire and Security Address: 26812 Vista Terrace, Lake Forest Ca. 92630 @Dl +Wl q 1-1-2010 Phone: 949-273-8340 Fax: 949-951-6922 E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. DESCRIPTION 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): NFPA 72, Fig 10 18.2 1 1 (p 1 of 12) Copyright © 2009 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. n 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2013 Additional description of system(s): Sprinhkler Monitoring System 3.1 Control Unit Manufacturer: Firelite Model number: MS905OUD 3.2 Mass Notification System ® This system does not incorporate an MNS 3.2.1 System Type: ❑ In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ® An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: FACP 3.4 System Software ® This system does not have alterable site -specific software. Operating system (executive) software revision level: Site -specific software revision date: Revision completed by: ❑ A copy of the site -specific software is stored on site. Location: 3.5 Off -Premises Signal Transmission ❑ This system does not have off -premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: National Monitoring Center Phone: 877-311-8579 Supervisory: National Monitoring Center Phone: 877-311-8579 Trouble: National Monitoring Center Phone: 877-311-8579 Entity to which alarms are retransmitted: Phone: Method of retransmission: Digital Dialer If Chapter 26, specify the means of transmission from the protected premises to the supervising station: DACT If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NF"A72 Fig 101821 1rp 'ot1'i Copyright © 2009 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. 16. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ® New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ❑ Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: ® NFPA 72, Edition: 2013 ® NFPA 70, National Electrical Code, Article 760, Edition: 2013 ® Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: Printed name: Date: Organization: Title: Phone: 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Date: Organization: Title: Phone: 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 11 of 12) Copyright © 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright © 2009 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 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 1 nations and Survivability Quantity: 4.1.1 pathway nations Class Desig Survivability level: 1 Pathways class: B (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media N/A Description: Quantity: 0 4.1.3 Device Power Pathways line pathway ®No separate Power p athway 0 power pathways are separate pathways from the signaling classification as the signaling line p but of the same PathwaY aling line pathway 0 power pathways are separate and different classification from the sign 4.1.4 Isolation Modules Quantity. 0 4.2 Alarm Initiating Device Pathways Quantity: � 4.2.1 Pathways Class Designations and Survivability 1 Survivability level: Pathways class: B (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media N/A Description: Quantity. 0 4.2.3 Device Power Pathways device pathway Pathway crate power Pathways from the initiating classification as the initiating device p �] No separate e athwaY Pathway []Power pathways are separate but of the sam P the initiating device p are separate and different classification from [I Power pathways 4.3 Non -Voice Audible System Pathways ability Quantity'1 Surviv 4.3.1 Pathways Class Designations and Survivability level'. 1 Pathways class: B -(See NFPA 72, Sections 12.3 and 12.4) Pathway 4 3 2 s Utilizing Two or More Media Description: NIA Quantity: 0 4.3.3 Appliance Power Pathways appliance pathway pathway Pathways from the notification apP the notification appliance J& No separate Power p athway classification as Power pathways are Separate but of the same p liance pathway are separate and different classification from the notification ap [j Power Pathways NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12) iation. This form may be cope ed for individual p�ght © 2009 National Fire Protection Assocuse other than for resale. It may not be copied for commercial sale or distribution. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ❑ This system does not have manual fire alarm boxes. Type and number of devices: Addressable: 4 Conventional: Coded: Transmitter: Other (specify): 5.1.2 Other Alarm Boxes ® This system does not have other alarm boxes. Description: Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: 4 Conventional: Other (specify): Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area Other (specify): Above FACP Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): 5.2.2 Duct Smoke Detectors ® This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors Type and number of devices: Addressable: Other (specify): Type of coverage: 5.2.4 Gas Detectors Type of detector(s): Number of devices: Addressable: Type of coverage: ® This system does not have radiant energy detectors. Conventional: Conventional: ® This system does not have gas detectors. 5.2.5 Heat Detectors ® This system does not have heat detectors. Type and number of devices: Addressable: Conventional: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ❑ Rate -of -rise ❑ Rate compensated Nr FAA 72 F Iq 11) 18 1 1 1 u 4 :,t i Copyright © 2009 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 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules Number of devices: 8 5.2.7 Waterflow Alarm Devices Type and number of devices: Addressable: 4 5.2.8 Alarm Verification Number of devices subject to alarm verification: 5.2.9 Presignal Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: 5.2.11 Other Initiating Devices Describe: ❑ This system does not have monitoring modules. ❑ This system does not have waterflow alarm devices. Conventional: Coded: Transmitter: 1 6. SUPERVISORY SIGNAL -INITIATING DEVICES ❑ This system does not incorporate alarm verification. Alarm verification set for seconds ® This system does not incorporate pre -signal. ® This system does not incorporate PAS. ❑ This system does not have other initiating devices. 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: 4 Conventional: Coded: 1 Transmitter: Other (specify): 6.2 Fire Pump Description and Supervisory Devices ® This system does not have a fire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) ® This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ® Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: NFPA 72, Fig. 10 18.2.1.1 (p. 5 of 12)• Copyright © 2009 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. r. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator E This system does not have a generator. 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel ❑ Other (specify): 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: Main Entry Location 2: Location 3: 9. ALARM NOTIFICATION APPLIANCES ❑ This system does not monitor special hazard systems. ❑ This system does not monitor other systems. ❑ This system does not have annunciators. 9.1 In -Building Fire Emergency Voice Alarm Communication System E This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound -processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 9.2 Nonvoice Notification Appliances Horns: With visible: Chimes: With visible: Visible only: Other (describe): 9.3 Notification Appliance Power Extender Panels Quantity: 3 Locations: E This system does not have nonvoice notification appliances. Bells: With visible: E This system does not have power extender panels. NFPA I , Fig 10 18 2 I 1 (p +i , t i '1 Copyright © 2009 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. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ® This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: Textual signs: Other (describe): Supervision class: MNS-only visible appliances: 10.3.1 Special Hazard Notification ❑ This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ® This system does not have a two-way telephone system. Number of warden stations installed: ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ❑ This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright © 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two -Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ❑ Hold -open door releasing devices ❑ Smoke management ® HVAC shutdown ❑ F/S dampers ❑ Door unlocking ❑ Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules Number of devices: Other (specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120VAC Overcurrent protection: Type: Circuit Breaker Location (of primary supply panel board): Disconnecting means location: 13.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: ® This system does not have control modules. Control panel amps: 3.0 AMPS Amps: 15 ® This system does not have a generator. Type of fuel: Nf t'4 /2, Fiq 10 1t5 ' : 1 fn C; fit I_, Copyright © 2009 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. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: FACP Type: GEL CELL Nominal voltage: 12vdc Amp/hour rating: 12 AH 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 ❑ Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ® This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: 13.2.2 Engine -Driven Generator Location of generator: Location of fuel storage: EVACS or MNS panel amps: Amps: ® This system does not have a generator. Type of fuel: 13.2.3 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): 13.2.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture Nominal voltage: In alarm mode (minutes): ❑ Battery calculations are attached Amp/hour rating: NFP4 72, Fig. 10 18.2.1.1 (p. 9 of 12) Copyright © 2009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power Input voltage of power extender panel(s): 120vac Overcurrent protection: Type: Circuit Breaker Location (of primary supply panel board): Disconnecting means location: 13.3.2 Engine -Driven Generator Location of generator: Location of fuel storage: ❑ This system does not have power extender panels. Power extender panel amps: 3.0 AMPS Amps: 15 ® This system does not have a generator. Type of fuel: 13.3.3 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): 13.3.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture 14. RECORD OF SYSTEM INSTALLATION Nominal voltage: In alarm mode (minutes): ❑ Battery calculations are attached Amp/hour rating: Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. This is a: ® New system ❑ Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) ® NFPA 72, Edition: 2013 ® NFPA 70, National Electrical Code, Article 760, Edition: 2013 ® Manufacturer's published instructions Other (specify): System deviations from referenced NFPA standards: Signed: Printed name: Date: Organization: Title: Phone: WF'A ' l--Iq !El 1'- _ ' 1 I, 1(} it 1.', Copyright © 2009 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. J . , . 16. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ® New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ❑ Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: ® NFPA 72, Edition: 2013 ® NFPA 70, National Electrical Code, Article 760, Edition: 2013 ® Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: Printed name: Date: Organization: Title: Phone: 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: /�j�� Printed name:�v2 Organization: (G.GtZ Title: -?�ZFk 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Organization: 14_v Z- Title: -75-2A 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: "'�� Printed name--7,9ri,UfZ'7 6,ps, } Organization: Title: —/?M- Date: $ 1 /s'/'f- Phone: 2�73-83'fo Date: 1 %,5'`t 5 Phone: ctc fcr . z7S-IE� 3`fu Date: 1/5/ 5' Phone: L7-& -&s fo NFPA 72, Fig. 10.18.2.1.1 (p. 11 of 12) copyright © 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. `� � Printed name: . I �C I `�12�Z� S Date: f ' Signed: CkA"Uo'� Organization: Title: ' N S 1OL—r-1—D Y7— Phone: C`t NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) copyright © 2009 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. STA-MOFCAUFORNIA i FIRE SAFETY INSPECTION.REQUEST STD.850(REV.10-94) See instructions on reverse. AGENCY CONTACT'S NAME TELEPHONENUMBER REQUESTDATE PROGRAM CHUCK BROWNING 916 . 322-2911 AMU EVALUATOR'S NAME REQUESTINGAGENCYFACIU YNUMBER REQUESTCODE CHUCK BROWNING NOT ASSIGNED YET IA LICENSING r Department of Alcohol and Drug Programs AGENCY Licensing and Certification Branch NAME AND 1700 K Street ADDRESS Sacramento, CA 95814-4037 L N 1. ORIGINAL. 6,.0IRE CLEARANCE 2. RENEWAL ' B. LIFE SAFETY 3. CAPACITY CHANGE 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUSCAPACITY CAPACITY PREVKx1SCAPACTTY CAPACRY PREVIOyUSCAPAC17Y FACILriyNAYE ll''iGit LICENS6CATEGORY I r .. •'ALCOHOL/DRUG FACILITY STREETADDRESS (AduatLowtion) NUMBER OF BUILDINGS 0 CITY RESTRAINT zz,da2,L�Y�',rr< NONE FACI 6NTACTPERSON'SNAME 24+HOURS FN CW PC) vZT 6 C 0rc+-• FIRE FA RI D le -PT. AUTHORITY NAME AND G' VI e C e-t-� r--yz b yZ ADDRESS LN C-w po,2:-% aekc-", C-V- �I ,Q (o UP O INSPECTOR'S NAME(7)WdorPdnted) TELEPHONENUMBER I P/ TIO DATE INSPECTORS [ l '1,& ft\ 1 / SIGNATURE l� Y k l`i l�iiVC' 0WNSTVYt Q-S O NL.j J CFIRS NUMBER �n 3D0S 1. FIRE CLEARANCE A. EXITS, B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS OCCUPANCYCLASS E. HOUSEKEEPING 1 • F. SPECIAL HAZARD G. OTHER ri�D�a�5 1JI ro r 1 45TH ST In the event of an Eme meet at the corner of Seashore & 45th St ets 0 0 • o PATIO p e■1► i DINING ■ LIVING ■ ■SQ ■ ■ • ■ ■ ■ ■ ■ ■ ■ ■ ■ m a ■ ■ i ng ■ I II ■ ♦ ■ ♦ III If�uli ■ ♦ ■ ♦ o r KITCHEN ■ oD Q ■ ■ Aflik 0° ■ Zn BEDROOM BEDROOM p -13'-0" x 11'-6"-13'-6" x 11'-6" W C. C. Q S N STORAGE GARAGE II GARAGE U 0 5' 10' 20' • Kevin Mello 6 Starbur'st et � � PH. Boo-76z-67t7 Newport Beach CA z66 USA kmeilo@hotelcaliforniabythesea.com bythesea.com � P � 9 3 www.hotelcaliforniabythesea.com 949-244-1115 September 18, 2013 Melinda Whelan Planner, Assistant City of Newport Beach 100 Civic Center Dr Newport Beach, CA 92660 Dear Ms. Whelan, My company (Hotel California By The Sea, LLC) is renting the property at 4504 Seashore drive, Newport Beach, CA 92663 from the owners Carl and Barbara Mosen. I am the operator and executive director of Hotel California By The Sea, LLC and my contact information is listed above. I nor Carl nor Barbara has operated any residential care facility in the state of California or any other state within past 5 years. Best Regards, Kevin I Mello Executive Director Hotel California by the Sea 4caraz, Debbie L from: Morris, Nadine Sent: Wednesday, October 16, 2013 4:20 PM To: Alcaraz, Debbie Cc: 'Kevin Mello' Subject: FW: 4504 Seashore Dr Hi Debbie, Please see Kevin's email below. Thank you for your assistance. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net From: Kevin Mello [mailto:kmello@hotelcaliforniabAhesea.com] Sent: Wednesday, October 16, 2013 3:42 PM To: Morris, Nadine Subject: Re: 4504 Seashore Dr Hi Nadine, I just wanted to check in, say hello and happy Wednesday. Also, I have not received the bill for the fire inspection. Can you email me a copy? Thanks Kevin J. Mello Owner, Executive Director Hotel California by the Sea, LLC P: (800) 762-6717 F: (949) 629-3883 C: (949) 244-1115 CA, t-a �-!1t• HotelCaliforniabythesea.com From: "Morris, Nadine" <NMorris@NBFD.net> Date: Thursday, September 19, 2013 10:04 AM To: Kevin Mello <kmello@hotelcaliforniabythesea.com> Subject: 4504 Seashore Dr Kevin — I've conducted the reinspection and approved the fire clearance. Attached is a copy and the original will be mailed to Licensing today. I've spoken with Melinda and she has approved the letter provided. She will follow-up with an email. In invoice for the fire clearance in the amount of $240.00 will be processed. Should it be mailed to the Seashore or Starburst address? Thank you and have a great day. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 I nmorris@nbfd.net 2 , 1 Alcaraz, Debbie From: Morris, Nadine Sent: Thursday, September 19, 2013 11:14 AM To: Alcaraz, Debbie Subject: RE: Seashore Invoice Funny, he just stopped in to pick up the invoice! I told him we've not that fast. LCIL Please invoice to: 2811 Villa Way Newport Beach, CA 92663 "t Nadine NADINE MORRIS i Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net From: Alcaraz, Debbie Sent: Thursday, September 19, 2013 11:08 AM To: Morris, Nadine Subject: RE: Seashore Invoice 10-4 Debbie Alcaraz Newport Beach Fire Department 100 Civic Center Drive, NB, CA 92660 949.644.3351 From: Morris, Nadine Sent: Thursday, September 19, 2013 10:58 AM To: Alcaraz, Debbie Subject: Seashore Invoice Hi Debbie, Hold off on invoicing the $240 for the fire clearance. I'm waiting to hear back as to where they'd like the invoice mailed. 1 #BWNKJHD #AR00000212162# HOTEL CALIFORNIA BY THE SEA 4504 SEASHORE DR NEWPORT BEACH, CA 92663 NUMBER: 0000021216 INVOICE: FS54004473 INV DATE: 12/11/13 DUE DATE: 01/10/14 N13ID: 557275 Description ---------------------------------------- Qty Unit Price -------- ------------- Tax ---- ------------- Extension FIRE PREVENTION DIVISION INSPECTI 1.00 240.00 0.00 240.00 INSP DATE: 09.19.13 PRE LICENSE FEE INSPECTION DOWNSTAIRS ONLY ---------------------------------------------------------------------------------- TOTAL INVOICE: $ 240.00 PAYMENTS/ADJUSTMENTS: $ 0.00 PAST DUE: $ 01.00 PENALTIES/INTEREST: $ 0.00 TOTAL AMOUNT DUE: $ 240.00 BILLING QUESTIONS SHOULD BE DIRECTED TO THE FIRE DEPARTMENT AT (949) 644-3106. THANK YOU. ....... ..... ...... ... ..... . . . .. Pieas - e --'zf6 tac lixs . ... . ..... .. .. n u., . . ..... .. ....... ....... ANNUAL & SPECIAL PERMITS - INVOICE HOTEL CALIFORNIA BY THE SEA 4504 SEASHORE DR NEWPORT BEACH, CA 92663 TOTAL AMOUNT DUE: $ AR 0000021216 INVOICE: FS54004473 INV DATE: 12/11/13 DUE DATE: 01/10/14 NBID: 557275 240.00 24000 O z z G) D 'D v O D r v WMZZDDO•-Io 'v DD �O_ 'v DO a= - O O O O 0 m c m 0 a CD � CD 0 -n-l_n_nOo W a)CA _._._.- N fD W 0 c N,,C CD 0.0 D o m Cn p0j tN CD w N 0 (n m (D N c O O 7.O Z Z O nQ' EminU�*t O v- CXD(XD00>>>> 0 N 0 O CD (O (0 (Q 00 CD Sq G N o �B -� w H ti m0"o N o c j0�D zoS ui fv n. n..-.; K -- CD -IDS°-' �' � 0 CD� N al" j w� Q Z D CA z •� co C po2 �. M O� (D �0 m n 0 m omDOm X m 0 �- �3 - 3 � -nCD n @ R on-�-G x (Doan z)- -0 mCD CD m CD zX N - cNwDO nDtD- m.. o ia6) wv ?m n 00 03,0 D * (D O N O W N (A O w ? V O O O d! 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X N M (D 0 o' ic CD -o p CD "0 � `m CD -OI Dz X °3Z CD ifl m M' � N N �N O w� N i N 0 ai 1 COUNTY OF ORANGE ORANGE COUNTY HEALTH CARE AGENCY ENVIRONMENTAL HEALTH PA08 1241 EAST DYER ROAD, SUITE 120 CUPA SANTA ANA, CA 92705.5611 (714) 433-6000 INVOICE#: IN0987420 Owner: CLEAN ENERGY CLEAN ENERGY SITE: CLEAN ENERGY (� T : -46?&MAEARTHuR-eeb1+T- �� N� t3 IGrS� t--��- 592 SUPERIOR AVE SBA-- 0 Q �� ( NEWPORT BEACH, CA- 92663 SEAL BEACH, CA 90740 Ac41 -a-_ ` f [)() County of Orange Tax ID# 95-6000928 District A/R # Facility # Invoice Date Due Date Billing Period AR1372365 FA0055846 08/01/2014 09/01/2014 07/01/14 to 06/30/15 Related Date PE PE Program # Site ID Description Amount. 08/01/2014 5865 5865 PR0076233 NPB383 HAZARDOUS MATERIALS,-NEWPORT BEACH - 3-128.00 08/01/2014 6210 6210 CUPA - STATE SERVICE CHARGE BASE FEE $ 35.00 Total Due: $ 163.00 PAYMENTS RECEIVED AFTER THE DUE DATE MAY BE SUBJECT TO A MAXIMUM 25% PENALTY. WE RECOMMEND THAT DISPUTES BE RESOLVED OR PAYMENT MADE PRIOR TO THE DUE DATE TO AVOID LATE FEES. FEES ARE DUE FROM ESTABLISHMENTS WHICH OPERATE AT ANY TIME DURING THE BILLING PERIOD. IF THERE�HAS BEEN A CHANGE IN OWNERSHIP PRIOR TO THE BILLING PERIOD, PLEASE RETURN THIS INVOICE WITH THE NEW OWNER'S NAME, MAILING ADDRESS AND THE CHANGE OF OWNERSHIP DATE. PLEASE DO NOT SUBMIT A POSTDATED CHECK (CHECK DATED LATER THAN THE ACTUAL DATE SUBMITTED) IN PAYMENT OF THIS OBLIGATION. ALL CHECKS WILL BE PROCESSED UPON RECEIPT. FOR ANY CHECKS RETURNED UNPAID, THE MAKER WILL BE CHARGED AN ADDITIONAL FEE. Retain too Dortion for vour records Return this bottom portion with payment **** Write invoice number on check CLEAN ENERGY 592 SUPERIOR AVE Billing Period: Facility # : FA0055846 NEWPORT BEACH, CA 92663 07/01/14 to 06/30/15 Billing CLEAN ENERGY Invoice # : (N0987420 Address: 4675 MACARTHUR COURT SUITE 800 Due Date: 09/0112014 Total Due: $163.00 SEAL BEACH, CA 90740-- - PLEASE REMIT TO: Payment Type: ORANGE COUNTY HEALTH CARE AGENCY Check ENVIRONMENTAL HEALTH ❑ 1241 EAST DYER ROAD, SUITE 120 Credit Card (see reverse) SANTA ANA, CA 92705-5611 CUPA FOR OFFICE USE ONLY DATE RECEIVED BATCWHSO # CHECK DATE CHECK NUMBER **** MAKE CHECKS PAYABLE TO: ** * BRING THIS INVOICE WHEN PAYING IN PERSON COUNTY of ORANGE �IIIIIIIIIIIIIIIIIIIIIIIlIllllllll'IIIWIIIIlip IIIIIIIIIjpill IIIIIIIIIIpp1III11IlIII1I NU w4o�4 09/16/2014 6210 0210 #BWNKJHD #AR00000174471# CLEAN ENERGY 3020 OLD RANCH PARKWAY SUITE 400 SEAL BEACH, CA 70740 Description HAZ MAT INVENTORY (1-4) INSPECTION DATE: 08.01.14 CUST#: 0000017447 NBID: 480938 INVOICE: FS54004750 INV DATE: 10/02/14 DUE DATE: 11/01/14 Qty Unit Price Tax Extension 1.00 128.00 0.00 128.00 TOTAL INVOICE: $ PAYMENTS/ADJUSTMENTS: $ PAST DUE: $ PENALTIES/INTEREST: $ TOTAL AMOUNT DUE: $ BILLING QUESTIONS SHOULD BE DIRECTED TO THE FIRE DEPARTMENT AT (949) 644-3106. THANK YOU. CLEAN ENERGY 3020 OLD RANCH PARKWAY SUITE 400 SEAL BEACH, CA 70740 ANNUAL & SPECIAL PERMITS - INVOICE TOTAL AMOUNT DUE: $ 128.00 0.00 0.00 0.00 128.00 CUST NBR: 0000017447 NBID: 480938 INVOICE: FS54004750 INV DATE: 10/02/14 DUE DATE: 11/01/14 128.00 AR 0000017447 12800 Alcaraz, Debbie From: Morris, Nadine Sent: Wednesday, January 07, 2015 11:27 AM To: Alcaraz, Debbie Subject: Invoice & Scan Attachments: chld-01@newportbeachca.gov_20150107_113023_0000de3e001b.pdf Debbie, Please invoice the facility $75.00 for a State License Inspection and scan the document. Thank you, Nadine STATE OF CrILIFORNIA ''FIRE SAFETY INSPECTION REQUEST STD. 850 (REV.10.44) See Instructions on reverse. r.GENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DEPARTMENT OF SOCIAL SERVICES 714 703-2840 Sept. 19, 2014 CCL-R EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Lucy Adams (T5A2) 306004738 1 A CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING Department Of Social Services, CCLD� 2. RENEWAL S. LIFE SAFETY AGENCY NAMEAND 770 The City Drive, Suite 7100 3. CAPACITY CHANGE ADDRESS 4. OWNERSHIP CHANGE Orange, CA 92868 6. ADDRESSCHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 0 160 0 0 0 160 FACILITY NAME LICENSE CATEGORY NEWPORT BEACH PLAZA RCFE STREET ADDRESS (Actud LmOon) NUMBER OF BUILDINGS_ 1455 SUPERIOR AVENUE 1 CITY RESTRAINT NEWPORT BEACH, CA 92663 NO FACILITY CONTACT PERSON'S NAME HOURS LIANA FOOTE (949) 645-6833 7/24 Hrs. SPECIAL CONDITIONS y - '" kellgia=•:iqt6 '"rL; C3uS•s °U' ':=i.'x^l`t si5' 'nni i 1 r �' Frs *�. pw w �� ,�ascflMPL>c�iseTtr�a�o 9aP.. £-i. ',: '_° .x.k?;;i,'rvkTt;fit�t;+'rw k' f.,^tst-d>~r!�LC�S�cT', :lay rs:'.:<cr+. s, { CLEARANCE ALQODE NEWPORT BEACH FIRE DEPT. CODES T. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED FIRE AUTHORITY P.O. BOX 1768 NAME AND ADDRESS NEWPORT BEACH, CA 92658-8915 A. EXITS L B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS INSPECTOR'S NAME (rows orPrkiW TELEPHONE NUMBER CRRS NUMBER OCCUPANCY CLASS ' N Abt NC- M0 R'R-\ S (qLj ) j LfL4 3l DS 30(:)SS E. HOUSEKEEPING F. SPECIALHAZARD G. OTHER INSPECTION (DATE INSPECTOR'S SIGNATURE (ryW orPMI#d) OD EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS fiqmg oulk 7H9 State Fire Marshall 1. Request Date 2. Program AUGUST 13, 2012 ; CCL Fire Safety Inspection Request STD 850 PRESCHOOL 51 Decrease I AUGL ST 23, 2012 INFANT 24 Increase TOTAL= 75 3. Agency Contact 4. Telephone 5. Evaluator (714) 703-2800 Fax (714)703-2831 SUSAN DU/vd : E2137 Department of Social Services 6. SFM Region 7 SFM I.D. # 8. Facility # 9. Request Code 300610699 3A 370 300610700 i 10. Response Required Codes 1. Original A. Fire Clearance Department of Social Sery ces 2. Renewal B. Life Safety Community Care Licensin 3. Capacity Change 750 The City Drive #250 I 4. Ownership Change Orange, CA 92868 5. Address Change 6. Name Change iNrw.,)TS = a Rze-s DOL A 7. Hours: Monday - Friday 7:OOam-6:OOpm Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Ca�p Capacity Medical Prev.Cap 75 75 Care? 75 Care? 18. Facility, Code - 16 - CCC No ! 0 No 0 ; 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC CHILDTIME LEARNING CENIfER 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 2601 VISTA DEL ORO NONE 4. APH ! 12. ICF/DDN 5. PHF 13. RCF City ! Zip Code 16. Under NEWPORT BEACH, CA. ; 92660 24 HRS. 6. SNF 14. CCF 7. ICF/OT , 15: DAF 17. Facility Contact Person Telephone # 16a. Special WILSON, ROBIN (949) 644-0232 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 _ 2. Fire Clear/Denied N fit'. D I i`�L M p � � � �j � c (�� (� �{ y j� Q- 3(j � � � l = 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code -I3-�Oe M ; I Explanation of Denial or SpecialConditions: :Denial Code i i Fire Agency Denial Codes 1.Exits 2.Construct. 3.Fire Alarm FIRE PREVENT1014 BUREAU 4.Sprinkl4s 3300 NEWPORT BLVD. 5.Housekeeping NEWPORT BEACH, CA. 92663 6.Special Hazard i 7.Other { NAPORT BEACH,FIiiIODE�PAATMENT P.O. Box 1768, 3300 NEWPORT BLVD., NEWPORT PHONE: (949) 644-3104 FAX: (949) 644-3120 SCOTT L. POSTER FIRE CHIEF September 13, 2012 Robin Wilson Childtime Learning Center 2601 Vista Del Oro Newport Beach, CA 92660 Subject: Fire Clearance — Capacity Change Dear Robin: It was a pleasure meeting you earlier this afternoon during the fire cl I've enclosed a copy of the approved fire clearance for your records original to Community Care Licensing. This letteris to inform you that any future increase to the occupant will require the installation of a manual and automatic fire alarm sy requirement for facilities with occupant loads of 50 or more. If your occupant load increases to more than 100, the facility is class occupancy and a fire sprinkler system is required. I wanted to bring this to your attention early so you may plan occupancy load increases. I, CA 92658-8915 EB: WWW.NBFD.NET �arance inspection. ind mailed the for this facility This is a as a 1-4 for any future Feel free to contact me if you have any questions. I can be reached I at (949) 644-3105 or nmorris -nbfd.net. Thank you. Sincerely, Nadine Morris Fire Inspector Enc. 1t r Robert Werbe, LEED AP 4200 Von Karman Avenue I San Francisco 415.576.1800 phone Newport Beach, CA 92660 949.752.5500 direct Menlo Park 949.752.5501 fax 650.701.1500 phone 650.283.5329 cell novoconstruction.com i rwerbe@novoconstruction.com he �t'�=. R i �, t ,.. � � •- � . ., „- ;1.,+; i..i , _ S _ - _. .� , .. .'t 1:.'1_'°Ue• „ �E v' '�'1..F •' '3u K h`-�. n'� A �S. c rt 1. 6:=r i�, d. „x 'i�� ,:� s . l.'. ws�. •.t - } '� ��' isa — ,•k i F > - i; � , .,A . � a' . � ` _ ,oRT,& I NEWPORT BEACH FIRE DEPARTMENT FIRE PREVENTION DIVISION P.O. Box 1768, Newport Beach, CA 92658-8915 �� w$ (949) 644-3106 AR� ................................................................................................................................. Notice of Reinspection and Non-Compliance .......................................................................................... _....................................: Date: ID -l �t `- l l' A member of the Newport Beach Fire Department conducted a fire and life safety inspection at the following location/business on Business Name: >N 01 / Business Address: 1?1-`z a Z7 V O,41 kA4,41 At that time, a Violation Notice was issued indicating the corrections required to gain compliance with the applicable codes, regulations, and ordinances pursuant to the - California Fire Code. This notice is to inform you that your business is entitled to one more fire company reinspection, which will occur on or after f / -- 01 '-`/ If all violations are not corrected at that time, your business will be referred to the Fire Prevention Division. The Fire Prevention Division will perform a subsequent reinspection of your business at the prevailing fee schedule set forth by City Council.. Your prompt attention in this matter is appreciated. Responsible Party: R 9 0-j BC Phone Number: 7S0 g g o Email Address: Fax Number: Inspector's Name: r dies Di-L- Phone Number: Left with Responsible Party 0 Faxed 0 Emailed (Rev. 9-28-10) Original - Owner/Responsible Party Yellow - FPD a - I NEWPORT BEACH FIRE DEPARTMENT 3300 Newport Blvd, Newport Beach, CA 92663 Office (949) 644-3106 Fax (949) 644-3120 VIOLATION NOTICE Business/Building Name: Inspection Date: Address: Issue Date: Notice of Reinspection and Non -Compliance t-Lo V 0 �'/ K A V-,/ Suite: Bus ess Phone: Issue Date: Notice of Referral to the Fire Prevention Division As a result of a fire inspection by the Newport Beach Fire Department, the violation(s) listed below were noted. See reverse side for violation code descriptions. Date Cleared (office nsr. nnivl -_ 0A 7- 2_ Pv' i1l % d A 1-' Vltll/I �_ /J L.1J.M R OO i SELF -CLEARING: Only a fire extinguisher violation may be self -cleared. If one was noted above, it may be self -cleared by certifying below that it has been serviced or replaced and tagged appropriately. Please return this notice to the above address within 14 days of the inspection date. I hereby certify that the are extinguisher violation has been corrected. Print Name: Date: Signature: 0 I,� ORDER TO COMPLY: You are hereby required to correct the above condition(s) immediately upon receipt. Noncompliance with the foregoing order before'the date of reinspecti�-may render you liableto the penalties provided by law for such violation(s). A reinspection elate is noted on the bottom,of&s notice. / / Print - Responsible Party Signature — Res4p ibl ' rV r Inspector Inspection Unit Reinspection Date Revised Jan 2011 Original — Business Yellow — Fire Prevention GENERAL PROVISIONS FOR FIRE SAFETY California Fire Code Sections A. Common Violations AA Provide extinguisher(s) with a minimum rating of 2-A:10-B:C. [906.1] AB Mount extinguisher(s) where readily available. 40 lbs or less = top, maximum 5' above floor / more than 40 lbs = top, maximum 3.5' above floor [906.9] AC Service and tag each extinguisher annually and after each use. [906.2] AD Post signs indicating location of extinguishers when obscured from view. 1906.61 AE Open burning, recreational fires, and/or outdoor fireplaces (objectionable or unapproved location). [307] AF Provide appropriate sign on fire department connection. [912.41 AG Fire department connection clearance is to maintain a 3' circumference.1912.3.21 AH Post street address numbers on front of building. Minimum 4" in height for residential and minimum 6" in height for commercial. [505.11 Al Fire hydrant clearance is to maintain a 3' circumference. [507.5.5] AJ Commercial dumpsters are to maintain a 5' separation from buildings. [304.3.3] AK Class K commercial kitchen extinguisher required. [904.11.5.2] AL Open flame cooking devices shall not be operated on combustible balconies or within 10' of combustible construction unless sprinklered. (308.1.41 B. Fire Protection Systems BA Provide Knox box for fire department access. [5061 BB Extinguishing systems shall be maintained and operable at all times. [901.6] BC Service and tag hood and duct extinguishing system semi-annually and after each activation. [904.5] BD Provide central station supervision of fire sprinkler system. [903.4] BE Inspect, test, and provide 5-year certification on sprinkler/standpipe system(s). [901.6.11 BF An approved occupant voice notification system shall be provided. [907.6.2.21 BG Hoods, grease -removal devices, fans, ducts, and other appurtenances shall be cleaned. [609.3.3] C. Maintenance of Exit Ways CA Remove all other locks or latches from doors and replace with panic hardware - Assembly occupancies (OL 50 or greater) [1008.1.101 CB Unlock all exit doors during business hours. [1008.1.9.3] CC Post approved sign "THIS DOOR TO REMAIN UNLOCKED WHEN BUILDING iS OCCUPIED." [1008.1.9.31 CD Post occupant load sign. [1004.3] CE Means of egress shall be illuminated at all times when occupied. [1006.1] CF Remove obstruction(s) from exits, aisles, corridors, and stairways. 11030] D. Flammable and Combustible Liquids DA Provide approved liquid storage cabinet for all flammable liquids. [3404.3.2] DB Flammable liquids shall be transferred by one of the approved methods, such as pumps taking suction through the top of the container. [3405.2.4] DC Provide approved safety cans for dispensing flammable liquids. [3404.3] E. Storage EA Reduce storage to 18" below level of sprinklers or 24" below ceiling in non-sprinklered building. [315.2.1] EB Good housekeeping. Arrange storage in an orderly manner and provide for exiting & fire department access. [315.2] EC Remove combustible storage in boiler, mechanical, or electrical rooms. [315.2.3] ED Proper storage of oily rags and similar materials shall be in listed disposal containers. [304.3.1] EE Remove storage from under exit stairways. [315.2.2] F. Electrical FA Provide cover plates. [605.11 FB Identify breakers in panel box. [605.3.1] FC Electrical panel and equipment shall have a minimum clearance of 36" in depth, 30" in width, and 78" in height. [605.3] FD Discontinue use of extension cords in lieu of permanent wiring. [605.5] FE Remove extension cords running through openings or attached in series, cords placed under rugs, furniture, or where subject to damage. 1605.51 FF Maintain wiring in good condition and protect from damage. [605.5.3] FG Discontinue use of multi -plug adapters. [605.4] G. Hazardous Materials GA Provide approved hazardous materials storage cabinet for all hazardous materials. [2703.8.7] GB Secure and identify compressed gas cylinders with name of product. [3003.5.3] GC Provide MSDS information for hazardous materials. [2703.41 GD Mark all fixed storage facilities in accordance with NFPA 704. [2703.5] GE Update hazardous materials inventory statement and/or hazardous materials management plan. 12701.5.1, 2701.5.2] H. Combustible Materials HA Remove all cut or uncut dead and dying weeds from the property. [305.5] HB Cut and remove trees and shrubs in wildland hazard reduction area. [4903] Z. Miscellaneous Violations ZZ Other code violation CHAPTER 1 REQUIRED OPERATIONAL PERMITS - Not an all inclusive list, only the most common. See Section 105.E for a complete list of required permits. • Combustible Dust -producing Operations (i.e. wood working). [105.6.6] • Compressed Gases: corrosive/flammable in excess of 200 CuFt; toxic, highly toxic, pyrophoric - any amount; inert at 6000 CuFt; oxidizing at 504 CuFt. [105.6.81 • Cryogenic Fluids: quantities on site are in excess of the amounts in Table 105.6.10. (i.e. flammable: more than 1 gallon inside and more than 60 gallons outside) • Dry Cleaning Plants: use of solvents to clean clothing. [105.6.12] • Flammable and Combustible Liquids: storage of Class I liquid in excess of 5 gallons inside or in excess of 10 gallons outside of a building; or storage of Class II or Class IIIA in excess of 25 gallons inside or in excess of 60 gallons outside of a building; or storage of Class IIIB liquids in tanks for fueling motor vehicles at motor fuel -dispensing facilities; or engage in the dispensing of liquid fuels into the fuel tanks of motor vehicles. [105.6.16] • Hazardous Materials: to store, dispense, use, or handle hazardous materials in quantities listed in Table 105.6.20. • Hot Work Operations: cutting, welding, brazing, soldering, grinding, and other similar activity. [105.6.23] • Industrial Ovens (i.e. parts, circuit boards, kilns, powder coating). [105.6.24] • LP -gas: storage and use. 1105.6.27] • Open FIames and Candles: in assembly areas, dining areas of restaurants or drinking establishments. [105.6.32] • Place of Assembly: 50 or more persons. [105.6.34] • Refrigeration Equipment: to operate a mechanical refrigeration unit or system. [105.6.38) • Repair Garages and Motor Fuel -dispensing Facilities. [105.6.391 • Spraying or Dipping (i.e. spray booths/rooms). [105.6.41] Revised fan 2011 lion Area • Fire and Life Safety Inspection Worksheet Occupancy Type B Occupancy ID # 30462 Assigned NT63C Inspection Month January Name: Dexus Property Group Location: 4200 VON KARMAN AVE 3 D Description : N/A (Stand alone) ❑ Business License License Number? Business Phone: (949)752-5500 Business EMail Address ❑ Bldg Status Status? -Email Address needed ❑ Stories Building. Stories? ❑ Fire Department Permits Required or UpdateNerify Contact Name Day Time Phone After Hours Phone Haug Guido (562)773-4002 After Hours Phone? Attributes: Fire Protection Equipment Type Description Comments Fire Alarm System Annual Insp Report Knox Box On column to the right of main Waterflow entrance. Fira PPntar_.tir5tt SvctPrrS (`e.F�rnir�4inn.'r1�t� Permits / State Mandated Insp Activities Fire Operations Inspection Issued Expires Assigned Units/Inspector AssignedDate NT63C 1 /1 /2014 A/DV-0. Completed Status Open Required Attributes: ❑ Elevator(s) ❑ Swimming Pool QTY. ❑ Fire Protection System ❑ Knox Box ❑ AED ❑ Yes Cert Date ❑ Electric gate access ❑ Photovoltaic System ❑ No ❑ Bi Directional Amplifier ❑ Hood .Last Serviced ❑ Fire Pump Service Date Printed: 08/21/2014 20:39:49 ,b Fire Alarm System Testing Record SCN, Security Communication Network, inc 470 E. Harrison SL Carona, CA '92879 (800) 450-4400 Site Information Contact Information Name: Master Development Corporation Name: Phone: Address: 4200 Von Karmen Ave. Contact: City/State/Zip: Newport Beach, CA 92660 Acct. #: SCN20939 FD #: Fire Control Panel: DMP XR100F Central Station Inforhi0tion Battery #1: Voltage: Charging Current: Operator: C'�S Date: AMPS: Size: On Test: 2—. 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D, Brea, CA 92821-2944 Sales,Representative.• (714) 989-1800 Fax: (714) 989-1619 Invoice To: Product Line: R A&D/Electrical 0'-Sprinkler/Mechanical R Extinguisher R Kitchen Hood -2 El Special Hazards, to'Inspection or'q R Other: Contact Name: C,01,01t) Agreement Type: ❑ Time & Material Ph #: 5'b- Z - 1 /-3 3 1 Fx #: Price Not to Exceed $ Lump Sum Fixed Price of $ Job Location: IUOV(;, 6.0A,"T7vA1C7'1'01"J- Site Information: YesNo q Inspection Due? F-1 Return Trip Required? El ff Customer Provided Fire Watch Required? 0- R Cosco Sticker Posted? El Contact Name: Ph #: Fx #: Panel Type: Work Description: 01 -r Labor/ Product # Description oty Unit[ Unit Extended Material Meas. Price Price sy Authorized Customer Signature. Labor and Other -Subtotal 7 Print Name & Title: Material Subtotal Customer PO: Tax All work is subject to the terms & conditions on Date: the back of this work order. //// I/ Y// Shipping & Handling All invoices are due net 10-days (no exceptions). Technician: T6tal Due 31940 FIRE ALARM SYSTEM RECORD OF COMPLETION �a flt a - To be completed by the system installation contractor at the time of system acceptance and approval. 1. Protected Property Information r Name of property: 4440 VON KARMAN Address: 4440 VON KARMAN AVE NEWPORT BEACH, CA 92660 Description of property: OFFICE BLDG Occupancy type: B y Name of property representative: GREENLAW PARTNERS Address: 18301 VON KARMAN AVE. #510 IRVINE, CA 92612 Phone: 949-331-1482 - - Fax: E-mail: Authority having jurisdiction over this property: NEWPORT BEACH FIRE DEPARTMENT Phone: Fax: E-mail: 2. Fire Alarm System Installation, Service, and Testing Information Installation contractor for this equipment: VFS FIRE & SECURITY SERVICES Address: 1011 EAST LACY AVE. ANAHEIM, CA 92805 Phone: 714-778-6070 Fax: 714-778-6090 E-mail: Service organization for this equipment: VFS FIRE Address: Phone: Fax: E-mail: Location of as -built drawings: OWNER / PANEL----- Location of Historical Test Reports: Location of system operation and maintenance manuals: OWNER �^ A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Address: VFS Phone: Fax: E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. Type of Fire Alarm System or Service NFPA 72® Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers (f applicable): Alarm: MACE CS Phone: 866-440-0311 Supervisory: MACE CS T J Phone: 866-440-0311 Trouble: MACE CS Phone: 866-440-0311 Entity to which alarms are retransmitted: PUBLIC TELEPHONE NETWORK __ Phone: Method of retransmission of alarms to that organization or location: PUBLIC TELEPHONE NETWORK NFPA 72, Fig. 4.5.2.1 (p. 1 of 5) Copyright © 2009 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. r • W • If Chapter 8, note the means of transmission from the protected premises to the central station: N Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2-way radio ❑ 1-way radio ❑ N/A If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: SILENT KNIGHT 5700 Site -specific software revision date: Revision completed by: 4. Signaling Line Circuits Characteristics of signaling line circuits connected to this system (see NFPA 72 ®, Table 6.6.1): Quantity: 1 Style: Y Class: B 5. Alarm -Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system (see NFPA 72® Table 6.5): Quantity: 10 Style: Y 5.1 Manual Initiating Devices Class: B 5.1.1 Manual Pull Stations Number of manual pull stations: 1 Type of devices: ® Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: 5 Type of coverage: ❑ Complete area N Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: N Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization N Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: 0 Type of coverage:__ — Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.3 Heat Detectors Number of heat detectors: 0 Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.4 Sprinkler Watertlow Detectors Number of waterflow detectors: 4_ ____ Type of devices: ®Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for 60 seconds 6. Supervisory Signal -Initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: 6 Type of devices: N Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A NFPA 72, Fig. 4.5.2.1 (p. 2 of 5) Copyright © 2009 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. E 6.2 Fire Pump Type of fire pump: ❑ Electric ❑ Diesel Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine -Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: 7. Annunciators 7.1 Annunciator 1 ❑ Local ®Remote Type: ❑ Addressable ® Directory ❑ Graphic ❑ N/A Location: 7.2 Annunciator 2 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 8. Alarm Notification Devices and Circuits 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of speakers: 8.2 Telephone Jacks Number of multiple voice alarm -channels: Number of speaker zones: Number of telephone jacks installed: 2 _ _ _ _ Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFPA 72® Table 6.5): Quantity: ------ -- -- - Style: 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device: Chimes: With visual device: Visual devices without audible devices: Class: Horns: With visual device: Bells: With visual device: Other (describe): NFPA 72, Fig. 4.5.2.1 (p. 3 of 5) Copynght ©2009 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. • 9. Emergency Control Functions Activated ❑ Hold -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ® Elevator recall ❑ Other 10.System Power Supply 10.1 Primary Power Nominal voltage: 120 _ Overcurrent protection: Type: Location (of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Amps: Amps: ELEC RM 20 Location: PANEL _ _ Type: m Nominal voltage: 12 Current raring: Number of standby batteries: 2 Amp hour rating: _7 , Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: 24 HOURS In alarm mode: 5 MINUTES ------------ 11. Record of System Installation Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) ® NFPA 720 ® NFPA 70®, Article 760 ® Manufacturer's published instructions ❑ Other (please specify): System deviations from referenced NFPA standards: Signed: — Printed name: e-�00 aDate: ©I 30 --I,3 Organization: VFS FIRE & SEC. —_ Title: ALARM TECH Phone: 714-778-6070 12. Record of System Operation All operational features and functions of this system were tested by or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of: ® NFPA 720 ® NFPA 70®, Article 760 ® Manufacturer's published instructions ❑ Other (please specify): ❑ Documentation in accordance with Inspection and Testing Form (Figure 10.6.2.3 of NFPA 72) is attached Signed: �� _ Printed name: le i2pQ �o,� t �QQ Date: 0 / - 30 — 1 Organization: VFS FIRE & SEC. _ Title: ALARM TECH Phone: 714-778-6070 NFPA 72, Fig. 4.5.2.1 (p. 4 of 5) Copyright © 2009 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. 11 13. Certifications and Approvals 13.1 System Installation Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: _ Printed name:-r6#100 d all" "o Date: C31 20—/.? Organization: VFS FIRE & SEC. Title: ALARM TECH. Phone: 714-778-6070 13.2 System Service Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: _ Printed name: i�,�,�:� �,Co.✓�tPo Date: ®---25P Organization: VFS FIRE & SEC Title: ALARM TECH Phone: 714-778-6070 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Ortanization: VFS FIRE & SEC Title: ALARM TECH Phone: 714-778-6070 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards- cited herein. Signed: _ Printed name: I Date: Organization: Title: Phone: 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, its approved sequence of operations, and with all NFPA standards cited herein. Signed: T� _ Printed name: Date: Organization: _ _ Title: -- Phone: NFPA 72, Fig. 4.5.2.1 (p. 5 of 5) Copynght ©2009 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. 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L' C taO U u u L u u i uC. U U U G U U U V C' u U tu `..tG '�� r• V u uOL <,U 0 u U .uuU VU AttY +, A RI..7i;•7 A?_ m o 0 o 0 c `G 0 -h 'CD Z fD tp 0 O o�,Z7 CD 0 Z �A o 4 N (D =' Co 91) Co0 t C N Q O � {jZ o o' _0 In ID CD m °a Z '0 m O ba ai eM o N -n 0 R j t0 Cn a� C 0) CA 4a N 7 Alcaraz, Debbie From: Morris, Nadine Sent: Monday, February 01, 2016 8:10 AM To: Alcaraz, Debbie Subject: Invoice Attachments: chld-01@newportbeachca.gov_20160201_081535_000OOf8b001b.pdf Hi Debbie, Please invoice TRL Systems for an off hours inspection: 02/01/2016 0600-0700=1 hour Thank you! Nadine Nq(Tin 1 NO Alcaraz, Debbie From: Morris, Nadine Sent: Wednesday, February 10, 2016 8:39 AM To: Alcaraz, Debbie Subject: Document for Scanning Attachments: chld-01@newportbeachca.gov_20160210_084502 00002d3e001b.pdf Categories: SCAN Please scan into•1617 Westcliff Dr #112. Thank you, Nadine FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM INSPECTION AND TESTING FORM To be completed by the system inspector or tester at the time ofthe inspection or test. It shall be permitted to modem this fora: as needed to provide a more complete andlor clear record. Insert A%A in all amused lines. Attach additional sheets, data, or calculations as necessary to provide a complete record. Date of this inspection or test: 1 22 2016 1. PROPERTY INFORMATION Name of property: WEST CLIFF ( SUITE 112 ) Address: 1617 WEST CLIFF Description of property: RESTURANT Occupancy type: EM Name of property representative: Address: Phone: Fax: Authority having jurisdiction over this property: Phone: Fax: Time of inspection or test: 13�00 NEWPORT BEACH E-mail: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION 0,D15-- U71 0_r(K- C-IRA�r1�u�C Service and/or testing organization for this equipment: AMERICA ALARM Address: 1101 S. GRAND AVE SANTA ANA CA 92705 Phone: 714 547 7474 Fax: E-mail: Service technician or tester: RICH TUCK Qualifications of technician or tester: REP A contract for test and inspection in accordance with NFPA standards is in effect as of 2013 The contract expires: Contract number: Frequency of tests and inspections: Monitoring organization for this equipment: AMERICAN ALARM Address: 1101 S. GRAND AVE G SANTA ANA CAS. 92705 Phone: 714 547 7474 Fax: E-mail: Entity to which alarms are retransmitted: PHONE LINES 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. O Fire alarm ❑ EVACS ❑ MNS ❑ Two-way, in -building, emergency communication system ® Other (specify): POWER SUPPLY ANN NFPA 72. Fig, 14 6 2.4 (p 1 of 11) Copyright © 2009 National Fire Protection Association This torn may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 3. TYPE OF SYSTEM OR SERVICE (continued) NPPfI 72 edition: 2013 Additional description of system(s): 3.1 Control Unit Manufacturer: SILNET KNIGHT 3.2 Mass Notification System 3.2.1 System Type: ® In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Other (specify): Model number: 5808 ❑ This system does not incorporate an MNS. ❑ Wide -area MNS ❑ Distributed recipient MNS 3.2.2 System Features: ® 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 DRIvINS interface ❑ Wide -area MNS to high -power speaker array (HPSA) interface ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ❑ An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the record record drawings are stored on site. Location: NIA 3.4 System Software ® This system does not have alterable site -specific software. Software revision number: 1 07 2016 Software last updated on: 1 22 2016 ❑ A copy of the site -specific software is stored on site. Location: N/A 4. SYSTEM POWER 4.1 Control Unit 4.1.1 Primary Power Input voltage of control panel: 121.2 4.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: Control panel amps: 20 ® This system does not have agenerator. Type of fuel: 4.1.3 Uninterruptible rower 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): ht alarm mode (minutes): NFPA72.Fig 14624(1) 2of I3t Copyright © 2009 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 4. SYSTEM POWER (continued) 4.1.4 Batteries Location: FRCP Type: SEALED Nominal voltage: 27.4 Amp/hour rating: 18 LEAD Calculated capacity of batteries to drive the system: In standby mode (hours): 24 In alarm mode (minutes): 5 N Batteries are marked with date of manufacture. 4.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System N 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: 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: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode (hours): In alarm mode (minutes): ❑ Batteries are marked with date of manufacture. 4.3 Notif►eation Appliance Power Extender Panels ® This system does not have power extender panels. 4.3.1 Primary Power Input voltage of power extender paneI(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 N 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): NFPA72 Fig 146241p 3of11) Copyright 02009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sate or distribution. 4. SYSTEM POWER (continued) 4.3A Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture. Ei '_ ' +, M 5.1 Location and Description of Annunciators Annunciator is ENTRY EXIT Annunciator 2: Annunciator 3: 6. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Building management Building occupants Authority having jurisdiction Other, if required i. TESTING RESULTS Contact: SHSWN Contact: Contact: Contact: Contact: 7.1 Control Unit and Related Equipment Nominal voltage: In alarm mode (minutes): Amp/hour rating: ❑ This system does not have annunciators. Time: 1450 Time: Time: Time: Time: Description Visual Inspection Functional Test Comments Control unit Lam s/LEDs/I,CDs Fuses ❑ ❑ Trouble signals Disconnect switches Ground -fault monitoring ❑ ❑ Supervision Local annunciator Remote annunciators ❑ ❑ Power extender panels Isolation modules ❑ ❑ Other (TmifY) NFPA 72 Fly_ 14 6 2 4 1p 4 of III Copyright 0 2009 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. 7. TESTING RESULTS (continued) 7.2 Control Unit Power Supplies Description Visual Inspection Functional Test Comments 120-volt power ® 2� Generator or UPS ❑ ❑ Battery condition Load voltage ❑ ❑ Discharge test ❑ ❑ Charger test Other (specify) ❑ ❑ 7.3 In -Building Fire Emergency Voice Alarm Communications Equipment Description Visual Inspection Functional Test Comments Control unit ❑ ❑ N/A Lam s/LEDs/LCDs ❑ ❑ Fuses ❑ ❑ Primary power supply❑ ❑ Secondary power supply❑ ❑ Trouble signals ❑ ❑ Disconnect switches ❑ ❑ Ground -fault monitorin ❑ ❑ Panel supervision ❑ ❑ System performance ❑ ❑ Sound pressure levels Occupied ❑ Yes ❑ No Ambient dBA Alarm dBA (attach report with locations, values, and weather conditions) ❑ ❑ System intelligibility ❑ CS1 ❑ STI (attach report with locations, values, and weather conditions) ❑ ❑ Other (specify) ❑ ❑ NFPA 72, Fig. 14.6.2.4 (p. 5 of 11) Copyright ©2009 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. 7. TESTING RESULTS (Coilflaued) 7.4 Notification Appliance Power Extender Panels Description Visual Inspection Functional Test Comments Lam s/I.EDsILCDs ❑ ❑ NIA Fuses ❑ ❑ Primary power supply❑ ❑ Secondary power supply❑ ❑ Trouble signals ❑ ❑ Ground -fault monitorin ❑ ❑ Panel supervision ❑ ❑ Other (s ee f ❑ ❑ 75 Mass Notification Equipment Description Visual Inspection Functional Test Comments Functional test ❑ Q NIA Reset( ower down test ❑ ❑ Fuses ❑ ❑ Prhmg 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 ❑ ❑ NF-PA 72, Fig. 14.6.2.4 (p. 6 of 11) Copyright 02009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commorclai sate or distribution. 7. TESTING RESULTS (continued) 7,5 Mass Notification Equipment (continued) Visual Functional Description Inspection Test Comments MNS to direct recipient NINS ❑ ❑ 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 ❑ ❑ NIA Phonejacks ❑ ❑ Off -hook indicator ❑ ❑ 0JI-in signal ❑ ❑ System performance ❑ ❑ System audibility ❑ ❑ System intelligibility ❑ ❑ Radio communications enhancement system ❑ ❑ Area of refuge communication system ❑ ❑ Elevator emergency communications system ❑ ❑ Other (specify) El ❑ 1VFPA 72, Fig. 14.6.2.4 (p. 7 of 11) Copyright C 2009 National Fire Protection Ausoclation- This form maybe copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 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 s eci Visual Inspection Functional Test Comments ❑ ❑ NIA ❑ ❑ Q ❑ 7.9 Emergency Communications System ❑ Visual ❑ Functional ❑ Simulated operation ❑ Ensure predischarge notification appliances of special hazard systems are not overridden by the MNS. See NFP,4 72, 24.4.1.7.1. 7.10 Monitored Systems Description (specify) Visual Inspection Functional Test Comments Engine -driven generator ❑ ❑ NIA Fire pump ❑ ❑ Special suppression systems ❑ ❑ Other (specify) ❑ ❑ IVFPA 72, Fig. 14.6.2.4 (p. 8 of 11) Copyright 02008 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. 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 ❑ ❑ NINS 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 ® ❑ S!jpervisory signal ® ❑ Supervisory restoration ® ❑ PJ Phi 72, Fig. 14.6.2.4 (p. 9 of 11) Copyright 02009 National Fire Protection Association. This form maybe copied for individual use other than for resale. It may not be copied ror commercial sale or distribution. 8. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: SHAWN Building management Contact: Building occupants Contact: Authority having jurisdiction Contact: Other, if required Contact: 9. SYSTEM RESTORED TO NORMAL OPERATION Date: 1 22 2016 Time: 1500 Time: 1600 'rime: Time: Time: 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: RICH TUCK Printed name: RICH TUCK Date: 1 22 2016 Organization: AM ALARM Title: REP. Phone: 714 547 7474 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: Organization: Printed name: Title: Date: Phone: NFPA 72, Flg. ,l4 0i.2.4 (p 10 of 11) Copyright Q 2009 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. DEVICE TEST RESULTS (Attach additional sheets if required) t1 FPA- 72 Fig 14 6 2.4 (p 11 of 1 1) Copyright 0 2009 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. .A Alcaraz, Debbie From: Sent: To: Subject: Attachments: Categories: Please scan for 1617 Westcliff Dr. Thank you, Nadine Morris, Nadine Wednesday, February 10, 2016 9:09 AM Alcaraz, Debbie FW: 1617 Westcliff Material & Test Certification Material & Test Certification For 1617 Westcliff.pdf SCAN From: ]ay Pogossian [mailto:jaayp amcofireprotection.com] Sent: Wednesday, February 10, 2016 8:22 AM To: Morris, Nadine Subject: 1617 Westcliff Material & Test Certification Good morning Nadine, Attached is 1617 Westclif project material test certification for your record. Please let me know if you have any questions. Thank you, ,day Pogossian 676 W. Wilson Ave. Unit F Glendale, CA 91203 Office: (818) 502-3250 Fax: (818)502-3990 email: JavP .amcofireprotection.com website: www.AMCOFireprotection.com Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be tilled out and signed by both representatives. Copies shall be prepared for approving authorities, owners and contractor. It is understood the owner's representative's signature In no way prejudices any claim against contractor for faulty material, poor workmanship, or'failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME Westdiff DATE 02/10/16 PROPERTYADDRESS 1617 Westcliff, Newport Beach CA PLANS ACCEPTED BY APPROVING AUTHORITIES (NAMES) ADDRESS INSTALLATION CONFORMS TO ACCEPTED PLANS 0 YES ❑ NO EQUIPMENT USED IS APPROVED IF NO, EXPLAIN DEVIATIONS 0 YES ❑ NO INSTRUCTIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN 0 YES ❑ NO HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: 1. SYSTEM COMPONENTS INSTRUCTIONS 0 YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS 0 YES ❑ NO 3. NFPA 25 OYES ❑ NO LOCATION OF SYSTEM SUPPLIES BUILDINGS MAKE MODEL YEAR OF MANUFACTURE ORIFICE SIZE QUANTITY TEMPERATURE RATING Globe GL5615 2015 5.6 114 155 SPRINKLERS Globe GL5606 2015 5.6 15 155 Globe GL5626 2015 5.6 7 200 PIPE AND FITTINGS Type of Pipe SCH 10 / 40 Type of Fittings DI ALARM VALVE OR FLOW ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST CONNECTION TYPE MAKE MODEL MINIMUM SECONDS INDICATOR Existing Potter VSR 0 45 DRY PIPE OPERATING TEST N/A DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP THROUGH TEST CONNECTION* WATER PRESSURE AIR PRESSURE TRIP POINT AIR PRESSURE TIME WATER REACHED TEST OUTLET* ALARM OPERATED PROPERLY MIN. SEC. PSI PSI PSI MIN. SEC. YES NO without Q.O.D. ❑ ❑ With Q.O.D ❑ 13 IF NO, EXPLAIN "MtAJUKtU t-KUM I ]Mt INSYt(:I UK'S I t6l UUNNtG I IUN IS UFkNtU. ATTACHMENT "B-1 FOR Aboveground Piping" (Page 1) OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO I DETECTING MEDIA SUPERVISED ❑YES ❑ NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS ❑ YES ❑ NO DELUGE & PREACTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? ❑ YES ❑ NO I IF NO, EXPLAIN VALVES DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE N/A YES NO YES NO MIN. SEC. 11 ❑ ❑ ❑ PRESSURE LOCATION MAKE & RESIDUAL FLOW RATE REDUCING & FLOOR MODEL SETTING STATIC PRESSURE PRESSURE VALVE TEST (FLOWING) N/A INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM) HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours of 50 psi (3.4 bars) above static pressure in excess of 150 psi (10.2 bars) for two hours. Differential dry -pipe valve clappers shall be left open during test TEST to prevent damage. All aboveground piping leakage shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1-1/2 psi (0.1 bars) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1- 1.2 psi (0.1 bars) in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HRS. IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED ❑ YES 0 NO EQUIPMENT OPERATES PROPERLY 0 YES ❑ NO DRAIN TEST READING OF GAUGE LOCATED NEAR WATER SUPPLY TEST CONNECTION: 90 PSI RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION OPEN WIDE 82 PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS TESTS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.85B ❑ YES ❑ NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING ❑ YES ❑ NO IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE, HAS IF NO, EXPLAIN REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? ❑ YES ❑ NO BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING ❑ YES 0 NO IFYES... WELDING DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10 9. LEVEL AR-3? ❑ YES [I NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN N/A COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS DI 9. LEVEL AR-3? ❑ YES ❑ NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE ❑ YES ❑ NO REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS 0 YES ❑ NO (DISCS) (DISCS) ARE RETRIEVED Page 2 HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA 0 YES ❑ NO NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS 02/09/16 NAME OF SPRINKLER CONTRACTOR AMCO Fire Protection, Inc. TESTS WITNESSED BY SIGNATURES FOR PROPERTY OWNER (SIGNED) TITLE DATE FOR SPRINKLER CONTRAC ) TITLE DATE Jay (?ogossian President 02/10/16 FOR AUTHORITY HAVING JtRISDI ON (IF WITNESSED) TITLE DATE ADDITIONAL EXPLANATION AND NOTES Page 3 Ak OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & Lif Safe Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. Safety ,11 For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. �rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrlcrrrrrrrrrrrrrrrrtrrr:rrrr■ FIRE DEPARTMENT: NE'WPORT BEACH FIRE DEPARTMENT Date of Inspection: Name of Building: VV�AV4't b' ;1 Address: an o � '�vl[A LC� This building has been inspected as a[ ] NEW KEMS TING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class RJ Construction Type Year Constructed Sprinkler Systems This building is in compliance with the applicable regulations. U4 YES [ ] NO The building is vacant. [ ] YES ftm A Plan of Correction has been accepted by the Fire Department. [ ] YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR: l N I Af O N'T" co -ass (08/05) A-;�7. "I (f�P'%nq�a�h�,�l� 11� �'EILIPOR.£ MAi •AC OFFICE OF THE STATE FIRE MARSHAL High Rise Building inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: %1 (/r YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair�l [ } [ I 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided} [ } [ I 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies [K} [ } [ } at opening are properly maintained • B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' [ [ I [ I 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. [ } [ } 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested [ [ l [ l 11 All heating, cooling and ventilation equipment is maintained safisfactodly. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner IG} [ l [ ] D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are. maintained in proper condition and free of grease [ l [ } 16 All areas are free of unusual amounts of storage tN I } [ l Gen.009 (Rev.3/02) Page 1 of 2 E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained 18 All fire extinguishing systems are properly maintained and [l [ [ l 19 serviced Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of paint/corrosion [Rl [ l [ l 21 Building alterations have not obstructed sprinklers or Pal [ [ l created unprotected spaces F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically [K] L I [ 1 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by: (1AAM 'Date: Gen.009 (Rev.3/02) Page 2 of 2 d OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & Lifer �!((A ,��;�� Safety Division South, 602 E.�Huntington Dr., Ste A, Monrovia, CA 91016. l� J For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the high -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Liife Safety by telephoning (626) 305-1908. �rrrrrrarrrrraraarrarrraarirrrarraaaraaraarrarrrrfrrraraarrrarrarrrrrarrrar■ FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: Name of Building: C e__ Address: 60/ DO, rye.. J This building has been inspected as a[ ] NEW [ ] EXISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class 6 Construction Type �pe- Year Constructed ' Sprinkler System Fvl This building is in compliance with the applicable regulations. YES [ ] NO The building is vacant. [ J YES [ENO A Plan of Correction has been accepted by the Fire Department. [ ] YES [ ] NO If a Plan of Correction has not. been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR:,v_ 4` kI f hJ L v f Gn-28s (08/05) A 4 $TAT0_s�vuk OFFICE OF THE STATE FiRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: 13 0' -D-0 YES NO N/A A. CONSTRUCTION - 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair [4 [] [] 2 Fireproofing of structural members is mainained KI [ ] 11 3 Proper interior and ceiling finish rating is provided [ttl [ 1 C l 4 Fire doors are of proper rating and operate satisfactorily Cf ] [ l [ ] 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained [ ] [ ] B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor •' 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. [ C ] [ ] 9 Corridors are not used as part of the air distribution system • C. MECHANiCAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested [;4 [ l [ ] 11 All heating, cooling and ventilation equipment is maintained safisfactorily. There are no visible defects ( [ ] C 1 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control [74 [ l C ] 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease [ ] [ ] 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 ' 6 Y E. FIRE EXTINGUISHING •, 17 All first -aid fire fighting equipment is properly located and maintained [ [ ] [ ] 18 All fire extinguishing systems are properly maintained and serviced Pq - [ ] [] 19 Water supply controls are locked/supervised and unobstructed bq [ I [] 20 Sprinklers are unobstructed and free of paint/corrosionA] [ ] [ ] 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARMIWARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically Dc] [ ] [ ] 23 Manual activation stations are properly located, readily visible and unobstructed Dq [ I [ 24 Occupant voice notification system, when required, is maintained and tested periodically ( [ ] [ ] 25 Fire department communication system is maintained and tested periodically po] [ ] [ ] 26 An acceptable method is provided for notifying the fire department of afire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS .% 27 Sensing devices at elevators are maintained and tested 14 [] [ I 28 Elevator lobbies are separated from the corridor and the remainder of the building [ ] [ ] 29 Elevators are equipped with fire department recall [ I [ I 30 An emergency pre -fire plan has been established, is acceptable to the fire department and is posted in appropriate places 0 COMMENTS Inspected by: Date: Gen.009 (Rev.3102) Page 2 of 2 r, OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING •INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. 2,�'►'�� Please complete and return this form to: Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E..Huntington Dr., Ste A, Monrovia, CA 91016. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the fiigh-Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. irrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■,rrrrrrrrrrrrrrrrr�rrrrrrrr■ FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: (a" ?''/ -&- Name of Building: i lme Or -PK,G(J � Address: +-t00 WW*4,9442 L-VO, This building has been inspected as a [ ] NEW %EXISTING high-rise structure, as defined in Section 13210, Health and .Safety Code. Major Occupancy Class '�> Construction Type J Year Constructed -rs �l�? Sprinkler System Pau_ This building is in compliance with the applicable regulations. [BYES [ ] NO The building is vacant. [ ] YES [-]..NO A Plan of Correction has been accepted by the Fire Department. D4 YES. [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR: GO-28S (08/05) tvioNz. OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained [<1 [ ] 11 3 Proper interior and ceiling finish rating is provided [r]. [ ] [] 4 Fire doors are of proper rating and operate satisfactorily Vi [ l [] 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' [ [ ] C ] 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed; and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system [4 [] [] C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested [9C] [ ] [ ] 11 All heating, cooling and ventilation equipment is maintained safisfactorily. There are no visible defects [l] [ ] [ ] 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease Kl [ l [ ] 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3102) Page 1 of 2 yC,AIl y „ • E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained [ f ] [ ] 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed (k] [ ] [ ] 20 Sprinklers are unobstructed and free of paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARMMARNING SYSTEMS 22 Fire Alarm/waming systems are maintained in an operable condition and tested periodically [94 [] [ ] 23 Manual activation stations are properly located, readily visible and unobstructed fk] [ ] [ ] 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested [Qq [ ] 28 Elevator lobbies are separated from the corridor and the remainder of the building [Ll [ ] ( ] 29 Elevators are equipped with fire department recall [k] [ ] [ ] 30 An emergency pre -fire plan has been established, is acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by: UV E AJQ&W�, Date. 6' R-,/ 2-- Gen.009 (Rev.3/02) Page 2 of 2 OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION AKNUAL HIGH-RISE BI1ILDING INSPECTION REPORT Health and Safety Code Section 13217(a) rewires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high -,rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 910I6. For your conveniences an inspection Guide has been developed for use with, this report. Any questions concerning the High Rise Building inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908, oaavoaaaosao as afl mamona am amamaaaamecaarsarrraaraaarrrrtlrarrYsaaarrrrrarre-•tl.rmm FIRE DEPARTMENT: NEWPORT BEACH FIRE I3Ei'AitTMENT, Date of Inspection: V- Dv Z--? ,'Zo ( i Name of Building: Ti-"� S' (— Address: gS74-<'- IM A-c Y 'Tt� R— This building has been inspected as, a [ ] NEW [ ] EMSTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class Construction Type _ F)- Year Constructed 7 Sprinkler System This building is in compliance with the applicable regulations. ' [*YES [ ] NO The building is vacant. [ ] YES [ ] NO A Plan of Correction has been accepted by the Fire Department. [ ) YES C ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? `4-�INSPECTOR: �~ -- co-zss (OWS) OFFICE OF THE, STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. �rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■ FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: �// 1// Name of Building:_,�G/(9!%� Address: ln*C AW 7 2 C 7. This building has been inspected as a [ ] NEW [EXISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class �Construction Type -�-- Year ConstructedSprinkler System V/'_ This building is in compliance with the applicable regulations. [..-]-YES [ ] NO The building is vacant. [ ] YES [,TN10 A Plan of Correction has been accepted by the Fire Department. [EYES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR:r t:/' 't - (30-28S (08/05) OFFICE OF THE, STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to:: Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia,, CA 91016. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. irrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr�rrrrrrrrrrarrrrrrrrrrrrrrrrrrrrrrrrrrrwr■ FIRE DEPARTMENT: NE PORT BEACH FIRE DEPARTMENT Date of Inspection: Name of Building: 02 1 e-- % Address: all C 49 r This building has been inspected as a [ ] NEW [1 EXISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class �3 Construction Type Year Constructed Sprinkler System ��._ This building is in compliance with the applicable regulations. [4,TVES [ ] NO The building is vacant. [ ] YES [CYN10 A Plan of Correction has been accepted by the Fire Department. [ g1YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR: r!:-::v l/'�`��z GO-28S (08/05) r r kmx�.�. `)_ ._J OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building 1A % N / C11-4 e 1. YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair W 1.1 [1 2 Fireproofing of structural members is mainained VT 11 [1 3 Proper interior and ceiling finish rating is provided K 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained [ [ ] [ ] B. EXITS 6 Proper corridor construction and opening protection are, provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. [mil [ ] .1 I 9 Corridors are not used as part of the air distribution system C. MECHANICAL/ELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained safisfactorily. There are no visible defects [11 ( I [1 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained • 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 A-1 L F. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and [/.f [ l L I maintained 18 All fire extinguishing systems are properly maintained and serviced VT [ l [ I 19 Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of-paint/corrosion [r1 [ I L 21 Building alterations have not obstructed sprinklers or created unprotected spaces FIRE ALARMIWARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested [ [ I 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is.acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by: Gen.009 (Rev.3/02) Page 2 of 2 Date: OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: t' '1 '?�; C 7 YES NO NIA A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained [r] [ ] [ l B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from _ each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained safisfactorily. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained - f/l L ] [ ] 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control (el I ] L ] 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained 18 All fire extinguishing systems are properly maintained and [ l [ I [ l serviced 19 Water supply controls are locked/supervised and unobstructed [ ] [ l 20 Sprinklers are unobstructed and free of•paint/corrosion J I L I 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARMIWARNING SYSTEMS 22 Fire Alarm/waming systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically Lr1 [ ] [ I 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested [el [ I [ 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is.acceptable to the fire department and is posted in appropriate places A [ I L I COMMENTS Inspected by: C-5�_Sl 1 62— Date: Gen.009 (Rev.3/02) Page 2 of 2 A WrAT Al. OFFICE OF THE STATE FIRE MARSHAL High Rise Building inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: L%S-D 06h)P6127 ct/7LCIC. D12. YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. fl} [ } [ } 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained safisfactorly. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING i 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Pagel of 2 E." FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of *paint/corrosion [rl [ I [ I 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARMIWARNING SYSTEMS 22 Fire Alarm/waming systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically LEI L I C I 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested 28 Elevator lobbies are separated from the corridor and the remainder of the building V1 [ l [ I 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is.acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by: Qv-([ r�� Date: Gen.009 (Rev.3/02) Page 2 of 2 w y 4 -� OFFICE OF THE. STATE FIRE MARSHAL FIRE- & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BVILDING INSPECTION REPORT Health and Safety Code Section 13217(4) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: -Office of the State Fire Marshal, Fire & Life 6�_Cc_ Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. I a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a t a a a a a a a a a a a a a a a a a a a a a s 'a a a a a a a a a a a a a a a a a 7 a■ FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection:.5- rL / 3 Name of Building: Address: gS_O N Ew Po(L--r This building has been inspected as a [ ] NEW { EXISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class_ Construction Type Year Constructed_ Sprinkler System This building is in compliance with the applicable regulations. [AYES [ ] NO The building is vacant. [ ] YES �PdO A Plan of Correction has been accepted by the Fire Department. [YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR: �-t t�-- Go-28s (osio>) � bt s'rAT L OFFICE OF THE STATE FIRE MARSHAL High Rise Building inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: �� y�w�o/Z� cej YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is rnainalned 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained B. EXITS 6 Proper corridor construction and opening protection are. provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained safisfactorily. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner [rI [ I [ l D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 T. �t E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of -paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/waming systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is -acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by: Gen.009 (Rev.3/02) Page 2 of 2 Date: OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. GG Please complete and return this form to: Office of the State Fire Marshal, Fire & Life -J- IL0 5 Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. co-, For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. 1 a a a a a a a a a a a a a a a a a a a a a a a a a a a a a■■■ a a a a a a a a a a a t a a a a a a a a a a a a a a a k a a a a a a a a a a a a a a a FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection:/3 Name of Building: Address: This building has been inspected as a [ ] NEW r)(ISTING high-rise structure, as defined in Section 13210, Health and Safety Co Major Occupancy Class 5 Construction Type Year Constructed Sprinkler System 1 g This building is in compliance with the applicable regulations. YES [ ] NO The building is vacant. [ ] YES t0 A Plan of Correction has been accepted by the Fire Department. j-YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR: C30-28S (08/05) s it L %I AT, OFFICE r OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: :�Rp I( 0K-(C li i��. YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained. safisfactorily. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained - 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control r1] [ l [ l 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner V] [ I [ l D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage [/] [ ] L l Gen,009 (Rev.3/02) Page 1 of 2 i I M E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained LJ1 [ ] [ l 18 All fire extinguishing systems are properly maintained and serviced [✓1 [ l [ ] 19 Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of -paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed [ [ 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically [ L 1 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested 28 Elevator lobbies are separated from the corridor and the remainder of the building [rl [ l [ l 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is.acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by: Date: Gen.009 (Rev.3/02) Page 2 of 2 w OFFICE OF THE. STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire _& Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 9101.6. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. .■rrrrrrrrrrrrrrrrrrrrr a rrrrrrrrr�rrrrrrrrrrrrrrrrrrrr■'rrrrrrrrrrrrrrr�rrr■ FIRE DEPARTMENT: EW ORT BEACH FIRE DEPARTMENT Date of Inspection: Y00 Name of Building: Address:- �� D A This building has been inspected as a [ ] NEW EXISTING high rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class_ Construction Type Year Constructed/Sprinkler System k-y� This building is in compliance with the applicable regulations. I-% "—S [ ] NO The building is vacant. [ ] YES ��N.O A Plan of Correction has been accepted by the Fire Department. A�_J-'YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR( �- Go)-288 (08/05) ys" Mn, OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: S AA. F d_r �� %- YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided [A [ I [ 1 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' y1 [ l [ l 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system [ [ ] [ I C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are, adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained satisfactorily. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner fl1 C I [ J D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 t '1 v E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of -paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces LEI' L l L l F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically L✓1 L l L I 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall J I [ I 30 An emergency pre -fire plan has been established, is.acceptable to the fire department and is posted in appropriate places [sT [ I [ I COMMENTS Inspected by: 2 Gen.009 (Rev.3/02) Page 2 of 2 Date: r OFFICE OF THE, STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to:: Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a r a a a a a a a a a a a a ba a FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: % eat Name of Building: Address: This building has been inspected as a [ ] NEWEXISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class Construction Type Year Constructed— Sprinkler System L This building is in compliance with the applicable regulations. ['ES [ J NO The building is vacant. [ ] YES VNO A Plan of Correction has been accepted by the Fire Department. ]'YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR(r&�2Z-- GO-288 (08/05) $TAT Al OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building `j ��D f g;�I PalL7 C%�7v�C`�C- /C' YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair [!f [ ] [ ] 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained [ ] ( ] B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system C. MECHANICAL/ELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained safisfactorly. There are no visible defects [x [ ] [ ] 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained [ I ( ] 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control [ l [ l 14 Electrical wiring, fixtures, and appliances are properly installed in and operate a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease f [ ] [ ] 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2. I A E: FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained [ ] [ 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of -paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARMIWARNING SYSTEMS 22 Fire Alarm/waming systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed [ [ ] 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested PIT [ ] [ ] 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is,acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by:/�: ►u �t�1t Date: Gen.009 (Rev.3/02) Page 2 of 2 3 OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: - Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. l a a a a 1 a a a t a a a a a a a a a a a a a a a a a a a a a t a f a a■ a a a a a a a a a a a t a a a a a a a a a a a a a a a f a a a a a a a a a a a FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: <c Name of Building: Address: s D I �-7i✓�OOZ� C' This building has been inspected as a [ ] NEW �*XISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class l) Construction Type Year Constructed_ Sprinkler System This building is in compliance with the applicable regulations. YES [ ] NO The building is vacant. [ ] YES �NO A Plan of Correction has been accepted by the Fire Department. �a YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR: �� 00-288 (08/05) F/ OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILD ING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & Lifer Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. !� For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. I r ON on r r r r r r r r r r r r r r r r t r unsung" w r s r r r s r r r r r r owns r r r r r r r r r r r r r r r r r r ■'r r r r r r WWI! FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: 5) Name of Building: Address: � t e u Cv Da'rr�' T-1 r( This building has been inspected as a [ ] NEW [L]�XISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class � Construction Type �- Year Constructed_______.__ Sprinkler System � This building is in compliance with the applicable regulations. [ ]'YES [ ] NO The building is vacant. [ ] YES [+-]'NO A Plan of Correction has been accepted by the Fire Department. [lyYES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR:'vV`li��TU'LL` Z 00-288 (08/05) OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: (p 10 A IL-7 all7'?2L D 12, YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained LIT C 1 [ ] B. EXITS 6 Proper corridor construction and opening protection are. provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained safisfactorily. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained - 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control V1 I ] [ 1 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner [ l [ l D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 P • c E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained L4 L ] L ] 18 All fire. extinguishing systems are properly maintained and 19 serviced Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of-paint/corrosion l [ ] 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested l [ l 28 Elevator lobbies are separated from the corridor and the remainder of the building [ ] [ I 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is.acceptable to the fire department and is posted in appropriate places COMMENTS JAJ? eZ,-) HtA2 LdW l.JILf-IffN U Vl'o r Inspected by: ) /� (j,�(,�E 2 Date: 2 a3 Gen.009 (Rev.3/02) Page 2 of 2 w OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this r report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. �1 For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. �r+��swrr��s��rMKa�a�r��es�Mt� a w��irisss��rMt�� a sat��err�t��r■ FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: Name of Building-i i{3 V ` C—d r'2 441 � Address: 10 !1f6LAO % ✓ �� This building has been inspected as a [ ] NEW N EXISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class Construction Type Year Constructed Sprinkler System This building is in compliance with the applicable regulations.] YES [ ] NO The building is vacant. [ ] YES�,NO A Plan of Correction has been accepted by the Fire Department. JTYES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance.? INSPECTOR: `ram G0-288 (08/05) �J {,i GCiKri R� 4%L OFFICE OF THE STATE FIRE MARSHAL High Rise Building inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: 6'-�-o Alzft,,�P o%2% CC1v1 C1Z OIL YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained [ [ ] [ ] 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained [ I [ l B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained safisfactorily. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained 18 All fire extinguishing systems are properly maintained and 19 serviced Water supply controls are locked upervise and unobstructed LEI [ 1 [ ] 20 Sprinklers are unobstructed and fr paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARMIWARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically. [ ] [ ] 23 Manual activation stations are properly located, readily visible and unobstructed L14 [ ] [ ] 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically] G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested LI L I L 1 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is -acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by:�Date: Gen.009 (Rev.3/02) Page 2 of 2 F OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. ff� tv% For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. �rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr urr■ FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: q/ 3 Name of Building: Address: This building has been inspected as a [ ] NEWPE)USTING high-rise structure, as defined in Section 13210, Health and Safety Co Major Occupancy Class __ b— Construction Type Year Constructed % % Sprinkler System This building is in compliance with the applicable regulations. ES [ ] NO The building is vacant. [ ] YES [l]"N0 A Plan of Correction has been accepted by the Fire Department. [-]''YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR: '�u7/'C UC_' GO-28S (08/05) OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: (o(t r11�y PC r CCU ".qt D fL , YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained U [ 1 [ I B. EXITS 6 Proper corridor construction and opening protection are. provided and maintained. Dead-end corridors do not exceed 20' [A [ ] [ J 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained satisfactorily. There are no visible defects [rJ [ ] [ J 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained [ [ J [ ] 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of-paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically Er] E ] [ l 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is -acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by: _ �� (� Date: 9 0� 1 3 Gen.009 (Rev.3102) Page 2 of 2 4{ HAZARDOUS MATERIALS DISCLOSURE FIELD INSPECTION NOTICE NEWPORT BEACH FIRE DEPARTMENT Fire Prevention Division (949) 644-3106 INSPECTN DAT INSPE R NAME 3 �J7��Z z BUS] ESS NAPE' V PHONE Vq o?7� 5-6 77 BUSINESS ADDRESS (2 AJ �- �-� CITY tiIC-W/o 7' 6 ZIP qa � 6 o MAILING ADDRESS (if different) CITY ZIP OWNER/MANAGER (Print) / bI a- .�Q N TITLE / 6gl.,V 4U` Ariitle:iSedlorls2�a8ilti�65 Si,alid:�3aGrol#oda % i. 4 tt+m Caltfami�Fl�alih.&:•a"ai�`G'ade �tfsiau2i3'Gh�pfet` :1�.> �l��uiattoils�'Ct�p[vi'sidt��R�t: �2i Hazardous Materials Disclosure is correct and up to date. ❑ Hazardous materials disclosure 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 below: The above marked item(s) is in violation of California law and requires immediate correction. Failure to correct the violation(s) will result in civil penalties and prosecution. Contact. the Fire Prevention Division regarding completing the necessary correction(s). I declare that I have examined and received a copy of this Field Inspection Notice. caner ana er I it e: i ature: ate: Original — FPD Yellow — Ownerfrenant P_ OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE ;SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a)!requires that local fire agencies submit this report no later than thirty (30) days after tiAe date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & LifV-nJ. _/,Jq, 13 Safety Division South, 602 E. Huntington Drive, Suite A, Monrovia, CA 91016 0.` r For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. �rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr�rrrrrrrrr■ FIRE DEPARTMENT: AJfWfd _� Date of Inspection: �- A I// � Name of Building: Address: �i (O () d c ��Fw7 'Da . This building has been inspected as a[ ] NEW [ ] EXISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class Construction Type Year Constructed- Sprinkler System This building is in compliance with the applicable regulations. [n]' YES [ ] NO The building is vacant. [ ] YES] NO A Plan of Correction has been accepted by the Fire Department. [] YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR:(Q/7/ c% Z GO-28s (01/07) I r y 1 �� i. STAT F aE.L• A hL ` OFFICE OF THEi STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: W) lic—An'-1 YES NO N/A i A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural membersjis mainained of [ 1 [ ] 3 Proper interior and ceiling finish rating is provided [11 [ ] [ ] 4 Fire doors are of proper rating and Iioperate satisfactorily V [ ] [ l 5 Vertical shaft enclosures are in gold repair and fire assemblies at opening are properly maintained B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' [!] [ ] [ l 7 There is access to at least 2 separate means of egress from each floor [ l [ ] 8 All means of egress are clear, inobr tructed, and free of storage. Exit ways and exit signs ire properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation :equipment is maintained safisfactorily. There are no visible ;defects yl [ I [1 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained V [ ] [ ] 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and ifree of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) i Page 1 of 2 �GANN�+ I -a 41. • E. FIRE EXTINGUISHING • 17 All first -aid fire fighting equipment is properly located and maintained 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25n Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by grz-, 6",&Z Date: i TVl I I Gen.009 (Rev.3/02) Page 2 of 2 OFFICE OF THE STATE FIRE MARSHAL TIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. i For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. �r■r��r�sr��r��iw�tar�atr*■rssrNar�ar��isa�es�rr�w�Mrr��wr�sxt��r�c�s�M�t�r• FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection:. Name of Building:i ��7 1 5 -Q E Address: This building has been inspected as a [ ] NEW F� MUST1NG high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class„ Year Constructed Construction Type. I'H i2 Sprinkler System This building is in compliance with the applicable regulations. J;✓]YES The building is vacant. [ 1 YES [ I NO t^0 A Plan of Correction has been accepted by the Fire Department. V.YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR: (30-28s (08105) M sr�T keN ` A OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: Vo /�)St 'oo � �oj-� YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided [•�l [ ] [ l 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' [rrI [ 1 [ 1 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system [I [ I [ I C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All 'heating, coaling and ventilation equipment is maintained satisfactorily. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control VI [ 1 [ 1 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 I E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained [ I [ I 14 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed 20 Sprinklers are unobstructed and free of-paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed YI [ ] [ ] 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested [/I E I [ 1 28 Elevator lobbies are separated from the corridor and the remainder of the building fr^l E I [ 1 29 Elevators are equipped with fire department recall] [ ] [ I 30 An emergency pre -fire plan has been established, is -acceptable to the fire department and is posted in appropriate places COMMENTS inspected by: Date:, Gen.009 (Rev.3/02) Page 2 of 2 cal' .I�ti!"� F _.'�PLA{. OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: qa A1-&WP0R'1 0�W7_ '0Z ) a. YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair Lod 1.1 [] 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily v [ ] [ ] 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained [O] [ ] [ ] B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 All heating, cooling and ventilation equipment is maintained safisfactorily. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control 14 Electrical wiring, fixtures, and appliances are properly installed, and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 VT [l ,[] [/I [I I I rAl r 1 r 1 E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed [f] [ l [ l 20 Sprinklers are unobstructed and free of -paint/corrosion [r1 [ I [ 21 Building alterations have not obstructed sprinklers or created unprotected spaces C✓r [ I [ l F. FIRE ALARMIWARNING SYSTEMS 22 Fire Alarm/waming systems are maintained in an operable condition and tested periodically 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically [oI [ I [ l 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically [sl C 1 C l G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested Co} E I [ I 28 Elevator lobbies are separated from the corridor and the remainder of the building [fl [ I [ l 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is.acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by: Gen.009 (Rev.3/02) Date: `d 1 Page 2 of 2 1 w. M OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BV1LDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this -form to: -Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. 1090a■■■5■■a■■■a■a0■aa0■5■a■a■■aa■a■atat0 a a■■0xa a■aaaa■ a s a■ a s on ra ra a a■ a a■■■ FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: a Name of Building: I S L .iD k_7Lt L Address:6gO AIf-4,jAotZ-7 �,Dd, This building has been inspected as a [ ] NEW [[EXISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class - ►v = Year Constructed-1 q ��_ Construction Type Sprinkler System This building is in compliance with the applicable regulations. [, kyES [ ] NO The building is vacant. [ J YES. NO A Plan of Correction has been accepted by the Fire Department. L�S [ J NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR:QrD�—Ax—z— (30-288 (08/05) �riy , (mA64 1?,-O-M SA.' OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: Office of the State Fire Marshal, Fire & Life ` Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. �aaaaaaarrrrrrrrrrarrrrrrarrrrrraaraaraararrararrararrrrrrrrrr a rarrrrarra■•a FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: _a� 3 Name of Building: Zfc/�1'C L�%� Address: '76 6 .VZ: t-V A-f er-7-�6� This building has been inspected as a[ ] NEW [ ] EXISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class Construction Type Year ConstructedSprinkler System l'lf�'5 This building is in compliance with the applicable regulations. [,-]'YES [ ] NO The building is vacant. [ ] YES VrNO A Plan of Correction has been accepted by the Fire Department. []'YES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? INSPECTOR: Go-28S (08/05) 4r STAT 84fiCit lA,L OFFICE OF THE STATE FIRE MARSHAL High Rise Building Inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: -70 Artew hda ee'`11 Z_ D67- YES NO NIA A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair 2 Fireproofing of structural members is mainained 3 Proper interior and ceiling finish rating is provided 4 Fire doors are of proper rating and operate satisfactorily 5 Vertical shaft: enclosures are in good repair and fire assemblies at opening are properly maintained (lI [ I [ I B. EXITS 6 Proper corridor construction and opening protection are provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor [rI E I E I 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. EfI E I E l 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested 11 Ali heating, cooling and ventilation equipment is maintained safisfactorily. There are no visible defects 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control EMI [ I [ l 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease [l1 E I E I 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 ? k E. FIRE EXTINGUISHING 17 All first -aid fire fighting equipment is properly located and maintained [ l [ l 18 All fire extinguishing systems are properly maintained and serviced 19 Water supply controls are locked/supervised and unobstructed VI 20 Sprinklers are unobstructed and free of-paint/corrosion 21 Building alterations have not obstructed sprinklers or created unprotected spaces F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/waming systems are maintained in an operable condition and tested periodically GPI [ l ( I 23 Manual activation stations are properly located, readily visible and unobstructed 24 Occupant voice notification system, when required, is maintained and tested periodically 25 Fire department communication system is maintained and tested periodically 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically G. MISCELLANEOUS 27 Sensing devices at elevators are maintained and tested 28 Elevator lobbies are separated from the corridor and the remainder of the building 29 Elevators are equipped with fire department recall 30 An emergency pre -fire plan has been established, is -acceptable to the fire department and is posted in appropriate places COMMENTS Inspected by: Gen.009 (Rev.3/02) Page 2 of 2 Date: /a 6 L OFFICE OF THE STATE FIRE MARSHAL FIRE & LIFE SAFETY DIVISION ANNUAL HIGH-RISE BUILDING INSPECTION REPORT Health and Safety Code Section 13217(a) requires that local fire agencies submit this report no later than thirty (30) days after the date of inspection of any high-rise building. Please complete and return this form to: -Office of the State Fire Marshal, Fire & Life Safety Division South, 602 E. Huntington Dr., Ste A, Monrovia, CA 91016. For your convenience, an Inspection Guide has been developed for use with this report. Any questions concerning the High -Rise Building Inspection Program may be directed to our staff at the OSFM Fire & Life Safety by telephoning (626) 305-1908. trrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr■-rrrrrrrrr■ FIRE DEPARTMENT: NEWPORT BEACH FIRE DEPARTMENT Date of Inspection: 2Z��a Name of Building: Address:'70';0 A164VPDil'T This building has been inspected as a [ ] NEW [L]-XISTING high-rise structure, as defined in Section 13210, Health and Safety Code. Major Occupancy Class Construction Type Year Constructed Sprinkler System This building is in compliance with the applicable regulations. [t-]''SAES- [ ] NO The building is vacant. [ ]YES [� A Plan of Correction has been accepted by the Fire Department. [ �ES [ ] NO If a Plan of Correction has not been accepted by the Fire Department, what action has been taken to achieve compliance? (30-288 (08/05) �) OFFICE OF THE STATE FIRE MARSHAL High Rise Building inspection Guide The following is to be used as a guide and is not intended to incorporate all applicable SFM requirements. Building: `Z�T"D h�Z�✓ Ypa1e7 cj!S r7�e'� 12R YES NO N/A A. CONSTRUCTION 1 Building construction type and fire resistive rating conforms throughout and is maintained in good repair [ [ ] [ ] 2 Fireproofing of structural members is mainained [ ] [ ] [ ] 3 Proper interior and ceiling finish rating is provided [ l [ 1 [ l 4 Fire doors are of proper rating and operate satisfactorily [ l [ l [ l 5 Vertical shaft enclosures are in good repair and fire assemblies at opening are properly maintained [ ] [ ] [ ] B. EXITS 6 Proper corridor construction and opening protection are. provided and maintained. Dead-end corridors do not exceed 20' 7 There is access to at least 2 separate means of egress from each floor 8 All means of egress are clear, inobstructed, and free of storage. Exit ways and exit signs are properly illuminated and maintained. [/I [ ] [ ] 9 Corridors are not used as part of the air distribution system C. MECHANICAUELECTRICAL 10 Fire dampers, smoke detectors and similar devices are adequate, properly maintained and tested L [ l [ ] 11 All heating, cooling and ventilation equipment is maintained safisfactorly. There are no visible defects [ l C l ( ] 12 Ventilation for the removal of products of combustion from the building is provided and properly maintained [ ] [ ] ( ] 13 Building air circulation systems (when provided) are equipped with override switches in acceptable locations to allow for manual control [ ] [ l [ l 14 Electrical wiring, fixtures, and appliances are properly installed and operate in a safe manner [ ] [ ] G ] D. HOUSEKEEPING 15 Kitchen range hoods, vents, fans, ducts, and filters are maintained in proper condition and free of grease 16 All areas are free of unusual amounts of storage Gen.009 (Rev.3/02) Page 1 of 2 t E. FIRE EXTINGUISHING 17 18 All first -aid fire fighting equipment is properly located and maintained All fire extinguishing systems are properly maintained and 19 20 21 serviced [ l [ l [ l Water supply controls are locked/supervised and unobstructed I [ [ I Sprinklers are unobstructed and free of-paint/corrosion 1 [ I [ l Building alterations have not obstructed sprinklers or created unprotected spaces l [ l [ l F. FIRE ALARM/WARNING SYSTEMS 22 Fire Alarm/warning systems are maintained in an operable condition and tested periodically [ J [ I [ l 23 Manual activation stations are properly located, readily visible and unobstructed [ ] [ ] [ l 24 Occupant voice notification system, when required, is maintained and tested periodically [ l [ l [ I 25 Fire department communication system is maintained and tested periodically [ [ [ 26 An acceptable method is provided for notifying the fire department of a fire or other emergency. This method is maintained in operable condition and tested periodically L I [ I L l G. MISCELLANEOUS 27 28 29 30 Sensing devices at elevators are maintained and tested [ I [ I [ I Elevator lobbies are separated from the corridor and the remainder of the building [ I [ I [ l Elevators are equipped with fire department recall [ I [ l [ I An emergency pre -fire plan has been established, is -acceptable to the fire department and is posted in appropriate places [ l [ 1 [ I COMMENTS Inspected by:� Date: o� Gen.009 (Rev.3/02) Page 2 of 2 F;LolS- (:)44� FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time ofsystem acceptance and'approval. 1. Protected Property Information Name of property: Pacifica Christian High School Address: 883 West 15`h Street Description of property: High School ^ Occupancy type: E --- Name of property representative: Luis Garcia _ _ Address: 883 West 15th Street Phone: 949-887-2070 Fax: E-mail: Authority having jurisdiction over this property: Newport Beach Fire Department Phone: 949-644-3255 Fax: E-mail: 2. Fire Alarm System Installation, Service, and Testing Information Installation contractor for this equipment: VFS FIRE & SECURITY SERVICES Address: 501 W Southern Ave Orange, CA 92865 Phone: 714-778-6070 Fax: 714-778-6090 E-mail: Service organization for this equipment: Address: Phone: Fax: E-mail: Location of as -built drawings: OWNER / PANED Location of Historical Test Reports: Location of system operation and maintenance manuals: _OWNER A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Address: Phone: Fax: _ E-mail: Contract expires: Contract number: — Frequency of routine inspections: 3. Type of Fire Alarm System or Service VFS NFPA 72® Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers (f applicable): Alarm: _National Monitoring Center Phone: 866-440-0311 Supervisory: National Monitoring Center _ Phone: 866-440-031'1 Trouble: National Monitoring Center _ Phone: 866-440-0311 Entity to which alarms are retransmitted: PUBLIC TELEPHONE NETWORK Phone: Method of retransmission of alarms to that organization or location: PUBLIC TELEPHONE NETWORK NFPA 72, Fig. 4.5.2.1 (p. 1 of 5) Copyright ©2009 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. 0. •► If Chapter 8, note the means of transmission from the protected premises to the central station: '❑ Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2-way radio ❑ 'l-way radio ❑ N/A If Chapter 9, note the type of connection: ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system (executive) software revision level: Site -specific software revision date: _ Revision completed by: 4. Signaling Line Circuits Characteristics of signaling line circuits connected to this system (see NFPA 72 ® Table 6.'6.1): Quantity: 2 Style: -Class: B 5. Alarm -initiating Devices and Circuits Characteristics of initiating device circuits connected to this system (see NFPA 72® Table 6.5): Quantity: 6 _____ __ _ Style: 5.1 Manual Initiating Devices Class: B 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: ® Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ® Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ® N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ® N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ® N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: 1 Type of devices: ® Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: 1 Alarm verification on this system is: ® Enabled ❑ Disabled ❑ Set for seconds 6. Supervisory Signal -Initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: 1 Type of devices: ® Addressable ❑ Conventional ❑ Coded ❑ Transmitter ,❑ N/A NFPA 72, Fig. 4.5.2.1 (p. 2 of 5) Copyright ©2009 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. 6.2 Fire Pump Type of fire pump: ❑ Electric ❑ Diesel Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional .❑ Coded ❑ Transmitter :® N/A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine -Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter :❑ N/A ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ LowTuel Other: 7. Annunciators 7.1 Annunciator i ❑ Local ®Remote Type: m Addressable ❑ Directory ❑ Graphic ❑ N/A 7.2 Annunciator 2 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ® N/A 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ® N/A 8. Alarm Notification Devices and Circuits 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of speakers: 28 --- 8.2 Telephone Jacks Location: Location: Location: Number of multiple voice alarm channels: 1 Number of speaker zones: 2 Number of telephone jacks installed: -_,_ Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered ® N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFPA 72® Table 6.5): Quantity: - -- — - — - Style: �- -- ------ — Class: 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: 1 With visual device: Chimes: With visual device: Visual devices without audible devices: 4 Horns: With visual device: Bells: With visual device: Other (describe): 28 SPEAKER/STROBES _ NFPA 72, -Fig. 4.5.2.1 (p. 3 of 5) Copyright© 2009 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. 9. Emergency Control Functions Activated ❑ Hold -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑ Elevator recall ;n Other 10.System Power Supply 10.1 Primary Power Nominal voltage: 120 Overcurrent protection: Type: ___ Location (of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Location: PANEL Type: Number of standby batteries: 2 Location of emergency generator: Amps: 20 Amps: Nominal voltage: 12 Amp hour rating: 7 Current rating: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: 24 HOURS In alarm mode: 15 MINUTES 11. Record of System Installation Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) ® NFPA 72® ® NFPA 70® Article 760 ® Manufacturer's published instructions ❑ Other (please specify): System deviations from referenced NFPA standards: Signe; Printed name: Xe4,040O .Date: d9"0e / r Organization: VFS FIRE & SEC. Title: ALARM TECH Phone: 714-778-6070 12. Record of System Operation All operational features and functions of this system were tested by or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of- ® NFPA 720 ® NFPA 70® Article 760 ® Manufacturer's published instructions ❑ Other (please specify): ❑ Documentation in accordance with Inspection and Testing Form (Figure 10.6..�2.3 of NFPA 728) is attached Signed. — �� r�- Printed name: ��o C 04--_rFfi✓ Date: Q$ Za —rr Organization: VFS FIRE & SEC. Title: ALARM TECH Phone: 714-778-6070 NFPA 72, •Fig. 4.5.2.1 '(p. 4 of 5) Copyright © 2009 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. 13. Certifications and Approvals 13.1 System Installation Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signer—r —�-� _ _ Printed name: Ac.Wp ��(c'�rr4e� 'Date: Organization: VFS FIRE & SEC. Title: ALARM TECH. _ Phone: 714-778-6070 13.2 System Service Contractor 08--2e—/f- This system as specified herein has been installed and tested according to all NFPA,standards cited herein. Signed � Printed name: )KefW0? 6ZVo v"o Date: Organization: VFS FIRE & SEC Title: ALARM TECH Phone: 714-778-6070 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Printed name: %�tG,9/4po C ooeoiy,4Ro 'Date: f.L Zc) �l— Organization: VFS FIRE & SEC Title: ALARM TECH Phone: 714-778-6070 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: _ _ Printed name: Date: Organization: Title: Phone: 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printedname: Date: Organization: _ Title: Phone: NFPA 72, Fig. 4.5.2.1 (p. 5 of 5) Copyright ©2009 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. Alcaraz, Debbie From: Morris, Nadine Sent: Monday, December 21, 2015 1:44 PM To: Alcaraz, Debbie Subject: SCANNING - 3000 Newport Blvd Attachments: Fire Sprinkler Five Year 8-26-15 - Fail-12-3-15 - Pass.pdf Categories: SCAN Debbie, Please scan into 3000 Newport Blvd. Thank you, Nadine From: Jered Stock [mailto Jered(a)ocfire.com] Sent: Monday, December 21, 2015 11:21 AM To: Morris, Nadine Cc: 'Robert Schacht' Subject: RE: 3000 Newport Blvd/401 & 403 30th Street Sorry about that! itJered Stock Account Manager ORANGE COUNTY FIRE PROTECTION 137 W Bristol Lane, Orange, CA 92865 Tel: (714) 974-9025 Fax: (714) 974-9075 www.ocfire.com From: Morris, Nadine [mailto:NMorris@NBFD.net] Sent: Monday, December 21, 2015 10:45 AM To: 'Jered Stock' Cc: 'Robert Schacht' Subject: RE: 3000 Newport Blvd/401 & 403 30th Street Good morning Jered, There was no attachment. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net From: Jered Stock [mailtoJered@ocfire.com] Sent: Friday, December 18, 2015 4:55 PM To: 'Robert Schacht'; Morris, Nadine Subject: RE: 3000 Newport Blvd/401 & 403 30th Street Hi Robert, Attached is your inspection report. You should have gotten it in the mail along with the repair invoice. lered Stock Account Manager ORANGE COUNTY FIRE PROTECTION 137 W Bristol Lane, Orange, CA 92865 Tel (714) 974-9025 Fax (714) 974-9075 www.ocfire.com Paae 1 of 6 Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: Name: 3000 Newport Blvd. Owners Assoc. Occupancy / Use: Commercial °1F CA Cl� Address: 401 30"' Street Construction Type: Steel, Concrete Q"r O� City: Newport Beach No. Stories: 2 Zip: 92663 Year Constructed: Unknown !RE MP Contact: Robert Schacht Telephone: (949) 945-3916 Contractor Information: Number of System Risers Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln � Owner Date 12/4/2015 ` City: Orange Fire AHJ Date 12/4/2015 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: George 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 LOT0 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 8/26/2015 System Riser ID: Property Information: Type of System: 01F CA 4/, Name: 3000 Newport Blvd. Owners Association Wet Pipe Address: 401 30' Street & 403 30' Street Dry Pip e a Preaction wl 9c`e M 3000 Newport & 3002 Newport Deluge g5`rQ City: Newport Beach Main Drain Test Results: (See attached sheet for multiple risers) Abbreviation Key: Initial Static Pressure: C 68 (psi) I = Inspection T = Test Residual Pressure: 55 (psi) M = Maintenance A-O = After Operation Restored Static Pressure: 65� (psi) MI = Per Manufacturer's Instructions Item Activity Frequency Description NFPA 25 Fail N/A Pass Reference 1.1 1 Daily Preaction/Deluge Valve — Enclosure 12.4.3.1 X Weekly temperature 1.2 1 Daily Weekl Dry Pipe Valves — Enclosure temperature 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 AES2 Paae 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: 8/26/2015 System Riser ID: Property Information: Type of System: occ r�o Name: 3000 Newport Blvd. Owners Association ❑X Wet Pipe _ �y Address: 401 30t" Street & 403 30t" Street o �, A Dry Pipe ��rJ Preaction�� 3000 Newport & 3002 Newport 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 I 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 5.2.3.3 X spaces) 1.22 1 5 Years Pipe and Fittings (Accessible concealed 5.2.2.3 X spaces) 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, 12.4.3.1.8 X orifices 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 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 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: 18/26/2015 Property Information: Name: 3000 Newport Blvd. Owners Association Address: 4013 Street & 403 30"' Street 3000 Newport & 3002 Newport City: Newport Beach System Riser ID: _ Type of System: �flr 4/ ❑X Wet Pipe �T 1 0 t 2 n Dry �D Pipe r ., Preaction 9'�`�•..._,...,-f'�� Re Mee` 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 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 - 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 Pane 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: 8/26/2015 System Riser ID: Property Information: Type of System: cAti� Name: 3000 Newport Blvd. Owners Association �aF Wet Pipe ❑ [ v Dry Pipe 1 Address: 401 30`t' Street & 403 30"' Street Preaction qV`�,__ --�Sr, 3000 Newport & 3002 Newport ARE MPS' Deluge City: Newport Beach Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: 1.9 1 — Replace corroded Grinnell 2000 br 1/" SR in heater closet of 403 30th St. 2.1 1 — Replace missing 110v 10" bell with back box 1.9 1 — Provide Tyco Ty3531 concealed cover white in restroom of 3000 Newport 1.9 1 — Provide Grinnell F978 cover plate white for entry way to kitchen 1.9 1 — Provide Grinnell F978 cover plate white in restroom & need to lower head'/" at 3002 Newport 2.22 9 — Replace Globe 1550 QR HSW (1995) due for UL testing in 401 30th Street 1.9 1 — Replace corroded 1550 br 1/" SSP that should be in SSU position in restroom of 401 301h 1.4 1 — Provide 1" plug for AUX drain above copy machine in 401 30th St 2.22 7 — Replace Globe 155' QR HSW (1995) due for UL testing in 403 30th Street 1.9 1 — Replace 155' chr'/" SR with 2000 in water heater closet 2.1 1 — Unable to locate ITV contact will look for ITV possibly behind mirror in 3002 Newport. If ITV cannot be found recommend adding ITV to end of sprinkler line in carport. Will need 1 x 1 x Y/2" Tee 12' of 1" pipe straight 1" valve, 1 x'/" 900 with '/" orifice mount to wall 1.10 1 — Provide Tyco w-type 7 SR wrench for Spare Head Box (SHB) 1.10 2 — Provide concealed heads for SHB 155° QR %" SSP k=4.2 1.10 2 — Provide 200° br 1/" SSP for SHB 1.10 1 — Provide HSW head wrench for Grinnell or head that will be installed 1.4 1 — Provide custom sign and mount to brick wall stating "OS&Y services 401 & 403 30th Street and 3000 & 3002 Newport Blvd" Above Repairs completed by George, Josh, Kamil, & Jack of Orange County Fire Protection ❑X See Continuation Pages(s) � (Indicate the number of continuation pages) ❑X PASS FAIL Signature: Date: 12/4/2015 Jesse Maldonado State Fire Marshal AES2 Paae 6 of 6 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 8/26/2015 Property Information: Name: 3000 Newport Blvd. Owners Association Address: 401 30t" Street & 403 301h Street 3000 Newport & 3002 Newport City: Newport Beach Type of System: ❑X Sprinklers (Chapter 5) of cA<i `o System Riser ID: Z Standpipe (Chapter 6) HPrivate Fire Main (Chapter 7) � ❑ Fire Pump (Chapter 8) RP E M 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: 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 12-2015 by Orange County Fire Protection Unprotected Area 1) Unprotected 4' x 4' storage unit behind 3000 Newport 2) Unprotected 3' x 8' hallway before restroom 3) Unprotected 15' x 4' storage area next to riser closet Unprotected areas are subiect to the Fire Department's review. These area's do not disqualify 401 30t" St, 40330thstreet 3000 Newport & 3002 Newport from Orange County Fire Protection's certifications. Signature: Date: 12/4/2015 Jesse Maldonado State Fire Marshal AES2 sc,Lboc, Q C-Cove- 3�L v icy L , c�r-E- C3 c�c4, C j -1 Is f �70 �L /A- 6 S CA-0 BHCS State of Caffomia—Health and Human SeMces Agency D6partm'eht of Health Care Services TOBY DOUGLAS r-161UNF V. VIIR *Cr J11- FIFE CLEARANCE C 01IRFCTCW );:? Fire Authority Name Addross Teloplione Number (Name of program) ,AnK s inspected this data for compliance mrift de,aranCe, to operate an Outpatient alcohol (Address of program — please include suite requireiretints, and is hereby granted a fire otl�/r," r,L t Irug treatment program at: I .4 if applicable) I I JZ1VtLULUJ Zj I le.Me kiypeo or printed), telegKone number (Signature and rank of inspector (Inspection date) tMictal seal 1*,3r v Zwlzlzinco Uix� D.,;order Currp,arum uter",in.9 axid Ctniiftutson M-.tnch. tsiS:*Gcia PO Box 99/413 5bAW -nV% CA 96890a 7413 N(W'240: (916022-2011, Fax(916)322-2658 3 LAM %.7CAIClY JC1 VItiG.Z- 100 Civic Center Drive Newport Beach, CA 92660 (949) 644-3106 FIRE CLEARANCE Fire Authority Name I o 0 C I V t C- C.L-'I�,J T -(L iD tz I N �3 q a to tp O Address (CjLtcj� &qLi- 310-s- Telephone Number SA- L,W (Name of program) was inspected this date for compliance with local requirements, and is hereby granted a fire clearance to operate an outpatient alcohol and/or other drug treatment program at: 4 3 O 31 *r S; , -4t-S I L� eW PO V2 eAtA-A Gi' a.to Io 3 (Address of program -please ni please' suite numbers if applicable) Inspector's name (typed or printed), telephone number I\� ftM Ls5 / t MSP5CTbiZ (Signature and rank of inspector granting clearance) O 1-- ! ,A- 960 I (inspection date) 12 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, 2015 RE: 430 31 st Street Suite B, Newport Beach, CA 92663 047-042-01 Dear Mr. Cullen: The above referenced property is located within Mixed -Use Cannery Village/15th Street (MU-CV/15th St) and is designated as within the Land Use Element of the General Plan as Mixed -Use Horizontal (MU-H4). MU-H4 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 therapeutic counseling with a maximum of two clients at a time, one-on-one counseling and the related office use has been determined to be in the Office, Professional Land Use Category and is a permitted use in the MU-H4 Zoning District. However, the following changes in the operation as provided in the attachment would constitute a change in use, 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 949-644-3221 or mwhelan(a-)newportbeachca.gov Sincerely, Kimberly Brandt, AICP, Community Development Director By: 'A" Melinda Whelan y Assistant Planner Enclosures: Description of outpatient program use for 430 31 st Street Suite B Balboa Recovery License Application DBA Ocean Sober Living Date: 12-16-14 Rev. 1 Facility Purpose and Description This company is requesting zoning approval from the city of Newport Beach for the purpose of obtaining outpatient certification from the state of California Health and Human Services Agency. This facility will be primarily used for documentation and storage of client progress notes and for billing purposes. In addition, this facility will be used for therapeutic counseling sessions. Therapeutic counseling sessions will primarily consist of one on one, therapist and client meetings. A therapist may meet with no more than two individuals. The maximum occupancy of the facility will not exceed 3 persons. This facility will be used for therapy sessions between the hours of gam and 5pm Monday --Friday. There will be no more than three sessions held per day. There will be an hour break between sessions. This is to ensure the privacy of our clients and prevent gathering at the facility. Counselors have one approved parking space provided in the rear of the building clear of the alleyway. Clients will be instructed to park in legal metered spaces on the street. Due to the insignificant number of clients, parking will not be impacted. This Facility Prohibits This facility will NOT hold or distribute medications of any type. There will be NO 12 step meetings held at this facility. There will be absolutely NO smoking/electronic cigarettes in or around the facility. This is NOT a residential facility and there will be NO drug testing, loitering, added trash waist, or traffic congestion. 430 315t St. Suit B, Newport Beach CA, 92663 Tel: (949) 723-2388 3 Balboa Recovery License Application DBA Ocean Sober Living Date: 12-16-14 Rev. 1 SKETCH OF BUILDING AND GROUNDS AULY WAY Tbf'A1, AM At, 24:4 4 1.2 `, 31s' ST. 430 3151 St. Suit B, Newport Beach CA, 92663 Tel: (949) 723-2388 2 19ft 6in I _Jraz, Debbie From: Lunde, Ty Sent: Sunday, July 19, 2015 9:44 AM To: Alcaraz, Debbie Subject: FW: FIre Inspection Attachments: Fire Sprinkler Five Year Cert 3-17-11.pdf Categories: SCAN Hi Debbie, Please attach this 5 year cert PDF to occupancy #30391. Thanks, Ty From: Anika Corpus[mailto:acorpusC�carewestinsurance.com] Sent: Thursday, July 16, 2015 5:06 PM To: Lunde, Ty Cc: Gary Jarvis Sr Subject: RE: FIre Inspection Please see attached per your request. Let me know if I could assist you with anything else. Thanks, Anika Corpus CWIRM Insurance Services, LLC Care West Insurance Risk Management, LLC www.carewestinsurance.com (800) 760-6204 ( (949) 673-0398 1 Fax: (949) 673-0362 Service with a sense of urgency! Workers' Compensation I General & Professional Liability I Health Benefits I Property I Commercial Auto I Bonds This message (including any attachments) is intended only for the use of the Addressee and may contain information that is PRIVILEGED and/or CONFIDENTIAL. This email (and its attachments) is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this email is not an intended recipient, you have received this email in error and any review, dissemination, distribution or copying is strictly prohibited. If you have received this email in error, please notify the sender immediately by return mail and permanently delete the copy you received. From: Lunde, Ty [mailto:TLunde@NBFD.net] Sent: Thursday, July 16, 2015 4:36 PM 'ika Corpus ;ct: Re: Pre Inspection The company that performed the last service is listed on the sticker located on the pipe that I showed you behind your office. They should be able to help you. Let me know if you have questions. Ty Sent from my iPhone On Jul 16, 2015, at 4:31 PM, Anika Corpus <acorpus carewestinsurance.com> wrote: Good Afternoon Ty, What was the number you said we could call to get the sprinkler certification? Anika Corpus CWIRM Insurance Services, LLC Care West Insurance Risk Management, LLC www.carewestinsurance.com (800) 760-6204 ( (949) 673-0398 1 Fax: (949) 673-0362 Service with a sense of urgency! Workers' Compensation I General & Professional Liability I Health Benefits I Property I Commercial Auto I Bonds This message (including any attachments) is intended only for the use of the Addressee and may contain information that is PRIVILEGED and/or CONFIDENTIAL. This email (and its attachments) is intended only for the personal and confidential use of the recipient(s) named above. If the reader of this email is not an intended recipient, you have received this email in error and any review, dissemination, distribution or copying is strictly prohibited. If you have received this email in error, please notify the sender immediately by return mail and permanently delete the copy you received. From: Lunde, Ty fmailto:TLunde@NBFD.net] Sent: Wednesday, July 15, 2015 7:41 AM To: Anika Corpus Subject: Flre Inspection Hi Anika, Thank you for helping me with the fire inspection yesterday. Per our conversation, you will need to complete or provide documentation of a 5 year sprinkler certification for the building. You can send me an email when complete. Please contact me with questions. Best, Ty Lunde Fire Captain Newport Beach Fire Department 949-644-3372 - Fire Station 2 949-644-3104 - Fire Administration tiunde _nbfd.net Page 1 of 6 Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 Property Information: Name: Monarch Building Association Occupancy / Use: Commercial Address: 424 32"" Street Construction Type: Concrete { y� CO - City: Newport Beach No. Stories: 2 Zip: 92626 Year Constructed: Unknown Contact: Tomas Telephone: (714) 751-7858 Contractor Information: Number of System Risers Name: Orange County Fire Protection Copy sent to: Address: 137 W Bristol Ln FX] Owner Date 3-22-11 City: Orange Fire AHJ Date 3-22-11 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: George De La Cruz 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 6 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 2-4-11 System Riser ID: Property Information: Type of System: ❑X WePipe of CA f /, Name: Monarch Building Association y Address: 424 32Id Street Dry Pipe Preaction 0t �� Deluge City: Newport Beach Main Drain Test Results: (See attached sheet for multiple risers) Initial Static Pressure: 60 (psi) Residual Pressure: 50 (psi) Restored Static Pressure: 60 (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 I 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 6 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 2-4-11 Property Information: Name: Monarch Building Association Address: 424 32"d Street System Riser ID: �1 Type of System: Of CA 4/ ❑X Wet Pipe o �! Dry Pipe Preaction�`_� R�S� R� M Deluge F� City: Newport Beach L 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 s aces 5.2.3.3 X 1.22 1 5 Years Pipe and Fittings (Accessible concealed s aces 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 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 Paqe 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: 2-4-11 Property Information: Name: Monarch Building Association Address: 424 32„tl Street System Riser ID: Type of System: �fl� °Rt/Al El Wet Pipe` Dry Pipe' ElPreaction cRE M Deluge 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 Paae5of6 Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 2-4-11 Property Information: System Riser ID: Type of System: Of CA tiro ❑X Wet Pipe �Q � J x � Dry Pipe � Preaction�, RE {V4A Deluge Name: Monarch Building Association Address: 424 32"a Street City: Newport Beach Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the item number of the activity listed above: 1.9 7 — Replace Rasco F1 %" SSP 155 chr outside Parking Overhang w/ wax or lead heads (no liquid in bulbs) 1.9 20 — Replace corroded Rasco F1 'h" SSP 155 chr Parking Overhang w/ wax or lead heads 1.9 3 — Replace corroded Rasco F1 '/" SSU 155 chr Parking Overhang w/ wax or lead heads 1.9 2 — Replace 2000 and 1650 head w/ Rasco F1 V SSP 155 chr 1.10 1 — Provide Rasco S/R wrench for SHB 1.4 2 — Provide ITV signs 1.4 1 — Provide Main Drain sign 1.4 2 — Provide CV signs 1.9 1 — Recommend relocating head that is 5' apart from another in Suite F above cubicle near exit 1.9 27 — Replace painted Rasco conc covers in Suite A 1.11 1 — Provide square FDC sign and mount to wall 2.1 1 — Replace bell and back box (rings intermittently, flow switch is okay) 1.5 1 — Provide bell sign 1.10 2 — Provide Tyco LF 11 160 Y2" conc K=4.2 for SHB; 1 — Provide wrench for Tyco LF II 160 %" conc=4.2 1.9 29 — Replace painted Rasco G4 conc throughout unit B (wht) 1.9 1 — Replace recalled CSC GB 155 Q/R SSP br 1/" under stairwell at front entrance in unit A 1.8 1 — 4' of 1 1/4" pipe was provided to extend the main drain into ground to help prevent splashing *Above repairs completed and system Five Year Certified by Raul and Greg of OCFP on 3-17-11 ❑X See Continuation Pages(s) [- 1—] (indicate the number of continuation pages) ❑X PASS FAIL Signature: Date: 3-22-11 Jered Stock State Fire Marshal AES2 Paae 6 of 6 Continuation Form for Deficiencies and Comments Date of Inspection, Testing, Maintenance: 2-4-11 _ Property Information: Name: Monarch Building Association Address: 424 32"d Street City: Newport Beach Type of System: Sprinklers (Chapter 5) OF C ❑X AL System Riser ID: Standpipe (Chapter 6) v H Private Fire Main (Chapter 7) 7� ,Q ❑ Fire Pump (Chapter 8) RE MP Fire Pump No. or ID: Water Storage Tank (Chapter 9) HJWater Spray System (Chapter 10) System Riser ID: ❑ Foam -Water System (Chapter 11) System Riser ID: Item Deficiencies and Comments Deficiencies and Comments item number must correspond to the item number of the Activity listed above: Unprotected Areas 1) 4' x 20' hallway leading to parking by unit B & unit C Unprotected Areas are subject to Fire Dept review and do not exclude 424 32"d Street from OCFP's Certifications. Signature: Date: 3-22-11 Jered Stock State Fire Marshal AES2 DEC 2 2015 (:: i ators, LLC 90377 Acacia St. RECEIV D Newport Beach, CA 92660 BY: Attn: Tony Gauthier Re: Fire Sprinkler Recertification: Please accept this letter as notification that Advance Fire Protection Co., Inc., has corrected all deficiencies found during the Five Year Recertification Test called for by the State Fire Marshal, under Title #19 of the Health and Safety Code. Stickers indicating the day, month, and year the inspection was performed have been affixed to the mains riser piping. Should you have any questions concerning your fire sprinkler system, please feel free to call. Very truly yours, U '6. Avy� Bill Small ADVANCE FIRE PROTECTION CO., INC. /g Cc Newport Beach Fire Department P.O. Box 1768 Newport Beach, CA 92658 Attn: Fire Prevention OK- Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19 3? Name: MICKEY MOTORS Occupancy/Use: B Address: 20377 ACACIA ST. Construction Type: Type IV -A CA��O City: NEWPORT BEACH ��pF No. Stories: 2 ZIP: 92660 Year Constructed: 2006 Contact. TONY GAUTHIER E M Telephone: (949) 777-3113 MET 76%0 7M W Gil is t Name: ADVANCE FIRE PROTECTION CO. Copy sent to: Address: 1451 WEST LAMBERT ROAD M/❑ owner Date: 10/26115 City: LA HABRA 171 Fire AHJ Date: 10/26/15 State: CA ❑ contractor Date: Telephone: (562) 691-0918 NOTES: 1) For specific inspection, testing, and maintenance 259936 requirements and information, see NFPA 25, 20-11 CA License#: Edition as amendedbyCalifornia Code of Regulations, Title 19, F01 to §906. Job #: 15-0695 2) Inspection items may be performed by the owner in Performed by: RON LATHROPE accordance with California Code of Regulations, Title 19, §904.1(a) I Age, li6iift-d Arm �ffl-,rt or A 4 Kfflip 0' W MIMI= Forms Included with this Report NFPA 25 Number of Forms N/A Fail* Pass Chapter Automatic Sprinkler System 5 ❑ Standpipe and Hose System 6 0 El El Private Water Supply System 7 0 El M Fire Pump 8 0 El 1:1 El F1 Water Storage Tank 9 0 F-1 El El Water Spray system 10 0 El 0 F"] El Foam Water Sprinkler System 11 0 0 ❑ Water Mist System 12 0 1:1 EL [I Concerns that are not deficiencies (i.e. Non-Sprinklered Areas) ❑ Yes No AES 1 September 3, 2013 f CZ•", , gg g gw, VI,'. I I", a 0 zk'��!,�Rlserslft --' "filly -,,'M h6l", 6MPiMk"Mf6 e M F11,11,31R661d, 6t, AiMAES 9 RION# i"d 0 11 Y FNIR 1 1ST FLOOR 23" 1 1/4" 75 65 75 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 -EN /e Y� F NIA; rig 10/26/15 P 1.2 1 Control Valves — Inspection 13.3.2 10/26/15 P 1.3 1 Waterflow Alarm Devices 5.2.5 10/26/15 P 1.4 1 Supervisory Devices 5.2.5 10/26/15 P 1.5 1 Gauges (Wet Pipe Systems) 5.2.4.1 10/26/15 P 1.6 1 Hydraulic Design Information Sign (For hydraulically designed systems) 5.2.6 10/26/15 P 1.7 1 Enter Water Supply Pressure Below Riser Check 5.2.4.1 10/26/15 70 psi P 1.8 1 Enter Water Supply Pressure Above Riser Check 5.2.4.1 10/26/15 75 psi P 1.9 1 Pressure Readings Acceptable 5.2.4.1 10/26/15 P 1.10 1 General Information Sign (not required for system prior to 2007 Edition NFPA 13) 5.2.8 10126/15 NA 1.11 1 Heat Tape 5.2.7 10/26/15 NA 1.12 1 Spare Sprinklers 5.2.1.4 10/26/15 P 1.13 1 Fire Department Connections 13.7 10/26/15 P 1.14 1 Alarm Valves — Exterior Inspection 13.4.1 10/26/15 P 1.15 1 Pressure Reducing Valves 13.5.1.1 10/26/15 P 1.16 1 113ackflow Preventers 13.6.1 10/26/15 P Form AES 2.2 Sept. 3, 2013 I = Ins pection T =Test M = Maintenance P=Pass F=Fall NIA=-N&Applicable ... t M Q -NKRI U., A Aj jy -�11?f;N 1.17 1 Small Hose Connections - Hose Valve* 5.1.6,13.5.2 13.5.5.1 10/26/15 N/A 1.18 I PRV — Fire Sprinkler Systems I 13.5.1.1 10/26/15 N/A 1.19 1 Buildings (Freeze Protection) 10/26/15 Owner's Responsibility N/A 1.20 1 Sprinklers 5.2.1 10/26/15 P 1.21 1 Sprinklers - Accessible Concealed Space 5.2.1.1.6 10/26/15 P 1.22 1 Pipe and Fittings 5.2.2 10/26/15 P 1.23 1 Pipe and Fittings - Accessible Concealed Space 5.2.2.3 10/26/15 P 1.24 1 Hangers 5.2.3 10/26/15 P 1.25 1 Hangers - Accessible Concealed Space 5.2.3.3 10/26/16 P 1.26 1 Seismic Braces 5.2.3 10/26/15 P 1.27 1 Seismic Braces - Accessible Concealed Space 5.2.3.3 10/26/15 P 1.28 1 Unsprinklered Areas CFC 901.4 10/26/15 Yes PJ-No 2.1 T Field Service Test Required Send Report to Fire Code Official 5.3.1 10/26/15 If REQUIRED, Enter'F'until results are returned from Lab 2.2 T Recalled Sprinklers ff not present= Pass; ffpresent =Fail Title 19 904.1 (c) 10/26/15 N/A 2.3 T Water Flow Alarm Devices 90 secs max. Enter time 5 ' 3 ' 3 13.2.6 10126/15 40 sec. P 2.4 T Main Drain Test (Enter data on Page I of this form) 13.2.5 13.3.3.4 10/26/15 'P 2.5 T Control Valve - Position 13.3.3.2 10/26/15 2.6 T Control Valve — Operation 13.3.3.1 10/26/15 P 2.7 T Supervisory Devices 13.3.3.5 10/26/15 P 2.8 T Backflow Preventer Assemblies 13.6.2 10/26/15 P 2.9 T Small Hose Connections* w/PRV Hose Valves — Partial Flow Test 13.5.2.3 13.5.3.3 10/26/15 N/A 2.10 T PRV — Fire Sprinkler Systems 13.5.1.3 10/26115 N/A 2.11 T Pressure Gauges - Calibration 5.3.2 10/26/15 P 2.12 T Small Hose Connections* 13.5.6.2.2 10/26/1-5 N/A * 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. I Form AES 2.2 Sept. 3, 2013 xS"Mx 0 i+ II ! ♦ -! �sS. _G' .,':�jj - - .a�'iix =Inspection T =Test M=Maintenance P=Pass F=Fail N/a-=Not Applicable -vltenli r' a6 his. N .,s'"'�ii7'', 1;Yy<"'- !tF"H c`�•c r":�',i:':.,s3,.� 3,n Y> f> ate. '.n.F'i a ,, d v _:}at n: •,. yam.. ��az� a .z <=k O `� t� a r'O""'"C' NFPA� } `.��.', Date �a is i.. ° Fa r; r' kpescription �. 1 ;,I .. :��:�R>�,efe_r;�nce.� s �• s , :,•,:.-�?��;��t�<_�� i?•:..SCom(��e On1Y Y..., .,i' i,tm.. ,.<F �3r ��: �T4+at`'E'"`j..vei tY ��•<��:A,.:�:;.��=:..,�:..�,".��.��.....�;-G.- r�....�;.".:r P;F;;M/Afr:, �•r5- +t^ o-S+=,' ii' ._�.� 3.1 M Check Valves - Internal inspection 13.4.2 10/26/15 P 3.2 M Control Valves 13.3.4 10/26/15 P 3.3 M FDC - Backflush 14.3.2.3 10/26/15 P 14.3.2.4 3.4 M Internal Pipe Inspection - See Deficiencies and 14.2 10/26/15 Yes f' - Comments Section for Results. No 3.5 M Obstruction Investigation Required. If "Yes", see 14.3 10/26/15 P Deficiencies and Comments Section for Results 3.6 M System Returned to Service 4.5.3 10/26/15 Nos P D = Deficiency C = Comment Indicate type) ,� ,n<. ±a.:--•fir,?�',•�'K,,a:t3<;c-;. _1 .r,—�r^r—;5?�. :•fn ;ry.�,� a.; ..�., e em',.--- '�;s.-?,�'rF t.�;.• `x fDeficienc esYhi{dGm eats _r v*t .,_ � Y ¢�.'{'i;;�}oa af`•F7�t .:�:o-,�..k4�f i��..�,� � ,�� $.,.,.:., AliRAM, -. r�purp_S�?Rt de�!rcesrati p�? fsatl�a v>feie �ep�lPe_d ¢C ep._lace 1 .3 3s t s h; 1.20 10/26/15 1 X ADD 1 PENDENT SPRINKLER OUTSIDE CONFERENCE ROOM ON 2ND FLOOR, SPRINKLER IS 12 FEET OFF ONE WALL 1.20 10/26/15 1 X ADD 1 PENDENT SPRINKLER AND ALSO RELOCATE 1 MORE SPRINKLER UPSTAIRS IN SUITE NEXT TO CONFERENCE ROOM. CORRECTIONS MADE 11/24/15 oft ❑ 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 oted in the "Deficiencies and Comments" section of this form. Print Name RON OP Signature Date 11/24/15 Form AES 2.2 Sept. 3, 2013 T J (R �U p U 2 -n !J w j 1�o C- Ali T J L a STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST See Instructions on reverse. SM. W (REV. iaw) AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DEPARTMENT OF SOCIAL SERVICES 714 703-2840 TApril 24, 2014 CCI_-R EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST OWE Luz Adams (T5A2) 306004642 1A CODES 1. ORIGINAL A. FIRECLEARANCE 2. RENEWAL B, LIFE SAFETY LICENSING Department Of Social Services, CCLD7 AGENCY NAMEAND 770 The City Drive, Suite 7100 3. CAPACITYCHANGE ADDRESS 4. OWNERSHIP CHANGE Orange, CA 92868 5. ADDRESSCHANGE L S. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVPUB CAPACITY 0 0 6 0 0 0 6 FACILITY NAME UCENSE CATEGORY HALE MAKUA EHA RCFE STREET ADDRESS (Actwf LONIk") NUMBER OF BUILDINGS 1601 ANITA LANE 1 CITY RESTRAINT NEWPORT BEACH, CA 92660 NO FACILITY CONTACT PERSONS NAME HWRS HERMIE "JOONEE" EVIDENTE III (562) 889-5095 1 7/24 Hrs. I NEWPORT BEACH FIRE DEPT. FIRE AUTHORITY P.O. BOX 1768 NAMEAND ADDRESS NEWPORT BEACH, CA 92658-8915 L VOMOMS NAME rr)WorftW4 TELEPHONE NUMBER CFIRS NUMBER S CLEARANCE IOEMAL COOS 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTIFILMON C. FIREALARM IPANCY CLASS D. SPRINKLERS E. HOUSEKEEPING T� a F. SPECIALHAZARD G. OTHER STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY FACILITY SKETCH (Floor Plan) CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING 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. 8.6 x 12). Keep close to scale. Use the space below. See back for vard sketah- • nuuntas: iFAl;✓ Mp'"Pt Z':HPr 1 N44M LP I MC NFOV-T 'I�LW C'A- 9.26&0 14-1 —� — 1 F -rig NNI t T LU _ l _ I 1� 1-� � � I oNI�L t �E _ C Ht�tA�M � r - '- - A-1 0 &v I-Al-66Y' UC 999 (3/99) _ STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY FACILITY SKETCH (Yard) CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNRY CARE LICENSING 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. FACILITY NAME; ADDRESS; _4tA--514A-V-4A t�:4,11a /l Oj aN I'(7q L-gklE:' ,1yr,-woo .rPt.1)o1 �,2w Morris, Nadine From: Whelan, Melinda Sent: Wednesday, June 25, 2014 4:39 PM To: Morris, Nadine Subject: RE: 1601 Anita Lane They are good to go. Thank you. From: Morris, Nadine Sent: Wednesday, June 25, 2014 4:37 PM To: Whelan, Melinda Subject: 1601 Anita Lane Hi Melinda, I conducted my reinspection today and they are approved. Let me know when I can issue their fire clearance. Thanks! Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net Hak A4akua „Home of Respected Elders„ Joonee Evidente Phone: 56z.889.5095 Jocelyn Scown 'It{ — p �{—� Fax: 71¢.88z.7927 Ofdia Juarez HaleMakuaEU&*fCare@Ooo.com Uanseel-A"dnwor www.HakmahuaEUerlgCare..corm 10¢¢2 Circulo Hpa,Mak�" de �+v 2C' Ca. 9�708 FE # *ogo5z Halt Manua Elua 16970 Mount Eden St., Fountain vallzy, Ca. 9270S RUE # 306004360 Hale Manua Eholit 5172 yearling Ave., Irvine, Ca. 9z6o¢ RCFE # 3060044zz ;Morris, Nadine From: Morris, Nadine Sent: Thursday, August 29, 2013 11:16 AM ��11 I GSlm �`� To: 'Hale Makua' Subject: RE: 1601 Anita Lane Hi Joonee, An exterior staircase is an acceptable means of egress for non -ambulatory clients on the 2nd floor. It just can't be winding or spiral and needs to meet the specifications of item #8 on the guideline. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net From: Hale Makua [mailto:halemakuaelderlycare yahoo.com] Sent: Wednesday, August 28, 2013 4:42 PM To: Morris, Nadine Subject: Re: 1601 Anita Lane Hi Nadine, Thanks for getting us that information. If you remember the bonus room upstairs has an exit to a balcony. Would that be considered an exit for non -ambulatory residents that live upstairs. Also can it just be an exit out of the house or would the exit need to have a way to get downstairs from that exit? Thank You, Joonee Evidente Sent from my iPhone On Aug 28, 2013, at 3:38 PM, "Morris, Nadine" <NMorris@NBFD.net> wrote: Good afternoon Joonee, I've addressed the issues we discussed during the pre -license inspection below: 1) Non -ambulatory clients on the 2nd floor — permitted since the residence is sprinklered but non -ambulatory client bedrooms shall have access to at least one exit that conforms to Item #6 on the guideline. 2) Width of hallway door — the existing width can remain. 3) Pool enclosure — not regulated by the fire department. 4) Outside egress — not regulated by the fire department. Please let me know if you have any questions or if I missed something. t It WAlso, what is the best mailing address to send the invoice in the amount of $240.00 for the residential care facility pre -license inspection? Thank you, Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department 100 Civic Center Dr, Newport Beach, CA 92660 (949) 644-3105 1 (949) 723-3505 FAX I nmorris@nbfd.net Safety, Service, Professionalism <A.09 Residential Group R-3.1 Occupancies 6-201 l.pdf> I(a01 ANiTA La-uE V. I G �U UIDELINES & STANDARDS '�31 GUIDELINE A.09 — Residential Group R-3.1 Occupancies A.09.1 PURPOSE The purpose of this guideline is to provide the minimum requirements necessary for review and approval of residentially based 24-hour care facilities. The regulations regarding a residentially based 24-hour care facility is found in the California Code of Regulations Title 19, California Fire Code (CFC), and California Building Code (CBC). A.09.2 SCOPE This guideline shall apply to residentially based 24-hour care facilities providing accommodations for six or fewer clients of any age. Clients may be classified as ambulatory, nonambulatory, or bedridden. Such residentially based 24-hour care facilities may include adult residential facilities, group homes, and residential care facilities for the elderly. Permits shall be secured from the Building Department for any structural, electrical, mechanical, or plumbing modifications. Any Building Department permits shall be finaled prior to the Fire Department fire clearance inspection. Upon Fire Department approval, a Fire and Life Safety form will be completed and forwarded to the governmental licensing agency. 2. A Zoning Compliance letter is required to be obtained from the City's Planning Division. They can be contacted at (949) 644-3200. The following information is required: a. A copy of your state license or your pending state license. b. A statement responding to each of the applicable requirements required by Section 20.48.170 to show compliance with this section: http://www codepublishina com/CA/NewportBeach/html/newportbeach2O/NewportBeach 2048.html#20.48.170 c. . A statement explaining that the operation will not be defined or classified as an integral facility per our Zoning Code as they are not permitted within the Zoning District. Definition from the Zoning Code: A.09 - Residential Group R-3.1 Occupancies Page 1, of 11 Revised: '�1 March 2014 LIFE SAFETY SERVICES DIVISION GUIDELINES Integral facilities (land use)" means any combination of two or more residential care (small licensed, small unlicensed, or general) facilities that may or may not be located on the same or contiguous lots, that are under the control and management of the same owner, operator, management company or licensee or any affiliate of any of them, and are integrated components of one operation shall be considered one facility for purposes of applying Federal, State, and local laws to its operation. Examples of integral facilities include, but are not limited to, the provision of housing in one facility and recovery programming, treatment, meals, or any other service or services to program participants in another facility or facilities or by assigning staff or a consultant or consultants to provide services to the same program participants in more than one licensed or unlicensed facility. Residential Group R-4 Occupancy - Facilities providing accommodations for more than six clients shall begin by applying for a Use Permit at the Newport Beach Planning Department. If the Use Permit is approved, a code analysis shall be submitted to the Fire Department evaluating the request for a change in occupancy. Once reviewed, plans may be required to be submitted to the Building Department if alterations to the building are required due to the change in occupancy. A.09.3 PROCEDURE Prior to requesting a fire and life safety inspection, new and existing facilities shall submit a site plan to the fire department. Please submit the drawing at least two weeks prior to requesting an inspection. The plan shall include the occupancy classification, number of clients and staff, building address, location of smoke alarms and fire extinguisher, exit doors, hallway widths, stairs, and gates. Include furniture layout for each client bedroom. Furniture shall be in place for the fire department inspection. Use this guideline to ensure that your plans have at least the minimum amount of information required to begin a review. Depending on the project, it may be necessary to provide additional information beyond what is initially requested in this guideline. A.09 - Residential Group R-3.1 Occupancies Page 2 of 11 Revised: jun 2011 March 2014 LIFE SAFETY SERVICES DIVISION GUIDELINES & STANDARDS GENERAL REQUIREMENTS Dl. Address numbers shall be posted on the residence and shall be visible from the street. The numbers shall not be less than 4 inches in height and contrast with their background. In new construction, the numbers shall be illuminated for viewing the numbers at night. Illumination may be either internal or external. 6\L--2. Afire extinguisher with a minimum classification of 2A:10BC is required and shall be mounted in a conspicuous and unobstructed location. The top of the extinguisher shall not be more than 5 feet above finished floor level. A current service tag shall be attached to the fire extinguisher at all times. a :PQ OV kts10§j The extinguisher shall be visually inspected annually and serviced every six years by a licensed company. 3. Single or multiple station smoke alarms shall be installed and maintained regardless of occupant load at all of the following locations: a. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms. b. In each room used for sleeping purposes. c. In each story within a dwelling unit, including basements but not including crawl spaces and uninhabitable attics. In dwellings or dwelling units with split levels and without an intervening door between the adjacent levels, a smoke alarm installed on the upper level shall suffice for the adjacent lower level provided that the lower level is less than one full story below the upper level. ID� d. Smoke alarms shall be provided throughout the habitable areas of the dwelling unit except kitchens. Abb So / N FLOM A.09 - Residential Group R-3.1 Occupancies Page 3 of 11 Revised: jun 2011 March 2014 LIFE SAFETY SERVICES DIVISION GUIDELINES & 0(e The smoke alarms shall be interconnected in such a manner that the activation of one alarm will activate all of the alarms in the individual unit. In new construction and in newly classified R-3.1 occupancies, required smoke alarms shall receive their primary power from building wiring where such wiring is served from a commercial source and shall be equipped with a battery backup. There shall be a minimum of two exits from the dwelling. Exterior doors shall be 36 inches with a 32 inch clear opening. (Interior doors are not regulated by the code unless required to meet accessibility requirements in Chapter 11 of the California Building Code.) A sliding glass door may be used as a bedroom exit however in order to provide a 32 inch clear opening a 6 foot or larger door will be necessary. Exits shall not pass through kitchens, garages, storerooms, or closets and shall not pass through more than one intervening room. Q\Ce. Bedrooms used by nonambulatory clients shall have access to at least one of the required exits, which conform to one of the following: (i.e. diagrams attached) a. Egress through a hallway or area into a bedroom in the immediate area which has an exit directly to the exterior and the corridor/hallway is constructed consistent with the dwelling unit interior walls. The hallway shall be separated from the common areas by a solid wood door not less than 1 3/8 inch in thickness, maintained self closing or shall be automatic closing by actuation of a smoke detector. f3Vb2-cg0&A, '•-, Z b. Egress through a hallway which has an exit directly to the exterior. The hallway shall be separated from the rest of the house by a wall constructed consistent with the dwelling unit interior walls and opening protected by a solid wood door not less than 1 3/8 inch in thickness, maintained self -closing or shall be automatic closing by actuation of a smoke detector. Vc. Direct exit from the bedroom to the exterior shall be 3 feet in width and not less than 6 feet 8 inches in height. A minimum of 32 inches clear exit width shall be provided. M j &TVIZ- G09—M d. An exit that passes through an adjoining bedroom that exits to the exterior. A.09 - Residential Group R-3.1 Occupancies Page 4 of 11 Revised: jun 2011 March 2014 LIFE SAFETY SERVICES DIVISION GUIDELINES & STANDARDS OV . Corridors and hallways on floors serving clients shall be a minimum of 36 inches in width. 0'%�- Existing stairways (except winding and spiral stairways) may be used as a means of egress provided the stairs have a maximum rise of 8 inches with a minimum run of 9 inches. The minimum stairway width may be 30 inches. 3:N TMI0Z ST}'V1Q c Provide a nonfire resistance constructed floor separation at stairs to -prevent smoke migration between floors. Such a floor separation shall equivalent construction of 0.5 inch gypsum wallboard on one side of wall framing. Exceptions: a. Occupancies with at least one exterior exit from floors occupied by clients. Occupancies provided with automatic fire sprinkler systems. Doors within such floor separations shall be tight fitting solid wood at least 1 3/8 inches in thickness. Door glazing shall not exceed 1,296 square inches with no dimension greater than 54 inches. Such doors shall be positive latching, smoke gasketed and shall be automatic -closing by smoke detection. Interior ramps are required in facilities housing nonambulatory clients when changes in level exceed 0.50 inches. If exterior ramps, handrails, or guardrails are installed they shall meet the requirements of the California Building Code Chapter 10 or Chapter 11 for accessibility. Plans shall be submitted to the Building Department for review and approval. Ok�-If the garage is attached to the dwelling, the door between the dwelling and the garage shall be maintained to be self closing and self latching. The door shall be a minimum of a 1 3/8 inch thick, solid wood door. The garage shall not be used for sleeping purposes. There shall be no openings from the garage into any of the sleeping areas. Maintain the garage in a neat, orderly fashion with minimal combustible storage. A.09 - Residential Group R-3.1 Occupancies Page 5 of 11 Revised: I -in 2011 March 2014 LIFE SAFETY SERVICES DIVISION GUIDELINES Clearance around the water heater shall be maintained in accordance with manufacturer's specifications and the heater's listing. Typically 18 inches is the required minimum clearance. C)\U. Provide an evacuation sign in a central location. The sign shall be properly framed and mounted. Show paths of travel to evacuate the building and include the statement "In Case of Emergency Dial 911". DYA,AII drapes, hangings, curtains, drops, and all other decorative material, including Christmas trees, shall be made from a nonflammable material or shall be treated and maintained in a flame-retardant condition by means of a flame-retardant solution or process approved by the State Fire Marshal. CSR-1 F. OF Tv+e-ATIMIFNz' pRov I Dt Exception: Individual patient room window curtains and drapes. pY5. Good housekeeping shall be maintained. The storage of flammable and combustible liquids shall not be permitted. bt' Chimneys shall be equipped with a spark arrestor. A.09 - Residential Group R-3.1 Occupancies Page 6 of 11 Revised: jun 294 4 March 2014 LIFE SAFETY SERVICES DIVISION DCC* (`73 10 ' 25-78 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS I Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR. Title 19 Property Information: NEWPORT BEACH PUBLIC LIBRARY Of C44 Name: Occupancy /Use: E-1 Address: 1000 AVOCADO AVE Construction TYid= 11-A City: NEWPORT BEACH No. Stories: 2 ZIP: 92660 Year Constructed: 1995 Contact: MELISSA KELLY Telephone: 949-717-3852 Contractor Information: Name: XL FIRE PROTECTION Address: 3022 N. HESPERIAN WAY City: SANTA ANA State: CA Telephone: 714 — 5 5 4 — 613 2 1 Number of System Risers Copy sent to: ❑ Owner Date 12/08/2015 ❑ Fire AHJ Date 12/08/2015 o Contractor Date 12/08/2015 1) For specific inspection, testing, and CA License# 311681 �--16 maintenance requirements and information, tion as amended by Jab # 15-4007 Califomia Code of Regulations, Tine 19, §901 Performed by: MARK ROONEY to §906. (Print) 2) inspection Items may be performed by the Owner In accordance with California Code of Note: Contractor information may be pre-printed I Regulations Title 19 J904.1 a Forms included with this report NFPA 25 Chapter Number of Forms N/A FAIL* PASS 0 Automatic Sprinkler System 5 3 X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 0 Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 ❑ Foam Water Sprinkler System 11 - I *See "Deficiencies and Comments' section at end of eaclrresoective form State Fire Marshal AES 1 March 21, 2006 t4 ANNEX B NFPA 25, Chapter 5 as amended by CCR, Title 19 25-79 Date of Inspection, Testing, Maintenance: 12/04/2015 System Riser ID: Property information: NEWPORT BEACH PUBLIC LIBRARY Type of System: �oA�,� • Name: t IN Wet Pie Address: 1000 AVOCADO AVE. 0 Dry Ripe 0 Pre action 0 Deluge City: NEWPORT BEACH 92660 Main Drain Test Results: 80 Initial Static Pressure: (psi) Residual Pressure: 74 (psi) Restored Static Pressure: 78 (psi) Abbreviation Key: I = Inspection T = Test M = Maintenance A-0 = After Operation Ml = Per Manufacturer's Instructions Item Activity Frequency Description NFPA-25 Reference Fail NIA 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 temperature 12.4.4.1.1 X 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) ) 6.2.4.2 6.2.4.3 X 1.4 1 Quarterly Control Valves 12.3.2.1 X 1.5 I Quarterly Alarm Devices 5.2.6 X 1.6 1 Quarterly Gauges (Wet Pipe Systems) 6.2.4.1 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 SEEIS OTES X 1.10 I Quarterly Spare Sprinklers 5.2.1.3 SEE Is OTES X 1.11 I 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 12.6.1.1 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 25"O INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS 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, Maintenance: 12/04/2015 System Riser ID: Property Information: Type System: �a4,� `1 Name: NEWPORT BEACH PUBLIC LIBRARY of �� 4 Iffi Wet Pipe aQ�`r ` 1 Address: 1000 AVOCADO AVE ❑ Dry Pipe rn 5, ❑ Preaction ❑ Deluge p�co_M'�r City: NEWPORT BEACH 92660 Item Activity Frequency Description NFPA 25 Reference Fail NIA Pass 1.18 I 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 0°ncealed 5.2.3.3 X 1.22 1 5 Years Pipe and Fittings (Accessible concealed 5.22.3 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 12A.2.1 X 1.27 1 5 Years Valves — Interior 12.4.3.1.7 X in�� spection 1.28 1 5 Years Preaction/Deluge Valves - Strainers,. 12.4.3.1.8 X L-rs, orifices 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.E X 2.1 T Annually Alarm Devices (90 Sec) 5.3.3 X 12.2.7 12.2.6 2.2 T Annually Main Drain Test(Enterdsta on Page 1) 12.2.6.1 X 12.3.3.4 2.3 T Annually Antifreeze Test 6.3.4 X 2A 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 PreadionValve — 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 ANNEX B 25-81 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, Maintenance: 12/04/2015 Property Information: Name: NEWPORT BEACH PUBLIC LIBRARY Address: 1000 AVOCADO AVE. City: NEWPORT BEACH 92660 System Riser ID: Type of System: a Azz . xl Wet Pipe ❑ Dry Pipe ❑ Preaction ❑ Deluge '►—'tom Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12A.4.2.1 X 2.11 T Annually DryPipe Valve — Low Air Pressure 12A.4.2.6 X 2.12 T Annually Device Dry Pipe Valve — Quick -Opening 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 12A.4.2.2.2 X 2.16 j 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 12.7A SEE I 10TE 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 6.3.1.1.1 X X 2.24 T 75 Years Sprinklers 75 years in service 6.3.1.1.1.4 X 2.25 T Sprinklers manufactured prior to 1920 — Replace 5.3.1.1.1.1 X 3.1 M Annually Control Valves 12.3A X 3.2 M Annually PreactiontDeluge Valves 12.4.3.3.2 X 3.3 M AnnuallyDry Pipe Valves/Quick-Opening Devices 12.4A.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 AES 2 March 21, 2006 25-82 INSPEGriON, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS 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, Maintenance: 12/04/2015 System Riser ID: Property information: Type of System: o� �A4A,� ` Name: NEWPORT BEACH PUBLIC LIBRARY Wet Pipe ❑ Dry Pipe Address: 1000 AVOCADO AVE. ❑ Preaction ❑ Deluge pX M � City. NEWPORT BEACH 92660 Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the Item number of the Acfjvq listed above: 1.9 IN BASEMENT AREA THERE ARE HARD LIDS (BOTTOM OF DUCT SHAFT) AND DUCTWORK WIDER THAN 4'-0" THAT REQUIRE COVERAGE PER NFPA-13 REF. 5.2.1.2 1.9 ON SECOND FLOOR IN STUDY ROOM 2 - TRIM MISSINON ON SPRINKLER AND SPRINKL APPEARS TO BE PUSHED UP INTO HARDLID 5.2.1.2 1.10 NO HEAD WRENCH FOR SPARE SPRINKLERS MODEL S-1 VIKING (CONCEALED) 2.18 WAFER CHECK FOR FDC WAS COMPLETELY RUSTED SHUT (SEE PICTURES) BACKFLU WAS PERFORMED (SEE PICTURES) NEW NUTS/BOLTS INSTALLED ON FDC FLANGE 2.1-2.6 FLOW AND TAMPER SIGNALS VERIFIED @ GREATER ALARM BY OPERATOR "T.R." 3.5 OBSTRUCTION TEST PERFORMED IN 1ST FLOOR MECH ROOM (AUX VALVE). WATER WAS CLEAR AND FREE OF ANY BLOCKAGE DEBRI. M See Continuation Page(s) 1 (Indicate the number of continuation pages) -] PASS ❑ FAIL MARK ROONEY 12/08/2015 Signature Date State Fire Marshal AES 2 March 21, 2006 I 25-82 INSPEC711ON, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25, Chapter 5 as amended by CCR, TWO 19 Date of Inspection, Testing, Maintenance: 12/04/2015 System Riser ID: Property information: Type of System: �p� t Name: NEWPORT BEACH PUBLIC LIBRARY N Wet Pipe �Nr ,p Z ❑ Dry Pipe 1000 AVOCADO AVE. Address: ❑ Preaction,� ❑ Deluge City: NEWPORT BEACH 92660 Item Deficiencies and Comments: Deficiencies and Comments item number must correspond to the Item number of the Activity listed above: *NOTE: SYSTEM IS RELATIVELYY NEW AND IN GOOD FITNESS. *NOTE: THERE IS LITTLE ACCESS TO SYSTEM RISER DUE TO ITEMS STORED AROUND IT. ❑ See Continuation Page(s) (indicate the number of continuation pages) _V PASS ❑ FAIL MARK ROONEY 12/08/2b15 Signature Date State Fire Marshal AES 2 March 21, 2006" Y 1 25-82 INSPECTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25, Chapter 5 as amended b CCR, Title 18 Date of Inspection, Testing, Maintenance: / System Riser ID: Property information: /nU l3 L! C Type of System: �Of lKi I Name: %$��-��l�ny ,.w_._. /�� Q Wet Pipe ❑ Dry Pipe Address: ��d---AYAe"� AVE ❑ Preaction ❑ Deluge City: Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above: !, 9 !A✓ ,8A5fAE&r AMA I'MAJU MAN LA ('60ffem 0,0 uCr SHA rr ,44.1b 3vcr vov'Lk Wlbt7L 7WA— / 1/=0" !,q dH XA-zCV 4 ri-00C IN Srvby 200^7 2. -- Ta /M /y//Ssn✓G ON S'P,IL/N�C2�n �4�ti'D sP/liiVkt�h- �'A�R,r To #Vt1.f 19-A !/P /AVTV fy.q" u d A/0 elAW b O=2/1 X/OXAC -5fR" /kt.�'7t..,9 .4/0 /h 01SL-"L - Ste' ! V//CAV6� 2.11 0,00 . C,IEek ,+won f DC C&AS Col"Ac Gy g1lS1 b "VIlpT SEE piervOeT) 4 AS �t±rx Ran- I&SYAU41b ON Fb C FtAOW6W- See Continuation Page(s) „ l (indicate the number of continuation pages) �Q PASS ❑ FAIL Skfnature C1 bate( State Fire Marshal AES 2 March 21, 2006 25-82 INSPECftUN, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Fire Sprinkler System Page 4 of 4 NFPA 25, Chapter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: IS System Riser ID: Property Information:. Type of System, Cq Name: /�%�w �� i��l' ll� L�Pipe' �� / Qi Wet ,�� • y ❑ Dry Pipe Address: .4 o A ve ❑ Preaction �`� ❑ Deluge Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above: 2.1- &b E'L 0kl AA,b 7-A1n Pam. SG t s rVA/F1Eb gs S aesmilo7ow TAT IPe&Foxmem /N Isr" ,cA-Ong Room A14MX- A/45 e4&* L. MOM /,S N'cW ,¢Avd /n/ (; oaf 1+��77iVEsS . Mvf-C .' 771e&E /S L 117XE' A eClESS TU ,5-Ys7r-lh 02/5 ok b vE r'V rM*5 57Wb D• See Continuation Page(s) (Indicate the number of continuation pages) )'Q PASS ❑ FAIL /2 S /S- i nature I Efate State Fire Marshal AES 2 March 21, 2006 w. FtSi I J'. 2 1 � 7 � LA Ar . t 7{ .a,.= .t+.rws.. - a �. J APPENDIX A 24-23 FIGURE A 9-2.1 Typical contractor's material and test certificate for private fire service mains (continued on next nacre) Contractor's Material and Test Certificate for Private Fire Service Mains PROCEDURE Upon completion of work, Inspection and tests shall be made by the contractor's representative and witnessed by an owners representative. All detects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be tiled out and signed by both representatives. Copies shalt be prepared for approving authorities, owners, and contractor. It is understood the owners representative's signature in no Way prejudices any claim against contractor for faulty material, poor workmanship, ar Influm to comoly witty n ravina acthoril P ra uirarnents or local otdinarim-L PROPERTY NAME A417kk �r1` DATE ([Z PROPERTY ADDRESS tt 6co ACCEPTED BY APPROVING AUTHORITIES (NAMES) N2w�airi" Cat:{n �tre. ��fi ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS Y ❑ NO EQUIPMENT USED iS APPROVED YES ❑ NO iF NO, STATE DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS 6eYES ❑ NO TO LOCATION OF CONTROL VALVES AND CAREAND MAINTENANCE OF THIS NEW EQUIPMENT? 1F NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND ❑ YES ❑ NO MAINTENANCE CHARTS BEEN LEFT ON PREMISES? IF NO, EXPLAIN LOCATION SUPPLIES BUILDINGS PIPETYPESANDCLASS✓ CqQ0 ISO TYPEJOI Gelry s aSe' i 0 - PIPE CONFORMS TO ANDARD YES ❑ NO PIPES AND FirnNG8 CONFORM TO STANDARD YES ❑ NO IF NO, EXPLAIN JOINTS BURIED JOINTS NEEDING ANCHORAGE CLAMPED, STRAPPED OR BLOCKED IN YES © NO ACCORDANCEWITH .rfL'(0� STANDARD IF NO, EXPLAIN FLU SHINS: Flow the required rate untllw[tater Is clear as Indicated by no collection of foreign material In burlap begs at outlets such as hydrants and btow-cffs. Flush at ilowa not less than 39D GPM (1476 Umin) for 4-inch pipe, 610 GPM (2309 Umin) for 5-Inch pipe, 860 GPM (3331 Umin) for 64nch pipe,1560 GPM (5905 Umin) for 8-inch pipe, 2440 GPM. (923S Umin) for 10•Inch pipe, and 3520 GPM (13323 Umin) for 12-Inch pipe. When supply cannot produce stipulated flow rates, oblain maximum available. TEST HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.8 bars) for two hours or 50 psi (3.4 bars) DESCRIPTION above Static pressure in excess of 1S0 psi (10.3 bars) for two hours. LEAKAGE New pipe laid with rubber gasketed joints shall, if the workmanship is satisfactory, have hM& or no leakage at the joints. The amount of leakage at the joints shall not exceed 2 qts. per hr. (1.69 M) per 100 joints inespeotive of pipe diameter. The amount of allowable leakage specified above may be Increased by 111 oz per in. valve diameter per hr. (30 mU25 mm1h) for each metal seated valve Isolating the test sw;on. It dry barrel hydrants are tested with the main valve open, so the hydrants are under pressure, an additional oz per minute (150 mLlmin) leakage is permitted for each hydre-ni. NEW PIPING FLUSHED ACCORDING TO STANDARD YES ❑ NO BY (COMPANY) IF NO, EXPLAIN FLUSHING WAS H PUSUC THROUGH ATTVPE OPPING TESTS e WA ERLOW OTANK OR RESERVOIR [--]FIREPUMP ❑ H DRAM BLJTTPIPE LEAD-INS FLUSHED ACCORDING TO STANDARD ffeYES ❑ NO BY (COMPANY) IF NO, EXPLAIN HMq FLUSHING FLOW WAS OBTAINED MPUSUC THROUGH WHATTYPE OP ING WATER ❑TANK OR RESERVOIR ❑'FIRE PUMP ❑ Y CONN. TO FLANGE MOPEN PIPE 8 SPIGOT 2000 Edition 24-24 PRIVATE FIRE SERVICE MAINS AND THEIR APPURTENANCES I.1GUI£ Appendix B Referenced Publications Wl The following documents or portions thereof are refer- enced within this standard for informational purposes only and thus are not considered part of the requirements of this document.The edition indicated for each reference is the cur- rent edition as of the date of the NFPA issuance of this docu- ment. W1.1 NFPA Publications. National Fire Protection Associa- tion, I Batterymarch Park, P.O. Box 9101, Quincy, MA 02269- 9101. NFPA 13, Standard for the Installation of Sprinkler Systems, 1994 edition. NFPA 13E, Guide for Fm Department Operations in Properties Pmtected by Sprinkler and Standpipe Systems, 1995 edition. NFPA 20, Standard for the Installation of Centrifugal Fire pumps, 1993 edition. NFPA 22, Standard far Water Tanks for Private Fire Protection, 1993 edition. NFPA 72, National Fire Alarm Code,1993 edition. NFPA 1962, Standard for the Care, Use, and Service Testing of Fite Hose Including Couplings and N=ks,1993 edition. B.i.l.i The following NFPA publications contain additional information relevant to this standard: NFPA 11, Standard for Low Expansion Foam,1994 edition. 2NO EdNian f. ,. nA,,.te fire service mains (continued) NFPA 14, Standard for the Installation of Standpipe and Hose system, 1993 edition. NFPA 15, Standard far Water Spray Fixed Systems for Fro Pratec- tion,1990 edition. NFPA 16, Standard for the Installation of Deluge Foam -Water Sprinkler and Foam -Water Spray Systems,1995 edition. NFPA 1963, Standard furl ire Hose Connections, 1993 edition. 11-1.2 ACPAPublication. American Concrete Pipe Associa- tion, 8320 Old Courthouse Road, Vienna, VA 20005. Concrete Pipe Handboak. B-1.3 ANSI Publication. American National Standards Insti- tute,11 West 42nd Street, NewYork, NY10036. ANSI BI6.1, Cast-Imn Pipe Flanges and ranged Httings for A 125, 250 and $00lb, 1989. WI.4 ASTM Publications. American Society for Testing and Materials,1916 Race Street, Philadelphia, PA 19103, ASTM A126, Specification for Gray Iron Castings for Valves, Flanges and Pipe Fittings,1993. ASTM A197, Specification for Cupola Malleable Iran,1987. ASTM A307, Specification for Carbon Steel Botts and Studs, 60,000 psi Tensile Stnmgth,1994. ASTM C296, Standard Specification for Asbestos -Cement Pres- sure pipe,1988. ASTM_B380, Standard Practice for Use of the International Sys- tem of Units,1991. 71caraz, Debbie From: Morris, Nadine Sent: Tuesday, February 02, 2016 9:50 AM To: Alcaraz, Debbie Subject: Scanning - 1600 W Balboa Blvd Attachments: Kana materials certification form.pdf Categories: SCAN Debbie, Please scan the attached document. Thanks, Nadine APPENDIX A Ea C) I S v 1-1 ar 2423 FIGURE M-2.1 'Typical contractor's material and test certificate for private fire service mains (continued on next page) Contractor's Material and Test Certificate for Private Fire Service Mains PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filed out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owners representative's signature in no Way prejudices any claim against contractor for faulty material, poor workmanship, or fa flupq to Corn vn rovino aL9horTl rea ulrements o r lowto M PROPERTY NAME fC t4. \ ,DATE r s n� �r 1'� t� PROPERTYADDRESS i {� _ �(_ O r ACCEPTED BYAPPROVING AUTHORITIES (NAMES) NCWPtIaT Catln �tYG . +it+aF !� ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ❑ NO EQUIPMENT USED iSAPPROVED YE5 ❑ NO IF NO. STATE DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS YES ❑ NO TO LOCATION OF CONTROLVALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS RAVE COPIES OFAPPROPRIATE INSTRUCTIONS AND CAREAND ❑ YES 0 NO MAINTENANCE CHARTS BEEN LEFT ON PREMISES? IF NO, EXPLAIN LOCATION SUPPLIES BUILDINGS a G PIPETYPES AND CLASS Cq60 rleite, ISO TYP JOm�T Axit4 i �- PIPE CONFORMS TO TANDARD YES Q NO FITTINGS CONFORM TO STANDARD YES ❑ NO IF fit} EXPLAIN El PIPES AND JOINTS BURIED JOINTS NEEDING ANCHORAGE CLAMPED, STRAPPED OR BLOCKED IN YES ❑ NO ACCORDANCEWITH STANDARD IF NO. EXPLAIN G 44 cpf- NU►'J f � `eatk [water TEST DESCRIPTION F USHiN : Flow the required rate until Is clear as Indicated by no collection of.ioreign material In burlap bags at Gullets such as hydrants and blow -offs. Flush at flows not less than 390 GPM (1476 Umin) for 4-inch pipe, B10 GPM (2309 Umin) for 5-Inch pipe, 850 GPM (3331 Umin) for 64nch pipe,1560 GPM (5905 Umin) for &Inch pipa, 2440 GPM (9235 Umin) for 10•Inch pipe, and 3520 GPM (13323 Umin) for 12-Inch pipe. When supply cannot produce stipulated flow rates, obtain maximum available. HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.8 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess of 150 psi (10.3 bars) for two hours. LEAKAGE New pipe laid with rubber gaskeled joints shall, if the workmanship Is satisfactory, have little or no leakage at the joints. The amount of leakage at the joints shall not exceed 2 qts. per hr. (1.89 Uh) per 100 joints irrespective of pipe diameter. The amount of allowable leakage specified above may be Increased by 111 oz per In. valve diameter per hr. (30 mU25 mmlh) for each metal seated valve Isolating the test section, if dry barrel hydrants are tested with the main valve open, so the hydrants are under pressure, an additional oz per minute (150 mUmin) leakage is permitted for each rant. NEW PIPING FLUSHED ACCORDING TO _ . STANDARD YES ❑ NO BY (COMPANY) IF NO, EXPLAIN FLUSHING TESTS HOV>LFLUSHING FLOW WAS OBTAINED PUBLIC WATER ❑TANK OR RESERVOIR [FIRE PUMP THROUGH WHAT TYPE �OP ING Q HYDRANT BUTT ( OPEN PIPE LEAD-INS FLUSHED ACCORDING TO STANDARD MI YES ❑ NO BY (COMPANY) IF NO, EXPLAIN KWJ FLUSHING FLOW WAS OBTAINED THROUGH WHAT TYPE OPPING PUBLIC WATER ❑TANK OR RESERVOIR ❑FIRE PUMP ❑ Y CONN. TO FLANGE Of!!N PIPE &SPIGOT 2000 Edition ` 4 24--24 PRIVATE FIRE SERVICE MAINS AND THEIR APPURTENANCES FIGUK Appendix B Referenced Publications B-i The following documents or portions thereof are refer- enced within this standard for informational purposes only and thus are not considered part of the requirements of this document The edition indicated for each reference is the cur- rent edition as of the date of the NFPA issuance of this docu- ment. B-1.1 NFPA Publications. National Fire Protection Associa- tion, I Batterymarch Park, P.O. Box 9101, Quincy, MA02269- 9101. NFPA 13, Standard for the Installation of Sprinkler Systems, 1994 edition. NFPA 13E, Guide for For Department Operations in Properties Protected by Sprinkler and standpipe Systems,1995 edition. NFPA 20, Standard for the Installation of Centrifugal N'Te pumps, 1993 edition. NFPA 22, Standard for Water Tanks for Private Pire Protection, 1993 edition. NFPA 72. National Fire Alarm Code, 1993 edition. NFPA 1962, Standard for the Care, Use, and Service Testing of Dire Hose Including Couplings and No=&% 1993 edition. B.1.1.1 The following NFPA publications contain additional information relevant to this standard: NFPA 11, Standard for Low Expansion Foanr,1994 edition. 200o Edition f.... nrt=te fire service mains (continued) NFPA 14, Standard for the Installation of Standpipe and Hose Sysums,1993 edition. NFPA 15, Standard for Water Spray Faed Systems for 1 vv Protec- lion,1990 edition. NFPA 16, Standard for the Installation of Deluge Foam -Water Sprinkler and Toam-Water Spray Systems,1995 edition. NFPA 1963, Standard form Hose Connectirms,1993 edition. B-1.2 ACPAPubiication, American Concrete Pipe Associa- tion, 8320 Old Courthouse Road, Vienna, VA 20005. Concrete Pipe Handbook. B.1.3 ANSI Publication. American National Standards Insti- tute,ll West 42nd Street, NewYork, NY 10036. ANSI B16.1, Cos t•Imn Pipe Ranges and Banged fittings far 25. 125, 230 and 800 lb, 1989. B.1.4 ASTM Publications. American Society for Testing and Materials,1916 Race Street, Philadelphia, PA 19103, ASTM A126, Specifualion for Gray Iran Castings for Valves, Flanges and pipe Ratings, 1993. ASTM A197, Sprcfftcation for Cupola Malleable Iron,1987. ASTM A307, Specification for Carbon Steil Botts and Studs, 60,000 psi TensileStrength,1994. ASTM C296, Standard Specifrcatio» for Asbestos Cement Pres sure pipe,1988. ASTM E380, Standard Practice for Use of the International Sys- tem of Units, 1991. . Alcaraz, Debbie From: Morris, Nadine Sent: Monday, November 23, 2015 8:43 AM To: Alcaraz, Debbie Subject: Scanning Attachments: chld-01@newportbeachca.gov_20151123_084811_0000300f001b.pdf Categories: SCAN Debbie, Please scan into 1600 W Balboa Blvd - Fire sprinkler aboveground piping certificate. Thanks! .Wadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net Aero Automatic Sprinkler Co. 4q=R0 170 N. Maple St. Suite 112 Corona, California 92880 Phone: 951.273.1889 Fax: 951.273.0257 -- AZ-L16-234798 CA-C16-901529 - -- AZ-C16-234797 NV-C41-69370 Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leaves the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. r^ tt�' PROPERTY NAME Marina Park Building 1 —1 st Floor PROPERTY ADDRESS 1600 W. Balboa Blvd., Newport Beach, CA 92663 ACCEPTED BY APPROVING AUTHORITIES (NAMES) City of Newport ADDRESS 100 Civic Center Dr., Newport Beach, CA 92660 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ® YES ❑ NO EQUIPMENT USED IS APPROVED ® YES ❑ NO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL ® YES ❑ NO VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: INSTRUCTIONS 1. SYSTEM COMPONENTS INSTRUCTIONS ® YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS ® YES ❑ NO 3. NFPA 25 ® YES ❑ NO LOCATION SUPPLIES BLDG OF SYSTEM Building 1 — 1s` Flr YEAR OF ORIFICE TEMPERATURE MAKE MODEL TYPE MANUFACTURE SIZE QUANTITY RATING Reliable F1 FR56 RA1425 SSU 2013/2014 1/2' 22 155° Reliable F1 FR56 RA1414 SSP 2013 / 2014 1/2" 55 155° Reliable F1 FR56 RA1435 HSW 2013 / 2014 1/2" 2 155° SPRINKLERS Reliable F1 FR56 RA1435 HSW 2013 / 2014 1/z" 2 200° Reliable F1 R1722 SSU 2013 / 2014 17/32" 3 286° Reliable F1 FIR RA1325 SSU 2013 / 2014 :V2." 11 2860 TYPE OF PIPE Sch. 10 / Edd 40 PIPE & FITTINGS FITTINGS Gry / Cl Thd ALARM DEVICE MAXIMUM TIME TO OPERATE ALARM VALVE THROUGH TEST CONNECTION OR FLOW TYPE MAKE MODEL MIN. SEC. INDICATOR Flow Indicator System Sensor WFD Series DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP WATER AIR TRIP POINT TIME WATER ALARM THROUGH TEST PRESSURE PRESSURE AIR PRESSURE REACHED OPERATED DRY PIPE CONNECTION* TEST OUTLET* PROPERLY OPERATING MIN. SEC. PSI PSI PSI MIN. SEC. YES NO TEST WITHOUT ❑ ❑ Q.O.D. WITH ❑ ❑ Q.O.D. IF NO, EXPLAIN * MEASURED FROM TIME INSPECTOR'S TEST CONNECTION IS OPENED. OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES El NO DETECTING MEDIA SUPERVISED [I YES ❑ NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS ❑ YES ❑'NO IS THERE AN ACCESSIBLE FACILITY IN EACH ❑ YES ❑ NO CIRCUIT FOR TESTING IF NO, EXPLAIN DELUGE - PREACTION DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT I MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE YES NO YES NO MIN. SEC. PRESSURE REDUCING LOCATION &FLOOR MAKE & MODEL SETTING STATIC PRESSURE INLET PSI OUTLET PSI (FLOWING) RESIDUAL PRESSURE INLET PSI OUTLET PSI FLOW RATE FLOW GPM VALVE TEST HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess of 150 psi (10.2 bars) for two hours. Differential dry pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage TEST shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1-1/2 psi (0.1 bars) in-24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1-112 psi 0.1 bars in 24 hours. ALL PIPING HYDROSTATICALLY TEST AT 200 PSI FOR 2 HRS. IF NO, STATE REASON DRY PIPING PNEUMATICALLY TEST ❑ YES ❑ NO EQUIPMENT OPERATES PROPERLY ® YES ❑ NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVES CHEMICALS,SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ® YES ❑ NO DRAIN TEST READING OF GAUGE LOCATED NEAR WATER SUPPLY TESTCONNECTION: PSI I RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION OPEN WIDE PSI TESTS UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.85B ® YES ❑ NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING. BYES ❑ NO IF POWDER DRIVEN FASTENERS ARE USED IN ® YES ❑ NO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK NUMBER USED LOCATIONS NUMBER REMOVED TESTING GASKETS WELDED PIPING ® YES ❑ NO IF YES....... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY ® YES ❑ NO WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN ® YES ❑ NO COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT ® YES ❑ NO OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS ® YES ❑ NO (DISCS) DISCS ARE RETRIEVE? HYDRAULIC DATA NAMEPLATE PROVIDED ® YES ❑ NO F NO, EXPLAIN NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF SPRINKLER CONTRACTOR: Aero Automatic Sprinkler Co. TESTS WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES FOR INK4R CONTRACTOR (SIGNED) TITLE DATE ADDITIONAL EXPLANATION AND -NOTES <s Aero Automatic Sprinkler Co, 1V'wr'1 AM L,, ANow 170 N. Maple St. Suite 112 Corona, Gallfornla 921380 Phone:951.273.1889 Fax:951.273.0257 AZ-L16-234798 CA-C16-901529 G AZ-C16-234797 NV-C41-69370 Contractor's Material and Test Certificate for AbovegroundPiping PROCEDURE Upon completion of work, Inspection end tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leaves the job. A certificate shall be filled out and signed by bath representatives. Copies shall be prepared for approving authorities, owners, and contractor. it Is understood the owner's representetive's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME Marina Park Building 1 — 2nd! Floor PROPERTY ADDRESS 1600 W. Balboa Blvd., Newport Beach, CA 92663 ACCEPTED BY APPROVING AUTHORITIES (NAMES) City of Newport ADDRESS 100 Civic Center Dr., Newport Beach, CA 92660 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS J( YES ❑ NO EQUIPMENT USED IS APPROVED ® YES []NO iF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL ® YES ❑ NO VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: INSTRUCTIONS 1. SYSTEM COMPONENTS INSTRUCTIONS ® YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS ® YES ❑ NO 3. NFPA 25 ® YES ❑ NO' _—LOCATION SUPPLIES BLDG OFSYSTEM Building 1 —2nd Fir YEAR OF ORIFICE TEMPERATURE MAKE .. MODEL TYPE MANUFACTURE -SIZE QUANTITY RATING Reliable F1FR55 RA1425 SSU 2013 /2014 1/? 4 155° Reliable F1 FR56 RA1414 SSP 2013 / 2014 WS 42 185, SPRINKLERS Reliable.171 FR R3612 SSP 2013 / 2014 17/3V 8 155° Reliable F1FR R3622 SSU 2013 /2014 1A 2 200° Reliable F1 R1722 SSU 2013 / 2014 17/32" 1 14 286° Reliable F1 R1722 SSU 2013/2014 17/32" 1 30 286° TYPE OF PIPE Sch.10 / Eddy 40 FITTINGS PIPE & FITTINGS Gry 101 Thd MAXIMUM TIME TO OPERATE ALARM VALVE ALARM DEVICE THROUGH TEST CONNECTION OR FLOW TYPE MAKE MODEL MIN. SEC. INDICATOR Flow indicator system Sensor WFD Series DRY VALVE Q.O.D. MAKE MODEL I SERIAL NO. MAKE MODEL SERIAL Nb, TIME TO TRIP WATER AIR TRIP POINT TIME WATER ALARM DRY PIPE THROUGH TEST CONNECTION* PRESSURE PRESSURE AIR PRESSURE REACHED TEST OUTLET* OPERATED PROPERLY OPERATING MIN. SEC. PSI PSi PSI MiN, SEC. YES NO TEST WITHOUT Q.O.D. WITH ❑ ❑ Q.O.D. IF NO, EXPLAIN * MEASURED FROM TIME INSPECTOR'S TEST CONNECTION IS OPENED. OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO DETECTING MEDIA SUPERVISED ❑ YES ❑ NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS ❑ YES ❑ NO IS THERE AN ACCESSIBLE FACILITY IN EACH ❑ YES ❑ NO CIRCUIT FOR TESTING IF N0, EXPLAIN DELUGE- PREACTION DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE YES NO YES I NO MIN. SEC. ❑ ❑ ❑ 1 ❑ PRESSURE REDUCING VALVE TEST LOCATION &FLOOR MAKE & MODEL SETTING STATIC PRESSURE INLET PSI OUTLET PSI (FLOWING) RESIDUAL PRESSURE INLET PSI OUTLET PSI FLOW RATE FLOW GPM HYDROSTATIC: Hydrostatic tests shall be made at not less then 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess -of 150 psi (10.2 bars) for two hours. Differential dry pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage TEST shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1-1/2 psi (0.1 bars) in 24 hours. Test pressure -tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1-1/2 psi 0.1 bars in 24 hours. ALL PIPING HYDROSTATICALLY TEST AT 200 PSI FOR 2 HRS. IF NO, STATE REASON DRY PIPING PNEUMATICALLY TEST ❑ YES ❑ NO EQUIPMENT OPERATES PROPERLY ® YES ❑ NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVES CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT'USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ® YES ❑ NO DRAIN TEST READING OF GAUGE LOCATED NEAR WATER SUPPLY TEST CONNECTION: PSI RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION I OPEN WIDE PSI TESTS UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.85B ® YES ❑ NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING. ® YES ❑ NO IF POWDER DRIVEN FASTENERS ARE USED IN ® YES ❑ NO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK NUMBER USED LOCATIONS NUMBER REMOVED TESTING GASKETS WELDED PIPING ® YES ❑ NO IF YES....... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY ® YES ❑ NO WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN ® YES ❑ NO COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT ® YES ❑ NO OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE AJRE REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS (DISCS) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS ® YES ❑ NO DISCS ARE RETRIEVE? HYDRAULIC DATA IF NAMEPLATE PROVIDED ® YES ❑ NO NO, EXPLAIN NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF SPRINKLER CONTRACTOR: Aero Automatic Sprinkler Co. TESTS WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES FOR SPRI K E NTRACTOR (SIGNED) TITLE DATE ADDITIONAL EXPLANATION ANDS Aero Automatic Sprinkler Co. :T 170 N. Maple St. Suite 112 Corona, California 92880 �-� Phone: 951.273.1889 Fax: 951.273.0257 AZ-L16-234798 CA-C16-901529 AZ-C16-234797 NV-C41-69370 Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, Inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leaves the Job. A certificate shall be filled out and signed by both representatives. Coples shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature In no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME Marina Park Building 2 PROPERTY ADDRESS 1600 W. Balboa Blvd., Newport Beach, CA 92663 ACCEPTED BYAPPROVING AUTHORITIES (NAMES) Cit of New art ADDRESS 100 Civic Center Dr., New oft Beach, CA 92660 PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ® YES ❑ NO EQUIPMENT USED IS APPROVED ® YES ❑ NO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL ® YES ❑ NO VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: INSTRUCTIONS 1. SYSTEM COMPONENTS INSTRUCTIONS ® YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS 1 ® YES ❑ NO 3. NFPA 25 ® YES ❑ NO - LacaTior� SUPPLIES BLDG OF SYSTEM Building 2 YEAR OF ORIFICE TEMPERATURE MAKE MODEL TYPE MANUFACTURE SIZE QUANTITY RATING Reliable F1 FR56 RA1425 SSU 2013 / 2014 112, 4 155, Reliable F1 FR56 RA1414 SSP : 2013 / 2014 1/z" 42 165, SPRINKLERS Reliable F1 FR R3612 SSP 2013 / 2014 17/32" 8 155, Reliable F1 FR R3622 SSU 2013 / 2014 1/z" 2 200, Reliable F1 R1722 SSU 2013 / 2014 17/32" 1 14 1286° Reliable F1 R1722 SSU 2013/2014 17/32" 1 30 1 286° TYPE OF PIPE Sch. 10 / Edd 40 PIPE & FITTINGS FITTINGS Gry / CI Thd MAXIMUM TIME TO OPERATE ALARM DEVICE THROUGH TEST CONNECTION ALARM VALVE OR FLOW TYPE MAKE MODEL MIN. SEC. INDICATOR Flow Indicator System Sensor WFD Series DRY VALVE Q.O.D. MAKE MODEL I SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP WATER AIR TRIP POINT TIME WATER ALARM THROUGH TEST PRESSURE PRESSURE AIR PRESSURE REACHED OPERATED DRY PIPE CONNECTION* TEST OUTLET* PROPERLY OPERATING MIN. SEC. PSI PSI PSI MIN. SEC. YES NO TEST WITHOUT ❑ ❑ Q.O.D. WITH ❑ Q.O.D. IF NO, EXPLAIN * MEASURED FROM TIME INSPECTOR'S TEST CONNECTION IS OPENED. OPERATION ❑ PNEUMATIC ❑ ELECTRIC ❑ HYDRAULIC PIPING SUPERVISED ❑ YES ❑ NO I DETECTING MEDIA SUPERVISED ❑ YES ❑ NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS ❑ YES ❑ NO IS THERE AN ACCESSIBLE FACILITY IN EACH ❑ YES ❑ NO IF NO, EXPLAIN DELUGE- CIRCUIT FOR TESTING PREACTION DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT I MAXIMUM TIME TO MAKE MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE -RELEASE YES NO YES I NO MIN. SEC. ❑ ❑ ❑ I ❑ PRESSURE LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE (FLOWING) FLOW RATE, REDUCING &FLOOR MODEL INLET PSI OUTLET PSI INLET PSI OUTLET PSI - FLOW GPM VALVE TEST HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) fortwo hours or 50 psi (3.4 bars) above static pressure in excess of 150 psi (10.2 bars) for two hours. Differential dry pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage TEST shall be stopped. DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1-1/2 psi (0.1 bars) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1-1/2 psi 0.1 bars in 24 hours. ALL PIPING HYDROSTATICALLY TEST AT 1200 PSI FOR 2 HRS. IF NO, STATE REASON DRY PIPING PNEUMATICALLY TEST ❑YES ❑ NO EQUIPMENT OPERATES PROPERLY ® YES ❑ NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVES CHEMICALS, SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ® YES ❑ NO DRAIN READING OF GAUGE LOCATED NEAR WATER SUPPLY RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION TEST TEST CONNECTION: PSI I OPEN WIDE PSI TESTS UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO.85B ® YES ❑ NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING. ® YES ❑ NO IF POWDER DRIVEN FASTENERS ARE USED IN ❑ YES ❑ NO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK NUMBER USED LOCATIONS NUMBER REMOVED TESTING GASKETS WELDED PIPING ® YES ❑ NO 1F YES....... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY ®-YES ❑ NO WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN ® YES ❑-NO WELDING COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT ® YES ❑ NO OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS ® YES ❑ NO (DISCS) DISCS ARE RETRIEVE? HYDRAULIC IF NO, EXPLAIN DATA NAMEPLATE PROVIDED ® YES ❑ NO NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: REMARKS NAME OF SPRINKLER CONTRACTOR: Aero Automatic Sprinkler Co. TESTS WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES FOR SPR ER C NTRACTOR (SIGNED) TITLE DATE ADDITIONAL EXPLANATION AND S `{wV' 7FPARA n S SONITROL VERIFIED ELECTRONIC SECURITY �j�V l J'� OOc?r7 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 moth 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: 111 ZOI S Time of inspection or test: f ©A M 1. PROPERTY INFORMATION Name of property: "� Address: l6 O O (� J. 4641f 6a�t 4/6-61? T �ec�c(,lr, /C-I �� Description of J property: C 0 04 04 N [ � " l.. iaT!("'�'� - Occupancy type: /L-4 X C- by, S, A) . Name of property/ representative: Address: t'O 6 C:c�d� C C Jj�er 0" // Phone: 'YY? 0111 :3Z 73' Fax: E-mail: Authority having / jurisdiction over this property: .•t�c4�•o/{!P Phone: 7Yy, 641y SO 75'Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Service and/or testing organization I?o lad Co t S Fax: Service technician or technician or accordance with NFPA standards is in effect as of Contract number: Monitoring organization for P�zXIC 561-uet-17 Fax: Entity to which alarms are retransmitted: for this equipment: Address: Phone:p/// 07 E-mail: �e�T% �G .sUve t7✓o�$J C fS h7 tester: Qualifications of tester: F� NJT>r, � N A contract for test and inspection in_ The contract expires: Frequency of tests and inspections: this equipment: Address: Phone: E-mail: Phone: 1 Leader in Commercial Security and Fire Systems Intrusion Detection I Access Control I Video Surveillance I Fire Detection Fleet Management a NIL SONITROL 14V VERIFIED ELECTRONIC SECURITY 3. TYPE OF SYSTEM OR SERVICE Fire alarm system (nonvoice) ❑ Fire alarm with in -building fire emergency voice alarm communication system (EVACS) JKL 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 Intrusion Detection ( Access Control I Video Surveillance ( Fire Detection I Fleet Management A 0 ANL SONITROL VERIFIED ELECTRONIC SECURITY 3. TYPE OF SYSTEM OR SERVICE (continued) NFPA 72 edition: Additional description of system(s): 3.1 Control Unit Manufacturer: F:, k �� Model number: qZ 0 0 tvL o s 3.2 Mass Notification System This system does not incorporate an MNS. 3.2.1 System Type: ❑ In-buildingMNS—combination ❑ In-buildingMNS—stand-alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS ACU only ❑ Wide -area MNS to regional national alerting interface 1 Local operating console (LOC) ❑ Direct recipient MNS (DRMNS) ❑ Wide -area MNS to DRMNS interface ❑ Wide -area MNS to high -power speaker array (HPSA) interface on -building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ❑ An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the record record drawings are stored on site. Location: 3.4 System Software ❑ This system does not have alterable site -specific software. Software revision number: Software last updated on: Dg A copy of the site -specific software is stored on site. Location: t= A C- () 4o 0 4. SYSTEM POWER 4.1 Control Unit 4.1.1 Primary Power Input voltage of control panel: c 4.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: Type of fuel: Control panel amps: 3 E, This system does not have a generator. 4.1.3 Uninterruptible Power System Q 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): Vie,, Leader in Commercial Security and Fire Systems Intrusion Detection I Access Control I Video Surveillance I Fire Detection I Fleet Management SONITROL VERIFIED ELECTRONIC SECURITY 4. SYSTEM POWER (continued) 4.1.4 Batteries , / Location: f90 wwt+' S °//y Type: /=r' iCl. Nominal voltage: 2 y Amp/hour rating: 4 Calculated capacity of batteries to drive the system: In standby mode (hours): Z `l In alarm mode (minutes): S ® Batteries are marked with date of manufacture. 4.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System [B-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: 4.2.2 Engine -Driven Generator IQ This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.2.3 Uninterruptible Power System [is] 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: P't'i°' �r Type: Nominal voltage:l2 A /3/ Amp/hour rating: 7 Calculated capacity of batteries to drive the system: In standby mode (hours): Z y In alarm mode (minutes): s� [ff,Batteries are marked with date of manufacture. 4.3 Notification Appliance Power Extender Panels Q This system does not have power extender panels. 4.3.1 Primary Power Input voltage of power extender panel(s): Power extender panel amps: 4.3.2 Engine -Driven Generator AThis system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.3.3 Uninterruptible Power System 0 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 Intrusion Detection I Access Control I Video Surveillance I Fire Detection ( Fleet Management SONITROL VERIFIED ELECTRONIC SECURITY 4. SYSTEM POWER (continued) 4.3.4 Batteries / Location: Pa, 4 / Type: Calculated capacity of batteries to drive the system: In standby mode (hours): Zy US Batteries are marked with date of manufacture. 5. ANNUNCIATORS 5.1 Location and Description of Annunciators Annunciator 1: ,.t/t4��a` �k�� tti/cd.y Annunciator 2: /L 114 Annunciator 3: 41/, Nominal voltage: r Z�2 $ol Amp/hour rating: 7 In alarm mode (minutes): ($- 6. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: too btcr +.5"1`Il Building management Contact: Building occupants Contact: Authority having jurisdiction Contact: Other, if required Contact: 7. TESTING RESULTS 7.1 Control Unit and Related Equipment ❑ This system does not have annunciators. Time: 9,.00 #V1 Time: Time: Time: Time: Description Visual Inspection Functional Test Comments Control unit Lamps/LEDs/LCDs Fuses Trouble signals Disconnect switches �I Ground -fault monitoring I� Supervision Local annunciator Remote annunciators Power extender panels Isolation modules Other (specify) Leader in Commercial Security and Fire Systems Intrusion Detection I Access Control I Video 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 N /A, Generator or UPS ❑ ❑ Battery condition al, in Load voltage Q IQ Discharge test 19 Charger test. Q Other (specify) ❑ ❑ 7.3 In -Building Fire Emergency Voice Alarm Communications Equipment Visual Functional Description Inspection Test Comments Control unit ❑ ❑ ! A 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 Intrusion Detection I Access Control I Video Surveillance I Fire Detection I Fleet Management 7. TESTING RESULTS (continued) 7.4 Notification Appliance Power Extender Panels Description Visual Inspection Functional Test Comments Lamps/LEDs/LCDs 9L Fuses Primary power supply K Secondary power supply RL Trouble signals Q Ground -fault monitoring 14 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 Intrusion Detection I Access Control I Video Surveillance I Fire Detection I Fleet Management 7. TESTING RESULTS (continued) 7.5 Mass Notification Equipment (continued) Visual Functional Description Inspection Test Comments MNS to direct recipient MNS ❑ ❑ 13 pr 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 Intrusion Detection I Access Control I Video Surveillance I Fire Detection I Fleet Management 7. TESTING RESULTS (continued) 7.7 Combination Systems Description Visual Inspection Functional Test Comments Fire extinguishing monitoring devices/system �'�'(� N'a Carbon monoxide detector/system ❑ ❑ Combination fire/security system ❑ ❑ Other (specify) ❑ ❑ 7.8 Special Hazard Systems Description (specify) Visual Inspection Functional Test Comments ❑ ❑ NIA ❑ ❑ ❑ ❑ 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 ❑ ❑ N 1& Fire pump ❑ ❑ Special suppression systems ❑ ❑ Other (specify) ❑ ❑ Leader in Commercial Security and Fire Systems Intrusion Detection I Access Control I Video Surveillance I Fire Detection I Fleet Management 7. TESTING RESULTS (continued) 7.11 Auxiliary Functions Description Visual Inspection Functional Test Comments Door -releasing devices ❑ ❑ l�1tA N �a Nia tj1A N �A Fan shutdown Q �. Smoke management/smoke control ❑ ❑ Smoke damper operation Smoke shutter release ❑ ❑ Door unlocking ❑ ❑ Elevator recall Elevator shunt trip ❑ ❑ NMS override of FA signals ❑ ❑ Other(specify) ❑ ❑ 7.12 Alarm Initiating Device K Device test results sheet attached listing all devices tested and the results of the testing 7.13 Supervisory Alarm Initiating Device A 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 Intrusion Detection I Access Control I Video Surveillance I Fire Detection I Fleet Management 8. NOTIFICATIONS THAT TESTING IS COMPLETE S�Zvlir2l Monitoring organization Contact: SON1T—fLOL Building management Contact: Building occupants Contact: Authority having jurisdiction Contact: Other, if required Contact: 9. SYSTEM RESTORED TO NORMAL OPERATION Date: k\ 11 0 11-* 193 Time: 3. b CG p 1,1 Time: 33 c' d ? "J Time: Time: Time: 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: Title: Organization: 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 Intrusion Detection I Access Control I Video Surveillance I Fire Detection I Fleet Management DEVICE TEST RESULTS (Attach additional sheets if required) Leader in Commercial Security and Fire Systems Intrusion Detection I Access Control I Video surveillance I Fire Detection I Fleet Management Morris, Nadine From: Central Station <central@sonitrolsj.com> Sent: Thursday, November 12, 2015 3:32 PM To: Morris, Nadine; fsanchez@sonitroloc.com Subject: A92758 - MARINA PARK Attachments: A92758 Fire Test.rtf Hello, V- l�l Fa Dr,5-cx'-� I've attached the activity for the fire test today, showing all the alarms. Zone 178 has been renamed to "HVAC SHUTDOWN RELAY", so it will display properly. Thank you, omz� 0. Central Station Customer Service - Sonitrol-Pacific West Security, Inc. I ®: central@sonitrolsi.com W. (San Jose) 408-279-8500, (Utah) 888-593-2002 (Sacramento/Orange County) 800-310-5772 & 408-287-6508 Et: 1587 Schallenberger Rd., San Jose, CA 95131 Please let us know if you would like to sign up for the FREE online MySonitrol access. MySonitrol.net provides hands on access to view/add/delete users, run reports and much more from your web browser or mobile device VALUED CUSTOMERS- Please confirm with our central station that your 2015 holiday schedule has been put into effect. Please let me know if you have any questions regarding your holiday schedule CONFIDENTIALITY NOTICE: This message (including any attachments) is intended exclusively for the individual(s) to whom it is originally addressed and may contain proprietary, protected, or confidential information. If you are not the named addressee, you are not authorized to read, print, copy, or disseminate this message or any part of it. If you have received this message in error, please notify the sender immediately. 11/12/2015 15:26 ID: 180 A92758 Customer Activity Report All Activity Marina Park AVenis^pi Customer ID: A92758 11/12/2015 12:01:00 Thru 11/12/2015 15:10:00 [Customer's Local Time Zone] Marina Park "f/a^nis^pi 1600 W. Balboa Blvd. Newport Beach CA 92663 Date Day Time Loa Description 11/12/2015 Thu 12:01:24 Sensor Trouble (System: 1 Zone: 178) 12:02:10 Restore'Added by Signal Handler' 12:02:15 Sensor Trouble 'Added by Signal Handler' 12:06:08 Restore'Added by Signal Handler' 12:06:27 System Restore (System: 1) 12:19:42 Sensor Trouble'DUCT DET. AHU2-1' 12:19:45 Sensor Trouble'DUCT DET. AHU2-5' 12:19:48 Sensor Trouble'DUCT DET. AHU2-2' 12:19:51 Sensor Trouble'DUCT DET. AHU2-6' 12:19:54 Sensor Trouble'DUCT DET. AHU2-7' 12:19:57 Sensor Trouble'DUCT DET. AHU2-4' 12:23:23 Fire Supervisory'DUCT DET. AHU2-3' 12:24:09 Fire Restoral 'DUCT DET. AHU2-3' 12:24:12 Restore'DUCT DET. AIU2-1' 12:24:14 Restore'DUCT DET. AHU2-5' 12:24:19 Restore'DUCT DET. AHU2-2' 12:24:22 Restore'DUCT DET. AHU2-6' 12:24:25 Restore'DUCT DET. AHU2-7' 12:24:28 Restore'DUCT DET. AHU2-4' 12:24:31 Fire Supervisory'DUCT DET. AHU2-3' 12:24:34 Sensor Trouble 'DUCT DET. AHU2-6' 12:24:37 Sensor Trouble'DUCT DET. AHU2-7' 12:24:40 Sensor Trouble 'DUCT DET. AHU2-4' 12:24:44 Sensor Trouble'DUCT DET. AHU2-1' 12:24:47 Sensor Trouble 'DUCT DET. AHU2-5' 12:24:49 Sensor Trouble 'DUCT DET. AHU2-2' 12:25:24 Fire Restoral'DUCT DET. AHU2-3' 12:25:28 Restore'DUCT DET. AHU2-6' 12:25:31 Restore'DUCT DET. AHU2-T 12:25:34 Restore'DUCT DET. AHU2-4' 12:25:37 Restore'DUCT DET. AHU2-l' 12:25:37 Runaway Warning'Possible Runaway Signals' 12:25:41 Restore'DUCT DET. AHU2-5' 12:25:43 Restore'DUCT DET. AHU2-2' 12:25:47 Sensor Trouble'DUCT DET. AHU2-l' 12:25:50 Sensor Trouble'DUCT DET. AHU2-5' 12:25:53 Sensor Trouble'DUCT DET. AHU2-2' 12:25:57 Sensor Trouble'DUCT DET. AHU2-6' 12:26:00 Sensor Trouble'DUCT DET. AHU2-7' 12:26:02 Sensor Trouble'DUCT DET. AHU2-4' 12:27:08 System Shutdown (System: 1) 12:27:12 Sensor Trouble'Added by Signal Handler' 12:27:14 Restore'Added by Signal Handler' 12:27:38 System Restore (System: 1) 12:27:41 Restore'DUCT DET. AHU2-1' Customer Activity Report Page 1/4 C 11/12/2015 15:26 A92758 Date Marina Park ^f/a^nis^pi Day Time 12:27:44 12:27:47 12:27:50 12:27:54 12:27:57 12:28:20 12:28:24 12:28:25 12:28:29 12:28:33 12:28:35 12:30:15 12:31:50 12:31:53 12:31:57 12:32:00 12:32:03 12:32:06 12:32:09 12:32:12 12:32:16 12:32:19 12:32:22 12:32:25 12:32:28 12:32:31 12:32:55 12:32:59 12:33:03 12:33:06 12:33:08 12:33:12 12:33:12 12:33:15 12:33:18, 12:33:22 12:33:24 12:33:28 12:33:31 12:33:34 12:33:37 12:35:17 12:35:19 12:35:24 12:35:27 12:35:30 12:35:33 12:35:37 12:36:50 12:36:53 12:36:57 12:37:00 12:39:36 12:39:39 1600 W. Balboa Blvd. Newport Beach CA 92663 Loci Description Restore'DUCT DET. AHU2-5' Restore'DUCT DET. AHU2-2' Restore 'DUCT DET. AIU2-6' Restore'DUCT DET. AHU2-7' Restore'DUCT DET. AHU2-4' Sensor Trouble'DUCT DET. AHU2-1' Sensor Trouble'DUCT DET. AHU2-5' Sensor Trouble'DUCT DET. AHU2-2' Sensor Trouble'DUCT DET. AHU2-6' Sensor Trouble'DUCT DET. AHU2-7' Sensor Trouble'DUCT DET. AHU2-4' Fire Supervisory'DUCT DET. AHUl-2' Fire Restoral'DUCT DET. AHUl-2' Restore'DUCT DET. AHU2-1' Restore'DUCT DET. AHU2-5' Restore'DUCT DET. AHU2-2' Restore'DUCT DET. AIU2-6' Restore'DUCT DET. AHU2-T Restore'DUCT DET. AHU2-4' Sensor Trouble'DUCT DET. AHU2-6' Sensor Trouble'DUCT DET. AHU2-7' Sensor Trouble'DUCT DET. AHU2-4' Fire Supervisory'DUCT DET. AHU2-3' Sensor Trouble'DUCT DET. AHU2-1' Sensor Trouble'DUCT DET. AHU2-5' Sensor Trouble'DUCT DET. AHU2-2' System Shutdown (System: 1) Fire Restoral 'DUCT DET. AHU2-3' Ground Fault (System: 1) Sensor Trouble'DAMPER RELAY BLD.2' System Restore (System: 1) Restore'DUCT DET. AHU2-6' Runaway Warning'Possible Runaway Signals' Restore'DUCT DET. AHU2-7' Restore'DUCT DET. AHU2-4' Restore'DUCT DET. AHU2-1' Restore'DUCT DET. AHU2-5' Restore'DUCT DET. AHU2-2' Restore'DAMPER RELAY BLD.2' Ground Fault Restore (System: 1) Ground Fault (System: 1) Sensor Trouble'DUCT DET. AHU2-l' Sensor Trouble'DUCT DET. AHU2-5' Sensor Trouble'DUCT DET. AHU2-2' Sensor Trouble'DUCT DET. AHU2-6' Sensor Trouble'DUCT DET. AHU2-7' Sensor Trouble'DUCT DET. AHU2-4' Sensor Trouble'DAMPER RELAY BLD.2' Restore'DAMPER RELAY BLD.2' Sensor Trouble'DAMPER RELAY BLD.2' Restore'DAMPER RELAY BLD.2' Sensor Trouble'DAMPER RELAY BLD.2' System Shutdown (System: 1) Restore'DAMPER RELAY BLD.2' ID. 180 Customer Activity Report Page 2/4 11/12/2015 15:26 A92758 Date Marina Park ^f/a^nis"pi Day Time 12:41:06 12:41:09 12:41:12 12:41:15 12:41:18 12:41:21 12:41:25 12:41:28 12:41:31 12:41:34 12:41:37 12:41:40 12:42:09 12:42:12 12:42:15 12:43:38 12:55:40 12:55:43 12:55:45 12:55:49 12:55:53 12:55:55 13:01:21 13:01:25 13:01:27 13:01:32 13:01:35 13:01:37 13:01:56 13:01:59 13:02:03 13:02:06 13:02:09 13:02:11 13:04:50 13:04:53 13:04:57 13:05:01 13:05:03 13:05:06 13:05:10 13:05:12 13:05:15 13:05:20 13:05:22 13:05:25 13:05:29 13:05:31 13:05:56 13:05:59 13:06:03 13:06:05 13:06:08 13:06:13 Log Description System Restore (System: 1) Restore'DUCT DET. AHU2-l' Restore'DUCT DET. AHU2-5' Restore'DUCT DET. AHU2-2' Restore'DUCT DET. AHU2-6' Restore'DUCT DET. AHU2-7' Restore'DUCT DET. AHU2-4' Ground Fault Restore (System: 1) Ground Fault (System: 1) Sensor Trouble'DUCT DET. AHU2-6' Sensor Trouble'DUCT DET. AHU2-7' Sensor Trouble'DUCT DET. AHU2-4' Restore'DUCT DET. AHU2-6' Restore'DUCT DET. AHU2-7' Restore'DUCT DET. AHU2-4' Ground Fault Restore (System: 1) Sensor Trouble'DUCT DET. AHU2-5' Sensor Trouble'DUCT DET. AHU2-6' Sensor Trouble'DUCT DET. AHU2-7' Sensor Trouble'DUCT DET. AHU2-4' Sensor Trouble'DUCT DET. AHU2-l' Sensor Trouble'DUCT DET. AHU2-2' Restore'DUCT DET. AHU2-5' Restore'DUCT DET. AHU2-6' Restore'DUCT DET. AHU2-7' Restore'DUCT DET. AHU2-4' Restore'DUCT DET. AHU2-l' Restore'DUCT DET. AHU2-2' Sensor Trouble'DUCT DET. AHU2-l' Sensor Trouble'DUCT DET. AHU2-5' Sensor Trouble'DUCT DET. AHU2-2' Sensor Trouble'DUCT DET. AHU2-6' Sensor Trouble'DUCT DET. AHU2-7' Sensor Trouble'DUCT DET. AHU2-4' Restore'DUCT DET. AHU2-l' Restore'DUCT DET. AHU2-5' Restore'DUCT DET. AHU2-2' Restore'DUCT DET. AHU2-6' Restore'DUCT DET. AHU2-7' Restore'DUCT DET. AHU2-4' Sensor Trouble'DUCT DET. AHU2-6' Sensor Trouble'DUCT DET. AHU2-7' Sensor Trouble'DUCT DET. AHU2-4' Sensor Trouble'DUCT DET. AHU2-l' Sensor Trouble'DUCT DET. AHU2-5' Sensor Trouble'DUCT DET. AHU2-2' Restore'DUCT DET. AHU2-6' Restore'DUCT DET. AHU2-7' Restore'DUCT DET. AHU2-4' Restore'DUCT DET. AHU2-l' Restore'DUCT DET. AHU2-5' Restore'DUCT DET. AHU2-2' Sensor Trouble'DUCT DET. AHU2-6' Sensor Trouble'DUCT DET. AHU2-7' 1600 W. Balboa Blvd. Newport Beach CA 92663 ID: 180 Customer Activity Report Page 3/4 11/12/2015 15:26 A92758 Date Marina Park ^f/aAnis^pi Day Time 1306:13 13:06:16 13:06:19 13:06:22 13:06:25 13:06:53 13:06:56 13:07:00 13:07:03 13:07:06 13:07:09 13:10:20 13:10:55 13:12:26 13:12:29 13:21:20 13:21:23 14:03:11 14:03:14 14:04:22 14:04:25 14:19:17 14:19:19 14:20:09 14:20:11 14:21:16 14:21:17 14:21:21 14:21:43 14:44:58 14:46:46 14:47:37 14:47:40 15:08:27 15:09:48 1600 W. Balboa Blvd. Newport Beach CA 92663 Log Description Runaway Warning'Possible Runaway Signals' Sensor Trouble'DUCT DET. AHU2-4' Sensor Trouble'DUCT DET. AHU2-1' Sensor Trouble'DUCT DET. AHU2-5' Sensor Trouble'DUCT DET. AHU2-2' Restore 'DUCT DET. AHU2- l' Restore 'DUCT DET. AHU2-5' Restore 'DUCT DET. AHU2-2' Restore 'DUCT DET. AHU2-6' Restore'DUCT DET. AHU2-T Restore 'DUCT DET. AHU2-4' Fire Smoke'SMOKE DET. ABOVE PANEL' Fire Smoke Restore'SMOKE DET. ABOVE PANEL' Fire Smoke'SMOKE DET. ABOVE PANEL' Fire Smoke Restore'SMOKE DET. ABOVE PANEL' Fire Water Flow'WATERFLOW BLD. 2' Fire H2O Flow Res 'WATERFLOW BLD. 2' Fire Water Flow'WATERFLOW BLD. F Fire H2O Flow Res'WATERFLOW BLD. F Fire Supervisory'TAMPER BLD. 1' Fire Restoral 'TAMPER BLD. P Fire Supervisory'PIV BLD. 1' Fire Restoral TIV BLD. F Fire Supervisory'PIV BLD. 2' Fire Restoral'PIV BLD. 2' Fire Supervisory'STREET OS&Y' Fire Restoral'STREET OS&Y' Fire Supervisory'STREET OS&Y' Fire Restoral 'STREET OS&Y' Fire Smoke'SMOKE DET. ABOVE PANEL' Fire Smoke Restore'SMOKE DET. ABOVE PANEL' Fire Supervisory'TAMPER BLD. 2' Fire Restoral 'TAMPER BLD. 2' Fire Smoke'SMOKE DET. BLD. 1' Fire Smoke Restore'SMOKE DET. BLD. P ID: 180 Customer Activity Report Page 4/4 CI irn'' or- + V 2, 3' �N in,," o m'tCA , t -15 Im Wtr 'p i ,Z fm M4 0 Mix _ rv- FT) t, Morris, Nadine From: Morris, Nadine Sent: Tuesday, October 20, 2015 11:43 AM To: 'Aristizabal, Luis' Subject: RE: Fire Alarm Monitoring Thank you Fernando. I will update our records. NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net From: Aristizabal, Luis [mailto:Fernando.Aristizabal@marriott.com] Sent: Tuesday, October 20, 2015 5:31 AM To: Morris, Nadine Subject: RE: Fire Alarm Monitoring Nadine, Sorry for the late response. The monitoring service for the fire alarm from Tyco was never disconnected, they sent us a letter because another contractor did not pay them an invoice. Tyco is still servicing the system. Best Regards, Fernando Aristizabal I Engineering Supervisor I Newport Beach Bayview Marriott 500 Bayview Circle Newport Beach, CA 92660 1 P-949-509-6014 I F-949-509-6056 I From: Morris, Nadine Sent: Monday, October 05, 2015 11:45 AM To: 'Aristizabal, Luis' Subject: RE: Fire Alarm Monitoring Hi Fernando, Did you find out anything about the monitoring service? Thank you. .Na&ne NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net From: Aristizabal, Luis [mailto:Fernando.AristizabaWmarriott.com] Sent: Tuesday, September 29, 2015 7:59 AM To: Morris, Nadine Subject: RE: Fire Alarm Monitoring 1 Nadine, I am not aware of this, I am looking into it. I will let you know if We have a new company. Best Regards, Fernando Aristizabal I Engineering Supervisor I Newport Beach Bayview Marriott 500 Bayview Circle Newport Beach, CA 92660 I P-949.509-6014 I F-949-509-6056 From: Morris, Nadine fmailto:NMordsaa Nl3FD.net] Sent., Tuesday, September 29, 2015 7,56 AM To: Aristizabal, Luis Subject: Fire Alarm Monitoring Good morning Fernando, Our office received the attached notice. Please advise if the Marriott has secured another monitoring company and who they are, or if the monitoring service with TYCO will be continued. Thank you. -Aadine NADIN E MORRIS I Life Safety Specialist Newport Beach Flre Department (949) 644-3105 1 nmorris@nbfd,net In#egra#e(f Secudry Fire Alarm System Discontinuance Letter IIIIN�I9IIV1UEOI�IVIIII� Newport Beach Fire Department Tyco Integrated Security 14200 E Exposition Ave Att n : Attn: Fire Prevention Aurora, CO 80012 100 Civic Center Drive Tel: Newport Beach, CA 92660 Fax: Check Toll Free:888-989-2647 One Type of Letter www.tycols.com IR This letter will serve as formal notification that the fire alarm system at the business location listed below will no longer be monitored by Tyco Integrated Security effective. n This letter will serve as a formal request that the fire alarm system at the business location listed below shall be removed from the local alarm board following your approval. Business Name: MARRIOTT SUITES NEWPORT 949-854-4500 Business Address: 500 BAYVIEW CIR City, State, ZIP Code: NEWPORT BEACH, CA 92660-2978 Reason for Discontinuance Customer Change in D Moved/ 13 Service EEC Non-payment D N/A Closed Provider Type of Discontinuance Full D (Monitoring/ D Monitoring Only D Maintenance Maintenance) Only Gate Effective: 10%9/2P15 Please do not hesitate to contact me at have. Thank you, Lori Yeager 303-306-5742 Tyco Integrated Security 888-989-2647 with any questions you may Debbie From: Morris, Nadine Sent: Tuesday, September 29, 2015 10:51 AM To: Alcaraz, Debbie Subject: Invoice Attachments: 500 Bayview Cir.pdf Hi Debbie, Please invoice the below fee to the NB Marriott Suites. Use the address listed under section "ll. Mailing Information" on the attached document. Billing Period 07/01/2015 to 06/30/2016 Hazardous Materials Inventory Disclosure Program 1-4 Chemicals $128.00 Thank you! Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net NEWPORT BEACH FIRE DEPARTMENT k< FACILITY INFORMATION BUSINESS OWNER/OPERATOR IDENTIFICATION 1. IDENTIFICATION BEGINNING DATE: 01/01/2014 ENDING DATE: 12/31/2014 BUSINESS NAME: NEWPORT BEACH MARRIOTT SUITES SITE ADDRESS: 500 BAYVIEW CIR NEWPORT BEACH CA 92860 BUSINESS PHONE: 9498544500 BUSINESS FAX: 9495096056 DUN & BRADSTREET: 618169254 PRIMARY NAICS: 721110 BUSINESS OPERATOR NAME: Host Marriott LP BUSINESS OPERATOR PHONE: 9498544500 BUSINESS EMAIL: John.McCann@marriott.com II. MAILING INFORMATION BUSINESS NAME: Newport Beach Marriott Bayview ATTN: Engineering CONTACT PHONE: 9498544500 MAILING ADDRESS: 500 Bayview Circle CITY: Newport Beach STATE: CA ZIP CODE: 92660 III. BUSINESS OWNER OWNER NAME: HOST MARRIOTT L P PHONE: 9498544500 NUMBER: 10400 STREET: FERNWOOD CITY: Newport Beach STATE: CA ZIP CODE: IV. ENVIRONMENTAL CONTACT NAME: John McCann EMAIL: john.mccann@marriott.com PHONE: 9498544500 EXT: MAILING ADDRESS: 500 Bayview Circle CITY: I STATE: CA ZIP CODE: 92660 -Primary- V. EMERGENCY CONTACTS -Secondary- NAME: John McCann NAME: David Townsend TITLE: DOE TITLE: AGM BUSINESS PHONE: 9498544500 EXT: BUSINESS PHONE: 9498544500 EXT: 24-HOUR PHONE: 7143762062 24-HOUR PHONE: 9498544500 CELL/PAGER#: 7143762062 CELL/PAGER#: 9493556628 VI. CERTIFICATION Certification based on my inquiry of those individuals responsible for obtaining the information. I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe that the information is true, accurate, and complete. Package Preparer: Fernando Aristizabal Certification Date: 09/29/2015 NBFD (Rev. 03/2010) will, COUNTY OF ORANGE ORANGE COUNTY HEALTH CARE AGENCY ENVIRONMENTAL HEALTH PA08 1241 EAST DYER ROAD, SUITE 120 CUPA SANTA ANA, CA 92705-5611 (714) 433.6000 INVOICE#: IN09874'44 Owner: HOST MARRIOTT L P NEWPORT BEACH MARRIOTT SUITES SITE: NEWPORT BEACH MARRIOTT SUITES 484gg-FEFtwweeB-" riFmt ( &W tkzj 500 BAYVIEW CIR -B€ 9A-MF9-Q98+7. ARk S i I z kgAL- C_N(l1"L NEWPORT BEACH, CA 92660 �12f t�.3 'S-0o 19A-Y1l t e-w C_ t RCI`C 1 N G C1 a to L, 0 (7 County of Orange Tax ID# 95-6000928 District: A/R # Facility # Invoice Date Due Date Billing Period AR1387735 FA0065882 08/01/2014 09/01/2014 07/01/14 to 06/30/15 Related Date PE PE Program # Site ID Description Amount 08/01/2014 5865 5865 PR0061696 NPB308 HAZARDOUS MATERIALS - NEINPORT BEACH �_ 128.00 08/01/2014 6210 6210 CUPA - STATE SERVICE CHARGE BASE FEE $ 35.00 Total Due: $ 163.00 PAYMENTS RECEIVED AFTER THE DUE DATE MAY BE SUBJECT TO A MAXIMUM 25% PENALTY. WE RECOMMEND THAT DISPUTES BE RESOLVED OR PAYMENT MADE PRIOR TO THE DUE DATE TO AVOID LATE FEES. FEES ARE DUE FROM ESTABLISHMENTS WHICH OPERATE AT ANY TIME DURING THE BILLING PERIOD. IF THERE HAS BEEN A CHANGE IN OWNERSHIP PRIOR TO THE BILLING PERIOD, PLEASE RETURN THIS INVOICE WITH THE NEW OWNER'S NAME, MAILING ADDRESS AND THE CHANGE OF OWNERSHIP DATE. PLEASE DO NOT SUBMIT A POSTDATED CHECK (CHECKbATED LATER THAN THE ACTUAL DATE SUBMITTED) IN PAYMENT OF THIS OBLIGATION. ALL CHECKS WILL BE PROCESSED UPON RECEIPT. FOR ANY CHECKS RETURNED UNPAID, THE MAKER WILL BE CHARGED AN ADDITIONAL FEE. Retain top portion for your records Return this bottom portion with payment **** Write invoice number on check NEWPORT BEACH MARRIOTT SUITES 500 BAYVIEW CIR NEWPORT BEACH, CA 92660 Billing NEWPORT BEACH MARRIOTT SUITES Address : 10400 FERNWOOD RD BETHESDA, MD 20817 PLEASE REMIT TO: ORANGE COUNTY HEALTH CARE AGENCY ENVIRONMENTAL HEALTH 1241 EAST DYER ROAD, SUITE 120 SANTA ANA, CA 92705-5611 Billing Period: Facility # : FA0065882 07/01/14 to 06/30/15 Invoice # : IN0987444 Due Date: 09101/12014 Total Due: $163.00 **** MAKE CHECKS PAYABLE TO: # COUNTY of ORANGE Payment Type: (� Check Credit Card (see reverse) CUPA FOR OFFICE USE ONLY DATERECEIVED 1 SATCHHSO# CHECK DATE H CNUM R BRING THIS INVOICE WHEN PAYING IN PERSON 09/16/2014 0210 0210 #BWNKJHD #AR00000074454# MARRIOTT SUITES HOTEL GENERAL MANAGER 500 BAYVIEW CIR NEWPORT BEACH, CA 92660 Description HAZ MAT INVENTORY (1-4) INSPECTION DATE: 08.01.14 CUST#: 0000007445 NBID: 138511 INVOICE: FS54004749 INV DATE: 10/02/14 DUE DATE: 11/01/14 Qty Unit Price Tax Extension 1.00 128.00 0.00 128.00 TOTAL INVOICE: $ 128.00 PAYMENTS/ADJUSTMENTS: $ 0.00 PAST DUE: $ 0.00 PENALTIES/INTEREST: $ 0.00 TOTAL AMOUNT DUE: $ 128.00 BILLING QUESTIONS SHOULD BE DIRECTED TO THE FIRE DEPARTMENT AT (949) 644-3106. THANK YOU. MARRIOTT SUITES HOTEL GENERAL MANAGER 500 BAYVIEW CIR NEWPORT BEACH, CA 92660 .. .. ..... . . . ......... . . . . .... . . . ...... .. ...... ANNUAL & SPECIAL PERMITS - INVOICE TOTAL AMOUNT DUE: $ CUST NBR: 0000007445 NBID: 138511 INVOICE: PS54004749 INV DATE: 10/02/14 DUE DATE: 11/01/14 128.00 AR 0000007445 12800 -7 N '0 m z 0 Z n O m D cnn 0 X O rD- < -W< r7 m y m wmzz>>0,: �) -0 DD -o DO � �- a0 0 0 mao g to to 0 aao*0 a o av o a0 D a uG# EL o zz o 0� 0 ;KCL *R0 fig=" co = (a (a to to 'n.• CD 0 N to G)M N CD -+ 0 y � 3CD ,n� mph 0 in a� c c w CO a Zw� + 1G b 3 Ttm 0 m m < 0 co0c, mo< CD ox �3 CD c Oa.. _ A-0om �mm D CCDD " v m ;aao _. c� •� CD .. CD �� =NO Dm� m n�. m o i/� in: ? z X ' CD Z 00 ,� D Dm W J' �D Z CA)z rn v 0< N CA CD CD ."0 CD N ,� O A O <fl Z o s2 a) m -0 <D o -N0 0 rn wm � CO M A Cl) 'A 40 bf iA OD A t0 OtDN0ppp c p O O O O O O O (D C 0 C 7 0a �x0mcD oyo0 � a p N CL -11 �� y v cri o w fD w �' o 0 7 N Z p 2 ��w 0 0 v 0 '�o�orn ao�NC y. 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CD cn CD m m ;�J CJ ^ N N r r X m P O P. �� to �A w w to 4A to _ cn 0 0 0 o c% ,�_ . c , -�.�-�. ?'ems -� � � -� LINDAMOOD-BELL Learning Processes i Lynsey Turner O11re Mumtger 4100 Campus Drive Euhoncing leaving Suite 100 Newport Beach, CA 92660 for all people, for all 949/252-9275 ages...for life.-- 800/300-1818 Fax 949/252-9276 Learning Centers lynsey.turuer@,hndamoodbell.com Worldwide www.hndanioodbell.com FIRE INSPECTION CLEARANCE* THIS ENTIRE FORM MUST BE COMPLETED BY THE INSPECTING AUTHORITY. Name of Nonpublic Nonsectarian A enc S Address: 3 9 D 0 % C. ST 3 City:�Pb%Z &a .ti County:013?0' State: Uq Zip: of to l� FACILITY CAPACITY: This facility is approved to serve (check appropriate one): ❑ a. ambulatory ❑ b. non -ambulatory %c. both This facility complies with all applicable standards related to fire and life safety (check one): Yes No ❑ This facility is in violation of standards; the following corrections are required (use back of form if more s ace is needed.) 1. 2. 3. 4. Title: Name Nothing contained herein shall be construed as encompassing the structural stability of any building or as abrogating any more restrictive requirements by other agencies having jurisdiction. For answers to any questions for (print name): tkiASm t, rE i ardinq the above clearance contact: Date of Contact the local city or county fire department or the fire district providing fire protection services to arrange for this clearance. If you cannot obtain a local fire clearance, your fire inspection can be ordered through the State Fire Marshal. Contact our office for this form. All sites MUST have individual fire clearances. it is a requirement of certification that a fire inspection clearance be issued by the appropriate city, county, fire district or state fire official not less than once each calendar year. *Other documentation provided by your local fire department (e.g., STD 850) may be utilized and attached to the CDE fire clearance form if it provides the same information, name of the nonpublic nonsectarian agency, location, total classroom occupant load and number of classrooms. California Department of Education Interagency -Nonpublic Schools/Agencies Unit Special Education Division July 2009 Revision �� cam►, �' �S 3� 7 Q n cat � �S�d�.�"1 � FIRE INSPECTION CLEARANCE* THIS ENTIRE FORM MUST BE COMPLETED BY THE INSPECTING AUTHORITY. Nothing contained herein shall be construed as encompassi►ig the structural stability of any building or as abrogating any more restrictive requirements by other agencies having jurisdiction. For answers to any questions .tor (print name): N A2� t_ �_ Title: Name of rding the above clearance contact: CZ9-A S Date of �.!J ,'-% — Contact the local city or county fire department or the fire district providing fire protection services to arrange for this clearance. If you cannot obtain a local fire clearance, your fire inspection can be ordered through the State Fire Marshal. Contact our office for this form.. All sites MUST have individual fire clearances. it is a requirement of certification that a fire inspection clearance be issued by the appropriate city, county, fire district or state fire official not less than once each calendar year. *Other documentation provided by your local fire department (e.g., STD 850) may be utilized and attached to the CDE fire clearance form if it provides the same information, name of the nonpublic nonsectarian' agency, location, total classroom occupant load and number of classrooms. California Department of Education Special Education Division Interagency -Nonpublic Schools/Agencies Unit July 2009 Revision E-Mail Address: RevenueHelp@newportbeachca.gov #BWNYJHD #AR00000153305# NUMBER: 0000015330 STEPPING STONES THERAPY INVOICE: FS54004457 ATTN: BROCK TROPEA INV DATE: 12/11/13 3900 BIRCH ST #103 DUE DATE: 01/10/14 NEWPORT BEACH, CA 92660 NBID: 362542 Description Qty Unit Price Tax Extension ---------------------------------------- -------- ------------- ---- ------------- CLINICS AND OFFICES 1.00 83.00 0.00 83.00 INSP DATE: 09-25-13 LOCATION: 3900 BIRCH STE 103 FIRE CLEARANCE INSPECTION -------------------------------------------------------------------------------- TOTAL INVOICE: $ 83.00 PAYMENTS/ADJUSTMENTS: $ 0.00 PAST DUE: $ 0.00 PENALTIES/INTEREST: $ 0.00 TOTAL AMOUNT DUE. $ 83.00 BILLING QUESTIONS SHOULD BE DIRECTED TO THE FIRE DEPARTMENT AT (949) 644-3106. THANK YOU. Please ret�ii�ii� the * .... -.'*lower-**5'portion 66tach'an ;of 'this:;:irivoae'::iaitli; ANNUAL & SPECIAL PERMITS - INVOICE STEPPING STONES THERAPY INVOICE: PS54004457 ATTN: BROCK TROPEA INV DATE: 12/11/13 3900 BIRCH ST #103 DUE DATE: 01/10/14 NEWPORT BEACH, CA 92660 NBID: 362542 TOTAL AMOUNT DUE: $ 83.00 AR 0000015330 8300 ............... E ............. ..... . .. .... ...... aymen Z . .. . . . ......... . . .... . .. .... .. ...... !i 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.gew ortbeachca.gov ZONING CLEARANCE LETTER January 20, 2016 RE: NSIGHT Psychology and Addiction Counseling Office 4000 Birch Street, Suite 112, Newport Beach, CA 92660 427-141-04 Dear Mr. Grosso: The above referenced property is located within the Newport Place Planned Community Zoning District (PC-11) with a PC Land Use of Professional and Business Office Site 9 and is designated as General Commercial Office (CO-G) within the Land Use Element of the General Plan. PC-11 Professional and Business Office Site 9 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 10 clients at any time), one-on-one counseling and the related office use has been determined to be in the CO-G Land Use Category and is a permitted use in the PC-11 Professional and Business Office Site 9 Zoning District. However, the following changes in the operation as provided in the attachment would constitute a change in use, 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 including an intensification of parking. Should you have any further questions, please contact me at 949-644-3221 or mwhelan(a)-newportbeachca.aov Sincerely, Kimberly Brandt, AICP, Community Development Director By: Melinda Whelan Assistant Planner Enclosures: Description of NSIGHT at 4000 Birch St. Ste. 112 including floor plan t� NsIGHT TM PSYCHOLOGY & ADDICTION January 11, 2016 VIA EMAIL ONLY TO: MGondrezQnewportbeachca.sov Melinda Whelan City of Newport Beach 100 Civic Center Drive Newport Beach, CA 92660 Re: Zoning Approval We recently relocated our outpatient psychotherapy offices to 4000 Birch Street, Suite 112, Newport Beach, CA 92660. CARF, the organization who accredits the psychotherapy services we provide, requires an updated fire clearance and zoning approval. NSIGHT provides adult outpatient mental health counseling (psychotherapy, biofeedback, vocational counseling, and psychological evaluations). The majority of services we provide are rendered in an individual setting, with appointments being scheduled directly between the patient and his/her therapist. NSIGHT also offers two small groups per day on issues relating to depression, anxiety, and trauma. These groups vary in size from 6 to 10 clients and are run by Licensed Master's and Doctoral clinicians. I have attached a copy of our building's floor plan for your review and records. If you would like to conduct a physical walkthrough of the building, I would be happy to arrange such. Otherwise, please let me know whether there is anything further you require. Thank you in advance for your prompt attention to this matter. Sincerely, DR. RALD J. GROS Clinical Director 3151 Airway Avenue Suite U-1 • Costa Mesa, CA 92626 Tel: 888-256-2201 or 949-216-3851 Fax: 949-203-0402 • www.NsightRecovery.com JI u mll.��: dVn�Kti"I„�,,td,q��Nl�!In��lu�l� ti��,.7�1a1�, ,ulti�,�.�4�d Fti,dlu L,:�a��pk�I�,I�,��N�i�e;��ig6a�N��ih�I�..,nlWu�t �l��lrl,,�l�ll,til.,, l ll�hl�d l.- Iu�:.t�,LI:IL� , iq�.11llll dt:11.111�.i"Llil�l , l,l l: , l � I:L It I � I IIId i�LIVd ll: 111 II:�I I�.ILII I I H W N w m a Newport Beach Fire Department Life Safety Services 100 Civic Center Drive Newport Beach, CA 92660 (949) 644-3106 FIRE CLEARANCE Newport Beach Fire Department — Life Safety Services Division (Fire Authority Name) 100 Civic Center Drive, Newport Beach, CA 92660 (Address) ,(949) 644-3106 (Telephone Number) NSIGHT Psychology and Addiction Counseling Office (Name of program) was inspected this date for compliance with local requirements and is hereby granted a fire clearance to operate an adult outpatient mental health counseling program at: 4000 Birch Street, Suite 112, Newport Beach, CA 92660 (Address of program -please include suite numbers if applicable) Nadine Morris (949) 644-3105 (Inspector's name - typed or printed) (Telephone number) kA &AJU./�s Life Safety Specialist (Signature and Rank of Inspector Granting Clearance) January 21 2016 (Inspection Date) Alcaraz, Debbie From: Morris, Nadine Sent: Thursday, January 21, 2016 3:30 PM To: Alcaraz, Debbie Subject: 4000 Birch St #112A Attachments: Zoning Compliance Letter for Outpatient Office.pdf, Nsight Rear Door.JPG; chld-01 @newportbeachca.gov_20160121_153333_0000elb8001b.pdf Debbie, Please invoice the facility for a fire clearance inspection, $76.00. Only the invoice needs to be mailed, but please scan all 3 documents. Thank you, Nadine EM SYSTEM RECORD OF -INSPECTION AND TESTING This form is to be completed by the system inspection and testing contractor at the time of a system test. to modify this form as needed to provide a more complete and/or clear record. It shall be permitted Insert N/A in all unused lines. Attabh additional sheets, data, or calculations as necessary to provide a complete record, a Inspection/Test Start DatelTime: 1 - Inspection/Test Completion Date/Time: Supplemental Form(s) Attached: i (yes/no) 1. PROPERTY INFORMATION �`� � � 0 Sa r (bN �SIlA&1 �C Nameofproperty: Address: Ack D Description ofproperty: Name of property representative: °' Address: Phone: Fax: E-mail: 2. TESTING AND MONITORING INFORMATION Testing organization: Tow pr 4� [`7t� Address: d Phone: QU A 4(a � l J_' Fax: E-mail:. Monitoring organization: TC)a —k k U, 5T%EVA S OC7� Address: Phone: (p2(p A "1f��,7 -7f5"l Fax: E-mail: Account number. A N 3 tit Phone line 1: Phone Iine 2: . Means of transmission: Entity to which alarms are retransmitted: �— Phone: 3. DOCUMENTATION On -site location of the required "record documents and site -specific software: 4. DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Model number. Manufacturer: 4.2 Software and Firmware Firmware revision number: 4.3 System Power 4.3.1 Primary (Main) Power IZ-V�,,�Q Nominal voltage: VZJ pe Amps: Location: via Overcurrent protection type: ! �Cl� Amps: Disconnecting means location: 1F(GU Copyright 0 2012 National Fire Protection Association. This form may be copied for lndlAdual use other than for resale. It may not be copied for commercial safe or distribution. 5 SYSTEM RECORD OF INSPECTION AND TESTING (continued) 4: DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type; ACa �� Location: Battery type (if applicable): Calculated capacity of batteries -to drive the system: In standby mode (hours): 2 A- In alarm mode (minutes): S 5. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: Time: Building management Contact: Time: Building occupants Contact: Time: Authority having jurisdiction Contact: !U-�� p�T Time: Other, if required Contact: Time: ` 6. TESTING RESULTS 6.1 Control Unit and Related Equipment Visual Functional Descriotion Inspection Test Comments Control unit I LyJ/ I ��/ I �A_ SS _ Lamns/LEDs/LCDs M [7 Fuses ❑❑/ Trouble signals Disconnect switches Ground -fault monitoring ❑ V ❑ Local annunciator IJ U Remote annunciators ASS Remote power panels ❑ ❑ 6.2 Secondary Power Description Visual inspection Functional Test Comments Battery condition Lit' Load voltage L`f Discharge test ❑ ❑ Charger test ❑ ❑ Remote panel batteries ❑ ❑ 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. • il� r' i�'i e�eam SYSTEM RECORD OF INSPECTION AND TESTING (continued) 7. NOTIFICATIONS THAT TESTING IS COMPLETE. - Monitoring organization Contact: �� V�" ""R g Time:. —T S / Building management Contact: Time: Building occupants Contact: Time: Authority having jurisdiction Contact: Time: Other, if required Contact: Time: B. SYSTEM RESTORED TO NORMAL OPERATION Date: I /i — 1 - S� Time:y� Ik u- s. CERTIFICATION This system as specified herein has hhassbeen inspected and tested according to NFPA 72,, 2013 edition, Chapter 14. Signed: C�`s C'�►"N" Psi1 Printed name: G� t e& Af Date; q Organization: R- Title: 7 1 IS— Phone: (Ova 4R� —71, nl Qualifications (refer to 10.5.3): 10. DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING, OR MAINTENANCE 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: Date: Title: Phone: Copyright ®2012 National Fire Protection Association. This form maybe copied for individual use other than for resale. It may not be copied fpr commercial sale or distribution. (r.�Cil�'7 I WOTIHCe TiM APPLIANCE SUPPLEMENTARY RECORD OF INSPECTION AND TESTING This form is a supplement to the System Record of Inspection and Testing. It includes a notification appliance 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. G� Inspection/Test Start Date/Time: 1' 2 `q 'I S� Inspection/Test Completion Date/Time: 2 F I` Number of Supplemental Pages Attached: 1. PROPERTY INFORMATION Name of property: Address: 2. NOTIFICATION APPLIANCE TEST RESULTS Copydght ©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. ti- 1 of 2,) Alcaraz, Debbie From: Morris, Nadine Sent: Thursday, January 22, 2015 3:41 PM To: Alcaraz, Debbie Subject: 20271 Birch St #202 - Fire Clearance Attachments: Birch Floorplan.pdf, 20271 Birch Street Zoning Approval.pdf, chld-01 @newportbeachca.gov_20150122_154327_0000eb78001b.pdf Please invoice the facility - $75.00 state fire clearance fee. Scan all the documents. Thanks, Nadine 5�du - /'?� 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 15, 2015 Akua Mind and Body Attn: Evan Miller, Ph.D. 30 Corporate Park, Suite 104 Irvine, CA 92606 evanmillerphd(c)-pmail.com RE: 20271 Birch Street, Suite 202 APN 930-685-08 Dear Mr. Miller: The above referenced property is located within the Business Park area of the Santa Ana Heights Specific Plan (SP-7) and designated General Commercial Office (CO-G) within the Land Use Element of the General Plan. The Business Park area of SP-7 allows professional and administrative office uses (which include psychological and psychiatric services) subject to the approval of a minor use permit. Research of the permit and entitlement history of the property verifies the following approvals were acquired from the City of Newport Beach. Planning Division to allow general office uses. Minor Use Permit No. UP2012-019 (PA2012-112) approved October 24, 2012, by the Zoning Administrator to amend the previously approved use permit by increasing the square footage allowed for medical office use from 5,000 square feet to 14,150 square feet within the existing five - building, office condominium development with the remainder dedicated to general office use. Planning Director's Use Permit No. UP2005-024 (PA2005-111) approved June 24, 2005, by the Planning Director to allow a portion of the approved office building to accommodate up to 5,000 square feet of medical office with the remainder dedicated to general office use. Per the description provided, the outpatient program including individual and group counseling (4-6 individuals at any one time) consisting of two sessions per day (9 a.m. — 12 p.m. and 6 p.m. — 8 p.m.) and related office use is consistent with the CO-G land use designation and determined to be an allowed use (general office) in the SP-7 zoning district, pursuant to the approved minor use permit. However, the following changes in operation, including but not limited to those referenced in the attached description may constitute a change in use and may require a separate review and approval: an increase in the number of groups, an increase in the size of the groups, offering services including acupuncture, yoga, massage, or conducting medical services/procedures of any kind on -site. Should you have any questions, please contact me at 949-644-3234 or 5van patten(a)-newportbeachca.gov. Sincerely, Kimberly Brandt, AICP, Community Development Director By: Jas Van Patten Planning Technician Attachments: 1. Description of Akua Mind and Body 2. Proposed Floor Plan 3. UP2012-019 4. UP2005-024 (amended, provided for reference only) Page 2 Tmplt: 04-04-13 ,� �' !. , ' �\ . • -h t' '� i ,rtin..^ . .,,!r'„ � � .�,y „ . x,'" , 1j I J Fr,i - � ' ,1�?S � _ _ �,� f' ✓ ' 1 t L� , �; ! '` Y:'t,'J �'�ud 4:p' (,{A'Y.^i . ,° ' !1 ` N ✓r2w% ;. x s., N �` ,�'�j ,r"�'�:p`, �� '^ �•-� , Y , _ �Di�3. „ ��". :=.i'*.,l' ,.� t r �'�;vW`a• ,`�3. Newport Disclaimer: Every reasonable effort has been made to assure the Beach accuracy of the data provided, however, The City of GIS Newport Beach and its employees and agents disclaim any and all responsibility from or relating to `taEWPoRT any results obtained in its use. 100 200 1 }, _� Imagery: 2009-2013 photos provided by Eagle v � Feet Imaging www.eagleaerial.com C'11.1 po ig% January 14, 2015 To: City of Newport Beach Re: Akua Mind& Body Address: 20271 SW BIRCH STE 202 NEWPORT BEACH, CA 92660 %SCEiv$0 commulory VAN Jj?� b ��63blrT The outpatient counseling will consist of two (2) sessions per day, Monday —Thursday. The -sessions will be at the following times: 9am-12pm & 6pm-8pm. The total amount of clients per session will be 4-6 individuals who choose counseling services on a voluntary basis. Staff will consist -of 3 liceiised' counselors who perform individual and group counseling. The goal of the coupseling:services is to help individuals with substance abuse issues recognize areas in their life to improve tapon.and create enhanced relationships. This location will serve as the administrative offices'for Akua Mind °&,,Body. Each client must arrive 10 minutes before group/individual sessions and Will Meet with their assigned counselor weekly to help provide accountability for their recovery plan. Each client wilt compleie-a total of 12 sessions. Akua Mind & Body utilizes only evidence -based treatment, including -the t2-steps, stages of change, and cognitive -behavioral counseling. The program will NOT include any of the following: acupuncture, yoga, massage, medical services; overnight stay, nor any medical/nursing personnel. The program will not provide transportation. If you have any further questions, please do not hesitate to contact me. Sincerely�,� Evan Miller, PhD CEO (949)542-9717 RESOLUTION NO. ZA2012-038 A RESOLUTION OF THE ZONING ADMINISTRATOR OF THE CITY OF NEWPORT BEACH APPROVING MINOR USE PERMIT NO. UP2012-019 TO REPLACE UP2005-024 (PA2005-111) TO INCREASE THE SQUARE FOOTAGE ALLOWED FOR MEDICAL OFFICE USE FROM 5,000 SQUARE FEET TO 14,150 SQUARE FEET WITHIN THE EXISTING FIVE -BUILDING, OFFICE - CONDOMINIUM DEVELOPMENT LOCATED AT 20321, 20311, 20301, 20281, AND 20271 SW BIRCH STREET. PARKING PROVIDED WILL BE CONSISTENT WITH ZONING CODE REQUIREMENTS. (PA2012-112) THE ZONING ADMINISTRATOR OF THE CITY OF NEWPORT BEACH HEREBY FINDS AS FOLLOWS: SECTION 1. STATEMENT OF FACTS. 1. An application was filed by Aliece Pickett, with respect to property located at 20311 SW Birch Street, and legally described as Parcel 1 of Parcel Map 89-341, as recorded in Book 268, Page 37 requesting approval of a Minor Use Permit. 2. The property is an office complex consisting of five, two-story buildings constructed -in a "U-shape" around an open area facing Birch Street. The floors of the buildings (10) are individually owned office -condominiums. Each floor consists of approximately 4,575-net-square-feet of floor area (total 45,750 net square feet). Pursuant to Use Permit No. UP2005-024 (PA2005-111), approved in 2005, the second floor of the property located at 20311 SW Birch Street (5,000 gross square feet) is currently. used for medical office use. The remaining office -condominiums are currently general office uses. Parking is provided within shared parking areas below each building and within the open area of the "U-shape" facing Birch Street. There are currently 189 parking spaces existing on the site. 3. The applicant proposes a Minor Use Permit to amend UP2005-024 (PA2005-111) to increase the square footage allowed for medical office use from 5,000 square feet to 14,150 square feet within the existing five building, office -condominium complex. Parking provided will be consistent with Zoning Code requirements. 4. Pursuant to Section 20.40.05, Table 3-10: Off -Street Parking Requirements of the Zoning Code, the additional 9,150-net-square-feet of floor area requested is equal to 20 percent of the net square footage of floor area of the five building, office - condominium complex that may be used for medical office use. 5. Of this total, 4,575-net-square-feet of floor area would be allocated to the first floor office -condominium located at 20311 SW Birch Street. The remaining 4,575-net- square-feet of floor area would be allowed within any of the office -condominiums located in the office complex. All parking will be provided on -site consistent with the requirements of Zoning Code. 6. The subject property is located withi Park (SP-7, BP) Zoning District and General Commercial Office (CO-G). Zoning Administrator Resolution No. ZA2012-038 Page2of7 n the Santa Ana Heights Specific Plan, Business the General Plan Land Use Element category is 7. The subject property is not located within the coastal zone. 8. A public hearing was held on October 24, 2012 in the City Hall Council Chambers, 3300 Newport Boulevard, Newport Beach, California. A notice of time, place and purpose of the meeting was given in accordance with the Newport Beach Municipal Code. Evidence, both written and oral, was presented to, and considered by, the Planning Commission at this meeting. SECTION 2. CALIFORNIA ENVIRONMENTAL QUALITY ACT DETERMINATION 1. The subject project qualifies for Class 1 (Existing Facilities) categorical exemption, Section 15301 of the California Environmental Quality Act. 2. The project would allow a minor change in use from general office use to medical office use within an existing, office -condominium development. The change could involve issuance of building permits for interior tenant improvements requiring minimal construction. SECTION 3. REQUIRED FINDINGS. In accordance with Section 20.52.020F of the Newport Beach Municipal Code, the following findings and facts in support of such findings are set forth: Finding: A. The use is consistent with the General Plan and any applicable specific plan. Facts in Support of Finding: 1. The office -condominium complex has a General Plan land use designation of General Office Commercial (CO-G) which is intended to provide for administrative, professional, and medical offices with limited accessory retail and service use. The change of use from general office to medical office use is consistent with this designation. 2. The site is located in the Santa Ana Heights Specific Plan District within the Business Park area (SP-7, BP). Medical office uses are allowed within this area with approval of a minor use permit. Finding: B. The use is allowed within the applicable zoning district and complies with all other applicable provisions of this Zoning Code and the Municipal Code. Tmplt: 05/16/2012 Zoning Administrator Resolution No. ZA2012-038 Page 3 of 7 Facts in Support of Finding: Medical office uses are allowed within the Business Park area of the Santa Ana Heights Special Plan District (SP-7, BP) with approval of a minor use permit. 2. In 2005, Use Permit UP2005-024 was approved to allow 5,000-gross-square-feet of medical office uses within the 45,750-net-square-foot, office -condominium complex. The proposed minor use permit would allow an additional 20 percent (9,150 net square feet) to be used for medical office purposes. 3. Parking for the five building, office -condominium development is provided within shared parking areas on the site. The existing lots provide 189 parking -spaces, which is adequate to accommodate the additional medical office use square footage requested. USE FLOOR AREA PARKING SPACES 71 Per Zoning Code: 1st 50,000 net sf: 20% medical office (applicant's request) 9,150 net sf +general office + 31,600 net sf 40,750 net sf 163. 1/250 net sf Medical office over 20% + 5,000 gross sf + 25 (1/200 gross sf) UP2005-024 1 TOTAL 188 required 189 existing) Finding: C. The design, location, size, and operating characteristics of the use are compatible with the allowed uses in the vicinity. Facts in Support of Finding: 1. The subject site is located in the Business Park (BP) area of the Santa Ana Heights Specific Plan District (SP-7) between Birch and Acacia Streets. Medical office uses are allowed in this area with approval of a minor use permit. Development on the subject site and surrounding properties consist of office buildings developed for various office uses. 2. The additional square footage of medical office use is similar in operation to those permitted with approval of UP2005-024 and currently existing on the site. The design of the buildings and site provides adequate_ access and parking spaces to accommodate the increase to the medical office use square footage. Tmplt: 05/16/2012 Zoning Administrator Resolution No. ZA2012-038 Paae 4 of 7 Finding: D. The site is physically suitable in terms of design, location, shape, size, operating characteristics, and the provision of public and emergency vehicle (e.g., fire and medical) access and public services and utilities. Facts in Support of Finding: The subject site is located between Birch and Acacia Streets in the Business Park area of the Santa Ana Heights Specific Plan District. The surrounding area consists of properties developed for various office uses. 2. The site consists of five, two-story buildings developed as office -condominiums. The buildings are constructed on the site in a "U-shape" with the opening in the "U" facing Birch Street. Parking spaces are located below each building and also within the opening of the "U". Adequate parking and access to accommodate the additional square footage for medical office uses is provided. 3. Tenant improvements to the existing general office space will require a building permit. All Fire and Building Code regulations will be verified during the plan check process. 4. There is adequate access to development on the site for fire and medical emergency vehicles. Finding: E. The Operation of the use at the location proposed would not be detrimental to the harmonious and orderly growth of the City, nor endanger, jeopardize, or otherwise constitute a hazard to the public convenience, health, interest, safety, or general welfare of persons residing or working in the neighborhood of the proposed use. 1. The increase in the square footage of medical office uses proposed fits well with the existing medical and general office uses on the site and in the surrounding vicinity. 2. There is adequate parking existing on the site to accommodate the increased medical office use square footage. Adequate access to the site for emergency vehicles is provided from Birch Street. Access to the second floor of the five buildings is provided via ramps and an elevator. 3. Any tenant improvements to accommodate the increased medical use will be minor in nature and will not impact the overall operation of the existing general office and medical office uses on the site. Tmplt: 05/16/2012 Zoning Administrator Resolution No. ZA2012-038 Paae 5 of 7 SECTION 4. DECISION. NOW, THEREFORE, BE IT RESOLVED: 1. The Zoning Administrator of the City of Newport Beach hereby approves Minor Use Permit No. UP2012-019, subject to the conditions set forth in Exhibit A, which is attached hereto and incorporated by reference. 2. This action shall become final and effective fourteen days after the adoption of this Resolution unless within such time an appeal is filed with the Director of Community Development in accordance with the provisions of Title 20 Planning and Zoning, of the Newport Beach Municipal Code. 3. This resolution supersedes Use Permit UP2005-024, which upon vesting of the,rights authorized by Minor Use Permit No. UP2012-019 (PA2012-112) shall become null and void. PASSED, APPROVED AND ADOPTED THIS 24TH DAY OF OCTOBER, 2012. Breitdh Wisneski, AICP, Zoning Administrator Tmplt: 05/16/2012 Zoning Administrator Resolution No. ZA2012-038 Page 6of7 EXHIBIT "A" CONDITIONS OF APPROVAL PLANNING 1. This approval supersedes Use Permit No. UP2005-024 (PA2005-111). The maximum square footage devoted to medical use shall not exceed 14,150 square feet of medical office use within the 5-building, office -condominium development unless an amendment to this Use Permit is approved. 2. The second floor office -condominium located at 20311 SW Birch Street (5,000 gross square feet) shall be allowed for medical office uses, as previously approved. The additional 9,150-net-square-feet of floor area approved for medical office use shall be allocated as- follows: 4,575-net-square-feet of floor area to the first floor office - condominium located at 20311 SW Birch Street. The remaining 4,575-net-square-feet of floor area shall be allowed within any of the office -condominiums located in the five - building office complex. 3. Prior to issuance of building permits or approval of a business license for medical office use within this office -condominium complex, a revised plan, which indicates the locations of medical office floor area approved with this use permit shall be provided to the Planning Division to include in the use permit file. 4. The total number of parking spaces provided for all uses on site will be consistent with requirements of the Zoning Code. 5. The project is subject to all applicable City ordinances, policies, and standards, unless specifically waived or modified by the conditions of approval. 6. The applicant shall comply with all federal, state, and local laws. Material violation of any of those laws in connection with the use may be cause for revocation of this Use Permit. 7. The Zoning Administrator may add to or modify the Conditions of this Use Permit approval; or they may revoke this permit should they determine that the proposed uses or conditions under which it is being operated or maintained is detrimental to the public health, welfare or materially injurious to property or improvements in the vicinity or if the property is operated or maintained so as to constitute a public nuisance. 8. Any expansion in area approved for medical office use shall require an amendment to this Use Permit or the processing of a new use permit. 9. Fair share fees to convert square footage from general office to medical office use shall be calculated at plan check and paid prior to building permit issuance. Tmplt: 05/16/2012 Zoning Administrator Resolution No. ZA2012-038 Page 7of7 10. Should the property be sold or otherwise come under different ownership, any future owners or assignees shall be notified of the conditions of this approval by either the current business owner, property owner or the leasing agent. 11. To the fullest extent permitted by law, applicant shall indemnify, defend and hold harmless City, its City Council, its boards and commissions, officials, officers, employees, and agents from and against any and all claims, demands, obligations, damages, actions, causes of action, suits, losses, judgments, fines, penalties, liabilities, costs and expenses (including without limitation, attorney's fees, disbursements and court costs) of every kind and nature whatsoever which may arise from or in any manner relate (directly or indirectly) to City's approval of the Birch Heights Professional Condominiums Minor Use Permit including, but not limited to UP2012-019 (PA2012-112). This indemnification shall include, but not be limited to, damages awarded against the City, if any, costs of suit, attorneys' fees, and other expenses incurred in connection with such claim, action, causes of action, suit or proceeding whether incurred by applicant, City, and/or the parties initiating or bringing such proceeding. The applicant shall indemnify the City for all of City's costs, attorneys' fees, and damages which City incurs in enforcing the indemnification provisions set forth in this condition. The applicant shall pay to the City upon demand any amount owed to the City pursuant to the indemnification requirements prescribed in this condition. Building Division Conditions 12. The applicant is required to obtain all applicable permits from the City's Building Division and Fire Department. The construction plans must comply with the most recent, City - adopted version of the California Building Code. The construction plans must meet all applicable State Disabilities Access requirements. Tmplt: 05/16/2012 PLANNING DIRECTOR'S USE PERMIT NO. UP2005=024 (PA2005-111) CITY OF NEWPORT 13EACH PLANNING DEPARTMENT 3300 NEWPORT BOULEVARD NEWPORT BEACH, CA 92663 (949) 644-3200 FAX (949) 6443229 June 24, 2005 Semira Bayati, M.D. 1501 Superior Avenue, Suite 111 Newport Beach, CA 92663 Staff Person: Javier S. Garcia, 644-3206 Appeal Period: 14 days after decision Application: Use Permit No. UP2005-024 (PA2005-111) Applicant: Semira Bayati, M.D. Address of Property Involved: 20311 Birch Street Legal Description: Parcel 1 of PM- 268137-39 Request as Approved: To allow the utilization, of a portion of the approved office building, to accommodate up to 5,000 square feet of medical office use. The remaining 41,175 square feet (this is the remaining office area located on -site) shall remain dedicated to general office only. The existing Use Permit, approved by the County of Orange, authorized general office use only, and it made no provision for medical office or other non -general office use. This approval will allow the establishment of the above -referenced use by review and approval from the Planning Director up to the maximum square footage specified. This approval will not authorize any other use (general office and limited medical office use) within the building or buildings without prior approval- of an amendment to this use permit. No parking waiver is proposed, since the Code -required parking can and will be provided on -site by re -striping the existing parking lot prior to implementation of the medical office use. The property is -located in the SP-7 (Santa Ana Heights Specific Plan Area) District. Director's Action: Approved June 24, 2005 In approving this application, the Planning Director analyzed the proposal with regard to compliance with the Land Use Element of the General Plan, Zoning Code Compliance (specifically, Chapter 20.44, Santa Ana -Height Specific Plan Area, BP District regulations), proposed uses (excluded and area restricted) and the parking requirements. The discussion can be found in the attached appendix. In this case, the Planning Director determined that the proposal, with the limitation on the mix of uses and requirement to conform to the Zoning Code -specified parking regulations (Chapter 20.66), would not be detrimental to persons, property or improvements in the neighborhood. In addition, the approval of the Use Permit would be consistent with the legislative intent of Title 20 of the Newport Beach Municipal Code based on the following findings: FINDINGS: 1. The property is designated for "Administrative, Professional and Financial Commercial" use by the Land Use Element of the General Plan and the Santa Ana Heights Specific Plan Area Business Park District regulations. The proposed mix of uses is consistent with those designations. 2. This project has been reviewed, and it has been determined categorically exempt from the requirements of the California Environmental Quality Act under Class 1 (Existing Facilities) and Class 5 (Minor Alterations in Land Use Limitations). 3. The approval of Planning Director's Use Permit No. UP2004-037 (PA2004-218) will not, under the circumstances of this case, be detrimental to the health, safety, peace, morals, comfort, and general welfare of the city for the following reasons: • Adequate on -site parking is provided and available. for the existing and proposed mix of uses. • The proposed mix of general office and medicalldental office uses will not create an intensification of trip -generation rates that require a Traffic Phasing Ordinance Analysis. However, in the future, if the mix of uses increases the trip -generation characteristics or exceeds the threshold limit of the Traffic Phasing Ordinance, appropriate analysis will be required prior to authorization of such change or increase in the mix of uses and will require an amendment to this use permit. 4. The approval of Planning Director's Use Permit No. UP2004-037 (PA2004-218) is consistent with the purpose and intent of the Santa Ana Heights Specific Plan Area District based on the following reasons: The proposed project is a well -planned business park. and commercial development which is adequately buffered from the adjacent residential neighborhood. The business park and residential traffic are separated to the maximum extent possible, since the subject property is located on a block that is bounded on the north, south, east and west by Business Park designated properties and does not abut any Residential Equestrian (REQ) designated property. The proposal to establish a mix of proposed uses does not alter or diminish the overall aesthetic character of the community. June 24, 2005 1AUSERSIPLN1Shared\PA's1PAs - 2005NPA2005-1 MUP2005-024 appr.doc Page 2 5. Compliance with all other applicable regulations of the Municipal Code, more specifically Chapter 20.66 Parking Requirements, will be required and enforced. CONDITIONS: 1. The development and mixture of permitted uses shall be in substantial conformance with the approved footage limitation plan. 2. The maximum square footage devoted to medical/dental use shall not exceed 5,000 square feet. The minimum area devoted to general office use shall not be .less than the reminder of the floor area of the subject building and the other buildings on -site unless an amendment to this use permit is first- approved. 3. The use permit authorizes general office uses and medical/dental uses, except any other uses which the Planning Director finds consistent with the purpose and intent of this use permit as a medical/dental or general office use. 4. Any changes to the existing parking lot configuration shall be subject to further review by the City Traffic Engineer for the on -site parking, vehicular circulation and pedestrian circulation systems. 5. All applicable parking requirements of Chapter 20.66 of the Newport Beach Municipal Code shall apply and be enforced (including parking at a rate of one space for each 200 gross square feet of floor area devoted to medical office use). 6. Employees shall park on -site at all times. 7. No temporary "sandwich" signs, balloons or similar temporary signs shall be permitted, either on -site or off -site, to advertise the proposed food establishment, unless specifically permitted in accordance with the Sign Ordinance of -the Municipal Code. Temporary signs shall be prohibited in the public right-of-way, unless otherwise approved by the Public Works Department in conjunction with the issuance of an encroachment permit or encroachment agreement. Standard City Requirements: 1. All signs shall conform to the provisions of Chapter 20.44, Santa Ana Heights Specific Plan and applicable sections of Chapter 20.67 of the Newport Beach Municipal Code, unless otherwise approved by the Planning Commission or the City Council in accordance with the provisions of the Municipal Code. 2. As specified by the Uniform Building Code, the facility shall be designed to meet exiting and fire protection requirements and be subject to review and approval by the Building Department. 3. The project shall comply with State Disabled Access requirements. June 24, 2005 !:\USERS\PLN\Shared\PA's\PAs - 2005\PA2005-111\UP2005-024 appr.doc Page 3 4. The Planning Director or the Planning Commission may add to or modify the Conditions of this Use Permit approval, or they revoke this permit upon a determination that the operation (which is the subject of this approval) causes injury, or is detrimental to the health, safety, peace, morals, comfort, or general welfare of the community. 5. This approval shall expire unless exercised within 24 months from the end of the appeal period, in accordance with Section 20.91.050 of the Newport Beach Municipal Code. Appeal Period The decision of the Planning Director may be appealed by the applicant or any interested party to the Planning Commission within 14 days of the date of the decision. Any appeal filed shall be accompanied by a filing fee of $975.00. PATRICIA L. TEMPLE, Planning Director By _gj�� -- Senior tanner Javier S. Garcia, AICP Attachments: 1. Appendix 2. Vicinity Map 3. Site Plan and Floor Plan 4. Letter from Santa Ana Heights " *oject Advisory Committee property owner Semira Bayati, M.D. 1501 Superior Avenue, Suite 111 Newport Beach, CA 92663 Copy: Code Enforcement Officer June 24, 2005 I:\USERS\PLN\Shared\PA's\PAs - 2005\PA2005-111\UP2005-024 appr.doc Page 4 u 0 APPENDIX General Plan Compliance The general plan designates the property for Administrative, Professional and Financial Commercial. Per the Land Use Element (LUE), medical offices and general commercial office uses are allowed within the APi= designation. Discussion The subject -property project is comprised of a single parcel developed with five buildings and located within the BP (Business Park) District on Birch Street, a parcel away from the General Commercial (GC) District of the Santa Ana Heights Specific Plan Area (SAH) and does not abut any Residential Equestrian (REQ) District. The Use Permit for the existing building, approved by the County of Orange, authorized general office use only. Medical, dental and a limited range of retail uses are permitted within the BP zone subject to the approval of a Use Permit by the Planning Director. This approval would allow the establishment of the above -referenced medical/dental office uses by separate review and approval by the Planning Director through Planning Department personnel, up to the maximum square footage authorized by this approval, without the necessity to file a new use permit application. Future uses would be reviewed by the Planning Department for compliance with all applicable codes and ordinances including the General Plan, the BP District of SAH Specific Plan Area and parking requirements established by the Zoning Code. Zoning Compliance The BP District is established to provide for the development and maintenance of professional and administrative offices, commercial uses, specific uses related to product development and limited light industrial uses. Attention is generally given to the protection of the nearby residential uses through regulation of building mass and height, landscape buffers, and architectural design features. The following excerpt from the Zoning Code Section 20.44.050 lists the permitted uses allowed in the Business Park District of the Santa Ana Heights Specific Plan Area. As listed, each use requires the approval of a Use Permit issued by the Planning Director. The applicant's request will allow a limited mix of office and medical/dental office uses with the establishment of maximum square footage for medical/dental uses within the project (Item I below, subject to review and approval by the Planning Director to determine compliance with the intent of this use permit). The request will also eliminate the necessity for future use permit applications for each individual medical/dental office use that remains within the proposed footage limitations and within the subject building. 20.44.050 Business Park District: SP-7 (BP) June 24, 2005 1:1USERStPLNIShared\PA's1PAs - 20051PA2005-1111UP2005-024 appr.doc Page 5 0 B. Principal Uses Permitted. The following principal uses are permitted subject to the approval of a use permit by the Planning Director per Chapter 20.91: a. Professional and administrative offices. b. Financial institutions. C. Civic and government uses. d. Office -serving commercial uses, including restaurants, located within a building primarily devoted to office uses. e. Communication transmitting, reception or relay facilities. f. Public/private utility buildings and structures. g. Blueprinting, reproduction and copying services. h. Message, mail and delivery services. 1. Medical and dental offices. j. Retail businesses. k. Service businesses. 2. The following principal uses are permitted subject to the approval of a use permit by the Planning Commission per. per Chapter 20.91: a. Restaurants subject to the following: (1) Not permitted adjacent to REQ lots. (2) No live entertainment. (3) No dancing. b. Automobile rental agencies not permitted adjacent to REQ lots. G. Commercial recreation. d. Assembly of components or finished products. e. Research, testing and development laboratories. f. Any other uses which the Planning Commission finds consistent with the purpose and intent of this district. Fire Department Concerns The Fire Department and the Building Department have both commented on the exiting and handicap accessibility requirements for medical uses and that the existing stairs and elevator may have to be upgraded to comply. The applicant has been made aware of those concerns and will be responsible for addressing issues related to exiting and handicap access requirements. Proposed and Excluded Uses The applicant has submitted the request to allow a portion of the existing general office building to be utilized for medical/dental office use. The applicant has not proposed to provide entitlement for any other uses, other than medical/dental office, with this use permit application. June 24, 2005 l:\USERS\PLN\Shared\PA's\PAs - 2005\PA2005-111XUP2005-024 appr.doc Page 6 9 0 Therefore, it is recommended and this approval is conditioned so that the medical/dental office uses are authorized by this approval. All other uses are excluded and will require additional review and approval of a Use Permit approved, by the Planning Director or the Planning Commission, as applicable. Proposed Use Limitations In order to be consistent with the General Plan and the Santa Ana Heights Specific Plan Area regulations, staff has reviewed the implications of an established mix of general office and medical/dental office as described in the table below. The medical office use and the general office uses are expressed as maximum and minimum limitations in order to comply with the provisions of the Traffic Phasing Ordinance. The proposed use limitations will allow medical use up to and not to exceed 5,000 square feet. The Planning Department will monitor the individual tenant improvement plans issued by the Building Department to maintain the mix of uses within the permitted maximums or allowances. Proposed Mixture of Uses Maximum Medical Office Allowed 5,000.00 square "feet General Office Minimum (minimum area required) 43,352.00 square feet General Office (Credited Conversion as a negative number)-5,000.00 square feet Santa Ana Heights.Proiect Advisory Committee (SAHPAC) The SAHPAC has had an opportunity to review the proposed project and has no objections to the concept of the list of uses that are consistent with the list of permitted uses under 20.44.050 B 1. It should be noted that the authority to review and approve a use permit is expressed in both the City's SAH Specific Plan Regulations (Chapter 20.44) and the former County version of the same document. Staff is of the opinion that the list and mix of uses proposed by this use permit are consistent with the intent of the Ordinance. Parking Requirement Based on a review of the floor plans of the existing building, it has been determined that the project was constructed with a parking ratio of 1 space per 250 square feet of gross floor area. There are currently 190 on -site parking spaces to serve the 5,081 gross square foot second floor of the subject building. Based upon current standards, off street parking requirements for the uses proposed by this permit are as follows: June 24, 2005 1AUSERS\PLN\Shared\PA's\PAs - 2005\PA2005-111\UP2005-024 appr.doc Page 7 i ! General Office Use 1 per 250 square feet of net floor area Medical and Dental Office Use 1 per 200 square feet of gross floor area Based on current standards, the maximum possible parking ratio for the uses approved under this permit would be 1 space per 250 square feet of gross floor area. Since the building was constructed with a parking ratio of 1 space per 250 square feet of gross floor area, any possible combination of uses under this permit would have to be addressed individually. Future uses up to the 5,000 square foot allocation for medical/dental office use will be reviewed by the Planning Department to ensure compliance with parking requirements. The parking requirement for medicalldental office use recently increased to one space for each 200 square feet of gross floor area. The change requires that the parking lot be modified to increase the number of on -site parking spaces to meet the increased parking requirement. This will require further analysis of the parking requirement based on the amount of general office and medicalldental office area calculations.- The maximum additional parking required -based on the build -out of 5,000 square feet - would be 5 additional parking spaces Traffic Phasing Ordinance The Traffic Phasing Ordinance requires that a traffic study be prepared for any project generating over 300 trips. The maximum trip -generating use that would be approved under this permit would be medical or dental office. The maximum amount of medical, dental that could theoretically be approved under this permit would be an aggregate of 5,000 square feet. Trips generated by the proposed project, based on the proposed mix, would not exceed the 300 trip threshold. Findings for Use Permit Approval The primary function of a use permit is to ensure that the proposed use is compatible with surrounding land uses. Per section 20.91.035, the following findings must be made for approval of a Use Permit: 1. The proposed location of the use is in accord with the objectives of this code and purposes of the district in which the site is located. • 'As stated above, the purpose of the BP zone is "to provide for the development and maintenance of professional and administrative offices, commercial uses, specific uses related to product development and light industrial uses" All uses proposed under this permit are permitted uses in the BP zone subject to approval of use permit. June 24, 2005 I:IUSERSIPLN1Shared\PNs1PAs - 20051PA2005-1 I MP2005-024 appr.doc Page 8 2. The proposed location of the use permit and the proposed conditions under which it would be operated or maintained will be consistent with the General Plan and the purpose of the district in which the site is located; will not be detrimental to the public health, safety, peace, morals, comfort, or welfare of persons residing or working in or adjacent to the neighborhood of such use; and will not be detrimental to the properties or improvements in the vicinity or to the general welfare of the city. • The medical/dental office proposed under this permit will have no significant impact on the health, safety or general welfare of persons residing or working in the district • The additional medical/dental office use approved under this permit will be subject to the review and approval of the Planning Department and the Planning Director, where appropriate, to ensure that they will generate no significant impacts on persons or property in the vicinity. 3. The proposed use will comply with the provisions of this code, including any specific condition required for the proposed use in the district in which it would be located As stated above, the uses approved under this permit satisfy all required conditions for the zone in which they are located and will comply with all provisions of the zoning code. June 24, 2005 I:IUSERS\PLN\Shared\PA's\PAs - 2005\PA2005-111\UP2005-024 appr.doc Page 9 Newport Beach Fire Department Life Safety Services 100 Civic Center Drive Newport Beach, CA 92660 (949) 644-3106 FIRE CLEARANCE Newport Beach Fire Department — Life Safety Services Division Fire Authority Name 100 Civic Center Drive, Newport Beach, CA 92660 Address (949) 644-3106 Telephone Number AKUA Mind & Body (Name of program) was inspected this date for compliance with local requirements, and is hereby granted .a fire clearance to operate an outpatient alcohol and/or other drug treatment program at: 20271 Birch Street Suite #202 Newport Beach CA 92660 (Address of program -please include suite numbers if applicable) 1 bs Inspector's name (typed or printed), telephone nu Lwr (Signature and rank of inspector granting clearance) a(- oa_-aOIs (Inspection date) ** INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY TIME RECEIVED REMOTE CSID DURATION PAGES STATUS September 21, 2012 2:25:21 PM PDT 9492409280 127 3 Received 09/21/2012 14:44 9492409280 PICKET[ & SCHKUEVEX PICKETT & SCHROEDER r-mut kilf J3 33322 Mesa Vista Drive Dana Point, CA 92629 949.240.9220 • Tel 949.240.9280 a Fax Ext. 213 TO: Jennifer Schultz, Fire Prevention Officer NEWPORT BEACH FIRE DEPARTMENT FAX: (949) 723-3533 Cc: Bonnie Sharp,.Manager SHARP HOA MANAGEMENT FAX: (562) 437-5377; (310) 614-1577 FROM: Aliece Pickett DATE: 9/21 /12 RE: 20311 Birch St., 1 st Floor, Newport Beach Invoice from service call to certify fire extinguisher NUMBER OF PAGES, INCLUDING THIS PAGE: 3 Dear Ms. Schultz: My tenant notified me that on September 12, 2012 the Fire Department inspected 20311 Birch St., 1 st floor Newport Beach, and reported to him that the hall fire extinguisher was not in compliance. The certification on the hall fire extinguisher was valid until September 15, 2012, as evidenced by the card on the fire extinguisher. In any event, the fire extinguisher was inspected and has been certified through September 14, 2013. Enclosed is Invoice BB00902 for that inspection and certification. If you have any questions, please contact me. AP. rzw i&Knz 01-4W21/2012 14:44 9492409280 Complete Fire Service Inc PO BOX 3804 • Tustin, CA 92781 (800)790-6607 If r' T !Ft f f -4 - PICKETT & SCHROEDER PAGE 02/03 Re Ce#vfad DATE- SEP202012 INVOICE Pickett & Schoecer Y .. 7,77 0-1 TOE: �1'l•.��• `r:.�''•ifJ . /�.s�.e�l/ � -� �-. , P.O. NUMBER 7ANNUAj SERV CALL SERV1CflrD EtY OUST TELEPHONEA. �'�7 �: � CASH CREDIT. �R l TERMS NET ON RECEIPT DESCRIPTION NEW EQUIP SERVICE INSPECT RECHARGE PER UNIT NON -TAX TAXABLE CARBON DIOXIDE EXTINGUISHERS Lb. Carbon Dioxide Lb. Carbon Dioxide Lb. Carbon Dioxide Hydrostatic Testing WET CHEMICAL EXTINGUISHERS Gal. Stored Pressure Gal. Stored Pressure Hydrostatic Testing DRY CHEMICAL EXTINGUISHE§IS•_ Lb. Stored Pressure Lb. Stored Pressure f �J Lb. Stored Pressure Lb. Stored Pressure Lb. Stored Pressure Lb. Stored Pressure Lb. Cartridge Lb. Cartridge Lb. Cartridge Hydrostatic Testing MISCELLANEOUS ruc �r_r.i wrf Inc n � rfuvrc .7lnl CN JCI1YIl.fCa rIHYt CSttN AUTHORIZED AND THAT SAID SERVICES HAVE BEEN RENDERED ACCORDINGLY I AM ALSO AWARE THAT SAID SERVICES MAY HAVE BEEN PERFORMED PRIOR TO TOTALS THIRTY DAYS OF EXPIRATION. NON-TAXABLE r SIGNATURE DATE TAXABLE SALES TAX AMOUNT DUE $ PLEASE PAY FROM THIS INVOICE Please Show Invoice A SERVICE CHARGE; OF 1.3% PER MONTH WILL BE CHARGED ON ALL; INVOICES OVER 30 YS Dumber On Checks 09,/21/2012 14:44 9492409280 PICKETT & SCHROEDER PAGE 03/03 Complete Fire Service, Inc. P.O. Box 3804, Tustin, CA 92781 Ph: (800) 790-6607 Fax: (714) 474-2931 License # E 2453 Re: The Fire X-tinguisher Service Company (Fire-X) Tri-County Fire Equipment Company (Tri-County Fire) Dear Customers: We proudly -announce that the future annual service and certification of your fire extinguishers will be provided by Complete Fire Service, Inc. (CFS). As part of the further mobilization of Fire-X and Tri= County Fire, CFS is providing a specific role in the provision of your overall fire protection needs.. CFS is a full service mobile fire protection service operation covering all counties in Southern California. CFS is affiliated with and endorsed by Fire-X and Tri-County Fire in order to make your services even more comprehensive, efficient, and economical for you. Our fast service, large inventory of new and reconditioned equipment, and expansive geographic coverage allows us to service your needs at the most reasonable prices.. We provide you with the following services: Fire Extinguisher Sales & Service Quarterly Inspection Sprinkler Testing 5 Year Sprinkler Certification Fire Hose Testing Smoke Detector Sensitivity Testing and Sales Fire Alarm Inspection 24 Hour Alarm Monitoring Fire Equipment, New & Reconditioned Fire Pump Testing Fire Escape Repairs Wet & Dry Standpipe Testing Kitchen Hood Extinguishing Systems Fire Demos If you have any questions, please call us at (800) 790-6607. Sincerely, Deann Kling President Email: deann@completefireservice.com Please Note: Invoice Enclosed, Insurance Requirements, and Tax ID VV-9 Enclosed for those companies who require these documents. Please keep, send back and or recycle if these do not apply to your company. '4�5 1 "�"o ('s — n-�- FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION 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 7. PROPERTY INFORMATION Name of property: LIBERTY BAPTIST CHURCH FAMILY LIFE CENTER Address- 1000 BISON AVE NEWPORT, BEACH,CA,92660 Description of property: CHURCH Occupancy type: S,B Name of property representative: - Address: Phone: Fax: E-mail: Authority having jurisdiction over this property: Phone: Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION DEFENCE ELECTRIC _ Installation contractor for this equipment: 11600 MATHEWS RD. MORENO VALLEY,CA,92557 _ Address: License or certification number: C-10#917079 Phone: (951)966-0065 Fax: E-mail: Service organization for this equipment: DEFENCE E LECTRIC Address: 11600 MATHEWS RD. MORENO VALLEY,CA,92557 License or certification number: C-10#917O79 Phone: (951)966-0065 Fax: E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of, Contracted testing company: Address: " Phone: Fax: E-mail: Contract number: Frequency of routine inspections: _ Contract expires: 3. DESCRIPTION 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): >>GFPA 72, Fig. i Q.1 E.2.1.1 (p_ 1 of 12) C;opynght @ 2009 National Fire Protection Association- This form maybe copied for individual use other than for resale. It may not be copied for commercial sate or distribution. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2013 Additional description of system(s): N/A 3.1 Control Unit FX350 Model number: Manufacturer: MIRCOM - This system does not incorporate an MNS 3.2 Mass Notification System 3.2.1 System Type: ❑ In -building MNS--combination El In -building MNS—stand-atone ❑ Wide -area MNS ❑Distributed recipient MNS ❑ Other (specify): N/A 3.2.2 System Features: Wide -area MNS to regional national ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ alerting interface ❑ Local operating console (LOC) ❑ Direct recipient MNS (DRMNS) ❑ Wide -area MNS to DRMNS interface ❑ Wide -area MNS to high -power speaker array (HPS A) interface ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): N/A 3.3 System Documentation ® An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: 3.4 System Software ❑ This system does not have alterable site -specific software. Operating system (executive) software revision level: FX350 CONFIG V2.5.2 Site -specific software revision date: JULY 30 2015 Revision completed by: ABEL SOLOR10 ❑ A copy of the site -specific software is stored on site. Location: N/A 3.5 Off -Premises Signal Transmission Name of organization receiving alarm signals with phone numbers: Alarm: N/A Supervisory: N/A Trouble: N/A Entity to which alarms are retransmitted: N/A Method of retransmission: N/A ® This system does not have off -premises transmission. Phone: N/A Phone. N/A Phone: N/A Phone: N/A If Chapter 25, specify the means of transmission from the protected premises to the supervising station: N/A Wired ❑ Wireless If Chapter 27, specify the type of auxiliary alarm system: ❑Local energy ❑Shunt ❑ rVFPA 72. Fig. 10.18.2.1.1 (p, 2 of 12) Copyright ©2000 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. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: Quantity: 1 (See NFPA 72, Sections 72.3 and 72.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: N/A Description: N/A _ 4.1.3 Device Power Pathways ® No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Survivability 1 Pathways class: B ty level: Quantity: (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: N/A Description: N/A 4.2.3 Device Power Pathways ® No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: Quantity: 4 (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: NIA Description: N/A -- - - 4.3.3 Appliance Power Pathways ® No separate power pathways from the notification appliance pathway ❑ Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12) Copyright 02009 National Fire protection Association. This form maybe copied for individual use other than for resale. it may not be copied for commercial sate or distribution. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ❑ This system does not have manual fire alarm boxes. Type and number of devices: Addressable: N/A Conventional: N/A Coded: N/A Transmitter: N/A_ Other (specify): N/A 5.1.2 Other Alarm Boxes ❑ This system does not have other alarm -boxes. Description: N/A Type and number of devices: Addressable: N/A Conventional: N/A Coded: N/A Transmitter. N/A Other (specify): - 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: 1 Conventional: N/A Other (specify): NIA Type of coverage: ® Complete area ❑ Partial area ❑ Nonrequired partial area Other (specify): N/A Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating Beam Other (specify). N/A 5.2.2 Duct Smoke Detectors ® This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: 8 Conventional: N/A Other (specify): N/A Type of coverage: N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors ® This system does not have radiant energy detectors. Type and number of devices: Addressable: N/A Conventional: N/A Other (specify): N/A Type of coverage: NIA 5.2.4 Gas Detectors ® This system does not have gas detectors. Type of detector(s): N/A Number of devices: Addressable: N/A Conventional: N/A Type of coverage: N/A 5.2.5 Heat Detectors ® This system does not have heat detectors. Type and number of devices: Addressable: N/A Conventional: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature 0 Rate -of -rise ❑ Rate compensated NFPA 72, Fig. 10.18.2.1-i (p. 4 of 12) Copyright 0 2009 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. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules ❑ This system does not have monitoring modules. Number of devices: 11 5.2.7 Waterflow Alarm Devices ❑ This system does not have waterflow alarm devices. Type and number of devices: Addressable: 1 Conventional: N/A - Coded: N/A - Transmitter: N/A 5.2.8 Alarm Verification ® This system does not incorporate alarm "verification. Number of devices subject to alarm verification: N/A Alarm verification set for N/A seconds 5.2.9 Presignal ® This system does not incorporate pre -signal. Number of devices subject to presignal: N/A Describe presignal functions: NIA 5.2.10 Positive Alarm Sequence (PAS) ® This system does not incorporate PAS. Describe PAS: N/A_-_--- 5.2.11 Other Initiating Devices ® This system does not have other initiating devices. Describe: N/A 6. SUPERVISORY SIGNAL -INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: 1 Conventional: N/A Coded: N/A Transmitter. N/A Other (specify): N/A _ 6.2 Fire Pump Description and Supervisory Devices ❑ This system does not have a fire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: N/A Conventional: N/A Coded: N/A Transmitter: N/A Other (specify): N/A --- 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): NIA _ 6.3 Duct Smoke Detectors (DSDs) ® This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: N/A Conventional: N/A Other (specify): NIA Type of coverage: N/A - Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: N/A - NFPA 72, rig- 10.18,2.1.1 (p. 5 of 12) Copyright ©2009 National Rre Protection Association. This form maybe copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Other (specify): N/A 7.2 Special Hazard Suppression Systems Description of special hazard system(s): NIA 7.3 Other Monitoring Systems Description of special hazard system(s): N/A 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: MAIN ENTRANCE Location 2: N/A Location 3: N/A ❑ This system does not have a generator. ❑ Selector switch not in auto ❑ Low fuel ® This system does not monitor special.hazard systems. ® This system does not monitor other systems. ❑ This system does not have annunciators. 9. ALARM NOTIFICATION APPLIANCES 9.1 In -Building Fire Emergency Voice Alarm Communication System ® This system does not have an EVACS. Number of single voice alarm channels: N/A Number of multiple voice alarm channels: N/A Number of speakers: NIA Number of speaker circuits: N/A Location of amplification and sound -processing equipment: N/A Location of paging microphone stations: Location 1: N/A Location 2: N/A Location 3: N/A - 9.2 Nonvoice Notification Appliances ❑ This system does not have nonvoice notification appliances. Horns: 7 With visible: 7 Bells: With visible: Chimes: NIA With visible: N/A Visible only: N/A Other (describe): N/A _ 9.3 Notification Appliance Power Extender Panels ❑ This system does not have power extender panels. Quantity: NIA Locations: N/A At PA 72. Fig. 10.18.2.1.1 (p. 6 of 12) Copyright © 2009 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. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ❑ This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: N/A Location 2: N/A Location 3: N/A 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: N/A - .- Location 1: N/A Location 2: N/A Location 3: N/A 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: N/A MNS-only visible appliances: N/A Textual signs: N/A Other (describe): N/A _ Supervision class: N/A 10.3.1 Special Hazard Notification ® This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ® This system does not have a two-way telephone system. Number of telephone jacks installed: N/A Number of warden stations installed: N/A Number of telephone handsets stored on site: N/A Type of telephone system installed: ❑ Electrically powered ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ❑ This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: N/A % General building areas: N/A % Amplification component locations: N/A Inbound signal strength: N/A dBm Outbound signal strength: N/A dBtn Donor antenna isolation is: N/A dB above the signal booster gain Radio frequencies covered: N/A Radio system monitor panel location: N/A _ NPPA 72, Fig. 10.18.2.1.1 {p. 7 of 12f Copyright 0 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system, Number of stations: N/A Location of central control point: N/A Days and hours when central control point is attended: N/A Location of alternate control point: N/A Days and hours when alternate control point is attended: N/A 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: NIA Location of central control point: N/A Days and hours when central control point is attended: N/A _ _ Location of alternate control point: N/A Days and hours when alternate control point is attended: N/A 11.5 Other Two -Way Communication Systems Describe: N/A _ _- 12. CONTROL FUNCTIONS This system activates the following control fuetions: ❑ Hold -open door releasing devices ❑ Smoke management ® HVAC shutdown ❑ F/S dampers ❑ Door unlocking ❑ Elevator recall ❑ Fuel source shutdown [I Extinguishing agent release ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules Number of devices: 8 Other (specify): N/A 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120VAC Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location. 13.1.2 Engine -Driven Generator Location of generator: N/A Location of fuel storage: N/A ❑ This system does not have control modules. Control panel amps: 10 Amps: - - ® This system does not have a generator. Type of fuel: N/A NFFA 72, Fig. 10.18.2.1.1 (p. S of 12) Copyright 02009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels ® This system does not have power extender panels. 13.3.1 Primary Power Input voltage of power extender panei(s): N/A Power extender panel amps: N/A Overctnrent Protection: Type: N/A Amps: N/A — -- Location (of primary supply panel board): - Disconnecting means location: N/A 13.3.2 Engine -Driven Generator ® This system does not have a generator. Location of generator: N/A Location of fuel storage: N/A Type of fuel: NIA 13.3.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: N/A Location of UPS system: NIA Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): In alarm mode (minutes): _ 13.3.4 Batteries Location: N/A Type: NIA Calculated capacity of batteries to drive the system: In standby mode (hours): N/A ❑ Batteries are marked with date of manufacture Nominal voltage: N/A Amp/hour rating: NIA In alarm mode (minutes): N/A ❑ Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. This is a: 0 New system ❑ Modification to an existing system Permit number: f 2015-0127 The system has been installed in accordance with the following requirements: (Note any or all that apply.) ® NFPA 72, Edition: 2013 ❑ NFPA 70, National Electrical Code, Article 760, Edition: ❑ Manufacturer's published instructions Other (specify)-. N/A System deviations from referenced NFPA standards: Signed: Printed name: Date: Organization: DEFENCE ELECTRIC Title: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright© 2o09 National Fire Protection Association. This form maybe copied for individual use other than for resale. It may not be copied for commercial sate or distribution. 13. SYSTEM POWER (continued) 13.1.3 Uninterruptible Power System ® This system does not have a UPS. Equipment powered by a UPS system: N/A Location of UPS system: N/A Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): N/A In alarm mode (minutes): 13.1.4 Batteries Location: INSIDE FACP Type: SEALED Nominal voltage: 12 Amp/hourrating: NICAD 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 ❑ Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ® This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: N/A EVACS or MNS panel amps: , N/A Overcurrent protection: Type: N/A Amps: NIA Location (of primary supply panel board): N/A Disconnecting means location: N/A 12 13.2.2 Engine -Driven Generator ® This system does not have a generator. Location of generator: N/A Location of fuel storage: N/A Type of fuel: _ 13.2.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: N/A Location of UPS system: N/A _ Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode (hours): N/A In alarm mode (minutes): N/A 13.2A Batteries Location: N/A Type: NIA Nominal voltage: N/A Amp/hour rating: NIA Calculated capacity of batteries to drive the system: In standby mode (hours): N/A In alarm mode (minutes): N/A ❑ Batteries are marked with date of manufacture [] Battery calculations are attached NFAA 72, Fig. 10.18.2.1.i (p. 9 of 12) Copyright 0 2009 National Fire Protection Association. This tone may be copied for individual use other than for resale. It may not be copied for commercial sale or distribution. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ® New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ❑ Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: ® NFPA 72, Edition: 2013 ❑ NFPA 70, National Electrical Code, Article 760, Edition: ❑ Manufacturer's published instructions Other (specify): N/A ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: Printed name: Date: Organization: MIRCOM ENGINEERED Title: TECHNICAL SERVICES Phone: (562)235- SYSTEMS 4841 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: d ,(� �GN �^ Printed name: J 4ft& 1 Y I Pii� Date: Organization: geAnse, F-N 'OV O Title: ��GS�Giew� d Phone: 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Date: _ Organization: Title: Phone: 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: _ Phone: NFPA 72, Fig. 10.18-2.'1.1 (p. 11 of 12) Copyright m 2009 National Fire Protection Association. This form may be copied for individual use other than for resale. It may not be copied for commercial sale ordistribution. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: T accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: rnnteu nautn: Organization: Title: Phone: _ 16.5 Authority Having Jurisdiction: 1 have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: Printed name: Date: _ Organization: Title: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright© 2009 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. 1 .a, 13-222 INSTALLATION OF SPRINKLER SYSTEMS Contractor's Material and lest Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by the property owner or their authorized agent. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. Property name �g �,y- Date F/ V > r Property address Accepted by approving authorities (names) A �4, I� Address Plans Installation conforms to accepted plans Yes ❑ No Equipment used is approved ❑ Yes ❑ No If no, explain deviations Has person in charge of fire equipment been instructed as JoYes ❑ No to location of control valves and care and maintenance of this new equipment? If no, explain Instructions Have copies of the following been left on the premises? .dYes Q No 1. System components instructions M Yes ❑ No 2. Care and maintenance instructions 'ayes ❑ No 3. NFPA25 ❑Yes MNo Location of Supplies buildings system Year of Orifice Temperature Make Model manufacture size Quanti rating G® 7 Sprinklers 11 701 P/ I s15 Type of pipe Pipe and Type of fittings fittings Maximum time to operate Alarm Alarm device through test connection valve or flow Type Make Model Minutes eco ds indicator } r Dry valve Q. O. D. Make Model Serial no. Make Model Serial no. Time to trip Time water Alarm through test Water Air Trip point reached operated Dry pipe connectiona,b pressure pressure air pressure test outleta,b properly operating test Minutes Seconds psi psi psi Minutes Seconds Yes No Without Q.O.D. With Q.O.D. If no, explain © 2006 National Fire Protection Association NFPA 13 (p. 1 of 3) a Measured from time inspector's test connection is opened b NFPA 13 only requires the 60•second limitation in specific sections FIGURE 24.1 Contractor's Material and Test Certificate for Aboveground Piping. 2007 Edition SYSTEMS ACCEPTANCE 13-223 Operation ❑Pneumatic ❑Electric ❑Hydraulics A7tA Piping supervised ❑Yes ❑No Detecting media supervised ❑Yes ❑No Does valve operate from the manual trip, remote, or both ❑Yes ❑ No control stations? Deluge and p Is there an accessible facility in each circuit If no, explain valves valves for testing? Yes ❑ No Does each circuit operate Does each circuit operate Maximum time to Make Model supervision loss alarm? valve release? operate release Yes No Yes No Minutes Seconds Al A Location Make and Residual pressure Pressure and floor model Setting Static pressure (flowing) Flow rate reducing valve test Inlet (psi) Outlet (psi) Inlet (psi) Outlet (psi) Flow (gpm) Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for 2 hours or 50 psi (3.4 bar) above static pressure in excess of 150 psi (10.2 bar) for 2 hours. Differential dry -pipe valve clappers shall be left open during the test to prevent damage. All aboveground piping leakage shall be stopped. Test description Pneumatic: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 11/a 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 11/2 psi (0.1 bar) in 24 hours. All piping hydrostatically tested at 20'V psi (— bar) for 2 hours If no, state reason Dry piping pneumatically tested ❑ Yes UNo Equipment operates properly (� Yes .�R 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? ❑Yes IRNo Drain Reading of gauge located near water Residual pressure with va ve in test Tests test supply test connection: jgU psi (— bar) connection open wide: psi (_ bar) Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping Verified by copy of the Contractor's Material and Test ❑ Yes IRNo Other Explain Certificate for Underground Piping. Flushed by installer of underground sprinkler piping U'Yes ❑ No If powder -driven fasteners are used in concrete, ❑ Yes l'No If no, explain has representative sample testing been �� satisfactorily completed? Blank testing Number used Locations Number removed gaskets Welding piping ❑ Yes ❑ No If yes... Do you certify as the sprinkler contractor that welding procedures used complied with ❑ Yes ❑ No the minimum requirements of AWS B2.1, ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as required by the AHJ? Do you certify that all welding was performed by welders or welding operators ❑ Yes ❑ No qualified in accordance with the minimum requirements of AWS 82.1, ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as Welding required by the AHJ? Do you certify that the welding was conducted in compliance with a documented ❑Yes ❑No quality control procedure to ensure that (1) 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 MG in. diameter, undercut deeper than the lesser of 25% of the wall thickness or 1/32 in.; and (5) completed circumferential butt weld reinforcement does not exceed 3/32 in.? © 2006 National Fire Protection Association NFPA 13 (p. 2 of 3) FIGURE 24.1 Continued 2007 Edition 13-224 1' INSTALLATION OF SPRINKLER SYSTEMS Cutouts Do you certify that you have a control feature to ensure that . AaYes U No (discs) all cutouts (discs) are retrieved? Hydraulic Nameplate provided If no, explain data nameplate ,,Yes (j No Date left in service with all control valves open Remarks Name of sprinkler contractor 61( -fir c,. 01 Tests witnessed by Signatures The property owner or their authorized agent (signed) Title Date For sprinkler contractor (signed) Title Date Additional explanations and notes © 2006 National Fire Protection Association NFPA 13 (p. 3 of 3) FIGURE 24.1 Continued 2007 Edition State Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request STD 850 December 14"', 2012 CCL :TODDLER OPTION = 16 PRESCHOOL = 46 TOTAL = 62 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714)703-2831 Malek Nancy/cc - E203 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 304370738 3A & ROOM, CHANGE 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 750 The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change 6. Name Change 7. ROOM CHANGE Hours: Monday - Friday: 7:00 am - 6:00 pm Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap 18. Facility Code -16 - CCC 62 Care? 36 0 Care? 0 62 No No 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC ORANGE TREE PRESCHOOLS 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 1000 BISON AVENUE 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 VANESSA ORTIZ 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 0CC 1. Fire Clear/Granted ,� A1�I 1�6 MDR ` D(� Q I S `� 4 q , (p L4Li 3 d5 3 b()s� 2• Fire ClearLDenied. 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance -Code 9- a to - l 3 N Explanation of Denial or Special Conditions: Denial Code ©oY,n E as 0C)a 11 'Zoo ,M 3 - )-L4 Fire Agency Denial Codes 1. Exits NEWPORT BEACH 2.Construct. 3300 NEWPORT BLVD 3. Fire Alarm NEWPORT BEACH, CA 92663 4.Sprinklers 5.Housekeeping 6.Special Hazard 7.Other ` U Room 2 Roo`" t 595 SF 77/ First i SmokeiHeat • Rest Aid V" Oetecfor �'n sl I \Smdce/Hea[ -' ,\\. west E t I PuA cxngu-- Stelioo, Fee Alarm Hom HBAway f Hom a F.t Axf DeteCbDr Restroom P�1 Fee Station •:y'•.` Erun9umher Room3 646 SF UK / ; Shut•oR \ South Exit Gas Water ShuFolf Shut-off East Eldi rn � S y ,V, R 9 � d z CD O v �m y i O a S m O CJ 7 m � K TUTOR Ti ME® CHILD CARE / LEARNING CENTERS MANDY UIEDA Associate Director 1550 Bristol Street North • Newport Beach, CA 92660 YE (949) 955-2672 ph • (949) 955-2680 fx muieda@tutortime.com 'A AL State Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request STD 850 NOVEMBER 15, 2013 CCL DAY CARE CENTER-105 decrease INFANT CARE- 40 increase TOTAL= 145 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714)705-6025 JUDY HANSON/vd E201 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 370 304370293 3A 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 6. Name Change 7. Hours: Monday - Friday 6:30am-8:30pm Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap ,401 Care? _32'' Care? 141T^ 18. Facility Code - 16 - CCC 145 No ! (a 3 0 No 0 1 145 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC TUTOR TIME CHILD CARE LEARNING CENTER 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 1550 BRISTOL STREET NORTH NONE 4. APH 12. ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under NEWPORT BEACH, CA. 92660 24 HRS. 6. SNF 14. CCF 7. ICF/OT 15. DAF 17. Facility Contact Person Telephone # qss' 16a. Special MANDY ULEDA (949) W-2672 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 (�} Ah l � Ic M D R�� 5 ( q 4 q (o H y, 3 1 p 6-3 DDSS .1 2. Fire Clear/Denied 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code Explanation of Denial or Special Conditions: Denial Code MAXI M 01%-1 T L QA<b I n3 ROO M S LJ I T A 00-17 \.N0 0KtTS (QN e7r 1R1Q t L, TO 7ktE_Oursk61F 1 s 10 - Fire Agency Denial Codes 1. Exits 2. Newport Beach Fire Department 3.Fire Alarm Life Safety Services 4.Sprinklers 100 Civic Center Drive 5.Housekeeping Newport Beach, CA 92660 6.Special Hazard 7.Other ,ws 4 --- — OIOdlagwaw 1 woo•)Iuegsn ®Aueq® + 1'� ®nor( 6uinaas®}o v�� Qo • .. � • ,L - +w t•-� ••�•`y • 1• fir/ •••%• , •.SS., +S•. ;�N 'I• - '. nw 44 1, • it - _ . -� - "'' - - y3.=�,_ =: .. ji. ` `t .• �;:- `},Ca. OL i. - :t1.:. • �`-' Sim.. CO CM all •`a. •.i'•' •ti .. a ..C- ••1. i` r,. • •� •r lt: .-y•^. .r'• ':�' ~:�, _ Jsu �'.... _. .,. 'Y i.G i,/•�� j;�� 1.t}; ::',;. .,- ire` .i••N ,T c• • :� :. •4} } t•. �•ei., •`yY 'L• '.,. .. 1 .E - 3'r .>� •' S'�%S. :�, S••` - J t J 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 July 28, 2015 Franklin Peters Survivor's Outpatient Counseling Office 2082 Bristol Street, Suites 200 & 201 Newport Beach, CA 92660 Subject: Fire Clearance 2082 Bristol Street, Suites 200 & 201 Newport Beach, CA 92660 Dear Franklin: The above subject location was inspected on July 28, 2015, 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 ?L 2., C A-1� 'P-A 1Z - ,, er R 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 July 10, 2015 RE: Survivor's Outpatient Counseling Office 2082 Bristol Street, Suites 200 and 201 Newport Beach, CA 92660 439-351-29 Dear Mr. Peters: The above referenced property is located within the Santa Ana Heights Specific Plan Zoning District (SP-7) with a SP Land Use of General Commercial (GC) and is designated as General Commercial (CG) within the Land Use Element of the General Plan. SP-7 GC 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 8 people at any time), one-on-one counseling and the related office use has been determined to be in the General Commercial Land Use Category and is a permitted use in the SP-7 GC Zoning District. The SP-7 GC 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, 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 including an intensification of parking. Should you have any further questions, please contact me at 949-644-3221 or mwhelan(aD_newportbeachca.gov Sincerely, Kimberly Brandt, AICP, Community Development Director By: Melinda Whelan Assistant Planner Enclosures: Description of outpatient program use for 2082 Bristol Street .Enclosures: Description of outpatient program use for 2082 SE Bristol St Newport Beach July 6th, 2015 Franklin Peters City of Newport Beach Planning Department Re: 2082 SE Bristol St SE, Ste: 200-201 Newport Beach, Ca. Dear Ms. Whelan, I am hereby requesting zoning clearance for my state application for Certification of our offices located at 2082 SE Bristol St Suite 200, Newport Beach, CA 92660. All customers receiving services would be voluntary. I do not provide transportation. I have provided at our office numerous reserved parking spaces for our clients. Per your request I will also provide my projected daily schedule for my business office includes but not limited to hours of operation, a detailed description of services to be provided as well as number of customer's projected to receive services after Certification is complete. If you have any questions or need any further information, please call me. Thank you for yourtime and consideration of this matter. Thank you, Franklin Peters CEO (951) 256 - 7698 Hours of Operation: Monday thru Friday 9:OOam to 6:OOpm Outpatient Treatment Program Adult (OP) (ASAM I Level of Care): Program Description. Our out patients program consists of one Three -hour group session a week, for a total of twelve (15) sessions, and various treatment program requirements. Clients will arrive 10 to 15 minutes early before every 1 on 1 and group session begins. Survivor's interactive treatment program also includes treatment measures based on the 12 step method. Our outpatient treatment programs will focus on addiction recovery;' incorporating in our 1 on 1 and group home exercise will be included. Our clients must attend all monthly treatment recovery plan groups and individual sessions scheduled by the program. Clients will follow all office rules and dress code. Who We Serve. Our outpatient program is designed for adults who meet criteria for ASAM I Level of Care and typically, have a substance abuse diagnosis, with no withdrawal. They are stable and able to make use of the group sessions and whose needs are manageable in this program. Survivor's client to staff ratio of 8 to 1, with no more than 8 participants assigned to any one group. Daily Schedule - Monday: 9:00am-10:00 Administrative/Insurance Billing 11:00- 12:00 * Process one on one counseling Max 2 clients 12:00-2:00 Lunch 2:00- 5:00 *Process Group Max 8 clients 5:00- 6:30, Progress notes/Insurance Billing Tuesday: 9:00am-10:00 Administrative/Insurance Billing 11:00-12:00 * Process one on one counseling Max 2 clients 12:00-2:00 Lunch 2:00- 5:00 *Process Group Max 8 clients 5:00- 6:30, Progress notes/Insurance Billing Wednesday: 9:00am-10:00 Administrative/Insurance Billing 11:00-12:00 * Process one on one counseling Max 2 clients 12:00-2:00 Lunch 2:00- 5:00 *Process Group Max 8 clients 5:00- 6:30, Progress notes/Insurance billing 9:00am to 12:00 noon —Scheduled appointments Thursday: 9:00am-10:00 Administrative/Insurance Billing 11:00-12:00 * Process one on one counseling Max 2 clients 12:00-2:00 Lunch 2:00- 5:00 *Process Group Max 8 clients 5:00- 6:30, Progress notes/Insurance billing 9:OOam to 12:00 noon —Scheduled appointments Friday: 9:00am-10:00 Administrative/Insurance Billing 11:00-12:00 * Process one on one counseling Max 2 clients 12:00-2:00 Lunch 2:00- 5:00 *Process Group Max 8 clients 5:00- 6:30, Progress notes/Insurance billing 9:OOam to 12:00 noon —Scheduled appointments OFFICE RULES 1. Must be properly dressed. 2. No Littering. 3. No smoking in unpermitted areas. 4. No hanging out outside building. 5. No soliciting to other businesses. 6. No skateboarding on property 7. No Horse play on property 8. No drug, alcohol and weapons of any kind 9. Must be quiet and respectful at all time - `6 » 2 0 k �O / 2 7 � 2 '6 b t" \ LQ c � 7 Jo O mo ] Window £ E § 7 § k k c $ ) ) ��§ E / / k i % \ 7 E% 0 @ aCL G 0 3 $ § § § ) E 2 § 0 CL 9 j W / In§ k - 8 § E2 o § 0 @ - e 0 rq \ Window \ q / q Jo O luoij Zz�lns 3 E co k % f v % � LQ � � � � 0 0 § $ > E \ COW f q Z 12 AAA-- !�( STATE OF CAUFORNIA, BUSINESS, TRANSFORTAMON AND HOUSING AGENCY DEPARTMEtin`OF HOUSING AND COMMUNITY DEVELOPMENT � DIVISION of CODES AND STANDARDS PRIVATE FIRE HYDRANT TEST AND CERTIFICATION REPORT ALL PARKS MUST RETURN THIS�FORM TO THE ENFORCEMENT AGENCY FOR THE PARK (SEE THE REVERSE SIDE FOR INSTRUCTIONS ON COMPLETING THIS FORM) Part i - IDENTfFiCA Old . Park Name: i'32NIA f Park iD# Park Address: City: CA ZIP: Park Operator Name ,X Phone Number Park Operator•Address and City 1✓' �� • lg�le�bA e- f Part 11-• CERTWICAi' ON EXCEPTtONS -Y.ou• do not need certification, but must complete this section if any of -the 150110win9 a p ❑ Hydrants are publicly owned and maintained - Water Company Name ❑ No hydrants and park -was -built before Septerrtber 1, 1.90 - List Date of Constri-ictloh: / f El Na.hydrant's-and park•has14 or less total lots - Enter Number of -Lots: ❑ No private hydrants and park was buittafter-September t,1958. •(Speciftc exception -at the time of construction.) Part 411- ANNUAL FIRE fiYDR-AtiT-.OPERATION TEST (certifier: initialyourverification in the appropriate column) To•becompleted. byauthorized-ceTfifierONLY. YES NO CORRECTED Standpipes are considered hydrants far certification requirements & PASSED 1. Hydrant stems and valves -operate fully„ freely, and are properly lubricated. ' 2. All hydrant threads and caps are undamaged. _. 3. Where subject to vehicular damage, hydrants are .physically protected. 4. Around aft hydrants is a minimum of 36 inches of unobstructed access. 5. All hydrants -outlets are 14 inches to 24, Inches above grade. (Standpipe outlets need not be a spe'Jffp height, but.mustbe readily -accessible.) 8. Each hydrant is clearly identfied or marked. 7. Each 1 z -inch hydrant has an approved hose in a marked enclosure. All "NO" answers are violations and will prohibit the issuance of the park Permit to Operate. Part IV — FfvE-YEAR FIRE -HYDRANT WATER FLOW -TEST Barrel Size Flow Pressure Barrel Size Flow Pressure Cinches) (GPM) (PSI) (inches) (GPM) (PSI) 1 / 4 2 5 _. 3 6 FOR MORE THAN & HYDRANTS IN THE PARK, ATTACH AN ADDITIONAL LIST USING THE FORMAT ABOVE. (GPM) -GALLONS PER MINUM (PS1)-RESIDUALPRESSUREINPOUNDS PER SMYMEINCH' . PART V — CERTIFICATION OF TEST RESULTS Certifier•Name �irl -- 51 PAL 1�1( iTE1 license Class and No: C I Q g 0 � Address R ) CC21 &M cli r, i 9 2-12•,L Telephone Number ` 511 3 LEI E-Mail Address Printed Name Q'A V 'BeriA rlue I Nspee--CLPR- - Signature Date of Test to 1 1 / 12, Fart VI APPROVAL FOR ONTINUED 6SE OFEMSTING SYSTEM TO BE COMPLETED BY LOCAL FIRE AGENCY ONLY Agent Name Title -Badge Number Signature HCb M 532 (Rev 74t) Side I 301 ?llkCqNT/A ACE SUITE aoa !SIERRA MEDICAL GAS TESTING Where Patient Care is Our Priority ( C;1 D 1 C ^ (^1 to IV (0 FACILITY: Medical Piping Systems Evaluation MASTER ALARM EVALUATION TEST REPORT SOS Dentistry DATE: 12/11 /2015 Location: 2nd Flooe AREA Exact Alarm Location Alarm, Manufacturer (Model) : y o . • a� ° '` o 3 ^a 7 H o y 1 d �. ' ` M; i~.' o H b0 W ` o i~ y .a,. -� Comments Main o/S Reception Accutron N S2 ✓ 60 ✓ _ _ ✓ ✓ N S1 ✓ 40 ✓ _ ✓ ✓ N S4 ✓ YES ✓ _ ✓ ✓ O S2 ✓ 60 ✓ _ ✓ ✓ O S 1 `� 40 ✓ _ `( `( O S4 ✓ YES ✓ _ ✓ ✓ SMGT 103 (1/2014) i SIERRA MEDICAL GAS TESTING Where Patient Care is Our Priority MASTER ALARM EXPLANATION MEDICAL PIPING SYSTEM EVALUATION LOCATION: Opp = Opposite (i.e., Opp Nursing Station) O/s = Outside (i.e., 0/s Rm 251) SYSTEM: V = Vacuum 0 = Oxygen A = Medical Air N = Nitrous Oxide NG = Nitrogen W = WAGD E = Evacuation C = "Carbon Dioxide DA = Dental Air DV = Dental Vacuum TYPE OF ALARM SIGNAL: S1= Line Pressure Low S6 = Reserve Low S11= Reserve Fail S2 = Line Pressure High S7 = Dew Point High S12 = Reserve. Pressure Low S3 = Line Pressure Abnormal S8 = Carbon Monoxide High S14 = Maintenance Required S4 = Reserve In Use S9 = Lag SS = Liquid Level Low S10 = High Temperature MASTER ALARM, GENERAL COMMENTS: A1= Area is required to have an alarm signal, but has none. A2 = Alarm signal is obstructed. Signal must be unobstructed and in a clear view. A3 = Alarm signal does not appear to be at a location of responsible surveillance. ✓ = The alarm signal is properly located for its intended use. HIGH/LOW PRESSURE POINT: Alarm activation should occur when the pressure varies more than 20% from normal line pressure (i.e., outside the range of 40-60 psi or below 12 Hg for vacuum). Positive Pressure Gases: Activation pressure recorded in PSI as follows, High/Low. Vacuum: Low vacuum activation point recorded in inches of mercury (Hg). --- : Point of activation not determined. HIGH/LOW PRESSURE ALARM, ALARM SIGNAL COMMENTS: M1: Main pressure switch should be adjusted to the proper activation pressure. M2: Point of activation not determined. Signal does not appear to be in working order. M3: High pressure not tested this date. Al : Alarm activated at the correct pressure level. ALARM SIGNAL, PRESSURE GAUGE READING: Positive Pressure Gases: Gauge reading recorded in pounds per square inch (psi). Vacuum: Gauge reading recorded in inches of mercury (Hg). --- : No gauge installed at alarm signal location. ALARM SIGNAL, GAUGE COMMENTS: G1: No gauge currently in place. G2: Gauge appears to be inaccurate/broken and should be repaired or replaced. G3: Gauge is not suited for the current application. G4: Label on gauge is ambiguous as to which gas it measures. ✓ : Gauge appears to be functioning properly and is correctly labeled. ALARM SIGNAL, TEST SWITCH: T1= Normal operation (green) lamp is not functioning and should be repaired. T2 = Visual alarm signal (red) lamp is not functioning and should be repaired. T3 = Audible alarm signal does not function or is not loud enough to be heard. T4 = Silence switch fails to silence audible signal and should be repaired. T5 = Audible alarm signal has been rendered inactive by tampering. T6 = Alarm signal appears to be disconnected from power source. The alarm should be powered by E Power. ✓ = Alarm signal test switch is functioning properly. ALARM SIGNAL, LABELING: Each visual indicator should be clearly labeled to identify the conditions of the alarm (Le., LOW OXYGEN PRESSURE). Emergency instructions should be posted at the alarm signal location to identify the responsible party to call during alarm. L1= Visual indicator is not labeled or is incorrectly labeled. L2 = Emergency instruction should be posted at the alarm panel. ✓ = Alarm Signal Labeling is up to date and correct. SMGT MAE (1/2014) SIERRA MEDICAL GAS TESTING 3,+i-ere Patient Care is Out Priority MEDICAL PIPING SYSTEMS CERTIFICATION ON -SITE TEST REPORT DATE: 12/11/2015 INSPECTOR: Harold Ellis FACILITY: SOS Dentisry REQUESTED BY: Keith Taylor ISSUED TO: Keith Taylor DEPT. / CO: Regency Plumbing SUBMITTED TO: Keith taylor DEPT. / CO: Regency Plumbing SMGT certifies that the items indicated below have been inspected and tested and were found to be in compliance with applicable NFPA, CGA, AIA quidelines except as indicated in the following Test Report. ITEM INSPECTED- _ -; ; : -_ - _ . _ SYSTEM MASTER ALARMS O, N AREA ALARMS ZONE VALVES ZONE VERIFICATION PATIENT TERMINALS O N CROSS CONNECTIONS O N PURITY (Contaminants)* O N PARTICULATES (FINE)** O N *Includes -White l 7oth ranicuiate 1 eSr" 1n accoroance witn 1VrYA yy -- Salnple taKen on .,tmmcron niters. Analysis otrerea as an option. = SYSTEM, CODES O= OXYGEN A=MEDICAL AIR WMEDICAL VACUUM N=NITROUS OXI DE NG=NITROGEN C=CARBONDIOXIDE W=WAGD E EVACUATION DA= DENTAL AIR DV= DENTAL VACUUM OTHERS TO BE LISTED OUT ADDITIONAL COMMENTS Testing was limited to indicated departments or areas as requested by contracting party. New oxygen, and Nitrous oxide system serving OPP 1-3 Only. ❑This ON -SITE TEST REPORT is not conclusive. SMGT will submit a final INSPECTION PERFORMANCE TEST REPORT which will include a complete list of items requiring attention with applicable recommendations. REPORT REPRESENT FINDINGS ON THE INDICATED DATE(S) ONLY. SMGT 123 (2/2014) 63 Via Pico Plaza #458 San Clemente, CA 92672 (949) 492-9798 office (949)492-9711 fax sierramedgas.com info@sierramedgas.com SIERRA MEDICAL GAS TESTING Where Patient Care is Our Priority PATIENT TERMINAL EXPLANATION MEDICAL PIPING SYSTEM EVALUATION LOCATION: Except where noted, terminals are listed LEFT to RIGHT, beginning at the primary patient door entrance to room. Overhead terminals are listed with furthest from door first, closest to door last. SYSTEM: V = Vacuum 0 = Oxygen A = Medical Air E = Evacuation N = Nitrous Oxide NG = Nitrogen W =WAGD DA= Dental Air DV= Dental Vacuum C= Carbon Dioxide FLOW: 4 symbol indicates the flow is greater than 180 LPM or vacuum/evacuation/WAGD meets minimum requirement of 3.00FM. Flow conversions: 1 CFM = 28.32 Liters 1 Liter = 0.0353 Cubic Feet FLOW RATE: Medical gas measurements are recorded in LPM (liters per minute). NFPA has established no minimum flow requirements for medical gases, however, it is noted that some respirators require 180 LPM. Vacuum/Evacuation/WAGD measurements are recorded in cubic feet per minute (CFM). Minimum flow for vacuum is 3.0 CFM. NFPA has not established a minimum CFM for evacuation/WAGD. PURITY %: Each pressure gas outlet shall be analyzed for concentration of gas, by volume. O 2 99% oxygen N z 10% oxygen NG >_ 99% nitrogen A >_ 19.5%-23.5% oxygen C > 10% oxygen GENERAL CONDITION: A = Terminal fails to lock secondary equipment snugly in place. B = Terminal fit is loose and, as a result, flow is reduced or leakage occurs. C = Terminal fails to release secondary equipment with ease, or release latch is broken. D = Terminal Leaks when secondary equipment is removed. E = Face place / terminal assembly is loose and should be re -secured. F = Face plate is cracked or missing screws. G = Terminal is significantly soiled and should be cleaned. H = Plastic color coded label/tag/indicator should be replaced. I = Terminal has inadequate space for proper mounting or use of secondary equipment. J = Equipment abuse. LEAKAGE VOLUME: +1= Mild leak (repair may be postponed) +2 = Moderate leak (repair should be scheduled) +3 = Severe leak (immediate repair required) LEAKAGE DESCRIPTION: K = Leakage appears to be due to worn 0-ring or valve not re -seating. L = Leakage appears to be behind the face place. M = Leakage appears to be due to excessive weight borne on terminal. N = Terminal fit is loose and, as a result, leakage occurs. LABELING: Terminal should be clearly and permanently labeled with name of gas and warning "Use No Oil." 0 = Terminal has no gas label in place. P = Terminal has no "Use No Oil' label in place. Q = Terminal has incorrect gas label in place. R = Temporary label in place. Permanent label should be installed. OUTLET TYPE: WL= Wall HW= Head Wall HR= Hose Reels HD= Hose Drop HB= Hose Block CL= Ceiling CP= Control Panel PD= Pedestal BM= Boom CC= Ceiling Column AW= ArtWall FC= Floor Column DC= Direct Connect (ie: Hyperbaric Chambers) PASS : J indicates all items are satisfactory. FAIL: indicates the terminal DOES constitute a distinct hazard to patient care. Terminal should be repaired as noted. UNAVAILABLE: � indicates the listed room or terminal was not available for inspection. REQUIRES CORRECTION: d indicates the terminal requires correction but condition does not constitute a distinct hazard to patient care or recovery. SMGT2014 PTE ~STEIN. MEDICAL GAS TESTING Where Patient Care is our sPrt®rity PATIENT TERMINALS Facility: SOS Dentistry Date: 12/11/2015 LOCATION 2nd Floor BED _ W ccROOM a . C o W:� - Z a-- - -�� Ztt gO•`- - - - W J a _ "LL W :. o - "s �r- OUTLET STYLE . piss COMMENTS OPP 1 O ✓ +180 ✓ N ✓ +180 ✓ OPP 2 O ✓ +180 ✓ N +180 ✓ OPP 3 O ✓ +180 N ✓ +180 ✓ SMGT 100 (2/2014) Debbie FrJm: Morris, Nadine Sent: Wednesday, September 23, 2015 6:52 AM To: Alcaraz, Debbie Subject: Invoice Attachments: chld-01@newportbeachca.gov_20150923_064920 0000bl5a001b.pdf Good morning Debbie, Please invoice TRL for an off hours inspection: 09/23/2015 6AM — 7AM Thank you, Nadine I o O E Z' O O O O O O d d N N N d D 7 D m co ai ei M M F- F W W O O F F U U >>> M F W O F U F N J > 0 Z F- (0 J > U z} O o CO W F- U F �� W J 7 Ln Z I- } In J U Z F }� !n ...1 D U z} O 0 U w F- U t- y tQ J 7 U Z F- U) J D U z} O 0 U W F U F COui U) J cn Z} O o cn a W F U a U lai. F ¢ W Y O 2 O LL a' W F a a¢ U LL F a W 'X O 0 3 }i O LL a' W F a}¢ o o F U W t.., N O U. 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J o t0 t0 Oo t> N to v 2 ' O0 N t0 i2 Lp mo -4 00 00 000 Coco 0 No NN N N N N NO Ntp > YN 0 to n11 0 w o ta LOro ro rn rn a> a> . 5 o a> `O0 rn rn rn m a> w o> `rINn, Z 10 O 0 O O O OOO O O OO O O O O O O O O O ti 00 O 00 6 N ty Cil a Alcaraz, Debbie From: Morris, Nadine Sent: Friday, November 20, 2015 10:46 AM To: Alcaraz, Debbie Subject: For Scanning Attachments: chld-01@newportbeachca.gov_20151120_105154_OOOOb314001b.pdf Categories: SCAN Debbie, Please scan into 2801 W Coast Hwy. Fire sprinkler material & test certificate. Thanks! Nadine NADINE MORRIS 1 Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net Print Form . 13-222 fNSTAI.LATiON Or SPRINKLER SYSTEMS Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by the property owner or their authorized agent. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. Property name Date RITZ SEAFOOD RESTAURANT 11/16/2015 Properly address 2801 W COAST HWY, NEWPORT BEACH CA 92663 Accepted by approving authorities (names) .� a NEWPORT BEACH FIRE�(�� - Addres s �~ 100 CIVIC CENTER DRIVE NEWPORT BEACH CA. 92663 Plans Installation conforms to accepted plans Yes ❑ No Equipment used is approved (21 Yes Q No If no, explain deviations Has person in charge of fire equipment been Instructed as 4SI Yes :,,,] No to location of control valves and care and maintenance of this new equipment? If no, explain Instructions - - -- Have copies of the following been left on the premises? ayes ❑No 1. System components instructions Yes CJNo 2. Care and maintenance instructions QNo rYes i 3. NFPA 25 [� Yes ❑ No Location of I ISupplies buildings system Year of { Orifice Temperature Make ; Model manufacture size Quantity rating _ TY-B 2015 i 1121, UP 08 Sprinklers I TY-B 2015 112 3 155 j i I Pipe and [Typeofpipe _.__ DUCTILE IRON fittings iType offittings DUCTILE IRON / CAST IRON CLASS 125 _ Maximum time to operate Alarm Alarm device through test connection valve or flow Type Make Model Minutes Seconds indicator �YCO ROE- VAl--V 00 1 45 Dry valve Q. O. D. _ _ Make Model Sedal no. Make Model Serial no. NA Time to trip i Time water All i through test Water Air Trip point i reached operated Dry pipe i connectiona,b pressure pressure air pressure test outlet0 properly operating test -- Minutes Seconds, psi psi psi Minutes Seconds Yes f No Without' Q.O.D.' With O.O.D.' I If no, explain © 2006 National Fire Protection Association NFPA 13 (p. 1 of 3) a Measured from time inspector's test connection is opened b NFPA 13 only requires the 60•second limitation in specific sections FIGURE 24.1 Contractor's Material and Test Certificate for Aboveground Piping. 2007 Edition IN PDF processed with CutePDF evaluation edition www.CutePDF.com SYST EMS ACCEPTANCE Operation ❑Pneumatic ❑Electric ❑Hydraulics Piping supervised ❑Yes ❑No Detecting media supervised UYes ❑No Does valve operate from the manual trip, remote, or both U Yea Ij No control stations? Deluge and preaction Is there an accessible facility in each circuit If no, explain valves foriesting? Yes i:3 No NA Does each circuit operate Does each circuit operate Maximum time to Make Model supervision loss alarm? valve release? operate release Yes Ne Yes No Minutes Seconds Location Make and Residual pressure Pressure and floor model Setting Static pressure (flowing) Flow rate reducing vaivNtteest Inlet (psi) outlet (psi) Inlet (psi) Outlet (psi) Flow (gpm) _ Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bar) for 2 hours or 5o psi (3.4 bar) above static pressure in excess of 150 psi (110.2 bar) for 2 hours. Differential dry -pipe valve clappers shall be left open during the test to prevent damage. All aboveground piping leakage shall be stopped. Test description Pneumatic: Establish 40 psi (2.7 bar) air pressure and measure drop, which shall not exceed 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 11h psi (0.1 bar) in 24 hours. . All piping hydrostatically tested at 200 psi (_ bar) for 2 hours If no, state reason Dry piping pneumatically tested Yes ❑ I Equipment operates property ❑ Yes [ 1 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? UN ❑No Drain Reading of gauge located near water Residual pressure with valve In test Tests test supply test connection: 87 psi (_bar) connection open wide: 84psf (_ bar) Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping Verified by copy of the Contractor's Material and Test Yes Q No Other Explain Certificaie for Underground Piping. Flushed by Installer of underground sprinkler piping Yes Q No If powder -driven fasteners are used in concrete, ❑ Yes No � If no, explain has representative sample testing been satisfactorily completed? Blank testing I Number used Locations ' Number removed gaskets NA Welding piping LJ Yes ❑ No If yes., Do you certify as the sprinkler contractor that welding procedures used complied with ❑ Yes ❑ No the minimum requirements of AWS 82.1, ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as required by the AHJ? Do you certify that all welding was performed by welders or welding operators Q Yes C3 No qualified in accordance with the minimum requirements of AWS B2.1, ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as Welding required by the AHJ? NA Do you certify that the welding was conducted In compliance with a documented QYes EjNo quality control procedure to ensure that (1) sit 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 In, diameter, undercut deeper than the lesser of 25% of the wall thickness or 1/32 in.; and (5) completed circumferential butt weld reinforcement does not exceed'/3v In.? © 2006 National Fire Protection Association NFPA 13 (p. 2 of 3) FIGURE 24.1 Continued 13-223 2007 Edition 13-224 INSTALLATION Or SPRINKLER SYSTEMS Cutouts Do you certify that you have a control feature to ensure that (6Yes ❑ No (discs) all cutouts (discs) are retrieved? Hydraulic Nameplate provided If no, explain data nameplate (Yes No Date left In service with all control valves open Remarks Net no of sprinkler contractor CAL -WEST FIRE PROTECTION Tests witnessed by Signatures The property owner or their authorized agent (signed) Title Date For sprinkler contract igne Title Date GONZALO PENA OPERATIONS MGR 11116115 Additional explanations and notes © 2000 National Fire Protection Association NFPA 13 (p. 3 of 3) MGt: RE 24.1 Cowhiued 2007 Edition 4 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 January 5, 2015 SOBER Partners Network ATTN: Scott Raffia or Leisha Mello 3101 W. Coast Highway Suite #200 Newport Beach, California 92663 Re; Outpatient Fire Clearance- Granted To Whom It May Concern, On December 17th the Newport Beach Fire Department, Life Safety Services Division, conducted a satisfactory inspection of the business (SOBER Partners Network) located at 3101 W. Coast Highway Suite #200. This business is in compliance with local Fire Code requirements, and is hereby granted a fire clearance to operate an outpatient alcohol and/or drug treatment program at 3101 W. Coast Highway Suite 200. , Sincerely, Raymi Wun Life Safety Specialist II Newport Beach Fire Department Phone: (949)644-3110 Email: rwun@nbfd.net 1- 5 _ , - S1 1� L f/5�qmw& - Sr /s- P,,�, &,o SP /3 e"IZ r2/f FYC 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. jzov ZONING CLEARANCE LETTER December 23, 2014 RE: 3101 W. Coast Highway, Newport Beach, CA 92663 049-130-18 Dear Ms. Leisha Mello: The above referenced property is located within the Mixed -Use Water Related Zoning District (MU-W1) and is designated as Mixed -Use Water Related (MU-W1) within the Land Use Element of the General Plan. MU-W1 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 8 people at any time), one-on-one counseling and the related office use has been determined to be in the Office, Professional Land Use Category and is a permitted use in the MU-W1 Zoning District. However, the following changes in the operation as provided in the attachment would constitute a change in use, 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 949-644-3221 or mwhelanCa)-newportbeachca.aov Sincerely, Kimberly Brandt, AICP, Community Development Director By: Melinda Whelan Assistant Planner Enclosures: Description of outpatient program use for 3101 W. Coast Highway Sober Partners Network December 9, 2014 Melinda Whelan City of Newport Beach Planning Department Re: 3101 West Coast Highway, Ste: 200, Newport Beach, Ca. Dear Ms. Whelan, Per our conversation on December 8, 2014, we are hereby requesting zoning clearance for our State application for Certification of our offices located at 3101 W. Coast Highway, Ste: 200, Newport Beach, Ca. All customers receiving services would be voluntary. We do not provide transportation. We have provided at our office eight reserved parking spaces for our customers or valet service is also available at an additional cost to the customer. Per your request please see enclosed our projected daily schedule for our business office including but not limited to hours of operation, a detailed description of services to be provided as well as number of customer's projected to receive services after Certification is complete. If you have any questions or need any further information, please call me. Thank you for your time and consideration of this matter. Thank you Leisha Mello Program Director (949) 201-5192 1 Sober Partners Network Hours of Operation: Monday thru Friday 9:00am to 6:00pm Outpatient Treatment Program Adult (OP) (ASAM I Level of Care): Program Description. OP consists of one two-hour group session a week, for a total of twelve (12) sessions, and various treatment program requirements. Group members must arrive 15 minutes before group begins. Sober Partners Network is an evidence -based interactive treatment program that includes standardized treatment measures based on The12 step method. The outpatient treatment programs will focus on the "Stages of Change," incorporating in-group activities as well as "take -away" experiential exercises to be completed at home. Each client will meet with their assigned treatment coordinator monthly to set up and or update their recovery plan as well as schedule their groups and individual session. No Clients will be allowed to attend groups unless it is scheduled with their treatment coordinator Who We Serve. OP is designed for adults who meet criteria for ASAM I Level of Care and typically, have a substance abuse diagnosis, with no withdrawal, who are stable and able to make use of the group process, and whose needs are manageable in this program. Sober Partners Network's client to staff ratio of 8 to 1, with no more than 8 participants assigned to any one group. 2 Sober Partners Network Daily Schedule - Monday: 9:00am-12:00noon Administrative/Insurance Billing 12:00-2:00 Lunch 2:00- 4:00 * Process Group Max 8 clients 4:00- 6:00, Progress notes/Insurance Billing Tuesday: 9:00am-12:00noon Administrative/Insurance Billing 12:00-2:00 Lunch 2:00- 4:00 *Process Group Max 8 clients 4:00- 6:00 Progress notes/Insurance Billing Wednesday: 9:OOam to 12:00 noon —Scheduled appointments only with counselors and administrators 12:00 to 2:00 Lunch 2:OOpm to 6:OOpm * Scheduled appointments for Insurance Verification and Financial evaluations. Thursday: 9:OOam to 12:00 noon-Charting/Insurance billing/Administrative. 12:00 2:00 Lunch 2:00-3:00 Staff preparation for outing 3:00- 5:00 * Outing on the Bay —Duffy Max 8 clients 5:00-6:00 Administrative/Charting Friday: 9:OOam to 6:OOpm Staff meetings/Book keeping and Charting. Everything indicated on this schedule with an * is a client service. All other items indicated in the schedule are staff duties and responsibilities. 3 Sober Partners Network BLANK PAGE .ELF-%'. State,Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request STD 850 AUHIST 27, 2013 CCL J� 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714)705-6025 N. MALEK/WT E203 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 370 300603987 7 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 6. Name Change NOTE: RENOVATION 7. PRESCHOOL= 100 TOTAL CAPACITY= 100 Hours: Monday - Friday 7:00 a.m. to 6:00 p.m. Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date 5/10/2013 Capacity Medical Prev.Cap Capacity Medical Prev.Cap 18. Facility Code -16 - CCC Care? Care? 100 100 No 100 0 No 0 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC TEMPLE BAT YAHM 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 1011 CAMELBACK STREET NONE 4. APH 12. ICF/DDN 5: PHF 13. RCF City Zip Code 16. Under NEWPORT BEACH, CA 92660 24 HRS. 6. SNF 14. CCF 7. ICF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special JUNCKER, ALBERT 949-644-6563 NONE 8. ICF/DD 16. Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Telephone # CFIRS ID# T-19 OCC Fire, Clear/Granted 2. Fire Clear/Denied 6-1e-v kni` &L 3. Fire Clear/Withheld Inspection Date Inspector's Sig a 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 3300 NEWPORT BLVD 4.Sprinklers NEWPORT BEACH, CA 92663 5.Housekeeping 6.Special Hazard 7.Other State Fire Marshall 1. Request Date 2. Program 1-ire Safety Inspection Request STD 850 April 8, 2013 CC 3:£Agency Contact 4. Telephone 5. Evaluator (714) 703-2800 Fax (714)703-2831 N. MALEK E203 / ES. Department of Social Services 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 300603987 7 A 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 750 The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change 6. Name Change 7.7_EFjgPDeA-rtY (ROOM C{ &t-XieS Hours: Monday - Friday Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap 100 100 Care? Care? 18. Facility Code - 16 - CCC No No 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC . TEMPLE BAT YAHM 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15, Restraint 1011 CAMELBACK STREET 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 JUNCKER ALBERT 949-644-6563 NONE 8. ICF/DD 16. Other _ t To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Telephone # CFIRS ID# T-19 OCC 1. Fire Clear/Granted 2. Fire Clear/Denied K A-bj CE O s t�L��(fit ft�,.��(�� 360,5s 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code 5-f 0-11 1 Explanation of Denial or Special Conditions: Denial Code C = I CLA&SgOOYL1 y 0 L)lq-t Ceioqi ryt c",a u rV = SR TWO ey-ITS RGCk012.f-1� Fire Agency Denial Codes QDC) - - - - - - . 1. Exits 2.Construct. Newport Beach Fire Department 3. Fire Alarm Life Safety Services 4.Sprinklers 100 Civic Center Drive S.Housekeeping Newport Beach, CA 92660 6.Special Hazard 7.Other 74 n PO t N5'iff)4z% MAI Mbh r i Morris, Nadine From: Morris, Nadine Sent: Friday, May 10, 2013 2:02 PM To: 'kjalbert@tby.org' Subject: Fire Clearance Good afternoon Karen, I'm glad we were able to meet today regarding the relocation of the daycare program. Below is the capacity breakdown: Each classroom has a maximum occupant load of 13. 18 x 26 = 468 - 35 = 13 The youth center has a maximum occupant load of 59. 33 x 27 = 891 = 15 (based on tables/chairs) = 59 A minimum of two exits are required from each classroom and the youth center. The fire clearance capacity of 100 meets the requirements of the Fire Code. Therefore the fire clearance will be approved and the original mailed to CCL and a copy to your attention. Thank you and feel free to contact me with any questions. Nadine .Nadine Morris Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 (949) 723-3505 Fax I nmorris@nbfd.net �t Safety, Service, Professionalism KAREN JUNCKER ALBERT, M.Ed Director, Early Childhood Education f.iTern Ie;I` M hiyl: s�'`" TEMnLE BAT YAHM 1011 Camelback St. (949) 644-6563 Ext. 217 Newport Beach, CA 92660 Fax (949) 644-9810 www.tby.org email: kjalbert@tby.org Ll_1 5 !MVUiCl G L CM2-A-0 G� • � Alcaraz, Debbie From: Morris, Nadine Sent: Monday, August 31, 2015 3:09 PM To: Alcaraz, Debbie Subject: Invoice Attachments: 4100 Campus Dr #100 & #130.pdf Hi Debbie, Please invoice the attached facility $75.00 for the fire clearance inspection. Thank you, Nadine From: Morris, Nadine Sent: Monday, August 31, 2015 3:08 PM To:'carinne.atman@lindamoodbell.com' Subject: Fire Clearance Good afternoon Carinne, Attached is the approved fire clearance letter. An invoice in the amount of $75.00 will be mailed to the facility. Thank you and feel free to contact me with any questions. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net I V()1/�l 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 August 31, 2015 Carinne Atman, Learning Center Office Manager LINDAMOOD-BELL Learning Processes 4100 Campus Dr, Suites 100 & 130 Newport Beach, CA 92660 Subject: Fire Clearance 4100 Campus Dr, Suites 100 & 130 Newport Beach, CA 92660 Dear Carinne: The above subject location was inspected on August 31, 2015, 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 STATE OF CALIFORNIA - FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST Srn_Aso /REV_4.20001 See instructions on reverse. AGENCY CONTACTS NAME �� TELEPHONE NUMBER -3�,`�- REQUESTDATE PROGRAM ' EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER Y REQUESTCIDbE 1� J CODES 9. ORIGINAL A. FIRE CLEARANCE RENEWAL B.L(FESAFETY LICENSING ��a-foma� � �x2. AGENCY NAMEAND pecoLI/ ti v'�`� 3. CAPACITY CHANGE �nI J �Ow" ,�'Vj�ar►al ADDRESSffiyuwlpl�.' 4.OWNERSHIP CHANGE �1 (,� Ul L +U� �- 5. ADDRESS CHANGE 6. NAMECHANGE G al SSILA T OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUSCAPACrrY CAPACITY PREVIOUS CAPACITY FACILITY NAME LICENSE CATEGORY ` f 1 STREET ADDRESS (ACtrrer L=fforr) r NUMBER OF BUILDINGS CI a(c� RESTRAINT FACILITYCONTA TPERSON'SNAME %ACJLllNTACT /w'PERSON'STELEPHONENUMBER C4 y HOURS SPEUTAL UUNUI I IUNJ TO BE COMPLETED BY INSPECTING AUTHORITY Newport Beach Fire Department AUTHORITY Life Safety Services NAME AND 100 Civic Center Drive ADDRESS Newport Beach, CA 92660 L ISPECTOR'S NAME (Typed orPrIated) TELEPHONE NUMBER N,o,ND1 tie Moarens (qq%qq-3( /SP TION DATE INSPECTOR'S SIGNATURE (Typed orPMeo _ `-t 25 13 I ld EXPLAIN DENIAL OR LIST SPECIAL CLEARANCE /DENIAL CODE 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS CFIRS NUMBER OCCUPANCY CLASS E. HOUSEKEEPING /� 3 005"5 F. SPECIAL HAZARD G. OTHER Oas I NBFD Station Area Fire and Life Safety Inspection Worksheet Occupancy Type B Occupancy ID # 4831 Assigned LS3 Inspection Month October Name: Lindamoodbell Learning ProceE Location: 4100 CAMPUS DR # 100 Description : Part of (Tenant) ❑ Business License N/A Business Phone: (949)252-9275 Business EMail Address ❑ Bldg Status In Normal Use ❑ Stories 2 ❑ Fire Department Permits Required or UpdateNerify Contact Name Day Time Phone After Hours Phone Carinne Atman (949)252-9275 (949)252-9275 Attributes: Description Comments None Entered Permits / State Mandated Insp Issued Activities State Fire Clearance Attributes: ❑ Elevator(s) ❑ Knox Box ❑ Electric gate access ❑ Bi Directional Amplifier Assigne LS3 ❑ Swimming Pool QTY. ❑ ❑ AED ❑ Photovoltaic System Cpe i 4 1 Required i led Status Entered 14 Closed 09/08/2014 Fire Protection System ❑ Yes Cert Date T ❑ No Hood Last Serviced Fire Pump Service Date Printed: 09/08/2014 i FIRE iNSPECTiON CLEARANCE* If services are provided on public or nonpublic school sites only, this farm is not required. r Nib CN I IKt: rurcM MUb I tat UUMPI..E7 Eu BY THE INSPECTING AUTHORiTY Name of Nonpublic, Nonsectarian A enc : L bk lul.DD r BeL_ eAww I QJ Address: 41 b b C-�rmPV S 1)2. 'It- I DO Aj skD 4►3Z0 i r2.CaC:€ss5 tz� S City: i P&9oV r County: OKN-PC-E State: C: ►,1f- Zip• Q,�;1 (o (c p FACILITY CAPACITY: KIA This facility is approved to serve (check appropriate: one): ❑ a. ambulatory ❑ b. non -ambulatory i!Xc. both This facility complies with all applicable standards related to fire add life safety (check one): Yes f4 No ❑ , This facility is in violation of standards; the following corrections are needed (use back of form for more violations 1 1. 2. r- 3. 4. NOMIng contained herein snail iDe construed as encompassing the structural stability of any building, or as abrogating any more restrictive requirementsby other agencies 1 having jurisdiction. I, For answers to any questions regarding the above clearanc6, contact: _ Inspector(print name): k Q 0 9,Vzt Title: ( t�mpva eT ,2 I I Name of Inspecting Agency: -W Tele hone: L4 -fit D u Date of, Inspection. --97-7' -a,0( a Contact the local city or county fire department or the.fire. district providing fire protection services to arrange for this clearance. if you cannot obtain a io I fire clearance, your fire inspection can be ordered through the State 'Flre�f arshal. Contact our office for this form. All sites MUST have individual fire clearances. lid is a requirement of certification that a fire inspection clearance be issued by the appropriate city, county, fire district or state fire official not less that once each calendar year. *The use of this form is optional; other documentation may be utilized that provides the same information, location, and name of the nonpublic, nonsectarian agency. This form is not needed if services are provided by, your agency in a student's home, public or nonpublic school. u vo (Z 13 � 6 , , , 3 Alcaraz, Debbie From: Morris, Nadine Sent: Tuesday, February 02, 2016 11:01 AM To: Alcaraz, Debbie Subject: SCANNING - 3606 Catamaran Drive, Corona del Mar Attachments: chld-01@newportbeachca.gov_20160201_154833_000OfOe9001b.pdf Categories: SCAN Please scan, thanks. Nadine NADINE MORRIS I -Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net From: Morris, Nadine Sent: Monday, February 01, 2016 3:44 PM To: 'kewonna.murry@dss.ca.gov' Subject: 3606 Catamaran Drive, Corona del Mar Good afternoon Kewonna, Attached is the approved fire clearance form for Astoria Retirement Residence — Corona del Mar. Let me know if you need anything further. Thank you, Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department 100 Civic Center Drive, Newport Beach, CA 92660 (949) 644-3105 1 (949) 723-3505 FAX I nmorris@nbfd.net Y � Safety, Service, Professionalism 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 REQUEST DATE PROGRAM Dept. of Social Services (916) 651-7903 10/28/15 Adult & Senior Care EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Kewonna Murry 306005176 IA CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING Attn: Kewonna Murry 2. RENEWAL B. LIFE SAFETY AGENCY Community Care Licensing Division NAME AND Centralized Applications Unit 3. CAPACITY CHANGE ADDRESS 744 P Street 4. OWNERSHIP CHANGE Sacramento, CA 95814 5. ADDRESS CHANGE email: Kewonna.murry@dss.ca.gov 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 5 1 6 FACILITY NAME LICENSE CATEGORY Astoria Retirement Residence - Corona Del Mar RCFE STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 3606 Catamaran Drive 1 CITY RESTRAINT Corona Del Mar n/a FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Teodor Abrudan (714) 306-2253 24/7 SPECIAL CONDITIONS Please advise of any delayed egress features and/or locked perimeters. TO BE COMPLETED BY INSPECTING AUTHORITY Newport Beach Fire Dept. FIRE 100 Civic Center Drive AUTHORITY Newport Beach, CA 92660 NAME AND ADDRESS L INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS N A D1 N ('- M c) 12c2t (d 4-3106- 0 b6-S INSPECTION DATE I INSPECTOR'S SIGNATURE (Typed or Printed) EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS CODE 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIREALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER STAM OFCAUA FORNIA-HEALTH AND HUMAN SBRMCES AMCY CALIFORMLAUEPARTMENT OF SOCIAL SERVICES COMMUNITY CARS LICENMNO 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 roam, etc. Circle the names of the rooms that will be used by staff/resldentelclientslchildren. poor and window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Shaw room sues (e.g. 8.5 x 12 Keep close to scale. Use tha Sparta haunt Cnc h�AL! Enr..nM . b..a..e. State Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request ST050 AUGUST 27, 2012 CCL 3. Agency Contact 4. Telephone 5. Evaluator (714) 703-2800 Fax (714)703-2831 M. MALEK/WT E203 Department of Social Services 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 300600711 3A 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 750 The City Drive #250 4. Ownership Change . Orange, CA 92868 5. Address Change 6. Name Change NOTE: PRESCHOOL= 65 (INCREASING) 7. ' TOTAL CAPACITY= 65 Hours: Monday - Friday 7:00 am - 6:00 pm Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance -Date 11/3/1980 Capacity Medical` Prev.Cap Capacity Medical Prev.Cap Care? Care? 65 18. Facility Code. - 16 - CCC 65 No 43 0 No 0 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC NEWPORT HARBOR LUTHERAN CHURCH 1 2. GACH/R 10. Clinic 3. SH 11. -Jail 14. Street Address (Actual Location) 15. Restraint 798 DOVER DRIVE - NONE 4. APH 12. ICF/DDN 5. PHF 18. RCF City Zip Code 16. Under NEWPORT BEACH, CA 92663 24 HRS. 6.'SNF 14. CCF 7. ICF/OT 15, 'DAF 17. Facility Contact Person Telephone # 16a. Special LEVEE, ROBIN 949-548-7198 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 2. Fire "Clear/Denied 64�Kn (P-4 3. Fire-Clear/Withheld Inspection Date In pect8r's Signature Clearance Code Explanatign of D nial or Special Conditions: Denial Code Fire Agency Denial Codes 1. Exits 2.Construct. 3. Fire Alarm NEWPORT BEACH FIRE PREVENTION BUREAU 4.Sprinklers 3300 NEWPORT BLVD. 5.Housekeeping NEWPORT BEACH, CA 92663 6.Special. Hazard 7.Other • • STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY FACILITY SKETCH (Floor Plan) CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING 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 12). Keep close to scale. Use the space below. See back for_y_ard sketch. FACILITY NAME: LIC 999 (3/99) ADDRESS: `% 18 CA �■ ■QQ��i■ Q■illr ■■■■■Q■■■■nn8■■■ ■■■i`lil■■■i�r�" �i■n■■■■nni■■■n■ . �11.■r�■ awd- a ��■ ■■■■■0 n■■�n ■ r imam am mum %r. ■ "■QQ■i ■■ "'Q■iiiiiQiiQQQQ■MI�'■■"■.�a��'Q■ ■■■■■■■■■■■■ NNE ■■■■■n\■■■■ �Q "�"�:::■'■■■■■ o■■■■■■■■■Q■■■■■■■:■■■ :■.■■ �■ ■■ ••••••QQQQQ :'000QQQQQ: QQQQQ : :QQ ■ ■ ■ ■■■■Q■Q■■■�■■■ ■■■■ ■■■■■ ■■■ MEMO ■Q■Q■ ■■■ ■■■ ■■■ nQ■■■■■■■■1 ■■■■■■iIn■■ ■■■■■■i■■■■ ]ME �■ ■■ ■■■■ ■ ■ ■ _■�,,■■ MEN ■11■■ ■ ■ M■■■Q"QQ"QQi0Q�nQQ■■■■�■■■■ ` '■"i ■.■■n■■ QQ ■■■ ■ ■■■ 'QQQ■'■'■'QQ�.10 MEN ■■■■t ■■ ■QQQniQ■iQQQQiQ' ■�1 ■■�■ rl"y'7�� n■■■■■■■■■■■■■■■■■■■� �. ■��■: i nnwu n■■■■■■■■■ ■■■■■ n�iimQ ,..■ n■■■■■■■■ ■ ■■■ Q ""it"i:i'��■■■■■■■■■■■■■■■■■■■.f ■■■� ■ �'�■'�'��iii 'Q"QiQ�.ii.'i1�:Q�� QQQQQQQ OEM QQ■E■■■. MEN .■i■■\ ��■��,'r,rTali■■■■■■■■■ ME ■n■■ ■ ■■■■QQ■'QQQ■'i 'i■"'i■Qi�■■■■■■ NONE �■■■■■ " ■■■ �'i'■.Q.■ ■ ■■ ■ Q.Q■ CQQ' 'Q'QQQQiiQ■"iQ'QQQQ'i■'■■n■ QQ. ■■■■■■■■■■■■ 'Q■■Q■QSEE■ ■■■■Q■Q■■■ ■ ■ QQ MOSS OEM ■■ ■MEERMSSM. ■.Q"........■....■� ■ MEMO "Q■■■■■■■■■■■■ ■■■om■■n■■ .■■Wa M MEN . Q ■ ■■■■■ ■■ ■■n■n■Q■ ■n■■n QQQ"■■Q.�■QQ ■n ■n'iii Q ■■ 0 'Q'n■■■ ■■■■ ... ■ � ■� ■n■■■■� ■■■■n ■i'i■n ■■ ■Q■■■■■■�■■n■■■■.■ ■■ ■0SM 'QQQ■■■ ■ 'i a C' ■""i'■Qi�' ■■■■■ ■■■■■ ■■ ■ C■n'■'■QiQQiam■n■■■■■noa■i'i QQMENEM ■nl•■■■■■■■■■■■ 0 STATE OF CALIFORNIA. HEALTH ANO WELFARE AGENCY 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 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 �gO ......... ............. ... . ........ ... .. . ............ ... ... .. . ... ............ ..... .... .... ...... . . .......... .... ... ...... . .. . . . . . . . . . . ... ....... . .......... . . . ........ .... ........ ... 4 .......... h.5 . .... ... . . ......... ... .......... .. .. ....... ... ... ......... ... ... ..... 4 ........ .... .. ....... . . . . . . . . . . . . ... .... .......... .... .... . ...... . . . . . . . . . . ........ ............. . . . . . . . . . . . . . . . . . . . . ....... . ... ... ... ........ ............. . - - - - - - - - - - .......... .......... .. . ...... - - -- - - ..•......... .... .4 ... .... i ... ....... . . ... ... ......... .... .... ..... ................. ... ... ........ ... ... ........... .. . .... . ........... ... .. I ......... ......... ... .... . . . ........ ... ........ ... . ... ... ...... .... .... . .... .... ..... ............ ;-.� ... ... ........ .... ....... ... . . .......... ... ......... . . ........ i .......... ... . . ............. ......... 1 ......... ... ......... ... ... ........ i ......... .... ... .. .........ii ............ .... ... ....... ......... ... . . .... ... t ... . ........ . . ....... ........ ........ ... ....... ............ i 1. .... .... .... .......... ... ... ........ .......... ..... ......... 4 ........ ............ ........ --------- .......... ... ... ... ......... ... ..... . .... ... ... . ..... . ... .............. ... ......... .. .... ........ ............. ......... ... .............. .... .............. ... ......... ......... ... .... ........ ... ........ ... ........ .... ... 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F" ......... ... ... . . .. ... .... ..... ... ........ --- ---... ........ ... ....... .... . ..... .......... ..... ----- - ..... ....... . ..... ....... . .... ......... .... . ........... -... .......... ... ........ ... .. . ... .. ......... .......... .. ....... ....... 7..q...........4......... .... . . . . ...... ... ............. ........ .... .... .... .... .... ..... ......... ... ........ ... ... ........ ... ......... .... ......... ... ... . .. . . .... .... .... .. ... .... ... ........ ... ........ .... .... . ........ ........ ... ... -144 -4 ..... + LIC M (W91) "� { 44-> I2�[i_..afa y q h t" f Mate File Marshall 1. Request Date 2. Program Fire Safety Inspection Request STD 850 JUNE 20, 2014 CCL 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714)703-2831 M. MALEK/WT E203 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 370 300600711 3A 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 6. Name Change NOTE: PRESCHOOL= 73 (INCREASING) 7. TOTAL CAPACITY= 73 Hours: Monday - Friday 7:00 am - 6:00 pm Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date 9/13/2012 Capacity Medical Prev.Cap Capacity Medical Prev.Cap 18. Facility Code -16 - CCC Care? Care? 73 73 No 58 0 No 0 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC NEWPORT HARBOR LUTHERAN CHURCH 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 798 DOVER DRIVE NONE 4. APH 12. ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under NEWPORT BEACH, CA 92663 24 HRS. 6. SNF 14. CCF 7. ICF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special LEVEE, ROBIN 949-548-7198 NONE 8. ICF/DD 16.Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Telephone # CFIRS IN T-19 OCC 1. Fire Clear/Granted CM 2. Fire Clear/Denied D VZ t2A (a `i - 3 I O5 3 SS 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code NA - Explanation of Denial or Special Conditions: Denial Code MU INQ�_ # ( - M AX I H0 M 0C L0 I S bv1/kV2 -*a- mAu►V�-kv KA 0CC, L,0 s a Z. Fire Agency Denial Codes 1.Exits 2.Construct. Newport Beach Fire Department 311re Alarm Life Safety Services 4.Sprinklers 100 Civic Center Drive 5_Housekeeping— Newport Beach, CA 92660 6.Special Hazard 7.Other �� lyl t - 5-1 V S 14:k G,- Aau� Ac� O IFS S FIRE INSPECTION CLEARANCE* If services are provided on public or nonpublic school sites only, this form is not required. THIS ENTIRE FORM MUST BE COMPLETED BY THE INSPECTING AUTHORITY. Name of Nonpublic, Nonsectarian Agencv: N tax) Pne-i- 1:2),Li0,LE t I <c�t�c�Prn►.» 1. Address: Citv:NcwPnr:r r•,eAt—jACounty: State: CA- zip: cla(Obh FACILITY CAPACITY: This facility is approved to serve (check appropriate one): a. ambulatory b. non -ambulatory c. both This facility complies with all applicable standards related to fire and life safety (check one): Yes No ❑ This facility is in violation of standards; the following corrections are needed (use back of i form for more violations) 1. 2. 3 4. Nothing contained herein shall be construed as encompassing the structural stability of aoy building, or as abrogating any more restrictive requirements by other agencies ,having jurisdiction. For answers to anv auestions reciardinq the above clearance, contact: Inspector (print name): NjAblIjEp Title: i2 Signature: Name of Inspecting Agency: - i'L%t , cd-1 ► t2 C7 Telephone: VLH to4Lt---EtQ5_ Date of Inspection: ! Contact the local city or county fire department or the fire district providing Tire protection services to arrange for this clearance. If you cannot obtain a local fire clearance, your fire inspection can be ordered through the State Fire Marshal. Contact our office for this form. All sites MUST have individual fire clearances. It is a requirement of certification that a fire inspection clearance be issued by the appropriate city, county, fire district or state fire official not less that once each calendar year. "The use of this form is optional; other documentation may be utilized that provides the same information, location, and name of the nonpublic, nonsectarian agency. This form is not needed if services are provided by your agency in a student's home, public or nonpublic school. Page 5 of 21 5' )P TV m E: rrLY bp-oop 41� contact: FIRE INSPECTION CLEARANCE* If services are provided on public or nonpublic school sites only, this form is not required. THIS ENTIRE FORM MUST BE COMPLETED BY THE INSPECTING AUTHORITY. Name of Nonpublic, Nonsectarian A enc : E T - -� l< �, QT Address: 1" I D ritv'KICIA, fDAV2T County: ©_ �' State: CIor up Zi : q FACILITY CAPACITY: This facility is approves to serve Icnecri dNN«yrja« wolw• a. ambulatory 4. _ Nothing contained herein shall be construed as encompassing the structural stability o any building, or as abrogating any more restrictive requirements by other agencies having jurisdiction. For answers to I ele none. 7 w —r - .7-> 1 �U Contact the local city or county fire department or the fire district providing fire protection services to arrange for this clearance. if you cannot obtain a local fire clearance, your fire inspection can be ordered through the State Fire Marshal. Contact our office for this form. All sites MUST have individual fire clearances. It is a requirement of certification that a fire inspection clearance be issued by the appropriate city, county, fire district or state fire official not less that once each calendar year. *The use of this form is optional; other documentation may be utilized that provides the same information, location, and name of the nonpublic, nonsectarian agency. This form is not needed if services are provided by your agency in a student's home, public or nonpublic school. Page 5 of 21 F�NUGH�� (.. -Is -D::� IQ Is ? � �A v-)-) -) 20 - Fs3 4-, PIN 0 CITY OF NEWPORT BEACH REVENUE DIVISION 100 CIVIC CENTER DRIVE P.O.BOX 1768, NEWPORT BEACH, CA 92658-8915 E-Mail Address: RevenueHelp@newportbeachca.gov NUi4L'&: PECIAL:Pt_RMIIS`VO_CEr :::'::::s .>'.>:::<:==:>? #BWNKJHD #AR00000039350# NUMBER: 0000003935 COHN, STEVEN OD/FCOVD INVOICE: FS54004458- OPTOMETRY INV DATE: 12/11/13 901 DOVER DR #100 DUE DATE: 01/10/14 NEWPORT BEACH, CA 92660 NBID: 12575 Description Qty Unit Price Tax Extension ------------------------------------------------------------- ---- ------------- CLINICS AND OFFICES 1.00 83.00 0.00 83.00 INSP DATE: 09-18-13 LOCATION: 901 DOVER ST #100 ---------------------------------------------------------------------------------- TOTAL INVOICE: $ 83.00 PAYMENTS/ADJUSTMENTS: $ 0.00 PAST DUE: $ 0.00 PENALTIES/INTEREST: $ 0.00 TOTAL AMOUNT DUE: $ 83.00 BILLING QUESTIONS SHOULD BE DIRECTED TO THE FIRE DEPARTMENT AT (949) 644-3106. THANK YOU. ..,,Please; etabh_: and xeturn' -tHe -lower : orEi on of '£Yi 's• ?invoice:->witH'< "ou'r-':- a ent ,'' °`-'::: >> : i>a>:; ?:s? -:' :> .`:`-: ; '::'`•'r':::;:;? ANNUAL & SPECIAL PERMITS - INVOICE COHN, STEVEN OD/FCOVD OPTOMETRY 901 DOVER DR #100 NEWPORT BEACH, CA 92660 TOTAL AMOUNT DUE: $ INVOICE: FS54004458 INV DATE: 12/11/13 DUE DATE: 01/10/14 NBID: 12575 83.00 AR 0000003935 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 October 2, 2014 Joann Hatch 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 Joann: The above subject location was inspected on October 2, 2014, for compliance with local fire code requirements. At that time no violations of the California Fire Code were found. A fire clearance was granted. 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(D Z (D ?p o -, 'p m (D "O io Z Al (D OD �' 0 0 n rn Q O v O� Alcaraz, Debbie From: Morris, Nadine Sent: Thursday, December 03, 2015 3:50 PM To: Alcaraz, Debbie Subject: Off Hours Invoice Attachments: chld-01@newportbeachca.gov_20151203_072159_OOOOd51b001b.pdf Hi Debbie, Please invoice TRL Systems for an off hours inspection: 12/03/2015 6 AM — 7AM Thank you, Nadine I� Alcaraz, Debbie From: Morris, Nadine Sent: Friday, August 28, 2015 8:23 AM To: Alcaraz, Debbie Subject: Invoice Attachments: chld-01@ newportbeachca.gov_20150828_082812_00001c00001b.pdf Debbie, Please invoice ORR Fire Protection for an off hours inspection. Thank you! 08/28/2015 6:00AM-7:00AM r at+ A a a ono uo 9 ? A 9 A a r M Lo to , ® O O 8 , a a a s i a 0 O 4t O a O N OF a g' d• C? a a s a a a a �/O L6 C � J -� w N :_ :? � � LL C� n. m U) m w h in QQJ T t� O p K � 1- N t0 0. 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C4 U) 0 in m a) v- 2 2 .2 a- 0 W c IL U) CD tam al 0) m tm CD ED < 3- 3: CD 0) (D -C: -E ro- v 0 C: Co z z 0- Lu R 0 -- -- -- m nt. < a; (�D r = co a) CD 0 co In m m U- m 0A.Lo m 0 -0 0 0-10 0 "a at) �o 0 5, 0 013 'i E 0 < CL < < 11 0 F- 0 < < z Z LL M Alcaraz, Debbie From: Spiker, Chad Sent: Friday, February 05, 2016 7:53 PM To: Alcaraz, Debbie Subject: FW: 2507-2515 Eastbluff Dr Attachments: IRP--- Eastbluff-Village-Center-l.pdf, IRP--- Eastbluff-Village-Center-2.pdf, IRP--- Eastbluff-Village-Center-3.pdf Categories: SCAN Hi Debbie, Attached are the fire alarm monitoring system tests for 2507-2515 Eastbluff. Thank you, Chad Spiker Captain Newport Beach Fire Department (949) 644-3104 From: Jimmy Kim Finailto:jimmykim@irvinecompany.com] Sent: Friday, February 05, 2016 1:51 PM To: Spiker, Chad Subject: Re: 2507-2515 Eastbluff Dr Chad, Attached are the inspection documents for Eastbluff. Jimmy Kim Operations Manager Irvine Company Retail Properties 110 Innovation Drive I Irvine, California 192617 Phone 949.720.3105 1 Fax 949.720.3101 jimmykim@irvinecompany.com On Fri, Feb 5, 2016 at 11:27 AM, Spiker, Chad <CSpiker@,nbfd.net> wrote: Jimmy, 1 Thank you for your quick response Chad Spiker Captain Newport Beach Fire Department (949) 644-3104 From: Jimmy Kim [mailto:jimmykim irvinecompany.com] Sent: Thursday, February 04, 2016 1:59 PM To: Spiker, Chad Subject: Re: 2507-2515 Eastbluff Dr Hi Chad, We will be working on getting the 5 yr cert again this year. I have also reached out the the fire monitoring company and will get the test paperwork. I should be able to send it to you soon. Jimmy Kim Operations Manager Irvine Company Retail Properties 110 Innovation Drive I Irvine, California 192617 Phone 949.720.3105 1 Fax 949.720.3101 jimmykim@irvinecompany.com On Mon, Jan 25, 2016 at 6:12 PM, Spiker, Chad <CSpiker(a�,nbfd.net> wrote: Hi Jimmy, I just spoke with Blake and he stated he was going to contact you. The 5 year certification is due on the fire sprinkler system. Also, I need the annual fire alarm system test paperwork. That would be the same ones you sent last year, however this will show the system is certified through 2016. If you have any questions please email me anytime. Thank you, Chad Spiker Newport Beach Fire Department Notice to recipient: This e-mail is only meant for the intended recipient of the transmission, and maybe a confidential communication or a communication privileged bylaw. If you received this e-mail in error, any review, use, dissemination, distribution, or copying of this e-mail is strictly prohibited. Please notify us immediately of the error by return e-mail and please delete this message from your system. Thank you in advance for your cooperation. Notice to recipient: This e-mail is only meant for the intended recipient of the transmission, and may be a confidential communication or a communication privileged by law. If you received this e-mail in error, any review, use, dissemination, distribution, or copying of this e-mail is strictly prohibited. Please notify us immediately of the error by return e-mail and please delete this message from your system. Thank you in advance for your cooperation. Fire Alarm and Life Safety System Inspection Certificate For IRP - Eastbluff Village Center 1 2400-2555 Eastbluff Dr 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 Dec 28, 2015 Building: IRP - Eastbluff Village Center 1 Company: Interface Systems Contact: Bill Schmidt Contact: Nancy Montejano Title: Service Manager Title: Fire Tech Executive Summary Generated by: BuildingReports.com Building Information - Building: IRP - Eastbluff Village Center 1 Contact: Bill Schmidt Address: 2400-2555 Eastbluff Dr Phone: 714-863-5348 Address: Fax: City/State/Zlp: Newport Beach, CA 92660 Mobile: Country: United States of America Email: Irisp,ecton Performed' Company: Interface Systems Inspector: Nancy Montejano Address: 3750 Schaufele Ave., STE 200 Phone: 714.863.4354 Address: Fax: City/State/Zip: Long Beach, CA 90808 Mobile: Country: United States of America Email: nancy.montejano@greateralarm.com e S.: st rnCon ; torl Unit �' Manufacturer: Fire-Lite Inspection Date: 12/28/2015 IDC Style: Model Number: MS9200UDLS Install Date: 10/21 /201 1 SLC Style: Software Version: Version Date: 10/21 /2011 NAC Style: Location: Electrical Rm Beside Urgent Care 2507 Current Protection: M'Ointorf ng Company: Phone: Account #: Central :Station Signal Verifieatior ,` ` Type: Mfg: Model #: Test Time/Date: Restore Time Interface Systems 1 02/05/2016 Inspection. Suminary, . Category Total-Items ery se, Pa"seed° -...- Failed/othe"r Supervisory Initiating Indicating Control 2 3 1 2 25.00% 37.50% 12.50% 25.00% 2 3 1 2 100.00% 100.00% 100.00% 100.00% 2 3 1 2 100.00% 100.00% 100.00% 100.00% 0 0 0 0 0% 0% 0% 0% Totals 8 100% 8 100.00% 8 100.0.0% . _ 0 0% Ceril�lC'atlon ........, ,. - - - Company: Interface Systems Inspector: Nancy Montejano Signed: Building: IRP - Eastbluff Village Center 1 Contact: Bill Schmidt Signed: Nand Monte] ano Certifltatloh T e,.; .. ;Number' • ; • ::1 Interface Systems Notes & Recommendations Generated by: BuildingReports.com ite Bzit l i- ;I", =' Eastbluff''�U ,age Center . Control. Panel: 1 -Fire-C:. 1VIS92QQUUD, LS: , The Notes & Recommendations Report details additional inspection notes made by the Inspectors during the course of the building inspection. Notes are grouped by Category. ScanlD,,,;, �Note� �Dexice."T ne' ' _ �,Locatlon "'" � Comment 1:68771,44 1 Waterflow Switch Riser Rm Beside ftent'Care 2507 IN At Riser Interface Systems 3 02/05/2016 Inspection & Testing Generated by: BuildingReports.com Coitro'1 Panel: 1` - Fire -Lute T! �V Building ,I'RB - EastMU illage' Center � S9200LTDLS 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. Device, T e Location Service ; ' . Time _ Date _ Passed Control Battery Electrical Rm Beside Urgent Care 2507 Visually quarterly 3:37:19 PM 12/28/2015 Control Panel Electrical Rm Beside Urgent Care 2507 Visually quarterly 3:37:07 PM 12/28/201 5 Indicating Bell Riser Bell Visually quarterly 3:36:50 PM 12/28/201 5: Initiating Pull Station Electrical Rm Beside Urgent Care 2507 Visually quarterly 3:37:40 PM 12/28/2015 Smoke Detector Electrical Rm Beside Urgent Care 2507 Visually Checked 3:37:32 PM 1'2/28/201 5 Quarterly Waterflow Switch Riser Rm Beside Urgent Care 2507 Visually quarterly 3:38:05 PM 12/28/2015 Supervisory Tamper Switch OS&Y In Front Of Urgent Care 2507 1 of 2 Visually quarterly 3:37:48 PM 12/28/2015 Tamper Switch OS&Y In Front Of Urgent Care 2507 2 of 2 Visually quarterly 3:37:57 PM 12/28/2015 Interface Systems 4 02/05/2016 Service Summary Generated by: BuildingReports.com Buldii IRP '-'astlli�f V°11a "`,e C.ezater:J The Service Summary section provides an overview of the services performed in this report. -Device TY061., Service - ., „ t, ,; Rivainti' Passed . Battery Visually quarterly 1 Bell Visually quarterly 1 Control Panel Visually quarterly 1 Pull Station Visually quarterly 1 Smoke Detector Visually Checked Quarterly 1 Tamper Switch Visually quarterly Z Waterflow Switch Visually quarterly 1 Total 8 Interface Systems 5 02/05/2016 Inventory & Warranty Report Generated by: BuildingReports.com Control Panel:: 1 -;Fire-Cite ., Bluilditi4: �I,RP' - Eastb'luff l age Center l . 1VIS'920.4UDI 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 r„ + :Cate?'o', %tof`invento.', uanfi Bell Indicating 12.50% 1 Control Panel Control 12:50% 1 Battery Control 12.50% 1 Smoke Detector Initiating 12.50% 1 Pull Station Initiating 12.50% 1 Tamper Switch Supervisory 25.00% 2 Waterflow Switch Initiating 12.50% 1 T e Q' s Model:#` Descri tion,;,, Install=;Rate,, In Service 3 .Years;to .3 Years: 'Yuasa Qty 2 Battery 1 NP12-12T 11 /26/2012 - Fire—Lite Control Panel 1 MS92000DLS 10/21 /201 1 In Service: -. 5. Years to I0 Years , . .. Smoke Detector 1 10/26/2007 Fire—Lite Pull Station 1 _10/26/2007 Potter Electric _ . -..... Bell 1 10/26/2007 Waterflow Switch 1 VSR-F 10/26/2007 'System Sensor Tamper Switch 2 OSY2 10/26/2007 Interface Systems 6 02/05/2016 Fire Alarm and Life Safety System Inspection Certificate For IRP - Eastbluff Village Center 2 2400-2555 Eastbluff Dr 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 orprovided for immediate review and approval. Inspection Date Dec 28, 2015 Building: IRP - Eastbluff Village Center 2 Company: Interface Systems Contact: Bill Schmidt Contact: Nancy Montejano Title: Service Manager Title: Fire Tech Executive Summary Generated by: BuildingReports.com Building Information', Building: IRP - Eastbluff Village Center 2 Contact: Bill Schmidt Address: 2400-2555 Eastbluff Dr Phone: 714-863-5348 Address: Fax: City/State/Zip: Newport Beach, CA 92660 Mobile: Country: United States of America Email: Inspect or ;P,erfon d By, .. Company: Interface Systems Inspector: Nancy Montejano Address: 3750 Schaufele Ave., STE 200 Phone: 714.863.4354 Address: Fax: City/State/Zip: Long Beach, CA 90808 Mobile: Country: United States of America Email: nancy.montejano@greateralarm.com Sstem'Coiitrol;Vriit. Y,. :.... ,., Manufacturer: Silent Knight Inspection Date: 12/28/2015 IDC Style: Model Number: SK-5208 Install Date: 10/21 /2014 SLC Style: Software Version: Version Date: 10/21 /2011 NAC Style: Location: FACP & Phone Cabinet Behind Bistro Le Current Protection: Crillon 2523 " lYlonitoaring Company: Phone: Account #: Central Station Signal Verification . Type: Mfg: Model #: Test Time/Date: Restore Time Interface Systems 1 02/05/2016 Inspection Summary Category . Total items Serviced '., Passed - Failed/Other Supervisory Indicating Initiating Control 1 1 3 2 14.29% 14.29% 42.86% 28.57% 1 1 3 2 100.00% 100.00% 100.00% 100.00% 1 1 3 2 100.00% 100.00% 100.00% 100.00% 0 0 0 0 0% 0% 0% 0% Totals 7 1 00%- -'1' 7 a:oo.00%` - i : 1 oo.00% . - o o% ' Certification Company: Interface Systems Inspector: Nancy Montejano Signed: Building: IRP - Eastbluff Village Center 2 Contact: Bill Schmidt Signed: Nancy 1Vlontejano ; Certification T e, Number , Interface Systems 2 02/05/2016 Notes & Recommendations Generated by: BuildingReports.com C`otrol Paned°;:1 - Serit Knight Building:: IRP Village.'.eri�e>: :astbluff SK,5208. The Notes & Recommendations Report details additional inspection notes made by the Inspectors during the course of the building inspection. Notes are grouped by Category. ScaniD; Note° Devtce;T e., Location ` ' corriirnent .., . 1,6817150 1 Waterflow Switch Riser Behind'Bistrq LgVillon 2523 .-_„ _, Passed IN in Rear by Unit 2525 Interface Systems 3 02/05/2016 Inspection & Testing Generated by: BuildingReports.com i, .. :.. Control:, Pararel. J, - `Sleet 'Knight Center 2:,; B;i1'dng:, ARP:,- ;Eastbinff:V.illage .. SK=520 , 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. Device;T ;e; : Location-' S,elilce = Tlirrie: Date Control Battery FACP & Phone Cabinet Behind Bistro Le Crillon Visually quarterly 4:09:20 PM 12/28/2015 - 2523 Control Panel FACP & Phone Cabinet Behind Bistro Le Crillon Visually quarterly 4:09:12 PM 12/28/2015 2523 Indicating Bell Riser Behind Bistro Le Crillon 2523 Visually quarterly 4:09.32 PM 1 2/28/201 5 Initiating Pull Station FACP Visually quarterly 4:08:53 PM 12/28/2015 Smoke Detector Panel Smoke Visually Checked 4:09:04 PM 12/28/2015 Quarterly Waterflow Switch Riser Behind Bistro Le Crillon 2523 Visually quarterly 4:09:47 PM 12/28/2015 Supervisory Tamper Switch Riser Behind Bistro Le Crillon 2523 Visually quarterly4:09:40 PM 12/28/2015 Interface Systems 4 02/05/2016 Service Summary Generated by: BuildingReports.com Btihdrig::IRP - Eastbliff Village The Service Summary section provides an overview of the services performed in this report. Devlc'e T e .. .. S.ervice� ` uantt" . . Passed- Battery Visually quarterly 1 Bell Visually quarterly 1 Control Panel Visually quarterly 1 Pull Station Visually quarterly 1 Smoke Detector Visually Checked Quarterly 1 Tamper Switch Visually quarterly 1 Waterflow Switch Visually quarterly 1 Total 7 Interface Systems 5 02/05/2016 Inventory & Warranty Report Generated by: BuildingReports.com Bulling. IRP - E,astbluff Vllrage'Center:2;. SK=52'08 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. Devtce.;or...ltem7; ;,Cate o % of invelhto' " '" uanti Pull Station Initiating 14.29% 1 Smoke Detector Initiating 14.29% 1 Control Panel Control 14.29% 1 Battery Control 14.29% 1 Bell Indicating 14.29% 1 Tamper Switch Supervisory 14.29% 1 Waterflow Switch Initiating 14.29% 1 ; Qtyl E' Models.:#. DescN' `tiont,.; Instalir,Date. In, Semce'.- ;l` Year to 2 Years Silent Knight Control Panel 1 SK-5208 10/21 /2014 lac Seviee . 2' Yearstto 3' Years Smoke Detector 1 O1 /lr5/2014 Fire-Lite Pull Station 1 01 /15/2014 'Ultra Tech (2) Batte ry 1270 Lead Acid 01 /1 5/2014 ln. Se ice-`5'.YMks to 10 .Years Potter Electric Bell 1 08/08/2009 Tamper Switch 1 OSYSU-2 08/08/2009 Waterflow Switch 1 VSR-F 6inch 08/08/.2009 Interface Systems 6 02/05/2016 Fire Alarm and Life Safety System Inspection Certificate For IRP - Eastbluff Village Center 3 2400-2555 Eastbluff Dr 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 Dec 28, 2015 Building: IRP - Eastbluff Village Center 3 Company: Interface Systems Contact: Bill Schmidt Contact: Nancy Montejano Title: Service Manager Title: Fire Tech Executive Summary Generated by: BuildingReports.com Building Information Building: IRP - Eastbluff Village Center 3 Contact: Bill Schmidt Address: 2400-2555 Eastbluff Dr Phone: 714-863-5348 Address: Fax: City/State/Zip: Newport Beach, CA 92660 Mobile: Country: United States of America Email: Inspection Performed B Y., Company: Interface Systems inspector: Nancy Montejano Address: 3750 Schaufele Ave., STE 200 Phone: 714.863.4354 Address: Fax: City/State/Zip: Long Beach, CA 90808 Mobile: Country: United States of America Email: nancy.montejano@greateralarm.com .System, �Conttol Uniti Manufacturer: Radionics Inspection Date: 12/28/2015 IDC Style: Model Number: D2071 A Install Date: 10/21 /201 1 SLC Style: Software Version: Version Date: 10/21 /201 1 NAC Style: Location: Phone & FACP Closet Behind The UPS Store Current Protection: 2549-B Monitoring Company: Phone: Account #: Central Station S'.gnal Vetf'cat'i'on. Type: Mfg: Model #: Test Time/Date: Restore Time Interface Systems 1 02/05/2016 Inspection Summary, CategoryQty Total items Serviced Passed' _' Failed%ofhiet . %, % %. . Supervisory Initiating Indicating Control 1 1 1 2 20.00% 20.00% 20.00% 40.00% 1 1 1 2 100.00% 100.00% 100.00% 100.00% 1 1 1 2 100.00% 100.00% 100.00% 100.00% 0 0 0 0 0% 0% 0% 0% Totals 5 1,00% 5 100:00% 5: 100:00%, 'Certification Company: Interface Systems Inspector: Nancy Montejano Signed: Building: IRP - Eastbluff Village Center 3 Contact: Bill Schmidt Signed: Nancy Montejana, :.... rvCertification T pd Interface Systems 2 02/05/2016 Notes & Recommendations Generated by: BuildingReports.com - C0iiir Panel: ,�. Rad onics: „ Building;: IRP -, E°astblif V=1°lager' Center '3 D26, T;� The Notes & Recommendations Report details additional inspection notes made by the Inspectors during the course of the building inspection. Notes are grouped by Category. ScanlD, Note° .Device T e; "' Location. `Comment. 01 1 Bell The'UPS.Store,.ln, Front of UPS Store Passed Note: before Testing Water Gone Bell Let the units Know that are Near the Fire Bell that you will be testing the Bell. Rio 16877154 2 Waterflow Switch Riser Behind The UPS' Store 2549=B' SEE'NOTES Passed-, Below. W : Before doing any testing make sure you have Ralph's put their fire system on test at the same time as ours it's tied into our fires stem and takedown NACS at their FACP at Ralph's. Interface Systems 3 02/05/2016 Inspection & Testing Generated by: BuildingReports.com B.ldng.: IRP;, Eastbluff yillage'SCerite:3, ... � 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. 'Deice T e ; Location, Seniice Time; Date.. Control Battery Phone & FACP Closet Behind The UPS Store Visually quarterly 4:31:52 PM 12/28/2015 2549-B Control Panel Phone & FACP Closet Behind The UPS Store Visually quarterly 4:31:44 PM 12/28/2015 2549-B Indicating Bell The UPS Store In Front of UPS Store Visually quarterly 4:31:36 PM 12/28/201,5 Initiating Waterflow Switch Riser Behind The UPS Store 2549-B SEE NOTES Visually quarterly 4:32:11 PM 12/28/2015 Below Supervisory Tamper Switch Riser Behind The UPS Store 2549-B Visually quarterly 4:32:01 PM 12/28/2015 Interface Systems 4 02/05/2016 Service Summary Generated by: BuildingReports.com Building,: IRR 4,:astbl£'1`lage',Cnter 3' - The Service Summary section provides an overview of the services performed in this report. ;Device; T :e G S:eivice .. Quanti, :. Pasged Battery Visually quarterly 1 Bell Visually quarterly 1 Control Panel Visually quarterly 1 Tamper Switch Visually quarterly 1 Waterflow Switch Visually quarterly 7 Total 5 Interface Systems 5 02/05/2016 Inventory & Warranty Report Generated by: BuildingReports.com C.ontrol,Panel:;-'1 Biildug°:, I;RP; Eastbluff pillage 3 - .center` D2;07aA.;`3 - The Inventory & Warranty Report lists each of the devices and items that are included in your Inspection Report. 71 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 :orIt6- ° Cate'"d'�: %of invento"' uantl Bell Indicating 20.00% 1 Control Panel Control 20.00% 1 Battery Control 20.00% 1 Tamper Switch Supervisory 20.00% 1 Waterflow Switch Initiatin 20.00% 1 "T" 'e G.;" _Modell# Desert"floe „ Install.Date j .. .. „ ... IA.S Ce - .2°fears Battery 1 (1) 1270 Lead Acid 06/06/2013 ,. In Service.-.3 ;Yearsto .5;'Years` Radionics Control Panel 1 D2071 A 10/21 /201 1 .. ;In:Se�vice -.5` �YeaNsao'lO YeaYs': Potter Electric Bell 1 VSR 10/10/2008 Tamper Switch 1 OSYSU-2 10/10/2008 Waterflow Switch 1 VSR 10/10/2008 Interface Systems 6 02/05/2016 i Alcaraz, Debbie From: Spiker, Chad Sent: Tuesday, September 15, 2015 4:57 PM To: Alcaraz, Debbie Subject: FW: Annual Fire Safety Inspection of 2503 Eastbluff Dr Attachments: 2012-5 yr. Insp. report.pdf Categories: SCAN Hi Debbie, Attached is the documentation for 5 year testing at 2503 Eastbluff Dr. Thank you, Chad Spiker From: Lisa Manolovitz [mailto:LManolovitz@stonewood.net] Sent: Tuesday, August 04, 2015 1:33 PM To: Spiker, Chad Subject: RE: Annual Fire Safety Inspection of 2503 Eastbluff Dr Chad, Attached is the copy of the 5 Year Certification. As you know I am new on the project and have found out that annual inspections have not been completed in the past. I am sending the authorization to the company to get this scheduled. As soon as I have the report, I will forward it on to you. Let me know if I can get you anything else. Thank you and have a great day! Lisa Manolovitz Project Manager S-rO N EVV OO D ,, , .,, Stonewood Properties, Inc. license # 01877541 From: Spiker, Chad f mailto:CSpiker@NBFD.net] Sent: Monday, August 03, 2015 10:00 AM To: Lisa Manolovitz <LManolovitz@stonewood.net> Subject: Annual Fire Safety Inspection of 2503 Eastbluff Dr Hi Lisa, I completed the annual fire safety inspection at 2503 Eastbluff Dr. Everything looked ok, however I need a copy of the annual fire alarm system test and a copy of the 5 year certification test. When you get a chance can you please email me a copy of each? Thank you, Chad Spiker Captain Newport Beach Fire Department r 25-78 INSPF,CTION, TESTING, AND MAINTENANCE OF WATER -BASED FIRE PROTECTION SYSTEMS Mon, Testing, and Ma NFPA 25 as amended Property Information: Eastbiuff Professional Name: 250 Eastbluff Drive Address: Newport Beach City: 92660 ZIP: Bryan Gerlach Contact: (949) 241-9059 Telephone: Occupancy /Use: pF C,q� Construction Type: No. Stories: 2 Year Constructed: Contractor Information: 1 Number of System Risers Name_ Shelton Fire Protection Co, Inc. Copy sent to: Address: 22745 La Palma Ave o Owner pate City: Yorba Linda ❑ Fire AHJ Bate State: CA ❑ Contractor Date (714) 692-3573 NOTES: Telephone: C16, C34-677631 1) For specific inspection, testing, and CA License# maintenance requirements and Information, 8772 see NFPA 25, 2002 Edition as amended. by Job # California Code of Regulations, Title 19, §901 ©scar Espinoza to §906. Performed by: (Print) 2) Inspection Items may be performed by the Owner In accordance with California Code of Note: Contractor information may be pre-printed 1 Regulations Title 19 904.1 a Forms included with this report NFPA 25 Gha ter Number of Forms NIA FAIL" PASS El Automatic Sprinkler System 5 (1) 5 Year X ❑ Standpipe and Hose Systems 6 ❑ Private Water Supply System 7 i--i Fire Pump 8 ❑ Water Storage Tank 9 ❑ Water Spray System 10 Q Foam Water Sprinkler System 11 "See "Deficiencies and Comments" section at end of each respective form. State Fire Marshal AES 1 March 21, 200$ r ANNEX S 25-79 and Maintenance I rater 5 as amended Date of Inspection, Testing, Maintenance: 9-24-12 Property Information: Name: Eastbluff Professional Address: Stonewood Properties 2503 EastBluff Drive City: Newport Beach by CCR, Title 19 System Riser ID: 1 Type of System:prr IJ Wet Pipe © Dry Pipe ❑ Preaction ❑ Deluge Main Drain Test Results: Abbreviation Key: 80 I = Inspection Initial Static Pressure: (psi) T = Test 7t1 M = Maintenance Residual Pressure: (psi) A-O = After Operation 85 MI = Per Manufacturer's Instructions . Restored Static Pressure: (psi) Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 1.1 I Daily Preaction/Deluge Valves — Enclosure 12.4.3.1 X Weekly temperature 1.2 I Daily Dry Pipe Valves — Enclosure 12.4.4.1.1 X Weekly temperature 1.3 1 Quarterly Gauges (Dry, Preaction, Deluge 5.2.4.2 X Systems) 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 5.2A 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 Quarter) y Preaction/Deluge Valves — Exterior 12.4.3.1.E X Inspection 1.14 I Quarterly Pressure Reducing Valves 12.6.1.1 X 1.15 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4 X 1.16 1 Quarterly Sackflow Preventers 12.6.1 X 1.17 1 Annually Buildings 5.2.5 X State Fire Marshal AES 2 March 21, 2006 25-80 INSPECTION, TESTING, AND MAINTENANCE OF WATER, -BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4 NFPA 2$, Cha ter 5 as amended b CCR, Title 19 Date of Inspection, Testing, Maintenance: 9-24-12 System Riser ID: 1 Property Information: Type of System: Eastbluff Professional Name: El Wet Pipe Stonewood Properties ❑ Dry Pipe Address: 0 Preaction 250$ East8luff Drive ❑Deluge Newport Beach City: Item Activity Frequency Description NFPA 25 Reference Fail NIA Pass 1.18 1 Annually Hangers 5.2.3 x 1.19 l Annually Seismic Braces 6.2.3 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 spamejs 1.22 1 5 Years Pipe and Fittings (Accessible concealed 5.2.2.3 x spaces) 1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4 x 1.24 1 5 Years Alarm Valves — Interior Inspection 12A.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 Preaction0eluge Valves — Interior 12.4.3.1.7 x Inspection 1.28 1 5 Years Preaction/Deluge Valves - Strainers, 12.4.3,1.8 x filters orifices 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 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 AES 2 March 21, 2006 ANNEX B 2,5-81 Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4 NFPA 25 Chapter 6 as amended by CCR, Title 19 Date of Inspection, Testing, Maintenance: 9-24-12 Property Information: Eastbluff Professional Name: Address: Stonewood Properties 2503 EastBluff Drive City: Newport Beach System fuser ID: 1 Type of System: cgc,,�a IZI Wet Pipe ❑ Dry Pipe coo � © Preaction , ❑ Deluge Item Activity Frequency Description NFPA 25 Reference Fail N/A Pass 2.10 T Annually Dry Pipe Valve — Priming Water 12A.4.2,1 X 2.11 T Annually Ala Pipe Valve — Low Air Pressure 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 Backfiow Preventer Assemblies 12.62 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 Rackfiush 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 5.3.1,1.12 X 2.23 T 50 Years Sprinklers 5 3.1.1.1 X 2.24 T 75 Years Sprinklers 75 years in service 5.5.1,1.1,4 X 2.25 T Sprinklers manufactured prior to 1920 — Replace 5 31 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 AnnuallyDry 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 AES 2 I 25-82 INSPECTTON, TESTING, AND MAINTENANCE Or WATER -BASED FIRE PROTECTION SYSTEMS Inspection, Testing, and Maintenance Fire Sprinkler System Rage 4 of 4 NFPA 26, Chapter 5 as amended b CCR, Title 19 Date of inspection, Testing, Maintenance: 9-24-12 System Riser ID: 1 Property Information: Name: Eastbluff Professional Typ©ofVeytPipe ��,�� 0 Stonewood Properties ❑ Dry Pipe ra Address: ❑ Preaction►' 2503 EastBluff drive 0 Deluge �iE Ni City: Newport Beach Deficiencies and Comments: Item Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above: ❑ See Continuation Page($) (Indicate the number of continuation pages) ElPASS 10-22-12 p FAIL _ Siann t _ Date State Fire Marshal AES 2 March 21, 2006 State Fire Marshall 1. Request Date 2. Program Fire Safety Inspection Request STD 850 AUGUST 20, 2013 CCL 3. Agency Contact 4. Telephone 5. Evaluator Department of Social Services (714) 703-2800 Fax (714)703-2831 MALEK, NANCY/vd E203 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 304370471 3A 370 10. Response Required Codes 1. Original A. Fire Clearance Department of Social Services 2. Renewal B. Life Safety Community Care Licensing 3. Capacity Change 750.The City Drive #250 4. Ownership Change Orange, CA 92868 5. Address Change 6. Name Change 7. Hours: Monday - Friday 7:OOam-6:OOpm Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date 08/11/2008 Capacitl Medical Care? Prev.Cap 48 Capacity 0 Medical Care? Prev.Cap 0 7� l" ,7$ No 18. Facility Code - 16 - CCC No 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC ST. MATTHEW'S MONTESSORI SCHOOL 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 2300 FORD ROAD NONE 4. APH 12. ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under NEWPORT BEACH, CA. 92660 24 HRS. 6. SNF 14. CCF 7. ICF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special RIZZO, ERLINDA (949) 219-0915 NONE 8. ICF/DD 16. Other - To Be Completed By Inspecting Authority Clearance Codes Inspector's Name # CFIRS ID# T-19 OCC 1.. Fire Clear/Granted �t I�/� i v At> l t� 1 \ �,22� S `�Iep�hPne Lf )) G k-{ q- 31 O S 2. Fire Clear/Denied 3. Fire Clear/Withheld Inspection Date Inspector's Signature Clearance Code IZ-Z-I.S Explanation of Denial or Special Conditions: Denial Code Fire Agency Denial Codes 1. Exits 2.Construct. (10V2..T" 19CA- -}A n Q b evoi- 3. Fire Alarm FIRE PREVENTION BUREAU 4.Sprinklers 3300 NEWPORT BLVD. 5.Housekeeping NEWPORT BEACH, CA. 92663 6.Special Hazard 7.Other j , .) VAS OIGA lagwaw tuoa•iluegsn ®nog( 6ui/ues® to py !i �jv CM 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 LIC 999 (3l99) -1 Alcaraz, Debbie From: Morris, Nadine Sent: Friday, January 29, 201612:45 PM To: Alcaraz, Debbie Subject: Scan & Invoice Attachments: chld-01@newportbeachca.gov_20160129_123534_000023ca001b.pdf Categories: SCAN 0 - Please scan into 2201 Francisco Drive. No need to mail. And invoice $76.00 for a fire clearance inspection. Thank you, Nadine oil [to �8�k4 j r � r-4TATEOFCALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST I STD. 650 (REV.4.2000) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM Dept ofSocial Services (714) 293-9439 01/29/2016 CCL»R EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE LYDIA MARTINEZ 306004577 7A CODES 1. ORIGINAL A. FIRE CLEARANCE t— I LICENSING Dept of Social Services 2. RENEWAL B. LIFE SAFETY AGENCY 770 The City Drive, Suite 7100 NAME AND Orange, CA 9286$ 3. CAPACITY CHANGE ADDRESS 4. OWNERSHIP CHANGE & ADDRESS CHANGE J____ s. NAME CHANCE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPAGTY CAPACITY PRMOUSCAPACITY CAPACITY PRWOUS CAPACITY 0 0 5 1 6 PACIUTYNAME LICENSE CATEGORY ANCORA SENIOR LIVING RCFE STREET ADDRESS (AGGDI L00110n) NUMBER OF BUILDINGS 2201 Francisco Drive I CITY RESTRAINT Newport Beach, CA 92661 NO FACILITY CONTACT PERSONS NAME PACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Laura Sardagna {949) 293_4956 7/24 hrs. SPECIAL C.ONOITIONS See attached sketch —Bedroom #7 will be BEDRIDDEN instead of bedroom #/1. TO BE COMPLETED BY INSPECTING AUTHORITY i Newport Beach hire Dept FIRE Attn. Nadine Morris AUT14ORITY P.O. Box 1768 NAME AND Newport Beach, CA 92658 ADDRESS L INSPECTOR'SNAME (TypWOfPIMIOU) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS (qqq) (p'49-31� IN5PECTIONDATE INSPECTOR' SIGNATURI-(Type¢orPrinl ) h I. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS S. CONSTRUCTION C. FIREALARM D. SPRINKLERS E.- HOUSEKEEPING F. SPECIAL HAZARD G. OTHER :a. I Y (1 7 ft I Sf*s'§F wian*bloft 1, [�('71- 4'- L 3-7 �B 1. N.M A. MEd41FWVE Departm. ent-Of Sodj61--$oTylw% COLD .7-1 7.70 The City Ddm% Suite 71,00, Oran.go, CA 92800 iWDRMCHAWE 'BEN MEN. ear n lAEvq ate. 4-A=. b Aic ACFE Xneer NO LA�U:RA 0014' 7/2-4 His. $9e*400 50ut (1) -FN-iwPORT' BEAOH -FIRE DEPT. bpobts - I- 0*qXAPAMXGR-AN'M P,G. tox tus V. FIFECLEWANGEMMED NEWPORT BEACH; GA 9266,"916 A. a= L a CORMUMN - Wtvaw t A-0 tza-I s Q. VM*fk 1 K-w —0,05, 5 ME-Momm- "M P .� z - ��, i omt µIf .,,� I. ;L - th p Y s:11 N D r7',� - �i.9•Ttr Twbm f R&Nl' YAM � 2'tUXL s LbC A - TVA !N' M6Q hk-cuO ► `� act I �+-p ck� 'STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD. W (REV. 10-94) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DEPARTMENT OF SOCIAL SERVICES 714 703-2840 Sept. 19, 2013 CCL-R EVALUATORS NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Lucy Adams (T5A2) 306004577 1A Bedridden CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY LICENSING F epartment Of Social Services, CCLD7 AGENCY 3. CAPACITY CHANGE NAMEAND 770 The City Drive, Suite 7100 ADDRESS 4. OWNERSHIP CHANGE Orange, CA 92868 S. ADDRESSCHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 0 5 0 1 0 6 FACILITY NAME VILLA SERENA LIVING STREET ADDRESS (AdW Loatlon) 2201 FRANCISCO DRIVE CITY NEWPORT BEACH, CA 92660 FACIUTY CONTACT PERSONS NAME LAURA SARDAGNA (949) 293-4956 SPECIAL CONDITIONS " See attached Sketch (1) NEWPORT BEACH FIRE DEPT. FIRE AUTHORITY P.O. BOX 1768 NAME AND ADDRESS NEWPORT BEACH, CA 92658-8915 L IdSPECTOR'SNAME rryW-PdW*0 TELEPHONE NUMBER WSPECTION DATE INSPECTOR'S SIGNATURE (TypedoaPMtsW 10-9---1-L I kD 1� -1 004AN DENIAL OR LIST SPECIAL CONDITIONS RCFE NUMBER OF BUILDINGS RESTRAINT NO HOURS 7/24 Hrs. CLEARANCE /DENIAL CODE CODES 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS S. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS CFIRS NUMBER OCCUPANCY CLASS E. HOUSEKEEPING is D05S C�" 3, F. SPECIALHAZARD G. OTHER lid rzo o y-k #Lf t S .A-PA4!2D V I~D 0-0 t2 A C L I 0 b w t 2 aE� R00M03 Z — -- 01, To a_ C1I cr CA11F w�rE,� 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.noUortbeachca.gov ZONING CLEARANCE LETTER October 1, 2013 Villa Serena Living Laura Sardagna, Owner/Operator 2201 Francisco Drive Newport Beach, CA RE: Zoning Clearance for Elderly Residential Care Facility with 6 or fewer beds 2201 Francisco Drive, Newport Beach, CA 92660, APN 426-011-10 Dear Ms. Sardagna: The above referenced property is currently located within the R-1-10,000 (Single - Unit Residential) Zoning District. This Zoning District allows for single-family development as well as residential care facilities with 6 or fewer beds that are licensed by the State of California. Based on the. pending State License and the documents provided, found attached, the proposed Elderly Residential Care Facility with 6 or fewer beds is found as a use in compliance with the R-1-10,000 Zoning District. Staff will maintain the contact phone number for Villa, Serena Living of 949-293-4956 should it is needed in the future to make contact with the operator. If there is construction or building modifications proposed with this use please know that a Building Permit may be required and contact the Building Division at 949-644-3282. Should you have any further questions, please contact me at 949- 644-3221, mwhelan annewportbeachca.gov . Sincerely, Kimberly Brandt, AICP, Community Development Director By: Melinda Whelan Assistant Planner Enclosures: Documents submitted by the operator including pending license Pending State License Facility No: 306004577 Capacity: 0006 License Status: Pending Client Type: ELDERLY VILLA SERENA LIVING 2201 FRANCISCO DRIVE NEWPORT BEACH, CA 92660 (949) 293-4956 Contact: LAURA SARDAGNA DO: ORANGE & INLAND A/SC (22) DO Phone: (714) 703-2840 Vala.,.., Sere*ial L w6nq,, 2201 Francisco Dr, Newport Beach, CA 92660 (949) 293-4956 September 30, 2013 Melinda Whelan Planning Division Community Development Department City of Newport Beach 100 Civic Center Drive Newport Beach, California 92660 Dear Melinda, Please accept -this statement responding to each of the applicable requirements required by Section 20.48.170 to showing compliance with this section: 20.48.1.70 Residential Care Facilities. This section provides standards for residential care facilities granted a conditional use permit in compliance with Section 20.52.030 (Conditional Use Permits in Residential Zoning Districts). A. Smoking in Outdoor Areas. Staff, clients, guests, or any other users of a residential care facility shall not smoke in an area from which the secondhand smoke may be detected on any parcel other than the parcel upon which the facility is located. Response: Villa Serena Living is a non-smoking facility. B. Management and Operation. 1. The property shall be operated in compliance with applicable State, Federal, and local law and in conformance with the management and operating plan and rules of conduct submitted as part of the application for a conditional use permit or as identified in the conditions of approval for a conditional use permit. Response: Villa Serena Living is operated in compliance with applicable State, Federal, and local law and in conformance with the management and operating plan and rules of conduct submitted as part of the application for a conditional use permit or as identified in the conditions of approval for a conditional use permit. 2. Each management and operation plan shall provide a phone number by which the operator may be contacted at all times. ' Response: Villa Serena Living's management and operation plan contains the Manager's cell phone number (949-293-4956) where she may be contacted at all times. 3. if applicable, the permittee shall comply with the business license provisions of Title 5 (Business Licenses and Regulations). -Response: Villa Serena Living complies with applicable license provisions in Title S. C. Standards for Residential Care Facilities. In order to. ensure that residential care facilities are operating in a manner that is consistent with State and Federal law and established industry standards and to ensure that operators do not have a pattern or practice of.operating similar facilities in violation of State, Federal, or local law, the standards listed below shall apply: 1. if the facility is not licensed by the State of California, owners, managers, operators, and . residents shall not: a. Provide any services on site if the provision of the service requires licensure of the facility under California law; or b. Provide any services to persons not residing on site. Response: N/A. Villa Serena Living is licensed by the State of California (pending). 2. If the facility is required to be licensed by the State of California, owners, managers, operators, and residents shall not: a. Provide any services other than those that the facility is authorized and licensed to provide by the State of California; or b. Provide any services to persons not residing on site. Response: Villa Serena Living does not provide any services other than those that the facility is authorized and licensed to provide by the State of California; nor does it provide any services to persons not residing on site. 3. The names of all persons and entities with an ownership or leasehold interest in the residential care facility, or who will participate in operation of the facility, shall be disclosed in writing to the City, and the persons and entities shall not have a demonstrated pattern or practice of operating similar facilities in or out of the City in violation of State or local law. Response: Villa Serena Living is owned and operated by Laura Sardagna. She has not owned nor operated any other facility in the past. 4. The operator of the residential care facility shall provide a list of the addresses of all similar facilities in the State owned or operated by the operator within the past five years and shall certify under penalty of perjury that none of the facilities has been found by State or local authorities to be operating in violation of State or local law. All information submitted shall be subject to verification by the Director. Response: N/A 5. Off-street parking shall be provided in compliance with Chapter 20.40. (Ord. 2010-21 § 1 (Exh. A)(part), 2010) Response: Villa Serena Living complies with Chapter 20.40. The facility has 2 garage spaces and 2 driveway spaces. Thank you for your time and assistance. Please let me know if I can provide any additional information. Best regards, Laura Sardagna Owner / Operator Villa Serena Living 2201 Francisco Dr Newport Beach, CA 9260 (949)-293-4956 VaIa,,-,Se41-e4q.a1 L w 6ngl 2201 Francisco Dr, Newport Beach, CA 92660 (949) 293-4956 September 30, 2013 Melinda Whelan Planning Division Community Development Department City of Newport Beach 100 Civic Center Drive Newport Beach, California 92660 Dear Melinda, Villa Serena Living will not be defined or classified as an integral facility per Zoning Code. Villa Serena Living is a single facility located on a single lot with no other affiliated facility located within the city of Newport Beach. Thank you for your time and assistance. Please let me know if I can provide any additional information. Best regards, Laura Sardagna Owner / Operator Villa Serena Living 2201 Francisco Dr Newport Beach, CA 9260 (949)-293-4956 Morris, Nadine From: Morris, Nadine Sent: Monday, September 23, 20131:17 PM To: 'Laura Sardagna' Cc: Whelan, Melinda Subject: 2201 Francisco Dr Attachments: A.09 Residential Group R-3.1 Occupancies 6-2011.pdf Good afternoon Laura, I received the 850 Form from DSS Community Care Licensing for a residential care facility for the elderly. The request is to license 5 nonambulatory clients and 1 bedridden client. The diagram provided does not state which bedroom is designated for the bedridden client. This bedroom needs to meet the exiting requirements on Page 6 Item #4 of the attached guideline. The City is requiring information from all residential care facility operators prior to a fire clearance being issued. Please go to the below link and review Section 20.48.170. This information needs to be provided to Melinda Whelan in the Planning Dept. She can be reached at 949-644-3221 or mwhelan@newportbeachca.gov if you have any questions. http:Hwww codepublishing com/CA/NewportBeach/html/newportbeach20/NewportBeach2O48.htm1#20.48.170 Feel free to contact me if you have any questions. Thank you, Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net A S A-�> I-AAczov (�,kAov Morris, Nadine From: Morris, Nadine Sent: Thursday, May 02, 2013 3:51 PM To: 'Laura Sardagna' Subject: RE: 2201 Francisco Drive Hi Laura, Sorry it's taken me awhile to respond to your email. My apologies. I reviewed the California Code of Regulations Title 19 Public Safety, and Article 9 Section 1330 states that a Seal of Registration of the State Fire Marshal of California is required to be displayed on the product treated. Unless the curtains have this seal, they are not approved for use in a Residential Care Facility for the Elderly in California. Thank you for checking, Nadine Nadine Morris Life Safety Specialist, NBFD (949) 644-3105 1 nmorris(cr.nbfd.net From: Laura Sardagna Finailto:laurasa rdagnaCa)gmail.com] Sent: Monday, April 29, 2013 4:08 PM To: Morris, Nadine Subject: 2201 Francisco Drive Hi Nadine, I hope you're doing well. I had a question about drapes. I found these fire retardent drapes and wanted to be sure they are ok for inspection prior to purchasing. They say the following: Firefend Meets the following flame retardant regulations: NFPA (National Fire Protection Association) -701 Small Scale, 1999, 2004, & 2010 Editions. BFD (Boston Fire Department) 1X-1 Here is a link to the product: htip•//www curtainshop com/704967/products/Firefend-Solid-Flame-Retardant- Panel.html Also, I was wondering if you had been contacted by licensing yet regarding the fire clearnace at MI Francisco Dr. My application was submitted a couple months ago, so they should be in touch soon if not already. Thanks and have a wonderful day! Laura Sardagna 949-293-4956 Morris, Nadine From: Morris, Nadine Sent: Friday, March 23, 2012 3:54 PM To: 'Laura Sardagna' Subject: RE: 2201 Francisco Drive Yes, you understood correctly. The interpretation 1 received is that the current surface may remain. Nadine From: Laura Sardagna[mailto:laurasardagna(�bgmail.com] Sent: Friday, March 23, 2012 3:49 PM To: Morris, Nadine Subject: Re: 2201 Francisco Drive Thank you very much, Nadine. This is very helpful. I have one question regarding #3 below (3. There is not an exterior surface requirement for access to the exterior gate but the Fire Department recommends maintaining an unobstructed exit path.). Does that mean that the existing pathway surrounding the house that would lead to exterior gate does not need to be widened to 32 inches and can remain as is as long as it is unobstructed? I just want to be positive I understand. It would be a great relief if that were the case. Thank you again for all of your help. Have a nice weekend, Laura Morris, Nadine From: Sent: To: Subject: Attachments: Good afternoon Laura, Morris, Nadine Friday, March 23, 2012 3:12 PM 'Laura Sardagna' RE: 2201 Francisco Drive Site Plan.pdf; CO Detectors.pdf The pending items in the email below dated 3/9/12 (highlighted in yellow) are addressed as follows: 1. All thresholds over exit doors shall be beveled to provide a slope for a smooth transition over the.tracks of the sliding doors and threshold over the front door. 2. All exit door and gate hardware shall be operable from the inside without the use of a key or special knowledge or effort. 3. There is not an exterior surface requirement for access to the exterior gate but the Fire Department recommends maintaining an unobstructed exit path. 4. Bedroom #2 (see attached site plan) — Interior door to bathroom measured 24" and exterior door from bathroom measured 30". The existing door widths may remain as long as the client can utilize the doors during everyday maneuvers and the bathroom is specifically designated for that client's use only. I've attached a copy of the California State Fire Marshal bulletin regarding Carbon Monoxide detectors. Their installation is not a condition of the fire clearance, but I did want to ensure you knew of the requirement. Building permit, X2011-2053, shall be finaled prior to afire clearance being granted. rl-112-Lilm Thank you for your patience and let me know if you have any questions. Have a nice weekend, Nadine .Nadine Morris Fire Inspector Newport Beach Fire Department (949) 644-3105 1 (949) 723-3505 Fax I nmorris@nbfd.net Safety, Service, Professionalism From: Morris, Nadine Sent: Friday, March 09, 2012 4:07 PM To: 'Laura Sardagna' Subject: 2201 Francisco Drive Hi Laura, Below is a brief summary of the pre -fire clearance inspection conducted on March 8, 2012. I've addressed each item number as listed on the guideline previously provided. 1. Address number is posted. 2. Fire extinguisher shall be mounted with purchase date noted. 3. & 4. Smoke alarms shall be interconnected and located throughout all habitable .areas of the home. A few areas require additional coverage. 5. The residence has two common exits — main front door and living room slider. 6. Direct exiting from each bedroom is provided via a sliding door. *Pending issue — exiting from a bedroom through a bathroom to the outside along with the bathroom interior door width at 24" and the exterior door width at 30". 7. Hallway widths meet the 36" requirement. 8. N/A 9. N/A 10. N/A 11. *Pending issue — thresholds over sliding doors being used as exits. 12. Garage door meets the requirements. 13. Evacuation sign pending. 14. Drapes and similar materials are not present in the residence. 15. Good housekeeping is being maintained. 16. Chimney is equipped with a spark arrestor. I hope to have clarification regarding the pending items listed below next week. If I missed an item,, please let me know. 1. Ramp. requirements over the thresholds of exit doors., 2. Exterior gate hardware., 3. Surface and width requirement for the exterior exiting pathway.. 4. Exiting from a bedroom through a bathroom and the bathroom door widths., Just as an FYI - I'll be out of the office until next Thursday, March 15th. Thank you and have a great weekend, Nadine .Nadine .'viorris Fire Inspector Newport Beach Fire Department (949) 644-3105 1 (949) 723-3505 Fax I nmorris@nbfd.net k w �. Safety, Service, Professionalism Morris, Nadine From: Laura Sardagna [laurasardagna@gmail.com] 1 Sent: Monday, March 05, 2012 3:31 PM d ` �''1%Gt Yi G 1 S �- . To: Morris, Nadine Subject: Re: 2201 Francisco Drive q a (pie 1) Attachments: 2201_Francisco_Dr.pdf Hi Nadine, Please find attached the site plan for 2201 Francisco Dr. Please advise if you have- any questions about the attached site plan. I would like either your first appointment or last appointment of the day please. Best regards, Laura Sardagna Cell: 949-293 -495 6 On Wed, Jun 8, 2011 at 12:01 PM, Morris, Nadine <NMorris@nbfd.net> wrote: Hi Laura, Attached is our guideline for residential care facilities. Please review and feel free to contact, me with any questions. The fee for the pre -license inspection is $233.00. Thank you, Nadine Z140W� Fire Inspector Newport Beach Fire Department W (949) 644-3105 F (949)644-3120 nmorris(o)_nbfd.net Safety, Service, Professionalism 1 1 AL i �S,Z)LNTIAL- agouP J':�-3,1 OCr-uP'ArJr-ll (Y 2201 F-RAN)CiSCO POR.-r 'SEAS CA 60 N EW CS)S q/-t A L A C Morris, Nadine From: Laura Sardagna [laurasardagna@gmail.coml Sent: Wednesday, June 08, 2011 12:33 PM To: Morris, Nadine Subject: Re: 2201 Francisco Drive Thank you, Nadine. This is very helpful. I look forward to meeting you in the future. Best regards, Laura Sardagna 949-293-4956 On Wed, Jun 8, 2011 at 12:01 PM, Morris, Nadine <NMorris o,nbfd.net> wrote: Hi Laura, Attached is our guideline for residential care facilities. Please review and feel free to contact me with any questions. The fee for the pre -license inspection is $233.00. Thank you, Nadine Fire Inspector Newport Beach Fire Department W (949)644--3105 F (949) 644-3120 nmorris@nbfd.net Safety, Service, Professionalism 1 FIDE SAFETY INSPECTION REQUEST Sm Instructions an re►+ot a AGENCYACT$ NAME DEPARTMENT OF SOCIAL. SERVICES EVA MAT(M NAME Rabin Ryan (T40M TELEPHONE NUMBER 714 703-2840 nMUESTINO AOUNCY FACILM NUMBER 306004577 11MOING F epartment Of Social Services, CCLD7 AGENCY AMEA s 770 The City Drive, Suite 7100 AWRE Orange, CA 92868 L CAPACITY I PR6YI w 0 j 0 FACW V NAME $IIIEETAWFES9 JApW IL=&N -�- 1 FRA,NCISCO DRIVE CITY NEWPORT BEACH, CA 92660 FA0Urr. G0KACT PERSCNM NAME MAMBULATORY PREYI $ CAPACITY CAPACITY 5 0 1 L' 11,l RECUEBrDAW PROGRAM Feb. 20, 2014 CDL-R F wuwr oom WiTI 1. ORIGINAL A. MMOLEARANCE 2. REMEWAL IL LIFE SAFETY R. CAPACITY CHANGE 4. OWNr;ASHIP CHANLiE 6, ADCITIESSCHANGR S. NAMr: CHANGE 7. MER 0 6 �— W MfW CATEt3fjFfY RCFE NUMBER OF OMAN% 1 RE8'i1'IAW NO FlvuRa L-MVr%M MM SAUNA 7/24 Firs SPECIAL CONC UMS (1) MAY BE BEDRIDDEN NEWPORT BEACH FIRE DEPT. FIRE A Q P-0, BOX 1768 ADDREU . NEWPORT BEACH, CA 92658-8918 L roFECii"Kmx almwarPmso TMIPMNE NUMBER K,-b1 Lf RAVECTICN GATE 92 :F= NUMmR OCCUPANCY CU 3t I R-3. I cL�AnANcE IOFlNA4 OQL1E t. RFIE CLEAFUME OPANTED 8. FIAECLEAAANCEDENIf.0 A. I�C1T$ IL CONSTRUCTION Q FIAR ALARM D. SPMNKLEFIS E. HOLiCOMIPING Ft SPEECIALHAZARO Q. OTHER PR%Z I10\)S C0 O K3 F-L (2:C-7 C=.Q MZA _ A PPEZI)VAL O 1J I 0-a-13 „— A-PPLV . TIME RECEIVED REMOTE CSID DURATION PAGES STATUS February 25. 2014 4:21:09 PM PST 55 2 Received DEPARTMENT OF SOCIAL SERVICES '� CONMt'MUNITY CARE ]LICENSING DIVISIONf ", ORANGE COUNTY AND INLAND ADUL,T AND SENIOR CARE REGIONAL OFFICE I,Y 77o TMa CITY DRIVE, SUITr 7900 ORANGE, CA 92968 (714) 703-2840 (714) 703-2068(FAX) .FA CSIMFLZ TRANS)WIT TAL SHRZ T TO: FROM- A, DATE: r -- t TOTAL NUMBER OF PAGES: FAX NUMBER: RE: COMMENTS: J 5ve - The information oontaired in this FAX may be CQNr-ME.NTIAL and is intended only for the addressee named above_ Tf you have received this IZAX in error, please call the number above and destroy the document(s), Dissemination, distribution or copying of this eommunicati.on is Prohibited. Thank you. Alcaraz, Debbie From: Morris, Nadine Sent: Wednesday, July 15, 2015 3:48 PM To: Alcaraz, Debbie Subject: Scanning Item Attachments: chld-01@newportbeachca.gov_20150715_154916_0000flla001b.pdf . Please scan into 1000 Halyard. Thank you! 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 REQUEST DATE PROGRAM CA Department of Social Services (916) 651-7901 6/29/15 Adult and Senior Care EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUESTCODE Bethany Hunter 306005154 I.A. CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING Attn: Bethany Hunter 2. RENEWAL B. LIFE SAFETY AGENCY Centralized Applications Unit NAME AND 744 P St, MS 8-3-91 3. CAPACITY CHANGE ADDRESS Sacramento, CA 95814 4. OWNERSHIP CHANGE Fax (916) 651-7916 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 42 0 42 FACILITY NAME LICENSE CATEGORY Newport Beach Memory Care RCFE STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 1000 Halyard 1 CITY RESTRAINT Newport Beach, CA 92663 N/A FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSONS TELEPHONE NUMBER HOURS SPECIAL CONDITIONS Facility has delayed egress exits. TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE ]DENIAL CODE 1 Beach Fire Department CODES FIRE CLEARANCE GRANTED Newport FIRE 100 Civic Center Drive AUTHORITY Newport Beach, CA 92660 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 C 9 4 Cj, E. HOUSEKEEPING t A D 1J C !" t �) R1Z1 S (D LA H —J 1 © `vS F. SPECIALHAZARD G. OTHER INSPECTION DATE INSPECTOR'S SIGNATURF,(TypedorPdntec0 ^7 -i -1 s I �& EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS I � w a s o 5? ati z ra �LUw =zU, L7 0 O 19 -if IV V it IVLI YVY v O N~ 9 �� 9 !�■ i 4 �1 ;� WAI r W0Zk,ON R�juJ� x J do WQ4 mwu—° Ni vF,i¢t, =ZUa a 9 s : p as s oea pP ! 7 7! `a(y i �mm m m® al (Dim a a"• a� b,�. (Q�j a. (®R� a®s d aR (a(�(®�R a;• a . a, oq a a f i ED vn W M S ii ' < N o �w C�� n� .. ��w �ZUw [� €o eFi4M U: S=�7s�1• i i ��6�9�8100�CC�r'��Ee€�119��f �OiJC��O�GIf�C6f:Id11��E08E�@C��e9�G3`a��a1G11111 NoI�aa'11§55 N s Kill R ou �1 ' o Q O a o a a o t=- a o s V ttx F O e W< ' os W � �w V = 0 0 oy`+ ju � 7o sa'23 T w � �zU d LL K ��rr�q � Lppi�'ee��*�*� k! Lqq�yy��pp: L ��,.qa ��. r��lYQr�Q�O��^00f�u4�WI�QIYQi.��l��{r"LW�I��I�DDi��EI�"1� �+'fir rr..r'`'q�•�• , .thy' p3 a OHO MHo h n aids 1; U IN a FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time ofsystem 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. 1. PROPERTY INFORMATION Name of property: Halyard Memory Care Facility p Address: 1000 Halyard Newport Beach, CA Description of property: Commercial Care facility Occupancy type: V-A Name of property representative: Address: Phone: Fax: Authority having jurisdiction over this property: Phone: 949-644-3255 Fax: City of Newport Beach E-mail: E-mail: -F a o 14-0��(CC 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: KOR Fire and Security Address: 26812 Vista Terrace Lake Forest CA 92630 License or certification number: 857710 Phone: 949-273-8340 Fax: 949-951-6922 E-mail: Service organization for this equipment: KOR Fire and Security Address: 26812 Vista Terrace Lake Forest CA 92630 License or certification number: 857710 Phone: 949-273-8340 Fax: 949-951-6922 E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of: 1-1-2010 Contracted testing company: KOR Fire and Security Address: 26812 Vista Terrace Lake Forest CA 92630 Phone: 949-273-8340 Fax: 949-951-6922 E-mail: Contract expires: Contract number: 3. DESCRIPTION OF SYSTEM OR SERVICE Frequency of routine inspections: ® 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): NFPA 72 Fig 10.18.2.1.1 (p. 1 of 12) Copyright © 2009 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. s 11 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2010 Additional description of system(s): Fire Alarm 3.1 Control Unit Manufacturer: Firelite Model number: MS9600 3.2 Mass Notification System ® This system does not incorporate an MNS 3.2.1 System Type: ❑ In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ® An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: FACP 3.4 System Software ® This system does not have alterable site -specific software. Operating system (executive) software revision level: Site -specific software revision date: Revision completed by: ❑ A copy of the site -specific software is stored on site. Location: 3.5 Off -Premises Signal Transmission ❑ This system does not have off -premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: National Monitoring Center Phone: 877-311-8579 Supervisory: National Monitoring Center Phone: 877-311-8579 Trouble: National Monitoring Center Phone: 877-311-8579 Entity to which alarms are retransmitted: Phone: Method of retransmission: Digital Dialer If Chapter 26, specify the means of transmission from the protected premises to the supervising station: DACT If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NI -PA rIg 1(i 162 1 l ,p v _)" i_'i Copyright © 2009 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. 0 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 1 Quantity: 1 (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: 0 Description:' N/A 4.1.3 Device Power Pathways ® No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: 0 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 1 Quantity: 1 (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: 0 Description: N/A 4.2.3 Device Power Pathways ❑ No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 1 Quantity: 1 (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: 0 Description: N/A 4.3.3 Appliance Power Pathways ® No separate power pathways from the notification appliance pathway ❑ Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10 18.2 1.1 (p. 3 of 12) Copyright © 2009 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. j r S. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes Type and number of devices: Addressable: 6 Other (specify): ❑ This system does not have manual fire alarm boxes. Conventional: Coded: Transmitter: 5.1.2 Other Alarm Boxes ® This system does not have other alarm boxes. Description: Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: 98 Conventional: Other (specify): 26 have B200SR Sounder Bases Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area Other (specify): Above FACP Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): 5.2.2 Duct Smoke Detectors ® This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors Type and number of devices: Addressable: Other (specify): Type of coverage: 5.2.4 Gas Detectors Type of detector(s): Number of devices: Addressable: Type of coverage: ® This system does not have radiant energy detectors. Conventional: Conventional: ® This system does not have gas detectors. 5.2.5 Heat Detectors ❑ This system does not have heat detectors. Type and number of devices: Addressable: 5 Conventional: 5 Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ® Fixed temperature ❑ Rate -of -rise ❑ Rate compensated PP 04 .*2 Flu iO `.d 2 1 1 q) 4 tit Copyright © 2009 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 S. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules Number of devices: 11 5.2.7 Waterflow Alarm Devices Type and number of devices: Addressable: 1 5.2.8 Alarm Verification Number of devices subject to alarm verification: 5.2.9 Presignal Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: 5.2.11 Other Initiating Devices Describe: ❑ This system does not have monitoring modules. ❑ This system does not have waterflow alarm devices. Conventional:. Coded: Transmitter: 1 6. SUPERVISORY SIGNAL -INITIATING DEVICES ❑ This system does not incorporate alarm verification. Alarm verification set for seconds ® This system does not incorporate pre -signal. ® This system does not incorporate PAS. ❑ This system does not have other initiating devices. 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: 2 Conventional: Coded: 1 Transmitter: Other (specify): 6.2 Fire Pump Description and Supervisory Devices ® This system does not have afire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) ® This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ® Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: NPPA 72, Fig. 10.18.2,1.1 (p. 5 of 12) Copyright © 2009 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. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator ® This system does not have a generator. 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel ❑ Other (specify): 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location 1: Main Entry Location 2: Location 3: 9. ALARM NOTIFICATION APPLIANCES ❑ This system does not monitor special hazard systems. ❑ This system does not monitor other systems. ❑ This system does not have annunciators. 9.1 In -Building Fire Emergency Voice Alarm Communication System ® This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound -processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 9.2 Nonvoice Notification Appliances Horns: With visible: 8 Chimes: With visible: Visible only: 47 Other (describe): 9.3 Notification Appliance Power Extender Panels Quantity: 1 Locations: ❑ This system does not have nonvoice notification appliances. Bells: With visible: ❑ This system does not have power extender panels. Nt-F'4 ; 2 r.q I iU 1 I kp o ); t_'t Copyright © 2009 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. 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ® This system does not have an.MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other (describe): Supervision class: 10.3.1 Special Hazard Notification ❑ This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ® This system does not have a two-way telephone system. Number of warden stations installed: ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ❑ This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright © 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two -Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ® Hold -open door releasing devices ❑ Smoke management ❑ HVAC shutdown ® F/S dampers ® Door unlocking ® Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release ® Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules Number of devices: 19 Other (specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120VAC Overcurrent protection: Type: Circuit Breaker Location (of primary supply panel board): Disconnecting means location: 13.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: ❑ This system does not have control modules. Control panel amps: 3.0 AMPS Amps: 15 ® This system does not have a generator. Type of fuel: NFF'A 72 FiU 1') lb' 1 1 1 ;iJ 8, of -, Copyright © 2009 National Fire Protection Association. This form may be copied for individual use other then for resale. It may not be copied for commercial sale or distribution. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: FACP Type: GEL CELL Nominal voltage: 12vdc Amp/hour rating: 12 AH 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 ❑ Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ® This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: 13.2.2 Engine -Driven Generator Location of generator: Location of fuel storage: EVACS or MNS panel amps: Amps: ® This system does not have a generator. Type of fuel: 13.2.3 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): 13.2.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture Nominal voltage: In alarm mode (minutes): ❑ Battery calculations are attached Amp/hour rating: NFPA 72, Fig. 10.18.2,1.1 (p. 9 of 12) copyright © 2009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power Input voltage of power extender panel(s): 120vac Overcurrent protection: Type: Circuit Breaker Location (of primary supply panel board): Disconnecting means location: 13.3.2 Engine -Driven Generator Location of generator: Location of fuel storage: ❑ This system does not have power extender panels. Power extender panel amps: 3.0 AMPS Amps: 15 ® This system does not have a generator. Type of fuel: 13.3.3 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): 13.3.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture 14. RECORD OF SYSTEM INSTALLATION Nominal voltage: In alarm mode (minutes): ❑ Battery calculations are attached Amp/hour rating: Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. This is a: ® New system ❑ Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: 2010 ® Manufacturer's published instructions Other (specify): System deviations from referenced NFPA standards: Signed: Printed name: Date: Organization: Title: Phone: NI-PA,'2 Fig i,i 16' i I oi, 10A I_; Copyright © 2009 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. 16. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ® New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ❑ Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following: ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: 2010 ® Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: Printed name: Date: Organization: Title: Phone: 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: ! t� yc-�tZ / ! Cr�'v� lam` y Date: 61 Z 5'! 16- Organization: JI.vZ, Y1'ZC� Title: "1Ee-H Phone: C?g4t-2-7 3c�v 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: - / t 1 j/(,aZ Date: 6 Organization: K-vZ j lZG Title: T tE Phone: r el.Z'7'5 . b-Sqv 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: Printed name: "rAy4, ,i � �(�" `1�% Date: Organization: 14oZ rjtZ.C� Title: 7t(,1.1 Phone: NFPA 72, Fig. 10 18 2 1.1 (p 11 of 12) copyright © 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited D) �herein. �A' Signed: � � Printed name: 1 V A-t ( IBC M OKet�, Date: Organization: ("� Title: NSPIZ-1-0Q Phone: �cm (04L(- 3/6S-- NFPA 72, Fig. 10.18 2.1.1 (p. 12 of 12) Copyright © 2009 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. STATE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 4-2000) AGENCY CONTACT'S NAME See instructions on reverse. TELEPHONE NUMBER REQUEST DATE PROGRAM Susan Seyboth 714-567-2906 04/24/2014 Licensing and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Susan Seyboth lA CODES 1. ORIGINAL A. FIRE CLEARANCE �— 1 � LICENSING California Deparbnent of Public Health 2. RENEWAL B. LIFE SAFETY AGENCY Licensing and Certification NAME AND 681 South Parlter Street 3. CAPACITY CHANGE ADDRESS Suite 200 4. OWNERSHIP CHANGE Orange, CA 92868 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 FACILITY NAME LICENSE CATEGORY Hoag Memorial Hospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92658-6100 FACILITY CONTACT PERSONS NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 JI'CUTAL UUNUI I IUNJ DME Ready now. TO BE COMPLETED BY INSPECTING AUTHORITY Newport Beach Fire Department FIRE PO Box 1768 AUTHORITY NAME AND Newport Beach, CA 92658 ADDRESS L 118111 INSPECTOR'S 'NAME (Typed or Printed) 'S S ,—eve M(C0 a e C INSPECTION DgT�E � IN�SPECTO TELEPHONE NUMBER CFIRS NUMBER c(yq- 6yy-310c; 1 '5005.5 CLEARANCE /DENIAL CODE . CODES FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS OCCUPANCY CLASS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER µ ** INBOUND NOTIFICATION : FAX RECEIVED SUCCESSFULLY ** TIME RECEIVED REMOTE CSID DURATION PAGES STATUS April 22, 2014 6:45:19 PM PDT 383 3 Received 04/22/2014 6:39:00 PM —0700 PAGE 1 OF 3 Fax To: From: CN=CEQA Admin,CN=Users,D Fax: 19496443120 Fax: C=agmd,DC=gov Company: Voice: Date: April 22, 2014 Subject: Ultramar Inc. (Valero Wilmington Refinery) Cogeneration Project Public Comments: Notice for SCAQMD Rule 1 714 Hello, The attached is a public notice for SCAQMD for Rule 1 714-Prevention of Significant Deterioration for Greenhouse Gases for Ultramar Inc. (Valero Wilmington Refinery). You are receiving this notice since you are signed up as an interested party to receive news regarding this facility. This fax originated from a Biscom FAXCOM® Fax Server. Secure Document Delivery — Everytime. Visit us at www.biscom.com 04/22/2014 6:39:00 PM -0700 PAGE 2 OF 3 04/22/2014 6:39:00 PM —0700 PAGE 3 OF 3 quantity of GHGs is calculated using the global warming potential for each compound and expressed in an amount equivalent to Carbon Dioxide (C%) emissions (CO2 equivalent). Calculations show that the new cogeneration unit will emit 274,040 tons/year COZ equivalent. SCAQMD staff has evaluated the GHG emissions from the cogeneration unit for compliance determination with applicable federal, state, and local air quality requirements. The cogeneration unit is found to comply with all applicable federal, state and SCAQMD air quality Rules and Regulations including the Best Available Control Technology (BACT) requirements for GHG emissions through the use of energy efficient gas turbines. Based on the result of our detailed analysis and evaluation, SCAQMD intends to issue the Permits to Construct for the equipment described above, However, prior to issuance of the final Title V permit; SCAQMD is providing an opportunity for public comments on the SCAQMD's proposed decision. SCAQMD will consider issuance of the final permit only after all pertinent public and EPA comments, if any, have been received and considered. Pursuant to SCAQMD Rule 1714 (e) — Public Participation, any person may request a public hearing pertaining to this project to address the air quality impact of the source, alternatives to it, the control technology required, and other appropriate considerations. A request for a public hearing can be made by submitting a complete Hearing Request Form (Form 500G) to South Coast Air Quality Management. District, Engineering and Compliance, 21865 Copley Drive, Diamond Bar, CA 91865, Attention: Mr. Danny Luong no later than May 9, 2014. This form is available on the SCAQMD website at http://www.ggmd.gov/permit/Fonnspdf/TitleV/AQMDForm500-00f,, or alternatively, the form can be made available by contacting Ms. Connie Yee at the e-mail address Mg@@Qmd.gov or the telephone number (909) 396-26I9. On or before the date the request is filed, the person requesting a proposed permit hearing must also send by first class mail a copy of the request to the facility address and contact person listed above. The proposed permits and other information are available for public review at the SCAQMD's headquarters in Diamond Bar, and at the Los Angeles Public Library,1300 N. Avalon Blvd., Wilmington, CA 90744. Additional information including the facility owner's compliance history submitted to the SCAQMD pursuant to California Health and Safety Code Section 42336, or otherwise known to the SCAQMD, based on credible information, is available at the SCAQMD for public review by contacting Ms. Connie Yee. A copy of the draft Permits to Construct can also -be viewed at hiip•//www3 aamd aovvlwebappl/PublicNoticcOJ Anyone wishing to comment on the GHG emissions elements of the permits must submit comments in writing to Mr. Danny Leong at the above address. Comments must be postmarked no later than May 24, 2014. If you are concerned primarily about zoning decisions and the process by which the facility has been sited in this location, contact the local city or county planning department for the city or unincorporated county in which the facility is located. For your general information, anyone experiencing air quality problems such as dust or odor can telephone in a complaint to the SCAQMD 24 hours a day by calling toll free 1-800-CIJT-SMOG (1-800-288-7664). STATE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 4-2000) See instructions on rever AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST.DATE' PROGRAM Susan Seyboth 714-567-2906 03/20/20'14 L 6n'sinc, and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Susan Seyboth lA CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFESAFETY LICENSING I California Department of Public Health � AGENCY Licensing and Certification 3. CAPACITY CHANGE NAME AND 681 South Parker Street ADDRESS Suite 200 4. OWNERSHIP CHANGE Orange, CA 92868 5, ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPPCITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 FACILITY NAME LICENSE CATEGORY ,lames Irvine Surgery Center (f ISC) GACH STREET ADDRESS -(Actual Location) NUMBER OF BUILDINGS One i loaf, Drive, 110 Box 6100 CITY RESTRAINT Newport Beach, CA 92658-6100 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS Ready now. TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE /DNI L CODE � � [Newport Beach Fire Department CODES j FIRE PO Box 1768 FIRE CLEARANCE GRANTED AUTHORITY NAME AND Newport Beach, CA 92658 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS L all B. CONSTRUCTION C. FIRE ALARM INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS D. SPRINKLERS j�/� !q [ J E. HOUSEKEEPING J 5 t+2 F. SPECIAL HAZARD '�%N INSPE TIODATE INSPECTOR'S SIGN dorPnnted) G. OTHER oi q 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 REQUEST GATE` 'PROGRAM' ` Susan Seyboth 714-567-2906 -02G1-t/20=14' - - - Lipensitiglnd-Gertification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST.CODE - Susan Seyboth 1A • CODE$ 1. ORIGINAL A. FIRE CLEARANCE 2,RENEWAL B.LIFE SAFETY LICENSING iC'aliforniaDepartment ofPubhc"Health AGENCY Licensing and Certification 3. CAPACITY CHANGE NAME AND 681 South Parker Street ADDRESS Suite 200 4. OWNERSHIP CHANGE Orange, CA 92868 5. ADDRESS CHANGE J L I 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 FACILITY NAME LICENSE CATEGORY Hoag Memorial Hospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Iloag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92663 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 1 949-764-8030 SPLUTAL DONUI I IUNS Breast Center Renovation - new TOMO. Ready now. TO BE COMPLETED BY INSPECTING AUTHORITY �— i Newport Beach Fire Department f DES 1. E CLEARANCE GRANTED FIRE PO BOY 1768 AUTHORITY Newport Beach, CA 92658 NAME AND 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS L E: CONSTRUCTION C. FIRE ALARM D. SPRINKLERS HOUSEKEEPING F. SPECIAL HAZARD G. OTHER INSPECTOR'S NAME (Typed orPrinted) ve TELEPHONE NUMBER CFIRS NUMBER Z,E. 30o.55 OCCUPANCY CLASS INSPECT10 DATE INSPECTOR'S SIGNATURE or EXP IN NIAL OR LIST SPECIAL CONDITIONS �SVW�I��Ib l� r Alcaraz, Debbie From: Alcaraz, Debbie Sent: Thursday, August 06, 2015 2:02 PM To: Carney, Seanne Subject: NBFD void invoice FS54005582 Invoiced wrong customer number. Thank you. Debbie Alcaraz I Administrative Technician Newport Beach Fire Department Life Safety Services Division 100 Civic Center Drive, NB, CA 92660 Ir 949.644.3351 31 A i t 01- CALIPORNIA — FORESTRY AND FIRE PROTECTION FIDE SA;:ETV INSPECTION REQUEST SrD' W gkV. 4-M) See 1ns&uc fions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM Juanita A. Jackson 916-327-3125 7-13-15 1 EVALUATORS NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Juanita A. Jackson 300329AP A CODES 1. ORIGINAL A. FIRE CLEARANCE 7 LICENSING 1 Department of Health Care Services AGENCY Licensing and Certification Section 2. RENEWAL B. uFE SAFETY NAME AND PO Box 997413 3. CAPACITY CHANGE ADDRESS Sacramento, CA 4. OWNERSHIP CHANGE 95899-7413 S. ADDRESS CHANGE L 1 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 21 0-NA 0-NA 0-NA 0-NA 0-NA 21 FACILITY NAME LICENSE CATEGORY SolMar Retreat Residential Alc/Drug Tx STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Dr. 1 CITY RESTRAINT Newport Beach --------_—.__ Non -Restraint - FACILITY CONTACT PERSONS NAME FACILITY CONTACT PERSONS TELEPHONE NUMBER HOURS Marshall Moncrief 949-400-4157 24 SF'tl:lAL UUNUI I IUNtj N/A TO BE COMPLETED BY INSPECTING AUTHORITY Newport Beach Fire Departmentp D INSTALLAMN EPTASLE TO RE ARMW FIRE PO BOX 1768 AUTHORITY Newport Beach, CA 92658 /VE INSPECTORt NAME AND ADDRESS Note: Ac�tar applies to proposal or Plans as submits cdl-�nd for construction indicated thereon -subject to field inspection. INSPECTOR'S NAME (ryped orf3inted) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCYCLASS ; 4q a�-' � f,, L q`/9-6 yV-'510Is INSPECTIO DATE INSPECTOR'S SIGNATU ypedcrPdnted) EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS CLEARANCE/DENIAL CODE I FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER s #BWNKJHD #AR00000000667# BYRNE, AARON PETER 3006 DOONYBROOK COSTA MESA, CA 92626 ANNUAL & SPECIAL PERMITS - INVOICE NUMBER: 0000 00066 INVOICE: FS5 005582 INV DATE: 07/ DUE DATE: 08/14/15 NBID: 65039 Description Qty Unit Price Tax ZExtension ------------------------------------------------------------- ---- ------------- STATE FIRE CLEARANCE 1.00 75.00 .00 75.00 SOL MAR RETREAT @ HOAG DATE: 07.13.15 ADDRESS: 3006 DOONYBROOK COSTA MESA CA OID# ------------------------------------------------ ----------------------- TOTAL INVOICE: $ 75.00 I/A��. P YMENTS/ADJUSTMENTS: $ 0.00 I�ttil PAST DUE: $ 0.00 x ! PENALTIES/ITEREST: $ 0.00 A, " 1TOTAL AMOUNT DUE: $ 75.00 BILLI QUESTIONS SHOULD BE DIRECTED TO THE FIRE D $fMENT AT (949) 644-3106. THANK YOU. :::. •.: . :.... , B ease;. detach 'and _"return:the 14wer:::pQrt3on of?„this::::invoice;;>Wi.1x:X.::.: ..� : :::::.: •::::.>::;,:•;:;•:,:;•;...:••;•:;::_;::.:. •:::... ANNUAL & SPECIAL PERMITS - INVOICE BYRNE, AARON PETER 3006 DOONYBROOK COSTA MESA, CA 92626 TOTAL AMOUNT DUE: $ INVOICE: FS54005582 INV DATE: 07/15/15 DUE DATE: 08/14/15 NBID: 65039 75.00 AR 0000000066 7500 IMPORTANT NOTICE Location of City Hall ,10,1r, is Ce -itei D - , . 'w "Jrt Be lch CA 926610 Billing Location - Di-,;ston (949) 64-1-3141 Office Tours" I'donday - Thursday 7 ,30am - 5.30pm Friday 7:30am - 4 30pm `excluding hol;d.ays Payment Location - Cashie s c,14,D) 644-3121 NOTICE OF INTENT TO NOTIFY FRANCHISE TAX BOARD OF UNPAID LIABILITIES The City of Newport Beach is required by law to provide this notice relating that failure to pay the liability owed will result in this debt being reported to the State Franchise Tax Board for tax offset In the event that you are owed a tax refund, win a California Lottery prize, or have unclaimed property claims, the Franchise Tax Board will intercept from that money the amount you owe this agency. California Government Code Sections 12419.8 and '12419.10 authorize the Office of the State Controller to collect money owed to a county or a city agency by intercepting any money that the state owed the debtor. If you have any questions, or do not believe that you owe this debt, please cont6ct us in writing within 30 days from the date of this notice. A representative will review your objections once they are received. If you do not submit any objections, or if your objections are insufficient, the City will proceed with this action. Establish or Cancel Water Service Contest a Parking Citation Buy a Parking Permit Apply for, Cancel, or Update Business License Many more online services available Change Mailing Address for all account types Pay City Bills View Past Statements for MSS and Business License Sign up for Select Alert Payments can be made using your credit card at www.newportbeachea.gov/payments , via phone by calling (949) 718-1990, by mail using the return envelope enclosed with this mailing, or in person at City Hall (bring your payment stub). Payments must be received by the due date on this invoice to avoid additional penalties (postmark dates are not acceptable). The City is not responsible for mail delays or online banking service delays. By presenting your signed check to the City of Newort Beach, you authorize the City of Newport Beach to use the account infonnation from the check to make an electronic fund transfer from your banking account for the same amount as the check. If the electronic fund transfer cannot be completed for any reason, the City of Newport Beach may attempt the transfer two additional times. Payments not received by the due date are subject to late payment fees. J CITY OF NEWPORT BEACH 3300 NEWPORT BLVD NEWPORT BEACH, CA 92663 PHONE: 949 644-3141 CUSTOMER0000018925 QUESTAR CONSTRUCTION 17841 MITCHELL NORTH IRVINE, CA 92614 INVOICE: FS54003698 PAGE 1 DATE: Nov 30, 2,011 OF 1 SERVICE: ANNUAL & SPECIAL PERMITS CUSTOMER PO: CUSTOMER PH: (949) 2*50-0060 TERMS: DUE IN 30 DAYS DUE DATE: Dec 30, 2011 SERVICE ADDRESS: QUESTAR CONSTRUCTION 17841 MITCHELL NORTH IRVINE, CA 92614 --- DESCRIPTION --------------- QTY---- UNIT PRICE OFF HOURS INSPECTION 1.50 282.00 HOAG CANCER CENTER 500 SUPERIOR AVENUE INSPECTION DATE:11/23/11 6:00 AM - 7:30 AM TOTAL CHARGES TOTAL TAX: TOTAL INVOICE PAYMENTS: ADJUSTMENTS: TOTAL DUE: -TOTAL PRICE- TAX 423.00 N 423.00 0.00 423.00 0.00 0.00 423.00 r x m= my COD I m m to PRESORTED FIRST CLASS A o N UNiras O N �' 9 cil 4 p o 1a yQ co Y N /I ci ` y �. OzQm Oo ma,�o C AA N NN \ O� CD W N 'Qa r CITY OF NEWPORT BEACH 3300 NEWPORT BLVD NEWPORT BEACH, CA 92663 PHONE: 949 644-3141 CUSTOMER0000018925 QUESTAR CONSTRUCTION 17842 MITCHELL NORTH IRVINE, CA 92614 INVOICE: FS54003698 PAGE 1 DATE: Nov 30, 2011 OF 1 SERVICE: ANNUAL & SPECIAL PERMITS CUSTOMER PO: CUSTOMER PH: (949) 250-0060 TERMS: DUE IN 30 DAYS DUE DATE: Dec 30, 2011 SERVICE ADDRESS: QUESTAR CONSTRUCTION 17842 MITCHELL NORTH IRVINE, CA 92614 ---------- DESCRIPTION --------------- QTY---- UNIT PRICE -TOTAL PRICE- TAX OFF HOURS INSPECTION 1.50 282.00 423.00 N HOAG CANCER CENTER 500 SUPERIOR AVENUE INSPECTION DATE:11/23/11 6:00 AM - 7:30 AM TOTAL CHARGES: 423.00 TOTAL TAX: 0.00 ------------- TOTAL INVOICE: 423.00 PAYMENTS: 0.00 ADJUSTMENTS: 0.00 TOTAL DUE: 423.00 Morris, Nadine V �� From: Kirk Feldkamp [kirkf@questarconstruction.com] -- Sent: Monday, November21, 2011 3:24 PM To: Morris, Nadine Cc: Alex Lee; Jesse Jenner; Dan Tedder; Bill Quiram; holcomb@mpassoc.com; Nancy Soo; Wilson, Ray; Lidecis, Erik Subject: Methane Alarm Nadine, Thank you for being able to fit us in your busy schedule prior to the holiday. I want to confirm we are on schedule for an inspection at 6:00 am November 23, 2011 for a partial occupancy on the methane alarm at Hoag Cancer Center in Newport Beach. Once the HDMI panel is installed, we will request the final inspection. We can meet in the second floor lobby like we did last time. If you have any questions, please call me. Thank you Kirk Feldkamp I NVUkC.E pig 4-A002S 1 NkSrA�-�0K) Asst Project Manager Questar Construction 30 r +A(Z S 17841 Mitchell NorthW1 i Irvine, CA 92614 kirkf(@ciuestarconstruction.com 949.250.0060 (main) 949.250.0070 (fax) 949.922.0280 (cell) www.guestarconstruction.com BES'i PLACES TO WORK ? U E 4) Privileged And Confidential Communication. This electronic transmission, and any documents attached hereto, (a) are protected by the Electronic Communications Privacy Act (18 USC §§ 2510-2521), (b) may contain confidential and/or legally privileged information, and (c) are for the sole use of the intended recipient named above. If you have received this electronic message in error, please notify the sender and delete the electronic message. Any disclosure, copying, distribution, or use of the contents of the information received in error is strictly prohibited. `-, Please consider the environment before printing this e-mail. 1 K X -n m "0 O D r O w Z 0 Z 0 O cn _0v 0 W � r rl D -0 0 00 0 X m m r 0 -D O m v � m C m z z _n-n-n_nmcow coo m m c c c c � m CD QQQQ CD CD 0 0 7 3 C T. 0 3 3 ca co ca co aa3 3 m S0-0 o _ M 0 C<D CD -i 0' = 3 m c D o w o 0 .. -I a' CD 0 o -n � 0 g 3.g m a CD C� 3 T CD -n m o o m FR CD m m CD w O O O O O b9 O � A A W EA ifl t0 {fl iR to iA w O O W O O O O W W 0 0? 0 0 0 O A -fl p p -p _n 7 0C C CD o a Nna pr En� =o art .n p co v D n m m w n cm p CD -n < 3 m CD CD 0 'm'^^ CDCD -n co CD o 0 v a 000 {, 0.0 coo m CD D C CD a r+ CD o CD CD a cn M � y � m CD 3 CD W Vi {fl N J O O W V O O O A w-nzzDDO-10 ao 0 a aa0,< o -0 DD = a-0 -o DO = a* 5 C- 0 0 Co p aao'a a o as .) 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( j <D 69 c � U a) N c N C_ L o 0. N 3 0 N d LL 000 00. 1�- 401,01RN 60A44 c" 4 ai U- U (� • - 4 U �a�� LJJ m LL! E '> LL n. LL ro U at 0 u- E N L LL N CL f- LL `oo a U N rn rn t U o ,c .c42212 iL a 0. n. d a �toccc;roCDao h o 0 0 o h o od, oi0000moov- o v) EA t# 4j- CD 1R 40 (+'� CD 0 0 0 0 0 40 W (D °' U U� ti. aoi = L' J o autr_ oU €IQ- „00ca CL p ro E ffi cafcaH J aa)crn LL C N �'`'L. c E Ea -a o a,pW O O a) a) v ovaUU := N N a N 0 U m c4 m m LL LL LL iL H `+ CD i 1-3 tr3 0 CD� im V cn Ocny aZL=WW OD . � .-.• z va 1;1 n � x x Im >��,, 2� NoCZi �v m o o tzi o ITED W LASS g: o O U N I I D 0 N IVFA U1 OD�1az (o N m 0 �m o W o _ m002 0 � N O ��iV N�� CDq W N STATE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST RTII R60 (REV. 4-20001 See instructions on reverse. AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM Susan Seyboth 714-567-2906 03/05/2015 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 ' 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 I L— 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY FACILITY NAME LICENSE CATEGORY Hoag Heart & Vascular Institute GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92658-6100 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSONS TELEPHONE NUMBER HOURS Monica D. Dang 1949-764-8030 SPECIAL CONDITIONS Newly renovated Heart & Vascular Institute locate&in the South Building. TO BE COMPLETED BY INSPECTING AUTHORITY Newport Beach Fire Department FIRE PO Box 1768 AUTHORITY Newport Beach, CA 92658 NAME AND ADDRESS L INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS S-�- 2Ve � �� lt'c�a`ti � `�`15- �yy0g 3CJ(aSS (-'�-- SPEC ION DATE INSPECTOR'S SIGNAT ype EXP IN DENIAL OR LIST SPECIAL CONDITIONS �55Nf�q"Mi CODE I CODES 10 FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIREALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER 67Q2 V6 - STATE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST RTn Rfi0 IRFV. d-2000) See instructions on reverse. AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM Susan Seyboth 714-567-2906 03/OS/2015 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 FACILITY NAME LICENSE CATEGORY Hoag Multispecialty Center GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92658-6100 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS Expansion of the Hoag Multispecialty Center located in the Cancer Center. TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE /DENIAL CODE Newport Beach Fire Department CODES 1. IRE CLEARANCE GRANTED FIRE PO Box 1768 AUTHORITY NAME AND Newport Beach, CA 92658 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 E. HOUSEKEEPING oo—L. > T-e ve 1 `( q - 3/ 0 y - O 0 S S 2 F. SPECIAL HAZARD G. OTHER INSPEC 1O(N'DATE INSPECTOR'S SIG TU y o fed! Ai-'s, G---� E.�PLAJN DENIAL OR LIST SPECIAL CONDITIONS Ajn(W� 070P. tE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION SAFETY INSPECTION REQUEST STD. 850 (REV. 4-2000) See instructions on reverse. AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM Susan Seyboth 714-567-2906 106/26/201 4 Licensing and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Susan Seyboth 1A CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY �— LICENSING 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 B. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY FACILITY NAME LICENSE CATEGORY Hoag Memorial Hospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT . Newport Beach, CA 92658-6100 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS Chemical Dependency Recovery Center (CDRC) Relocation to One South TO BE COMPLETED BY INSPECTING AUTHORITY F Newport Beach Fire Department FIRE PO Box 1768 AUTHORITY Newport Beach, CA 92658 NAME AND ADDRESS I__ 01 INSPECTOR'S NAME (Typed or Printed) Ve i�� ,e� TELEPHONE NUMBER i�i��Gfr(�(��l®� CFIRS NUMBER ��SS OCCUPANCY CLASS lag. INSPECTION DATE I INSPECTOR'S SIG tURgaidv edorPdntetdY OR LIST SPECIAL CONDITIONS CLEARANCE /DENIAL CODE CODES 1./FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER ZOLo �( I� �' asp �1'� STATE OF CALIFORNIA— FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST eTn GFn tDM%/ A_9nnn% See instructions on reverse. TELEPHONE NUMBER REQUEST DATE PROGRAM Licensing and Certification AGENCY CONTACT'S NAME Susan Seyboth 714-567-2906 09/29/2014 EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Susan Seyboth 1A CODES 1. ORIGINAL A. FIRE CLEARANCE �— LICENSING California Department of Public Health 2. RENEWAL B. LIFE SAFETY AGENCY Licensing and Certification 3. CAPACITY CHANGE NAME AND 681 South Parker Street ADDRESS Suite 200 4. OWNERSHIP CHANGE Orange, CA 92868 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACRY FACILITY NAME LICENSE CATEGORY Hoag Memorial Iospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92658-6100 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDI I IONS Newly renovated Sterile Processing Decontamination (SPD) department TO BE COMPLETED BY INSPECTING AUTHORITY [Newport Beach Fire Department FIRE PO Box 1768 AUTHORITY Newport Beach, CA 92658 NAME AND ADDRESS L —I VSPECTOR'S NAME (Typed orPnnted) TELEPHONE NUMBER CFIRS NUMBER Save �i �cc�rL A `�`r`�' b��• 3t��vnS S NSPECTION DATE I INSPECTOR'S S1GKG (TURE.(2gP,((,,orPrinted) N DENIAL OR LIST SPECIAL CONDITIONS CODE CODES FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM ,CUPANCY CLASS D. SPRINKLERS d E. HOUSEKEEPING 1-2- F. SPECIAL HAZARD G. OTHER 5 .sue!•.. CC)SCCO v •.s Aas•� �� -•�••• Fire Protection Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19 �►�y`�,� v6 Cosco WO 1211-1415 Property Information: Name: Hoag Hospital Ancillary Bldg. 16 Occupancy/Use: institutional of CA<i,�o� co Address: One Hoag Dr. Construction Type: I No. Stories: 2 9 Q City: Newport Beach Year Constructed: 1966 �tE MA Zip: 92663 Monitoring Company: Hoag Hospital Contact: Ray Wilson Phone Number: Hoag Hospital Phone: 949-764-5504 Time system off-line: Hoag Hospital Time system on-line: Hoag Hospital Contractor Information: Name: Cosco Fire Protection Inc., Address: City: State: Phone: 1075 W. Lambert Rd. Bldg. D Brea CA 714-989-1800 2 Number of System Risers Copy sent to: Owner Date 12/7/2012 Fire AHJ Contractor 12/7/2012 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. CA License# C-10/C-16 577621 2) Inspection Items may be performed by the Owner in Job # 1211-1415 accordance with California Code of Regulations Title 119 901.1(a) Performed by: Shawn Arballo (Print) Note: Contractor information may be Forms included with the report NFPA 25 Chapter Number of Forms N/A FAIL* PASS I✓ Automatic Sprinkler System 5 1 ❑ Q ! Standpipe and Hose Systems 6 F 1__f C Private Water Supply System 7 F Fire Pump 8 ❑ I, r Water Storage Tank 9 IJ 0 r Water Spray System 10 rv-01 0 1 0 C Foam Water Sprinkler System 11 I� *See "Deficiencies and Comments" section at end of each respective form> co sc -• •- Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems Page 1 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 cosoo WO 1211-1415 AES 2 Date Inspection, Testing, Maintenance: 12/07/2012 Date Of Last Five Year Inspection: 10/14/2010 ❑ NSA System Riser ID:1 & 2 Property Information: Type of system: �oF cA4 Hoag Hospital Ancillary Bldg. 16 IQ Wet Pipe 5 Year Name: 9 p rY 9• One Hoag Dr. JJ Dry Pipe v Address: g 9 4 City: Newport Beach 0 Preaction Zip: 92663 0 Deluge Main Drain Test Results: Initial Static Pressure: 1) 95 2)95 (psi) 1 8080 2 Residual Pressure: ) ) (psi) Restored Static Pressure: 1)95 2)95 (psi) Recovery Time: 1)2 2) 2 (sec) 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 1.2 1 Daily Weekly DRY PIPE VALVES - ENCLOSURE TEMPERATURE 12.4.4.1.1 0 1.3 1 Quarterly GAUGES ( DRY, PREACTION, DELUGE SYSTEM) 5.2.4.2 5.2.4.3 1.4 1 Quarterly CONTROL VALVE 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 El R-j 1.7 1 Quarterly HYDRAULIC NAMEPLATE 5.2.7 ❑ ❑ r` 1.8 1 Quarterly PIPE AND FITTINGS 5.2.2 ❑ va 1.9 1 Quarterly SPRINKLERS 5.2.1 n El Cri 1.10 1 Quarterly SPARE SPRINKLERS 5.2.1.3 1.11 1 Quarterly FIRE DEPARTMENT CONNECTIONS 12.7.1 Q ❑ Ej 1.12 1 Quarterly ALARM VALVES - EXTERIOR INSPECTION 12.4.1.1 ❑ 0 C 1.13 1 Quarterly PREACTION/DELUGE VALVES - EXTERIOR INSPECTION 12.4.3.1.6 ❑--, 1.14 1 Quarterly PRESSURE REDUCING VALVES 12.5.1.1 ❑ G 1.15 1 Quarterly DRY PIPE VALVES - EXTERIOR INSPECTION 12.4.4.1.4 ❑ 1.16 1 Quarterly BACKFLOW PREVENTERS 12.6.1 1.17 1 Annually BUILDINGS 5.2.5 ❑ ►;,► �-- C<JScc ----� Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems Page 2 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 cosco wo 1211-1415 AES 2 Date of Inspection, Testing, Maintenance: 12/7/2012 System Riser ID:1 & 2 Property Information: Type of System: r- CAti.�o Name: Hoag Hospital Ancillary Bldg. 16 9 Wet Pipe Address: One Hoag Dr. CJ Dry Pipe city:Newport Beach C! Preaction 9e MPQa3Z� 92663 I� Deluge Zip: Item Activity Frequency Description NFPA25 Reference Fail N/A Pass 1.18 1 Annually HANGERS 5.2.3 0 ❑ G 1.19 1 Annually SEISMIC BRACES 5.2.3 U (' i C 1.20 1 5 year HANGERS (Accessible Concealed Spaces) 5.2.3.3 F ❑ G 1.21 1 5 year SEISMIC BRACES (Accessible Concealed Spaces) 5.2.3.3 Q 11 C 1.22 1 5 year PIPE AND FITTINGS (Accessible Concealed Spaces) 5.2.2.3 ❑ �f C 1.23 1 5 year SPRINKLERS (Accessible Concealed Spaces) 5.2.1.1.4 [j- 1.24 1 5 year ALARM VALVES - INTERIOR INSPECTION 12.4.1.2 G r-- 1.25 1 5 year ALARM VALVES - STRAINERS, FILTERS, ORIFICES 12.4.1.2 �— 1.26 1 5 year CHECK VALVES - INTERIOR INSPECTION 12.4.2.1 ❑ C, 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 ED Ej Ul 1.29 1 5 year DRY PIPE VALVES - INTERIOR INSPECTION 12.4.1.1.5 1.30 1 5 year DRY PIPE VALVES - STRAINERS, FILTERS, ORIFICES 12.4.4.1.6 �! 2.1 T Annually ALARM DEVICES (90 SEC) 5.3.3-12.2.7 r n 2.2 T Annually MAIN DRAIN TEST (ENTER DATA ON PAGE 1) 12.2.6 12.2.6.1 12.3.3.4 0 ED Ej 2.3 T Annually ANTIFREEZE TEST 5.3.4 ❑ F ED 2.4 T Annually CONTROL VALVE - POSITION 12.3.3.1 D r 2.5 T Annually CONTROL VALVE OPERATION 12.3.3.1 0 � C 2.6 T Annually SUPERVISORY 12.3.3.5 2.7 T Annually PREACTION VALVE - PRIMING WATER 12.4.3.2.1 D r 2.8 T Annually PREACTION VALVE - LOW AIR PRESSURE ALARM 12.4.3.2.10 2.9 T Annually PREACTION - FULL FLOW TRIP TEST 12.4.3.2.2 13 Ell .sf•.... cQs'\...Icp r►sl►•. WOO Fire protection Inspection, Testing, Maintenance Fire Sprinkler Systems Page 3 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco w0 1211-1415 AES 2 Date Inspection, Testing, Maintenance: 12/7/2012 System Riser ID: 1 & 2 Property Information: Type of System: of CA41 Wet Pipe Name: Hoag Hospital Ancillary Bldg. 16 Dry Pipe ' Address: One Hoag Dr. CI Preaction� Newport Beach sae M� City: P El Zip: 92663 Item Activity Frequency Description NFPA25 Reference Fail N/A Pass 2.10 T Annually DRY PIPE VALVE - PRIMING WATER 12.4.4.2.1 C 2.11 T Annually DRY PIPE VALVE - LOW AIR PREASSURE 12.4.4.2.6 ❑ n 17 2.12 T Annually DRY PIPE VALVE - QUICK -OPENING DEVICE 12.4.4.2.4 �J R5 2.13 T Annually DRY PIPE VALVE - TRIP TEST 12.4.4.2.2 Cj 2.14 T Annually BACKFLOW PREVENTER ASSEMBLIES 12.6.2 ❑ [ C 2.15 T 3 year DRY PIPE VALVE - FULL FLOW TRIP TEST 12.4.4.2.2.2 ❑ - Evi El 2.16 T 5 year GAUGES 5.3.2 0 M F 2.17 T 5 year PRESSURE REDUCING VALVES 12.5.1.2 ❑ P-1 ❑ 2.18 T 5 year FIRE DEPARTMENT CONNECTION BACKFLUSH 12.7.4 n ,11 2.19 T 5 year SPRINKLERS - EXTRA HIGH TEMPERATURE 5.3.1.1.1.3 2.20 T 5 year SPRINKLERS - CORROSIVE ENVIRONMENT OR CORROSIVE WATER 5.3.1.1.2 n Q ❑ 2.21 T 10 year SPRINKLER - DRY 5.3.1.1.1.5 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 r; 2.25 T SPRINKLERS MANUFACTURED PRIOR TO 1920 - REPLACE 3.1 M Annually CONTROL VALVES 12.3.4 0 C 3.2 M Annually PREACTION/DELUGE VALVES 12.4.3.3.2 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 1-7 n 3.5 M 5 year OBSTRUCTION INVESTIGATION Chapter 13 0 r coscco Fire Protection Inspection, Testing, Maintenance Fire Sprinkler Systems Page 4 of 4 NFPA 25, Chapter 5 as amended by CCR, Title 19 Cosco Wo 1211-1415 AES 2 Date Inspection, Testing, Maintenance: 12/7/2012 System Riser ID:1 & 2 Property Information: Name: Hoag Hospital Ancillary Bldg. 16 Address: One Hoag Dr. City: Newport Beach Zip: 92663 Type of System: R-1 Wet Pipe t�Cf Cg4�o ❑ Dry Pipe y ga C Preaction 9 ❑ Deluge /RE Item I Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above: Note The Ancillary building 16 is a two story above ground building. The Ancillary building has two 8" risers. one 8" riser (North riser #2) feeds the Ancillary building and the other (South riser 41) feeds the first floor of the West Tower. Note Each riser has a separate control valve and water flow. The PIV and FDC are located outside on West Hoag Dr. This building has 1 1/2" class II hose cabinets located on the ground floor, but are no longer in service. Note There are also (2) 1 1/2" hose valves on the roof that are no longer in service. This building also houses the cafeteria that has a grease duct with a grease duct sprinkler system attached to the North system with separate control valves and main Note **No Defects Found** Note { I k C PASS r FAIL C. 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 the 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 this report and that the Owner shall have full responsibility for the correction 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. 12/11/201'dd Customer Signature Date Inspector Signature Date 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 REQUEST DATE "PROGRAM Susan Seyboth 714-567-2906 [42/16/2,013.- ._ . _Ut.erisiug,and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Susan Seyboth lA CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY � — LICENSING I California Department of Public Health AGENCY Licensing and Certification 3, CAPACITY CHANGE NAME AND 681 South Parker Street ADDRESS Suite 200 4. OWNERSHIP CHANGE Orange, CA 92868 5. ADDRESS CHANGE I— 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 FACILITY NAME LICENSE CATEGORY Hoag Memorial Hospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92663 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS Multispecialty Center in Cancer Center - ready now. TO BE COMPLETED BY INSPECTING AUTHORITY I Newport Beach Fire Department FIRE PO Box 1768 AUTHORITY Newport Beach, CA 92658 NAME AND ADDRESS L I NSPE�CTTO'R''SNAME (Typed or P�rintteed) ' ) INSPECTION DATE INSPECTOR'S SIGNATU EXP IN DE IAL OR LIST SPECIAL CONDITIONS TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS 67gq~ ('yy-3%C)g' 300S5 `f1 CLEARANCE A)EtNIAL CODE CODES 19 FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER if W 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 REQUEST DATE"' - ' - PROGRAM' Susan Seyboth 714-567-2906 - 1211612013 -- I -Licensitig and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Susan Seyboth - .,1A 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 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 FACILITY NAME LICENSE CATEGORY Hoag Memorial Hospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OFBUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92663 FACILITY CONTACT PERSONS NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS 4 new LDRP beds on fifth floor of Women's Pavilion Building - ready now. TO BE COMPLETED BY INSPECTING AUTHORITY I Newport Beach Fire Department FIRE PO Box 1768 AUTHORITY Newport Beach, CA 92658 NAME AND ADDRESS L J INSPECTOR'S NAME (Typed or Printed) s (erg �ji<c��e L INSPECTION DATE INSPECTOR'S SIG 1 (b 116k EXPLAIN DEN AL OR LIST SPECIAL CONDITIONS F55��H�D TELEPHONE NUMBER I CFIRS NUMBER OCCUPANCY .T -2- CLEARANCE /DENIAL CODE I IRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER STATE OF CALIFORNIA— FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST ^STD. 850 (REV. 4-2000) See.instructions pn reverse. AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM _ Barbara Ruger 714-567-2906 10/23/2012 Licensin and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE' Barbara Ruger 1A 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 Sheet s. CAPACITY CHANGE ADDRESS Suite 200 4. OWNERSHIP CHANGE Orange, CA 92868 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 FACILITY NAME LICENSE CATEGORY Hoag Memorial Hospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92663 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS Catheterization Lab 3 - ready now. TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE /DENIAL CODE �— i Newport Beach Fire Department CODES FIRE PO Box 1768 1. FIRE CLEARANCE GRANTED AUTHORITY Newport Beach, CA 92658 2. FIRE CLEARANCE DENIED NAME AND ADDRESS A. EXITS L B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS E. HOUSEKEEPING 'C h p-e y q b LIy — vo ( '3®®S 5 : F. SPECIAL HAZARD G. OTHER INSPECTION DATE INSPECTOR'S SIGNA J�FfpWor Printed) d® 42 2 1 -e EXPLA N DENIAL OR LIST SPECIAL CONDI S 1� V STATE OF CALIFORNIA- FORESTRY AND FIRE PROTECTION ,j FIRE SAFETY INSPECTION REQUEST STD" 850 (REV. 4-2000) t f See inkructions'ori-reverse: : AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE ' 'PROGRAM Barbara Ruger 714-567-2906 10/23%2012 . "Licensing and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE; Barbara Ruger 1A CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY r LICENSING F California Deparhnent of Public Health AGENCY Licensing and Certification 3. CAPACITY CHANGE NAME AND 681 South Parker Street ADDRESS Suite 200 4. OWNERSHIP CHANGE Orange, CA 92868 5. ADDRESS CHANGE L_ 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 FACILITY NAME LICENSE CATEGORY Hoag Memorial Hospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92663 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS South Entrance - ready now. TO BE COMPLETED BY INSPECTING AUTHORITY [Newport Beach Fire Department FIRE PO Box 1768 AUTHORITY NAME AND Newport Beach, CA 92658 ADDRESS L INSPECTOR'S NAME (Typed l Y / 1 ,Ch4eL INSPECTION D E INSPECTOR'S SIGN EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS vif-d qy-36o K 1'$0055 1-::c CLEARANCE /DENIAL CODE 1. F RE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER 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 REQUEST DATE PROGRAM Barbara Ruger 714-567-2906 10/31/2012 Licensing and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Barbara Ruger 1A CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY LICENSING 1 C.'alifornia 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 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 FACILITY NAME LICENSE CATEGORY Hoag Memorial Hospital Presbyterian GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92663 FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS 10 West - ready now. TO BE COMPLETED BY INSPECTING AUTHORITY f Newport Beach Fire Department FIRE PO Box 1768 AUTHORITY NAME AND Newport Beach, CA 92658 ADDRESS L INSPECTOR'S NAME (Typed or Printed) N(U�M•BfER? CFIRS NUMBER S i Pit o C-G: �TgE`LLEPHONE � �j f 1 �' f 7' 1/ f% (5 'U o Jr s INSPECTION DATE INSPECT ed or Printed) EX LAI DENIAL OR LIST SPECIAL CONDITIONS CLEARANCE /DENIAL CODE V FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS OCCUPANCY CLASS E. HOUSEKEEPING % G- F. SPECIAL HAZARD G. OTHER f75 5LIW LiiiZ a STATE OF CALIFORNIA — FORESTRY AND FIRE PROTECTION FIRE SAFETY INSPECTION REQUEST RTn R5n tRFV. 4-9ana) See instructions on reverse. AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM Susan Seyboth 714-567-2906 06/10/2015 Licensing and Certification EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE Susan Seyboth IA CODES 1. ORIGINAL A. FIRE CLEARANCE 2. �ENEWAL B. LIFE SAFETY LICENSING ' 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 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY - FACILITY NAME LICENSE CATEGORY Hoag Hospital Newport Beach GACH STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS One Hoag Drive, PO Box 6100 CITY RESTRAINT Newport Beach, CA 92658-6100 FACILITY CONTACT PERSONS NAME FACILITY CONTACT PERSONS TELEPHONE NUMBER HOURS Monica D. Dang 949-764-8030 SPECIAL CONDITIONS New MRIPET Scanner at Hoag Hospital Newport Beach TO BE COMPLETED BY INSPECTING AUTHORITY Newport Beach Fire Department FIRE PO Box 1768 AUTHORITY Newport Beach, CA 92658 NAME AND ADDRESS L J INSPECTOR'S NAME (Typed or Printed) e MI'C�,( INSPECTION DATE INSPECTOR'S: ExPLAIN DE IAL OR LIST SPECIAL CONDITI TELEPHONE NUMBER CFIRS NUMBER q'iI-- by y-31og 3o0s s OCCUPANCY CLASS CLEARANCE /DENIAL CODE CODES 0 FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING R SPECIAL HAZARD G. OTHER Fire Alarm System Record of Completion Name of protected property: HOAG Hospital Address: 1 Hoag Drive, Nev Representative of protected property (name/phon Authority having jurisdiction: NBFD Address/telephone number: 3300 Newport Blvd Newport Beach, CA 92663 OSHPD # : HVI 5 Story Elevator Bldg# 38 1. Type(s) of System or Service Ray Wilson NFPA 72, Chapter 3 - Local If alarm is transmitted to location(s) off premises, list where received: Fao►a-o1-7S GUN lk1-1--% - — 5001-J liRIC X NFPA 72, Chapter 3 - Emergency Voice/Alarm Service Quantity of voice/alarm channels: n/a Single: Multiple: Quantity of speakers installed: n/a Quantity of speaker zones: Quantity of telephones or telephone jacks included in system: n/a NFPA 72, Chapter 5 - Auxillary Indicate type of connection: n/a Local energy n/a Shunt n/a Parallel telephone Location of telephone number for receipt of signals: n/a NFPA 72, Chapter 5 - Remote Station Alarm: Via Telephone- (800) 253-3538 Supervisory: Via Telephone (800) 356-1378 NFPA 72, Chapter 5 - Proprietary If alarms are retransmitted to public fire service communications centers or others, indicate location and telephone numbers of the organization receiving alarm: Indicate how alarm is retransmitted: Via Telephone NFPA 72, Chapter 5 - Central Station Prime contractor: Tri-Signal Central station location: Alicia Viejo, Ca Means of transmission of signals from the protected premises to the central station: Mcculloh Multiplex One-way radio x Digital alarm communicator Two-way radio Others Means of transmission of alarms to the public fire service communications center: (a) Via Telephone (b) Via Telephone System location: Organization name/phone Installer RedHawk / 818-683-1500 Supplier RedHawk 1 818-683-1500 Service organization RedHawk / 818-683-1500 Location of record (as -built) drawings: Fire Control Room Location of owners manuals: Engineering Office Representative name/phone Gary Ramirez / 714-685-8100 Gary Ramirez 1 714-685-8100 Gary Ramirez / 714-685-8100 Location of test reports: Engineering Office A contract, dated for test and inspection in accordance with NFPA standard(s) No(s). , dated ,is in effect. 2. Record of System Installation (Fill out after installation is complete and wiring checked for opens, shorts, ground faults, and improper branching, but prior to conducting operational acceptance tests.) This system has been installed in accordance with the NFPA standards as shown below, was inspected by Gary Ramirez on 12/3/2012 , includes the devices shown below, and has been in service since 12/3/2012 X NFPA 72, Chapters 1 2 3 4 5 6 7 (circle all that apply) NFPAA70, Nation trical Code, Article 760 Man cAu rers4gludons signed: _-.Z Organization: Red 3. Record of System Operation Date: 12/3/2012 All operational features and functions of this system were tested by Gary Ramirez on 12/3/2012 and found to be operating properly in accordance with the requirements of: X NFP 72, Chapters 1 2 3 4 5 6 7 (circle all that apply) NF 70, Na ' a Electrical Code, Article 760 M n factur .'s in ructions Signed: Organization: 4. Alarm - Initiating Devices and Circuits Date: 12/3/2012 Quantity and class of initiating device circuits (see NFPA 72, Table 3-5) Quantity: Style: Z Class: A MANUAL (a) Manual stations Nocoded, activating Transmitters Coded (b) Combination manual fire alarm and guard's tour coded stations AUTOMATIC Coverage: Complete: Partial: (a) 1 Smoke detectors Ion 1 Photo (b) n/a Duct detectors Ion Photo (c) 5 Heat detectors x FT RR FT/RR RC (d) n/a Sprinkler waterflow switches: Transmitters Noncoded, activating Coded (e) 4 Other (list): Elevator Relay 5. Supervisory Signal -Initiating Devices and Circuits (use blanks to indicate quantity of devices) GUARD'S TOUR (a) n/a Coded stations (b) nla Noncoded stations, activating transmitters (c) n/a Compulsory guard tour system comprised of transmitter v stations and intermediate stations Note: Combination devices are recorded under 4(b) and 5(a) SPRINKLER SYSTEM (a) n/a Coded valve supervisory signaling attachments Valve supervisory switches, activating (b) n/a Building temperature points (c) n/a Site water temperature points (d) n/a Site water supply level points Electric fire pump: (e) n/a Fire pump power (f) n/a Fire pump running (g) n/a Phase reversal Engine -driven fire pump: (h) n/a Selector in auto position (1) n/a Engine or control panel trouble Q) n/a Fire pump running Engine -driven generator: (k) n/a Selector in auto position (1) n/a Control panel trouble (m) n/a Transfer switches (n) n/a Engine running Other supervisory function(s) (specify): transmitters 6. Alarm Notification Appliances and Circuits Quantity and class (see NFPA 72, Table 3-7) of notification appliance circuits connected to the system: Types and quantities of notification appliances installed: Quantity: Style: Z Class: A (a) n/a Bells Inch (b) n/a Speakers (c) n/a Horns (d) n/a Chimes (e) n/a Other: (f) n/a Visual signals Type: 0 with audible n/a w/o audible relocated (g) n/a Local annunciator 7. Signaling Line Circuits Quantity and class (see NFPA 72, Table 3-6) of signaling line circuits connected to system: Quantity: n/a Style: Y Class: A 8. System Power Supplies (a) Primary (main): Existing Nominal voltage: Overcurrent protection: Type: Location: (b) Secondary (standby): Storage battery: Amp -hour rating: Current Rating: Current Rating: I I 1 Calculated capacity to drive system, in hours 24 60 Engine -driven generator dedicated to fire alarm system: Location of fuel storage: (c) Emergency or standby system used as backup to primary power supply, instead of using a secondary power supply: Emergency system described in NFPA 72, Article 700 Legally required standby system described in NFPA 70, Article 701 Optional standby system described in NFPA 70, Article 702, which also meets the performance requirements of Article 700 or 701 9. System Software (a) Operating system software revision level(s): Ver. 5.10 (b) Application software revision level(s): Ver. ??????? (c) Revision completed by: Gary Ramirez RedHawk (name) (firm) 10. Comments (signed) for central station or alarm service company or installation contractor/supplier (title) (date) Frequency of routine tests and inspections, if other than in accordance with the referenced NFPA standard(s): System deviations for the referenced NFPA standard(s) are: N/A (signed) for central station or alarm service company or installation contractor/supplier (title) (date) Upon completion of the system(s) satisfactory test(s) witnessed (if required by the authority having ;uri�diationn)4� ►� 1 i ►- i a (signed) representative of the authority having jurisdiction itle) (date) Alcaraz, Debbie From: Lunde, Ty Sent: Saturday, February 20, 201610:47 AM To: Alcaraz, Debbie Subject: 'FW: 351/361 Hospital Road: INSPECTIOIN REPORTS Attachments: NEWPORT LIDO MEDICAL - 351 HOSPITAL RD ANN CFA CSM 6-15 EP25.pdf Categories: SCAN Debbie, Please add the attached file to occupancy #1122. Thanks, Ty From: dboler@newportlido.com [mailto:dboler@newportlido.com] Sent: Wednesday, February 17, 2016 11:23 AM To: Lunde, Ty Cc: robledodavid@yahoo.com; 'Zully Garcia' Subject: RE: 351/361 Hospital Road: INSPECTIOIN REPORTS Gotcha! So, here's the 2015 annual report for the 351 Building only. To the best of my knowledge, all deficiencies were corrected. I've copied David Robledo, Chief Engineer, on this email, if you have any further questions. FYI: We will actually be scheduling the annual testing for March this year; I'll send you a copy of that report at that time. And, is there another NBFD captain who would need the reports for the 361 Building? Thank you! Debi Deborah Boler I Executive Engineer I Newport Lido Medical Center ( o 949.645.0500 c 949.300.6219 f-949.645.1729 dboler@newportlido.com NE1S1PORT LIDO -- Medical Center 351 Hospital Road, Suite 307 Newport Beach, CA 92663 This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system. E-mail transmission cannot be guaranteed to be secure or error -free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain viruses. The sender therefore does not accept liability for any errors or omissions in the contents of this message, which arise as a result of e-mail transmission. From: Lunde, Ty [mailto:TLunde0bNBFD.net] Sent: Wednesday, February 17, 2016 11:01 AM To: dboleNdiinewportlido.com Subject: Re: 351/361 Hospital Road: INSPECTIOIN REPORTS Good morning, I am responsible for the 351 Hospital Road building, so I only need that annual test record. The other records, (quarterly and semi-annual), are not required for my records. Email is the most efficient way for me to communicate. Please let me know if you have any more questions. Best, Ty On Feb 17, 2016, at 10:55 AM, dboler@,newportlido.com wrote: Good morning... sorry to bug you, but... I have all the reports ready to email, but there are quite a few of them, obviously, since we test quarterly, semi-annually and annually. (Both buildings and two surgery suites.) Would it be better to copy them and mail all the reports to you? I can certainly email, I'll just have to send them in more than a few separate emails so both our systems can send and receive the large files. Please let me know if mail is OK or if you'd prefer emails. Thank you! Deborah Boler ( Executive Engineer I Newport Lido Medical Center ( o 949.645.0500 c 949.300.6219 f 949.645.1729 dboler@newportlido.com <image001.png> 351 Hospital Road, Suite 307 Newport Beach, CA 92663 This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system. E-mail transmission cannot be guaranteed to be secure or error -free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain viruses. The sender therefore does not accept liability for any errors or omissions in the contents of this message, which arise as a result of e-mail transmission. From: Lunde, Ty [mailto:TLunde(s1NBFD.net] Sent: Tuesday, February 16, 2016 4:36 PM To: dboler newportlido.com Subject: Re: 351 Hospital Road Hi Deborah, Thanks for the reply. Don't worry about the timing. I just need the records by the end of the month. Thanks, Ty Sent from my !Phone On Feb 16, 2016, at 15:31, "dboler@newportlido.com" <dboler@newportlido.com> wrote: My apologies... first, we were out -of -the -office yesterday for the holiday so I didn't see your email until today. And secondly, I was remiss in sending you the report copies as we've had the building systems test... I don't think I forwarded anything last year, at all. At least I couldn't find a record of that. Therefore, I'll be sending you all of the reports for Newport Lido Medical Center (351 and 361 Hospital Road) for 2015 and the most recent testing from January 2016. I'll send the reports in a few separate emails to make tracking easier. And, I will do my best to remember to forward all future reports to you, as well. If you need anything else, please let me know! Deborah Boler I Executive Engineer I Newport Lido Medical Center I o 949.645.0500 c 949.300.6219 f 949.645.1729 1 dboler@newportlido.com <image001.png> 351 Hospital Road, Suite 307 Newport Beach, CA 92663 This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this e-mail by mistake and delete this e-mail from your system. E-mail transmission cannot be guaranteed to be secure or error -free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete, or contain viruses. The sender therefore does not accept liability for any errors or omissions in the contents of this message, which arise as a result of e-mail transmission. From: Lunde, Ty [mailto:TLunde@NBFD_.net] Sent: Monday, February 15, 2016 4:05 PM To: 'dboler@newportlido.com' Subject: 351 Hospital Road Hi Deborah, I hope is well. At your convenience, please send me the most recent annual fire alarm test record for 351 Hospital Road. The fire code requires an annual test and I wanted to update your record. Best, Ty Lunde Fire Captain Newport Beach Fire Department 949-644-3372 - Fire Station 2 949-644-3104 - Fire Administration tlunde(a nbfd.net On Dec 12, 2014, at 2:52 PM, Debi Boler <dboler@newportlido.com> wrote: Capt. Lunde: Per your request, attached are the latest inspection reports (September 2014) for Tower 1 / 351 Building and Tower 2 / 361 Building. Coincidentally, we just had our quarterly inspections this morning and I'll forward the report copies to you upon receipt (estimated 10-14 days from TRL Systems). Also attached, per request, are the 5-year reports for both buildings, as well. Please let me or David know if you need any further information or have any questions. Thanks and have a good weekend! Deborah Boler I Executive Engineer ) 949-645-0500 p 1 949-300-6219 c (949-645-1729 f I dboler@newportlido.com <image001.png> 351 Hospital Road . Suite 307 Newport Beach . CA. 92663 www.newportlido.com <NEWPORT LIDO MEDICAL - 351 HOSPITAL RD QRT WF TS CS 9-14 EP25.pdf><NEWPORT LIDO MEDICAL - 361 HOSPITAL RD QRT WF TS CS 9-14 EP25.pdf><2012 T1 5-Year.pdf><2012 T2 5-Year.pdf> 4 DocuSign Envelope ID: 25A94088-B8A0-45D4-BF2D-DDFDC7DF256A Newport Lido Medical Center 351 Hospital Road Fire Life Safety System Test Results Test Date(s) -June 27, 2015 ZRL Systems Testing Agency: When Reliability Counts 800 West Doran Street Suite 200. Glendale, CA 91203 Phone (800) 266-1392 Technicians: Richard Beesley, Arin Grigorian, Moin Ather Phone Number: 1.800.266.1392 Ext # 4409 Email Addresses: Testing dept@trlsystems.com The following test results consist of the selected items: ❑ EC 02.03.05 EP1 (Supervisory Signals) - Quarterly- NFPA 72, 1999 Table 7-3.2................................................... ❑ EC 02.03.05 EP2 (Water Flows/Tampers/PIV) - Semi -Annual- NFPA 72,1999 Table 7-3.2.................................. ® EC 02.03.05 EP2 (Water Flows/Tampers/PIV) - Quarterly- NFPA 25,1998 Section 2-3.3.................................... ® EC 02.03.05 EP3 (Initiating Devices & Electromechanical Releasing Devices) - Annually. .................................... NFPA 72, 1999 Table 7-3.2 ® ECO2.03.05 EP4 (Audio/Visuals) - Annually- NFPA 72, 1999 Table 7-3.2............................................................... ® EC 02.03.05 EP5 (Central Station Signaling) - Quarterly- NFPA 72, 1999 Table 7-3.2........................................... ❑ EC 02.03.05 EP7 (Water Storage Tank High And Low Water Level Alarms) - Semi -Annual. ................................ NFPA 25,1998 Section 6-3.5 ❑ EC 02.03.05 EP9 (Sprinkler System Main Drain) - Annually- NFPA 25,1998, Section 9-2.6.............................:... ❑ EC 02.03.05 EP10 (Fire Department Connections Inspected) - Quarterly- NFPA 25,1998 Section 9-7.1........... _ ❑ EC 02.03.05 EP11 (Fire Pumps Tested Under Flow) - Annually- NFPA 25,1998 Section 5-3................................ ❑ EC 02.03.05 EP12 (Water Flow Test For Standpipe Systems) - 5 Years- NFPA 251998......................................... Tables 3-1 & 3-2.3 ❑ EC 02.03.05 EP13 (Automatic Kitchen Fire Extinguishing System) - Semi -Annual- NFPA 96,1998..................... ❑ EC 02.03.05 EP14 (Gaseous Automatic Fire Extinguishing System) - Annually- NFPA 2001, 2000...................... ❑ EC 02.03.05 EP17 (Fire Hoses Hydro Tested 5 Years After Install, Every 3 Years After That) - 5 Years ................. NFPA 1962,1998 Section 2-3 & NFPA 25, 1998 ❑ EC 02.03.05 EP18 (Smoke And Fire Dampers) - 6 Years- NFPA 80, 2007 Section 19.4.1.1&................................ NFPA 105, 2007 Section 6.5.2 ® EC 02.03.05 EP19 (AHU Shutdown) - Annually- NFPA 90A, 1999 Section 4............................................................ ® EC 02.03.05 EP20 (Roll Down Doors, Won Doors & Elevator Fire Curtains) - Annually- NFPA ............................. 80, 1999 Section 15-3.4 ® Other -Automatic Elevators & Fire Alarm System Power Supply Panels............................................................ ® Discrepancies/Comments/Repairs -.............................................................................................................................. DocuSign Envelo a ID, 25A94088-B8A0-45D4-BF2D-DDFDC7DF256A Lrace mms When Reliability Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 FACILITY ' ''' [NEWPORT LIDO MEDICAL CENTER T- ESTSITE'ADDRESS - tj 351 HOSPITAL ROAD I.TE-ST •DATE(S); <',;;', ; ' `, ,TUNE 27, 2015 `CITY,;STATE,',ZIP,, ; , NEWPORT BEACH, CA 92663 0TAKlr%A0n r-f, no n4 nS-GD ) AI =ALARM TR=TROHRIF AP= SI IPFRVI.SCIRY P=.PASS F=FAIL NT=NOT TESTED VALVE TAMPER SWITCHES AND WATER FLOW DEVICES FREQUENCY: QUARTERLY 351' HOSPITAL R'OAD;' , h:, , s , r - .-. :,. .•.,<;:,,, ,,,.., :_. <,...,.. SIMPL"EX'_:4100ES ..., ; ,` ,..: ",:. ,• , M .... ,.•..'.. '1... FL'O.OR"MAIN LOBBY` • WATER,FLOW,$&;TAMI,,ERS; ,,.,,,' [FLOOR, ; i,' "LOCATION; ",AL VTR -•'•SP; TJUNEi ,' COMMENTS ` HYPE,, ZONE 1 TAMPER 1 STAIR 1 P 6/27 1 TURN POINT ADDRESS 5-1-0 ZONE 2 TAMPER 1 STAIR 1 P 6/27 1 1/4 TURNS POINT ADDRESS 5-2-0 M1-8 TAMPER 1 STAIR 1 P 6/27 1 TURN ZONE 3 W F B STAIR 1 P 6/27 28 SECONDS / ITV BASEMENT STAIR 1 POINT ADDRESS 5-3-0 Page 1 of 14 Richard Beesley C10, C16; 413747 Lead Technician & License # �Dacu510catl hy: �Z,a 6-J, �(fgajU$e 7.3D. DocuSign Envelo a ID: 25A94088-B8A0-45D4-BF2D-DDFDC7DF256A w� 5'' _s ADDRESS OF TESTING AGENCY 800 West Doran Street,"Suite.200 When Reliability courns -Glendale, CA 91203 innnr9Fa_1aQ9 DUCT DETECTORS, HEAT DETECTORS, MANUAL FIRE ALARM BOXES, AND SMOKE DETECTORS FREQUENCY: ANNUALLY 3'5fHOSPITAL ROAD, SIMPL EX°41;OOESr � 1, !'FL'O,OR'MAINIOBBYf' ."INITIATING; DEVICES, DEVICE` FLOOR' LOCATION ,. ;; AL„ TR SQ ,DUNE' "' ; " 'COMMENTS; j E TYI?E E ZONE 49 P 6/27 1 DOES NOT DISPLAY THE FLOOR NUMBER ON OINTADDRESS 11-1-0 SD ROOF BOILER ROOM FACP ZONE 49 P 6/27 1 DOES NOT DISPLAY THE FLOOR NUMBER ON POINTADDRESS 11-1-0 SD ROOF BOILER ROOM FACP ZONE 49 P 6/27 DOES NOT DISPLAY THE FLOOR NUMBER ON POINTADDRESS 11-1-0 SD ROOF BOILER ROOM 1 FACP ZONE 49 SD ROOF BOILER ROOM P 6/27 DOES,NOT DISPLAY THE FLOOR NUMBER ON POINT ADDRESS 11-1-0 FACP ZONE 48 SD ROOF CHILLER ROOM P 6/27 POINT ADDRESS 10-8-0 ZONE 48 SD ROOF CHILLER ROOM P 6127 POINT ADDRESS 10-8-0 ZONE 48 SD ROOF CHILLER ROOM P 6/27 POINT ADDRESS 10-8-0 ZONE 47 MPS 6 BY STAIR 1 P 6/27 POINT ADDRESS 10-7-0 ZONE 48 MPS 6 BY STAIR 3 P 6/27 POINT ADDRESS 10-7-0 ZONE 37 SD 6 CORRIDOR P 6/27 ADDRESS POINT 9-5-0 ZONE 37 SD 6 CORRIDOR P 6/27 ADDRESS POINT 9-5-0 ZONE 37 SD 6 CORRIDOR P 6/27 ADDRESS POINT 9-5-0 ZONE 37 SD 6 CORRIDOR P 6/27 ADDRESS POINT 9-5-0 ZONE 37 SD 6 CORRIDOR P 6/27 ADDRESS POINT 9-5-0 ZONE 37 SD 6 CORRIDOR P 6/27 ADDRESS POINT 9-5-0 ZONE 37 SD 6 CORRIDOR P 6/27 ADDRESS POINT 9-5-0 Richard Beesley C10, C16; 413747 Lead Technician & License # Docu31p,d by. 2 of 14$frME88t443D. DocuSign Envel ID 25A94088'B8AO-45D4-BF2D-DDFDC7DF256A IF strate mz When Rellablilty Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 ['FACILITY,-:-- `NEWPORT LIDO MEDICAL CENTER 351 HOSPITAL ROAD TUNE 27,2015 "CITY, NEWPORT BEACH, CA 92663 QTAMnADn =(' n9 M n6m FP 'A A) = Al APKA TP = TPr)l IRI r Ap = -ql JPPPVI.qr)py Po PARR F=FAIL NT - NOT TESTED DUCT DETECTORS, HEAT DETECTORS, MANUAL FIRE ALARM BOXES, AND SMOKE DETECTORS FREQUENCY: ANNUALLY 35VROSPIT-AL'IROAM" r-' -,;SIMRLEX,4100E5,,,;, A, -FLOOR'-.mAINb0,,9 +!INITIATINGrDEVICES�-,,,,;, "DIE' f,FCOOR!` "LOCATION., AL, J.jTR�-!'SR':, DUNE,VICE!" COMMENTS YPE: ZONE45 MPS 5 BY STAIR I P 6/27 ADDRESS POINT 10-5-0 ZONE45 MPS 5 BY STAIR 3 P 6/27 ADDRESS POINT 10-5-0 ZONE35 SO 5 CORRIDOR P 6/27 ADDRESS POINT 9-3-0 ZONE35 SD 5 CORRIDOR P 6/27 ADDRESS POINT 9-3-0 ZONE35 SO 5 CORRIDOR P 6/27 ADDRESS POINT 9-3-0 ZONE35 SD 5 CORRIDOR p 6/27 ADDRESS POINT 9-3-0 ZONE 35 SD 5 CORRIDOR P 6/27 ADDRESS POINT 9-3-0 ZONE35 SD 5 CORRIDOR P 6/27 ADDRESS POINT 9-3-0 ZONE35 SD 5 CORRIDOR P 6/27 ADDRESS POINT 9-3-0 ZONE43 MPS 4 BY STAIR 1 P 6/27 ADDRESS POINT 10-3-0 ZONE43 MPS 4 BY STAIR 3 P 6/27 ADDRESS POINT 10-3-0 ZONE33 SD 4 CORRIDOR P 6/27 ADDRESS POINT 9-1-0 ZONE33 SD 4 CORRIDOR P 6/27 ADDRESS POINT 9-1-0 ZONE33 SD 4 CORRIDOR P 6/27 ADDRESS POINT 9-1-0 ZONE33 SD 4 CORRIDOR P 6/27 ADDRESS POINT 9-1-0 1 ZONE33 SD 1 4 CORRIDOR P 6/27t ADDRESS POINT 9-1-0 Richard Beesley C1 0, C1 6; 413747 Lead Technician & License # FD—Slg— by: �CIviRO &.IW Page 3 of 14 10- -t--.3D DocuSign Env *loe ID, 25A94088-B8A0-45D4-BF2D-DDFDC7DF256A w L systoms When Reliability Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 (800) 266-1392 NEWPORT LIDO MEDICAL CENTER TEST SITE ADDRESS 351 HOSPITAL ROAD , JI S TEST'D�LTE(S); JUNE 27,2015 T�TE,Z!f' -1 j NEWPORT BEACH, CA 92663 STANDARD EC 02 03 05: EP 3 AL = ALARM TR=TROUBLE SP = SUPERVISORY P = PASS F = FAIL NT=NOTTESTED DUCT DETECTORS, HEAT DETECTORS, MANUAL FIRE ALARM BOXES, AND SMOKE DETECTORS FREQUENCY: ANNUALLY IN '3,5jA0SPITAL'ROA'IJ,:' -ISIMPLEX-41,601ES," .,,f',FLO.MWA 'IMBY," ''',',;INITIAT,,iNG•DEVICES, "v- "DEVICOV"' ","Y'DIEVICE, �"FLO OR 'LOCATIONF,�" TR ],;�Sp"" J;JU C 9MMENT • TY,'PE"- ZONE33 SD 4 CORRIDOR P 6/27 ADDRESS POINT 9-1-0 ZONE33 SD 4 CORRIDOR p 6/27 ADDRESS POINT 9-1-0 ZONE41 MPS 3 BY STAIR I P 6/27 ADDRESS POINT 10-1-0 ZONE41 MPS 3 BY STAIR 3 P 6/27 ADDRESS POINT 10-1-0 ZONE 31 SD 3 CORRIDOR p 6/27 ADDRESS POINT 8-7-0 ZONE31 SD 3 CORRIDOR P 6/27 ADDRESS POINT 8-7-0 ZONE31 SD 3 CORRIDOR P 6/27 ADDRESS POINT 8-7-0 ZONE31 SD 3 CORRIDOR P 6/27 ADDRESS POINT 8-7-0 ZONE31 SO 3 CORRIDOR P 6/27 ADDRESS POINT 8-7-0 ZONE31 SD 3 CORRIDOR P 6127 ADDRESS POINT 8-7-0 1 ZONE31 SD 3 CORRIDOR P 6/27 ADDRESS POINT 8-7-0 ZONE39 MPS 2 BY STAIR 1 p 6/27 ADDRESS POINT 9-7-0 ZONE39 MPS 2 BY STAIR 3 p 6/27 ADDRESS POINT 9-7-0 ZONE29 SD 2 CORRIDOR P 6/27 ADDRESS POINT 8-5-0 ZONE29 SD 2 CORRIDOR P 6/27 ADDRESS POINT 8-5-0 1 ZONE29 SD 2 CORRIDOR 1 P 6/27 ADDRESS POINT 8-5-0 Richard Beesley CIO, C1 6; 413747 Lead Technidan & License # D..Sl, d ty: Page 4 of 14 1:6 DocuSign Envelo eID:25A94088-B8A0-45D4-BF2D-DDFDC7DF256A L5YStamw-s When Reliability Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91208 (800) 266-1392 (FACILITY' %>.; j NEWPORT LIDO MEDICAL CENTER TEST-S•ITE;i4DDRESS 361 HOSPITAL ROAD TEST'DATE(S),+. JUNE 27, 2015 „CITY„STATE, ZIP ; NEWPORT BEACH, CA 92663 @TA K I1ADD PC 02 03 05: PP 3 AL = ALARM TR = TROUBLE SP = SUPERVISORY P = PASS F = FAIL NT = NOT TESTED DUCT DETECTORS, HEAT DETECTORS, MANUAL FIRE ALARM BOXES, AND SMOKE DETECTORS FREQUENCY: ANNUALLY ,,, g . 1, ,.FLOOR,MAINiLOBBY 351 HQSFITAL;ROAD _ ::..:. _, SIMPCEX.4100ES „, a; "' ^•; "" `'INITIATINGrDEVICES,.� -', r � `DEV.ICE'#' `;DEVICE' 'FLOO)2''- "'`' 'L'OCATION'' `'"-' i ^ `- .• f AL,' i;T,R t�SP. sJU,NE C,OgAMENTS.. ZONE 29 SD 2 CORRIDOR P 6/27 ADDRESS POINT 8-5-0 ZONE 29 SD 2 CORRIDOR P 6/27 ADDRESS POINT 8-5-0 ZONE 29 SD 2 CORRIDOR P 6/27 ADDRESS POINT 8-5-0 ZONE 29 SD 2 CORRIDOR P 6/27 ADDRESS POINT 8-5-0 ZONE 20 MPS 1 BY STAIR 1 P 6/27 ADDRESS POINT 7-4-0 BY NEWPORT LIDO PHARMACY SUITE 107 N/A 6/27 STAND ALONE DEVICE NOT CONNECTED TO - SD 1 ENTRANCE FACP NEWPORT LIDO PHARMACY SUITE 107 N/A 6/27 STAND ALONE DEVICE NOT CONNECTED TO' SD 1 ENTRANCE FACP ZONE 19 MONITOR 1 SUITE 105 CAFE ANSUL SYSTEM NT NT NO ACCESS AT THE TIME OF THE TEST ZONE 11 SD B CORRIDOR NEAR STAIR 3 P 6/27 ADDRESS POINT 6-3-0 ZONE 11 SD B FAN ROOM BY STAIR 3 P 6/27 ADDRESS POINT 6-3-0 M1-1 I SD B SUITE 007 LAUNDRY ROOM P 6/27 ' M1-3 SD B OUTSIDE ELEVATOR LOBBY P 6127 M1-4 MPS B NEAR STAIR 3 P 6/27 M1-5 MPS B BY ELEVATOR LOBBY P 6/27 M1-6 MPS B BY STAIR 1 P 6/27 Page 5 of 14 Richard Beesley C10, C16; 413747 Lead Technician & License # �,rD—Signed by: p 'S ee4.A.v�U dteSfu-I ___ aftfF899] .0 DocuSign Envelope ID: 25A94088-68A0-45D4-BF2D-DDFDC7DF256A When Rellability Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 iFAGiL'1fY;.; "'.'4'' NEWPORT LIDO MEDICAL CENTER 1I TEST SITE,ADDRESS• 351 HOSPITAL ROAD ITEST•'DATE,(. ) S !' ` '; ' "' ' °"; JUNE 27, 2015 ;CITY; STATE,,tIP,NEWPORT BEACH, CA 92663 nn cn nn nn ne. cn a -1D1 c CD - CI IDCP\/ICf1RV P = PACS P =FAIT NT = NOT TESTED ELECTROMECHANICAL RELEASING DEVICES FREQUENCY: ANNUALLY 351;HOSPITAL:ROAD',...';:" ;::'';:.`'.'.: " ,,. ;_: .:._ ".:_:. ' SIMPCEX',4100ES•`':'..' ',•:, .,.. . • 1 ,FL00R•.MAIWLOBBY; ... „ .., ,. G• ;.-; .,:,. „ ,•; ._;. ;, ,. ; : _ Di:EGRESSiDOORS-.,.: ,r ;' . • , • : ,_„ • • MAGNETIC;FIRE'DQORSc/�DELAYE ' ` _,_,,, TYRE' EQUIPMENT w I FL'%OOR" ,, , ;', •LOCATION: pA55% ;JUNE' `COMMENTS; „ .,, ...,. :FAIL i l MAGNEETITI C DOOR 6 THROUGHOUT P 6/27 RELEASE TESTED FIRE R HOLDERS MAGNETIC DOOR 5 THROUGHOUT P 6/27 RELEASE TESTED FIRE DOOR HOLDERS MAGNETIC DOOR 4 THROUGHOUT P 6/27 RELEASE TESTED FIRE DOOR HOLDERS MAGNETIC DOOR 3 THROUGHOUT P 6/27 RELEASE TESTED FIRE DOOR HOLDERS MAGNETIC DOOR 2 THROUGHOUT P 6/27 RELEASE TESTED FIRE DOOR HOLDERS MAGNETIC DOOR 1 THROUGHOUT P 6127 RELEASE TESTED FIRE DOOR HOLDERS MAGNETIC DOOR g THROUGHOUT F 6127 RELEASE TESTED FIRE DOOR HOLDERS Richard Beesley C10, C16; 413747 Lead Technician & License # D/oo��Slow by: ---- —Page 6 of 14 111-997443D_ DocuSign Envelo eID:25A94088-B8A0.45D4-BF2D-DDFDC7DF256A zy-st4wms When Reliability Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 FACILITY' NEWPORT LIDO MEDICAL CENTER BEST, SITE ADDRESS; ", 351 HOSPITAL ROAD TEST DATE(S). JUNE 27, 2015 CITY;; STATE;, Zip,„ NEWPORT BEACH, CA 92663 TD _ronl1.1c eD -QI IPCPVIQnPv P=PAAR Fo FAIT NT=NeW TPATm AUDIBLE AND VISUAL FIRE ALARM NOTIFICATION FREQUENCY: ANNUALLY r _SIMP.LEX:4100,ES'., ;, . , 351''HOSPITAL;ROAD�'..', �. � .� ': ... ....... .... . ...... �,_. a . , , - ' - ' 1 FLOORMAIN,LOBBY, AUDIBLEh;VISUAL ;DEVICE-, DEVICE,. ° TYPE;: FLOO „�2` '` LOCATION;,.-,'; QASS/`„ FAIL JUNE,, "COMMENTS ' HORN ROOF MECHANICAL ROOM P 6/27 STROBE ROOF MECHANICAL ROOM P 6/27 HORN/STROBES 6 THROUGHOUT P 6/27 STROBES 6 RESTROOMS P 6/27 HORN/STROBES 5 THROUGHOUT P 6/27 STROBES 5 RESTROOMS P 6/27 HORN/STROBES 4 THROUGHOUT P 6/27 STROBES 4 RESTROOMS P 6/27 HORN/STROBES 3 THROUGHOUT P 6/27 STROBES 3 RESTROOMS P 6/27 HORN/STROBES 2 THROUGHOUT P 6/27 STROBES 2 RESTROOMS P 6/27 HORN/STROBES 1 THROUGHOUT P 6/27 STROBES 1 RESTROOMS P 6/27 HORN/STROBES B THROUGHOUT P 6/27 STROBES B RESTROOMS P 6/27 Richard Beesley C10, C16; 413747 Lead Technician & License # f�DDo Slgnea by: ") ,.l..Yt.Y- de.wkl - -- - - - --� -� Page 7 of 14 alFAggsWaesD.. DocuSign Envelo a ID: 25A94088-B8A0-45D4-BF2D-DDFDC7DF256A When Relwbitit,y Counts ADDRESS OF TESTING AGENCY 800 West -Doran Street, Suite 200 Glendale, CA 91203 (800) 266-1392 FACILITY " _ NEWPORT LIDO MEDICAL CENTER 1,1 TEST;'SITE'{'ADDRESS 351 HOSPITAL ROAD TEST DA'TE($)` , , -' JUNE 27, 2015 CITY; STATE, ZIP NEWPORT BEACH, CA 92663 STANDARD EC.02.03.05: EP 5 AL = ALARM TR = TROUBLE SP = SUPERVISORY P = PASS F = FAIL NT = NOT.TESTED CENTRAL STATION SIGNALING (EMERGENCY SERVICES NOTIFICATION TRANSMISSION EQUIPMENT) FREQUENCY: QUARTERLY CAST NIS = •, ' ;'CENTRA ATIO I,GNALING,� TELEPHONE,NUMBER., 800,7Q0-0038 ; , ACC OUNT'�NUMBERSN.T0625�; ` �....• . -• " ' _ PASSCODE:,NLMC, , • -• ,- `, 7 MONITORING'.PANEI. ; ' '',,FLOOR- MAKE/MODEL LOCATION.." °' ".AL' ; TR ! SP •i DUNE+ COMMENTS FIRE LITE MS-5012 1 2 1 INSIDE ELECTRICAL ROOM P N/A I N/A 1 6/27 On June 27, 2015 an alarm was initiated at location. Technician contacted Criticom, the offsite company that monitors the fire alarm panel. Please note panel activity as listed below: Alarm Initiated in Field: 7:29:02 AM Alarm Received at Fire Panel: 7:29:03 AM Alarm Received by Monitoring Company: 7:29:22 AM Richard Beesley C10, C16; 413747 Lead Technician & License # DD...Sisn,d by: Page 8 of 14 sywsD DocuSign Envelo eID:25A94088-B8A0.45D4-BF2D-DDFDC7DF256A When Reliability Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 1;1.'.- : 4 DRESS. ,FACIE"1TY; "` NEWPORT LIDO MEDICAL CENTER ("TEST•SIT351 HOSPITAL ROADE�AD TEST DATES) .• JUNE 27, 2015 GI,TwYi-STATE;,ZIP.. ; NEWPORT BEACH, CA 92663 BTAIJnARD EC 02 03 05: EP 19 AI = AI ARM TR = TRt7URl E SP = SUPERVISORY P = PASS F = FAIL NT = NOT TESTED. SMOKE DETECTION SHUTDOWN DEVICES FOR HVAC FREQUENCY: ANNUALLY ...,, _ .... . - SMPLEX41OOE,. - " LOB BY35f,HOROAD"::1,,FLOOR MAIN , :i • „r ,, ,. ,. HVAC'SHUTDOWN,. DEVICE#�l DEVI,CE It"TYPE' i',FLpPk, ; o LOCATION tw ' •:,,,. PASS/, ; FAIL- ;.JUNE;:' COMMENTS 6 AIR HANDLER UNITS IN MECHANICAL FAN ROOM P 6/27 5 AIR HANDLER UNITS IN MECHANICAL FAN ROOM P 6/27 4 AIR HANDLER UNITS IN MECHANICAL FAN ROOM P 6/27 3 AIR HANDLER UNITS IN MECHANICAL FAN ROOM P 6/27 2 AIR HANDLER UNITS IN MECHANICAL FAN ROOM P 6/27 B AIR HANDLER UNITS IN MECHANICAL FAN ROOM P 6/27 FOR BASEMENT & 1 FLOOR Richard Beesley C10, C16; 413747 Lead Technician & License # D—Slp,d by: Page 9 of 149atFAa991449D. DocuSign Envelo eID:25A94088-B8A0-45D4-BF2D-DDFDC7DF256A .5tomzo When Retrabnicy Counn ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 !F.ACILITY 3 - - ,' : „, . NEWPORT LIDO MEDICAL CENTER 'TEST'SITE:ADDRESS, 351 HOSPITAL ROAD CITY, .. . TEST DATE(S); "° "; JUNE 27, 2015 STATE, 21P NEWPORT BEACH, CA 92663 CTANrIARII EC-0203 05e EP 20 Al =ALARM TR=TROUBLE SP = SUPERVISORY P=PASS F=FAIL NT=NOT TESTED HORIZONTAL & VERTICAL ROLLING & SLIDING DOORS FREQUENCY: ANNUALLY 351..H6SPITAL,f20AD,' -,SIMPLEX-4100EST",.,.,. 1 "FLOORMAIN,LOBBY -.. > • ,:.. ,..w,. ROL''L;POWNDOORS/,WONtDOORSIiFIRE,CURTAINSi�,-..,,.._.,.' TYPE: EQUIPMENT DEVI CEt, ; FLOOR LOCATION' PASSP !1J,UNE; ', - _ COMMENTS:: .. .. f.. ..... .............. .'/ :.." r:..,,. ;.. .'FAIL;",:a,.,. - FIRE MOTORIZED B IN FRONT OF ELEVATOR 1 P 6/27 RESET SWITCH AT ELEVATOR LOBBY CURTAIN FIRE MOTORIZED B IN FRONT OF ELEVATOR 2 P 6/27 RESET SWITCH AT ELEVATOR LOBBY CURTAIN Richard Beesley C10, C16; 413747 Lead Technician & License # r , o—Sip.d by.p � � e4.,9.ro �...s.u,J Page 10 of 14 '-Sial(9fe997.30 DocuSign E_nvelo a ID: 25A94088-B8A0-45D4-BF2D-DDFDC7DF256A When Reliabilltv Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 (800) 266-1392 F 'CIL'ITY ° NEWPORT LIDO MEDICAL CENTER ITEST.SITE,ADDRESSI 351 HOSPITAL ROAD A.. ;TE$T'DATE(S) µ JUNE 27, 2015 :CITY,:S- ATE,;,zIP NEWPORT BEACH, CA 92663 STANDARD OTHER AL = ALARM TR = TROUBLE SP = SUPERVISORY P = PASS 'F = FAIL NT = NOT TESTED AUTOMATIC ELEVATOR RECALL FREQUENCY: ANNUALLY ..;..:SIMP.,LEX''4:10QI5&- :. 1 'FLOORiMA1N=LOBBY, L EVATOR:RECALL ;DEVICE':#.`,! � °' DEVICE 1 • 'TYRE •. FLOOR ; - L;''O'CA71QN' " PA'S'S/', `FAIL, ,JUNE COMMENRS , M1-18 HD I ROOF ELEVATORS 1 AND 2 MA CHINE ROOM P 6/27 RECALLS ELEVATORS 1 & 2 M1-17 SD 1 6 ELEVATORS 1 AND 2 LOBBY P 6/27 RECALLS ELEVATORS 1 & 2 M1-16 SO 5 ELEVATORS 1 AND 2 LOBBY P 6/27 RECALLS ELEVATORS 1 & 2 M1-15 SO 4 ELEVATORS 1 AND 2 LOBBY P 6/27 RECALLS ELEVATORS 1 & 2 M1-14 SO 3 ELEVATORS 1 AND 2 LOBBY P 6/27 RECALLS ELEVATORS.1 & 2 M1-13 SO 2 1 ELEVATORS 1 AND 2 LOBBY P 6127 RECALLS ELEVATORS 1 & 2 M1-12 SD 1 ELEVATORS 1 AND 2LOBBY P 6/27 RECALLS ELEVATORS 1 & 2 TO ALTERNATE M1-2 SO B ELEVATORS 1 AND 2 LOBBY P 6/27 RECALLS ELEVATORS 1 & 2 Richard Beesley C10, C16; 413747 Lead Technician & License # �o. 1� ..aey: 'S �4-.LrY1 &eesiW Page 11 of 14 mlcmeseyaas DocuSign Envelope ID: 25A94088-B8A0-45D4-BF2D-DDFDC7DF256A When Reliability Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 NEWPORT LIDO MEDICAL CENTER aTEST:SITE ADD ESS, 351 HOSPITAL ROAD TESTDATE(S) JUNE 27, 2015 CITY ;STATE ZIP' NEWPORT BEACH, CA 92663 4TAmnARn r'lTWFR AL =AI ARM TR=TRN IRIS RP = SUPERVISORY P=PASS F=FAIL NIT =NOT TESTED FIRE ALARM SYSTEM POWER SUPPLY PANELS & BATTERIES FREQUENCY: ANNUALLY ;RANEE "' :'TYPE'° ` 'FLQOR' LOCATION"" BATT "• ?`VOLTS' ` ,AMPS ; :BATT : ; PASS%'.:JU,NE'- ,.; ','' COMMENTS _ DATE ,. F,.AIL ALTRONIX BOOSTER 6 TELEPHONE ROOM BY STAIR 3 2 12 7.0 3/14 P 6/27 AL3000L-MR ALTRONIX BOOSTER 3 TELEPHONE ROOM BY STAIR 3 2 12 5.0 6/12 P 6/27 AL6000L-ADA ALTRONIX BOOSTER 3 TELEPHONE ROOM BY STAIR 3 2 12 8.0 9/13 P 6/27 AL6000L-ADA FIRE LITE MONITOR 2 TELEPHONE ROOM BY STAIR 1 1 12 8.0 9/13 P 6/27 MS-5012 SIMPLEX FACP 1 MAIN LOBBY 2 1 12 1 33.0 1 9113 1 P 1 6/27 4100ES Richard Beesley C10, C16; 413747 Lead Technician & License # DD—Siena ny: r- ��lvEv- t p -0,q Page 12 of 14 a(F1X---43D._ DocuSign Envelo eID:25A94088-B8A0.45D4-BF2D-DDFDC7DF256A *f_ ote Wh— Reliability C.—m ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 FACILITY „ NEWPORT LIDO MEDICAL CENTER TES T'SITE.ADDRESS, 351 HOSPITAL ROAD ;7EST'DATE(S) ,' JUNE 27, 2015 i CITY,,STATEi ZIP- ..� NEWPORT BEACH, CA 92663 Discrepancies/ Comments/ Repairs DATE(S): June 27, 2015 DEVICE NUMBER /DEVICE TYPE/LOCATION/REASON FOR FAILURE/PART NUMBER 1. NONE FOUND 2. 3. 4. "FTR (Facility to Repair) DESCRIPTION CHANGES 5. NONE FOUND 6. 7. 8. FTR (Facility to Repair) FACILITY TO REPAIR: NONE FOUND REPLACED 'F.T.R. REPAIR WO# REPAIRED RETESTED REPLACED 'F.T.R. REPAIR WO# REPAIRED RETESTED COMMENTS: ROOF LEVEL — THE FOUR BOILER ROOM SMOKE DETECTORS REPORT TO THE FIRE ALARM CONTROL PANEL WITHOUT A FLOOR NUMBER, ZONE 48 ADDRESS 6 FLOOR— THE ELEVATOR LOBBY MAGNETICALLY HELD OPEN DOUBLE SWINGING FIRE DOORS FAIL TO LATCH. 1 FLOOR —THE MAGNETICALLY HELD OPEN SWINGING FIRE DOOR IN FRONT OF SUITE 107 (PHARMACY) FAILS TO CLOSE WITH ACTIVATION OF THE ADJACENT STAND ALONE SMOKE DETECTORS. ONE OF THE DOORS DOES NOT REACH THE HOLD OPEN DEVICE, AND INSTEAD GETS CAUGHT ON THE FLOOR. 1 FLOOR — NO ACCESS TO SUITE 105 DELI AT THE TIME OF THE TEST. 1 FLOOR — STAIR 1 SUPERVISORY TAMPER DETECTOR, ZONE 2 ADDRESS 5-2-0, REPORTS TO THE FIRE ALARM CONTROL PANEL AS A TROUBLE SIGNAL RATHER THAN A SUPERVISORY. Richard Beesley C10, C16; 413747 Lead Technician & License # r/m..si,.a ny: Q - �c4.N.v0 �uuW Page 13 of 14sw++=o DocuSign Envelo a ID: 25A94088-68A0-45D4-BF2D-DDFDC7DF256A When Reliabtitty Counts ADDRESS OF TESTING AGENCY 800 West Doran Street, Suite 200 Glendale, CA 91203 FACIL•ITY!;; ;,; ,";; :•' ; NEWPORT LIDO MEDICAL CENTER TEST'SITE ADDRESS 351 HOSPITAL ROAD TEST''DATE(S) JUNE 27, 2015 CITY;rSTAJE,,ZIP• NEWPORT BEACH, CA 92663 BASEMENT LEVEL —THERE IS AN OLD STYLE SMOKE DETECTOR IN THE NORTH CORRIDOR BY ELECTRICAL ROOM THAT IS NO LONGER CONNECTED TO THE FIRE_ ALARM CONTROL PANEL. RECOMMEND REMOVING THIS ION SMOKE DETECTOR, MODEL SIH-24F. BASEMENT— SUITE 007 MAGNETICALLY HELD OPEN DOUBLE SWINGING FIRE DOORS FAIL TO RELEASE WITH ACTIVATION OF THE FIRE ALARM SYSTEM. THE WIRES FOR THE TROUBLE AND SUPERVISORY ZONES FROM THE CENTRAL STATION MONITORING PANEL TO THE FIRE ALARM CONTROL PANEL ARE NOT CONNECTED AT THE FIRE ALARM CONTROL PANEL. THE WIRES ARE THERE; HOWEVER THEY ARE DISCONNECTED AND WRAPPED IN WHITE TAPE. 'Faciii4yto cFieck,(x}-onenitem ti'elow:,. TRL'Systems'fo retu[n at';first+'available'.date!to:cdmplete repairs as standard „ I acknowledge and understand the failure sheet as it has been presented. Items listed as "Facility to Repair "are the responsibility of the facility as indicated above and should be handled accordingly. It is understood that the facility is responsible for notifying TRL Systems once repairs are complete for retesting/certification. Customer Signature: Richard Beesley C10, C16; 413747 Lead Technician & License # uoo.si9..d bpp Page 14 of 14 l9 Q9aiFAPd99]d43D COUNTY OF ORANGE ORANGE COUNTY HEALTH CARE AGENCY ENVIRONMENTAL HEALTH 1241 EAST DYER ROAD, SUITE 120 SANTA ANA, CA 92705-5611 (714) 433.6000 HOAG MEMORIAL HOSPITAL PRESBYT cto CALIF COMMERCIAL REAL ESTATE SERVIC 500 SUPERIOR AVE S-TE-1-F, 5 NEWPORT BEACH, CA 92663 PA08 CUPA INVOICE#: IN0987430 Owner: HOAG MEMORIAL HOSPITAL PRESBYTERIAN SITE: HOAG MEMORIAL HOSPITAL PRESBYT 351 Hospital RD STE 110 NEWPORT BEACH, CA 92663 County of Orange Tax ID# 95-6000928 District : A/R # Facility # Invoice Date Due Date Billing Period AR1371755 FA0055371 08/01/2014 09/01/2014 07/01/14 to 06/30/15 Related Date PE PE Program # Site ID Description Amount 08/01/2014 5865 5865 PR0075410 NPB378 HAZARDOUS MATERIALS - NEWPORT BEACH $ 128.00 08/01/2014 6210 6210 CUPA - STATE SERVICE CHARGE BASE FEE $ 35.00 Total Due: $ 163.00 PAYMENTS RECEIVED AFTER THE DUE DATE MAY BE SUBJECT TO A MAXIMUM 25% PENALTY. WE RECOMMEND THAT DISPUTES BE RESOLVED OR PAYMENT MADE PRIOR TO THE DUE DATE TO AVOID LATE FEES. FEES ARE DUE FROM ESTABLISHMENTS WHICH OPERATE AT ANY TIME DURING THE BILLING PERIOD. IF THERE HAS BEEN A CHANGE IN OWNERSHIP PRIOR TO THE BILLING PERIOD, PLEASE RETURN THIS INVOICE WITH THE NEW OWNER'S NAME, MAILING ADDRESS AND THE CHANGE OF OWNERSHIP DATE. PLEASE DO NOT SUBMIT A POSTDATED CHECK (CHECK DATED LATER THAN THE ACTUAL DATE SUBMITTED) IN PAYMENT OF THIS OBLIGATION. ALL CHECKS WILL BE PROCESSED UPON RECEIPT. FOR ANY CHECKS RETURNED UNPAID, THE MAKER WILL BE CHARGED AN ADDITIONAL FEE. Retain top portion for your records Return this bottom portion with payment **** Write invoice number on check HOAG MEMORIAL HOSPITAL PRESBYT 351 Hospital RD STE 110 Billing Period: Facility # : FA0055371� NEWPORT BEACH, CA 92663 07/01/14 to 06/30/15 Billing HOAG MEMORIAL HOSPITAL PRESBYT Invoice IN0987430 Address: c/o CALIF COMMERCIAL REAL ESTATE SERVIC Due Date: 09/01/2014 Total Due: $163.00 500 SUPERIOR AVE STE 135-- NEWPORT BEACH, CA 92663 PLEASE REMIT TO: Payment Type: ORANGE COUNTY HEALTH CARE AGENCY Check ENVIRONMENTAL HEALTH 1241 EAST DYER ROAD, SUITE 120 Credit Card (see reverse) SANTA ANA, CA 92705-5611 CUPA FOR OFFICE USE ONLY DATE RECEIVED BATCH'HSO # CHECK DATE CHECK NUMBER **" MAKE CHECKS PAYABLE TO: **: BRING THIS INVOICE WHEN PAYING IN PERSON COUNTY of ORANGE (IIIIIIIIIIIII Illilllllillllllllllll I IIII(IIIIIIIIII I III (III II[i 0911612014 �5'11AA)�11U� a/o# �0`�In� 6210 a, j Alcaraz, Debbie _ From: Morris, Nadine Sent: Tuesday, September 30, 2014 3:40 PM To: Alcaraz, Debbie Subject: RE: Copy of Invoice Please only invoice the $128.00 fee. Below is the new address. Once the invoice is created, please email a copy tome. No need to mail. Thanks! Here's the new address: California Commercial Real Estate Services 520 Superior Ave #265 Newport Beach, CA 92663 From: Alcaraz, Debbie Sent: Tuesday, September 30, 2014 3:28 PM To: Morris, Nadine Subject: RE: Copy of Invoice Not created yet. Non-stop with lots of peeps today with me. Give me a new address and direction thereafter. Thanks Nadine. From: Morris, Nadine Sent: Tuesday, September 30, 2014 3:15 PM To: Alcaraz, Debbie Subject: FW: Copy of Invoice If by chance the invoice has not been created, let me know and I'll provide the new address. Thanks, and sorry for all the emails. It's been non-stop all afternoon between them, me, and CUPA. Geez!!! From: Morris, Nadine Sent: Tuesday, September 30, 2014 2:42 PM To: Alcaraz, Debbie Subject: FW: Copy of Invoice Sorry, there seems to be some confusion regarding this account. Is there any chance you can check on this today? From: Morris, Nadine Sent: Monday, September 29, 2014 3:33 PM To: Alcaraz, Debbie Subject: Copy of Invoice Hi Debbie, I need a copy of the CNB invoice. Is this something you can provide me? 1 Thank you, Nadine #BWNKJHD #AR00000209684# CALIFORNIA COMMERCIAL REAL ESTATE HOAG MEMORIAL HOSPITAL PRESBYTERIAN 520 SUPERIOR AVENUE SUITE 265 NEWPORT BEACH, CA 92663 Description HAZ MAT INVENTORY (1-4) INSPECTION DATE: 08.01.14 CUST#: 0000020968 NBID: 278383 INVOICE: FS54004748 INV DATE: 10/02/14 DUE DATE: 11/01/14 Qty Unit Price Tax Extension 1.00 128.00 0.00 128.00 TOTAL INVOICE: $ 128.00 PAYMENTS/ADJUSTMENTS: $ 0.00 PAST DUE: $ 0.00 PENALTIES/INTEREST: $ 0.00 TOTAL AMOUNT DUE: $ 128.00 BILLING QUESTIONS SHOULD BE DIRECTED TO THE FIRE DEPARTMENT AT (949) 644-3106. THANK YOU. ANNUAL & SPECIAL PERMITS - INVOICE CALIFORNIA COMMERCIAL REAL ESTATE CUST NBR: 0000020968 HOAG MEMORIAL HOSPITAL PRESBYTERIAN NBID: 278383 520 SUPERIOR AVENUE INVOICE: FS54004748 SUITE 265 INV DATE: 10/02/14 NEWPORT BEACH, CA 92663 DUE DATE: 11/01/14 TOTAL AMOUNT DUE: $ 128.00 AR 0000020968 12800 i Sf7' tlot N r if ems CJ„ , t3' µ;�, µ _ W t f , 3 �i�r��jj i(..}�,'�"' .fir R mW sir' Qp a � # a r, t 'LLi'` Qo N '' Ng' VI AMMON 6< g: �5 WW WHO! —.,;_'' AW w�M nor, } sib fit 6J , f >S� ah :i cj. i; C4s`: 'tS py ' :'Ltt !{{: t$, I" "" ai' m VE ` we ; _.ty C' ! 94 4 HOW T'X y � ,3_ hill 1, f oil fra 2' ; Lr C's ' 6 s s ,ar �f .4 S: into,QQ Y �P•:vw,"n.,r"r �ry. > �}{3 ..'y>,; Yam' 1Yfll WWI -. r•I �¢,5� - *•Qitr AMR tF x. �Yv y - e' #,Aw }! aayy' Yi YI i �T3i ' s - r' z1C x f:" '05— j in ;Ys f xi± i- IS _ Y . 5- :Jiro t4'=•' �( -- w (: Qw s } _ :titmoo 'OW :U3:. yt. kQ} C'r k< �s in Roy of it: TW4 r,0 C Went n--;XRK R�. _ ^t 6�r ,E. " AV- tom., k cc- �a LL RAW s 4 v as: m y�y gs p �s ;2- '-tL -of o'j - ns, § %T C )� [J� m. - N" R!: Q �+ j( _ V jE s ,s. •.i �i �s " ' rS i 0 omit j 31. c=" = ci r� cmm a' .r c; :: t �. 1J' �r p{ S7 *a FIFA 1.1. L' " `O r C' o: gt - b= �s w v== <tC Whip I o' Zvi -ice f�.roff >r q� Oyu i; �...., ., r V• c ,44", m = F► s4 not A too MY i' K all TAK!, :' = A ED 010 RAN tl . hip- two _mow —1. � W: ,Au lz i W �{ W .. vY x 1i;"A re a6 ' tt, 4 g r a. y� 10,' ✓ •r3 �j �_ tR r. jy g y� `t> 1+js " x1 3oo,1A Pill s xV^ lilt n1m: s h�= -, Orion,. I h Alcaraz, Debbie From: Morris, Nadine Sent: Thursday, February 27, 2014 11:35 AM To: Alcaraz, Debbie Subject: Invoice Attachments: 351 Hospital Rd-Invoice.jpg Hi Debbie, Our printer has been having issues all week and it's again waiting for the technician. O I took a photo of the permit that needs to be invoiced for an off -hours inspection. LOU ! Please invoice SimplexGrinnell for one -hour at $156.00/hour. 2/27/14 6am-7am Fire alarm testing @ 351 Hospital Rd, #007 (F2014-0056) Thanks! .Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department 100 Civic Center Dr, Newport Beach, CA 92660 (949) 644-3105 1 (949) 723-3505 FAX I nmorris@nbfd.net Safety, Service, Professionalism �a 1 5Yate Fire Mar_^hall 7 1. Request Date 2. Program Fire Safety Inspection Request STD 850 JUNE 30, 2014 .CCL 4 3. Agency Contact 4. Telephone 5. Evaluator (714) 703-2800 Fax (714)703-2831 M. MALEKIWf E203 Department of Social Services 6. SFM Region 7. SFM I.D. # 8. Facility # 9. Request Code 304370944 1A 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 - 750 The City Drive #250 4.Ownership Change Orange, CA 92868 5. Address Change (q 6. Name Change NOTE: PRESCHOOL= 28' TOTAL CAPACITY= ;T 7. Hours: Monday - Thursday 8:30 am to 1:00 pm Date of Original Request: 11. Ambulatory Non -ambulatory Total Cap. Last Fire Clearance Date Capacity Medical Prev.Cap Capacity Medical Prev.Cap 18. Facility Code -16 - CCC Care? Care? 0 ( No 0 0 No 12. Facility Name 13. # of Bldgs. 1. GACH 9. ADHC THE SUSAN PHILLIPS DAY SCHOOL 1 2. GACH/R 10. Clinic 3. SH 11. Jail 14. Street Address (Actual Location) 15. Restraint 2401 IRVINE AVENUE NONE 4. APH- - ._12- ICF/DDN 5. PHF 13. RCF City Zip Code 16. Under NEWPORT BEACH, CA 92660 24 HRS. 6. SNF 14. CCF 7. ICF/OT 15. DAF 17. Facility Contact Person Telephone # 16a. Special HERRON, MARTY 949-645-1949 NONE 8. ICF/DD 16.Other To Be Completed By Inspecting Authority Clearance Codes Inspector's Name Telephone # (Q qq� CFIRS ID# T-19 OCC 1. Fire Clear/Granted p� Mt)42o S 40LI L(_ 3 t 0 � 3 0 U S 2. Fire Clear/Denied 3. Fire ClearMithheld Inspection Date\r Inspector's Signature Clearance Code J Lam' f J � M l/ Explanation of Denial or Special Conditions: Denial Code Fire Agency Denial Codes 1.Exits 2.Construct. NEWPORT BEACH FIRE PREVENTION BUREAU 3.Fire Alarm 3300 NEWPORT BLVD. 4.Sprinklers NEWPORT BEACH, CA 92663 5.Housekeeping 6.Special Hazard /�1 7.Other 0 .�� -55�u1�114� w /r ." k5l"I :, An A R.� ,. �� n i -cam % Nv F f l p"d ' •;Way Y v Public Utilities Gas / Electrical Water - Main Shut C urch S nctuary Kitcl"wn Itl Functi Mass om - Hall 30'X2 it h Office ` .� o I°'laygr and sy TurfArea4s' x 60' '= u - � !'chain link fence LJ 4 -� Parking Area i.. < California Department of Education Special Education Division Interagency -Nonpublic SchoolsfAgencies Unit FIRE INSPECTION CLEARANCE* THIS ENTIRE FORM MUST BE COMPLETED BY THE iNSPECTIOG AUTHORITY: Name of Nonpublic Nonsectarian School or Agency: �p A Address: aSoo trVInf, City: oh County: OraiNno. State: CA TIE-1116100 For Schools nly: Total Classroom Occupant load: (Based Upon The California Building Code fCCR, Title 241) Number of Classrooms: This facility is approved to serve (check appropriate one): ❑ a. ambulatory ❑ b. non -ambulatory 9 c. both This facility complies with all applicable standards related to fire and life safety (check one). - Yes ill No This facility is in violation of standards; the following corrections are required (use` back of form if more space is needed) 2. 3. • 4. Nothing contained herein shall be construed as encompassing the structural stability of any auilaing, at as abrogating any more restrictive requirements by other agencies having jurisdiction. For answers to any questions regarding the above clearance contact: Inspector (print name): 1 ►Qe QYZO� Title: f FJ cS"e2TZ)(Z_ Signature: 'lam l.p Name of Inspecting Agency: j f ' � Telephone: (q L4- _3j 0 S Date of Inspection: Contact the local city or county fire department or the fire district providing fire protection services to arrange for this clearance. If you cannot obtain a local fire clearance, your fire inspection can be ordered through the State Fire Marshal. Contact our office for this form. All sites MUST have individual fire clearances. It is a requirement of certification that afire inspection clearance be issued by the appropriate city, county, fire district or state fire official not less than once each calendar year. *Other documentation provided by your local fire department (e.g., STD 850) may be utilized and attached to the CDE fire clearance form if it provides the same information.. F�SN�ao7o 153Af � rY a a' 17 J '?, v ,,...�, pyy ^ �i .. - i 4 F, - -W - _ laic- . r - ,.°.•- •.,•'� ,.�P .�, ,� - K-.�. ..;>:z• �. a . -"4"w• a Aow ,�_. ' �r ° MI � y / .��/w��/�f\��~� �� -�� `6 ' , - �«»��`<2\�_ . . }\� � � �� ^ ` � � � I"" A lw a , i 0 - , " mW I e- Debbie From: Morris, Nadine Sent: Wednesday, February 10, 2016 1:47 PM To: Alcaraz, Debbie Subject: FW: Invoice & Scanning Attachments: chld-01@newportbeachca.gov_20160210_133929_000067f5001b.pcif, chld-01 @ newportbeachca.gov_20160210_135246_000074f6001 b.pdf Sorry Debbie. I forgot to attach an additional document I'd like scanned. Thanks. From: Morris, Nadine Sent: Wednesday, February 10, 2016 1:43 PM To: Alcaraz, Debbie Subject: Invoice & Scanning Debbie, Please invoice for a State Fire Clearance, $76.00 and scan into 20371 Irvine Ave #170. Thank you, Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net Z16 t 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 February 10, 2016 Dawn Davis, Learning Center Office Manager LINDAMOOD-SELL Learning Processes 20371 Irvine Ave, Suite 170 Newport Beach, CA 92660 Subject: Fire Clearance 20371 Irvine Ave, Suite 170 Newport Beach, CA 92660 Dear Dawn: The above subject location was inspected on February 9, 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, 1 can be reached at (949) 644-3105 or nmorrisCcD-nbfd.net. Thank you. Sincerely, Nadine Morris Life Safety Specialist 4 Morris, Nadine From: Van Patten, Jason Sent: Thursday, February 04, 2016 4:17 PM To: Morris, Nadine Subject: RE: 20371 Irvine Ave, Bldg A, Suite 170 Hi Nadine, A conditional use permit was approved for their use so no zoning clearance. Thanks .7ason Van Patten, Assistant Planner P. 949.644.3234 newportbeachca.ci From: Morris, Nadine Sent: Thursday, February 04, 2016 2:53 PM To: Whelan, Melinda Subject: 20371 Irvine Ave, Bldg A, Suite 170 Hi Melinda, You will be hearing from Dawn Davis (949) 252-9275 from Lindamood-Bell Learning Processes. They are requesting a fire clearance for their new location on Irvine Ave. They moved from 4100 Campus Dr#100 & #130. Thank you, Nadine NADINE MORRIS 1 Life Safety Specialist Newport Beach Fire Department (949) 644-3105 1 nmorris@nbfd.net 1 X. Debbie y From: Sent: To: Subject: Morris, Nadine Monday, March 21, 2016 7:19 AM Alcaraz, Debbie; Wun, Raymi; Michael, Steve RE: Compliance It's for scanning into the address file. From: Alcaraz, Debbie Sent: Monday, March 21, 2016 7:09 AM To: Wun, Raymi; Michael, Steve; Morris, Nadine Subject: FW: Compliance Good morning: Any suggestions where this goes? Thank you. Debbie Alcaraz I Administrative Technician Newport Beach Fire Department EMS Division 100 Civic Center Drive, NB, CA 92660 949.644.3351 From: Spiker, Chad Sent: Saturday, March 19, 2016 4:16 PM To: Alcaraz, Debbie Subject: FW: Compliance Hi Debbie, The attached document is the annual fire alarm monitoring report for Palisades Tennis Club. Occ ID 6739 Chad Spiker Captain Newport Beach Fire Department (949) 644-3104 From: Terri DeLong[mailto:terri(5)palisadestennis.com] Sent: Thursday, March 17, 2016 1:09 PM To: Spiker, Chad Subject: Compliance Hi Chad, When you and the guys came out for the annual inspection you left me with a couple of outstanding items that I was supposed to take care and get back to you on. Attached please find the report Fire Alarm/Water Flow Test results from our fire protection vendor. Also attached are photos of the CO2 tank from the cafe which has now been secured and the fire extinguisher in the bar which now has a 1 9 03/17/2016 12:36:64 CS# TFP2406 to TFP2406 Name to Date Operator Zone Area TFP2406 - Palisades Tennis Club 03/09/2016 16:00:02 03/09/2016 15:20:54 6 0 03/09/2016 1520:54 CALLID 03109/20161520:05 6 0 03/09/2016 15.20:03 CALLID 03/09/2016 15:17:49 2 0 03/09/2016 15.17:46 CALLID 03109/2016 15.17:27 2 0 03/09/201615:17:25 CALLID 03/09/2016 15:12:40 3 0 0310912016 15:12:40 3 0 03/09/2016 15:12:37 CALLID 03/09/2016 15:10.20 OQ1 0 03/09/2016 15.10.19 CALLID 03/09/2016 15:0331 3 0 03/09/2016 15:03.31 CALLID 03109/2016 15.00.40 3 0 03/09/2016 15.00.38 CALLID 03/09/2016 1456.49 3 0 03/09/2016 14:56:49 CALLID 03/09/2016 14:56 21 3 0 03/09/2016 14:56.19 CALLID 03/09/2016 14:47:48 3 0 03/09/2016 14:47:48 CALLID 03/09/2016 14:47:19 3 0 03/09/2016 14:47:19 CALLID 03/09/2016 14 28:00 E320 0 03/09/2016 14:27:57 CALLID 03/09/201614:27:31 E320 0 03/09/2016 14:27:29 CALLID 03/09/2016 14:27:03 E320 0 State Event History 03/09/2016 to 03/09/2016 Site# to City to Event ID to Primary State to Secondary Sort Zone Comment User Name TY105-TEST EXPIRED Cal: 1 R CIR203-RESTORE GATE VALVE SENSOR "Test FIRE TAMPER A 8G039-CALLER ID 'Test CallerlD: (949) 999 -3299 A 501-FIRE SUPERVISORY 'Test FIRE TAMPER GATE VALVE SENSORDelay:20.00 A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIRE ALARM "Test WATERFLOW A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 501-FIRE SUPERVISORY 'Test WATERFLOW Delay:20.00 ' A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIREALARM 'Test PULLSTATION A 101-FIRE- DISP 1ST 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR320-RESTORE SOUNDER OR RELAY TRBL 'Test A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIREALARM "Test PULLSTATION A SG039-CALLER ID "Test CallerlD: (949) 999 - 3299 A 101-FIRE- DISP 1ST "Test PULLSTATION A SG039-CALLER ID "Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIRE ALARM "Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIREALARM "Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 101-FIRE- DISP 1ST 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 101-FIRE- DISP 1ST "Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 536-TROUBLE E-MAILA/C 'Test SOUNDER RELAY A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 536-TROUBLE E-MAILA/C "Test SOUNDER RELAY A SG039-CALLER ID "Test CallerlD: (949) 999 - 3299 A 536-TROUBLE E-MAILA/C "Test SOUNDER RELAY Page 1 of 4 User ID Page 1 of 03/17/2016 12:36:54 CS# TFP2406 to TFP2406 Name to Date Operator Zone Area TFP2406 - Palisades Tennis Club 03109/2016 14:27:01 CALLID 03/0912016 14:26:36 E320 0 03/09/2016 14,26:31 3 0 03/09/2016 14:26:29 CALLID 03/09/2016 14 26:03 3 0 03/09/2016 14:25:58 3 0 03/09/2016 14.25:58 E320 0 03109/201614:25"55 CALLID 03/09/2016 14:25:29 3 0 03/0912016 14:25:26 E320 0 03/09/2016 14:25:26 CALLID 03/09/2016 1423:20 3 0 03/09/2016 14:23:17 CALLID 03/09/201614:22:50 3 0 03/09/2016 14:22:48 CALLID 03/09/2016 14:22:27 3 0 03/09/2016 14:22:27 CALLID 03/09/2016 14:21,59 3 0 03/09/2016 14.21.59 CALLID 03/09/2016 1421:33 3 0 03/09/2016 14:21:33 CALLID 03/09/2016 14:21:04 3 0 03109/2016 14.21:02 3 0 03109/201614:21.01 CALLID 03/09/2016 14:20:32 3 0 03/09/2016 14:20:32 CALLID 03/09/2016 14:19:58 OQ1 0 03/09/2016 14.19 58 CALLID 03/09/2016 14:19:31 OQ1 0 03/09/2016 14:19:29 CALLID 03/09/2016 14:13:35 3 0 Event History Page 2 of 4 0310912016 to 0310912016 Site# to to Primary City to State to Secondary Sort State Event ID Zone Comment User Name User ID A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 536-TROUBLE E-MAILAIC 'Test SOUNDER RELAY R CIR373-RESTORE FIRE TROUBLE 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR373-RESTORE FIRE TROUBLE 'Test PULLSTATION T 573-FIRE TROUBLE 'Test PULLSTATION Delay:60.00 A 536-TROUBLE E-MAILA/C 'Test SOUNDER RELAY A SG039-CALLER ID "Test CallerlD: (949) 999 - 3299 T 573-FIRE TROUBLE 'Test PULLSTATION Delay:60.00 A 536-TROUBLE E-MAILAIC 'Test SOUNDER RELAY - A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIREALARM 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIREALARM 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 101-FIRE- DISP 1ST "Test PULLSTATION A 5G039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 101-FIRE- DISP 1ST 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIREALARM 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIREALARM 'Test PULLSTATION A 101-FIRE- DISP 1ST 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD• (949) 999 - 3299 A 101-FIRE- DISP 1ST 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999-3299 R CIR320-RESTORE SOUNDER OR RELAY TRBL 'Test A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR320-RESTORE SOUNDER OR RELAY TRBL 'Test A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR110-RESTORE FIREALARM 'Test PULLSTATION Page 2 of 03/17/2016 12:36:54 CS# TFP2406 to TFP2406 Name to Date Operator Zone Area State Event History 0310912016 to 03/09/2016 Site# to City to Event ID to Primary State to Secondary Sort Zone Comment User Name TFP2406 - Palisades Tennis Club 03/09/2016 14:13:32 CALLID A SG039-CALLER ID `Test CallerlD: (949) 999 - 3299 03/09/2016 14:13:05 3 0 R CIR110-RESTORE FIREALARM 'Test PULLSTATION 03/09/2016 14:13:05 CALLID A SG039-CALLER ID 'Test CallerID:(949) 999-3299 0310912016 14:12.23 E320 0 A 536-TROUBLE E-MAILA/C 'Test SOUNDER RELAY 03/09/2016 14:12:22 CALLID A SG039-CALLER ID 'Test CallerID:(949) 999-3299 03/09/2016 14.11:54 E320 0 A 536-TROUBLE E-MAILA/C 'Test SOUNDER RELAY 03/0912016 14:11:54 CALLID A SG039-CALLER ID "Test CallerlD: (949) 999-3299 03/09/2016 14:10:39 OQ1 0 R CIR320-RESTORE SOUNDER OR RELAY TRBL 'Test 03/09/2016 14,1037 CALLID A SG039-CALLER ID 'Test CallerlD. (949) 999-3299 03/0912016 14:10:10 001 0 R CIR320-RESTORE SOUNDER OR RELAY TRBL 'Test 03/09/2016 14.10:08 CALLID A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 03/09/2016 14:07:29 3 0 A 101-FIRE- DISP 1ST 'Test PULLSTATION 03/09/2016 14:07:28 CALLID A 5G039-CALLER ID "Test CallerlD: (949) 999 - 3299 03/09/2016 14.07:00 3 0 A 101-FIRE-DISP IST 'Test PULLSTATION 03/0912016 1407,00 CALLID A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 03/0912016 14:0637 3 0 R CIR110-RESTORE FIRE ALARM 'Test PULLSTATION 03/09/2016 14:06:35 CALLID A SG039-CALLER ID 'Test CallerlD:(949) 999-3299 03/09/2016 14:06:08 3 0 R CIR110-RESTORE FIREALARM 'Test PULLSTATION 03/0912016 14.06.06 CALLID A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 03/09/2016 14:03:57 3 0 A 101-FIRE- DISP 1ST 'Test PULLSTATION 03109/2016 14:03 56 CALLID A SGO39-CALLER IO 'Test CallerlD: (949) 999 - 3299 03/0912016 14:03.28 3 0 A 101-FIRE- DISP 1ST 'Test PULLSTATION 03109/2016 14,0327 CALLID A SGO39-CALLER ID 'Test CallerlD: (949) 999 - 3299 03/09/2016 14:02:45 E320 0 A 536-TROUBLE E-MAILA/C 'Test SOUNDER RELAY 03/09/2016 14:02:43 CALLID A 8G039-CALLER ID 'Test CallerlD: (949) 999-3299 03/09/2016 14:02:15 E320 0 A 536-TROUBLE E-MAILA/C 'Test SOUNDER RELAY 03/09/2016 14.02:13 CALLID A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 03/09/2016 13:57:52 3 0 R CIR110-RESTORE FIRE ALARM 'Test PULLSTATION 03/09/2016 13.57:51 CALLID A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 03/0912016 13.5725 3 0 R CIR110-RESTORE FIREALARM 'Test PULLSTATION 03/09/2016 1367.20 3 0 A 101-FIRE- DISP 1ST 'Test PULLSTATION Page 3 of 4 User ID Page 3 of .7 03/17/2016 12:36:54 CS# TFP2406 to TFP2406 Name to Date Operator Zone Area TFP2406 - Palisades Tennis Club 03/09/2016 13.57:20 CALLID 03/09/2016 13:56.51 3 0 03/09/2016 13:56:49 CALLID 03/09/2016 13:55:03 OQ1 0 03/09/2016 13:55:03 CALLID 03/09/2016 13:54:34 OQ1 0 03/0912016 13:54.32 CALLID 03/09/201613:05:28 E320 0 03109/2016 13.05.26 CALLID 03/09/2016 13:04:59 E320 0 03109/2016 13.04:59 CALLID 03109/2016 12:54:03 ABR 0310912016 12:53:55 ABR 03/09/2016 12.52:07 ABR 03/09/2016 04:1838 E602 0 03/09/2016 04:18:36 CALLID 03/09/2016 04:18:10 E602 0 03/09/2016 04:18.07 CALLID State Event History 03109/2016 to 03109/2016 Site# to City to Event ID to State to Zone Comment Page 4 of 4 Primary Secondary Sort User Name User to A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 101-FIRE- DISP 1ST 'Test PULLSTATION A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR320-RESTORE SOUNDER OR RELAY TRBL `Test A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 R CIR320-RESTORE SOUNDER OR RELAY TRBL 'Test A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 536-TROUBLE E-MAILA/C 'Test SOUNDER RELAY A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 A 536-TROUBLE E-MAILA/C 'Test SOUNDER RELAY A SG039-CALLER ID 'Test CallerlD: (949) 999 - 3299 ONTEST-PLACED ON TEST 'Test (Site Codewordl) Cat. 1 Cat 1 Expires: 03/09/2016 16.00.00 All Zones 1999-CODE VERIFIED (Site Codewordl) IC -INCOMING CALL Brian A 20-TIMER TEST A SG039-CALLER ID CallerlD: (949) 999-3298 A 20-TIMERTEST A SG039-CALLER ID CallerlD. (949) 999 - 3298 Page 4 of FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION 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. 1. PROPERTY INFORMATION Name of property: Chase Bank Address: 1470 Jamboree Rd Newport Beach, CA 96266 Description of property: Bank Occupancy type: B Name of property representative: Address: Phone: Fax: Fa ot Lf- OD 3S E-mail: Authority having jurisdiction over this property: City of Newport Beach Phone: (949) 644-3106 Fax: E-mail: 2. INSTALLATION, SERVICE, AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: KOR Fire and Security Address: 26812 Vista Terrace Lake Forest, CA 92630 License or certification number: 857710 Phone: 949-273-8340 Fax: 949-951-6922 E-mail: Service organization for this equipment: KOR Fire and Security Address: 26812 Vista Terrace Lake Forest, CA 92630 License or certification number: 857710 Phone: 949-273-8340 Fax: 949-951-6922 E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of: 1-1-2010 Contracted testing company: KOR Fire and Security Address: 26812 Vista Terrace Lake Forest, CA 92630 Phone: 949-273-8340 Fax: 949-951-6922 E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. DESCRIPTION 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): NFPA 72, Fig 10.18 2 1 1 (p 1 of 12) IRt Copyright © 2009 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. 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2010 Additional description of system(s): Sprinhkler Monitoring System 3.1 Control Unit Manufacturer: Firelite Model number: MS9050 3.2 Mass Notification System ® This system does not incorporate an MNS 3.2.1 System Type: ❑ In -building MNS—combination ❑ In -building MNS—stand-alone ❑ Wide -area MNS ❑ Distributed recipient MNS ❑ Other (specify): 3.2.2 System Features: ❑ Combination fire alarm/MNS ❑ MNS autonomous control unit ❑ 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 ❑ In -building MNS to wide -area MNS interface ❑ Other (specify): 3.3 System Documentation ® An owner's manual, a copy of the manufacturer's instructions, a written sequence of operation, and a copy of the numbered record drawings are stored on site. Location: FACP 3.4 System Software ® This system does not have alterable site -specific software. Operating system (executive) software revision level: Site -specific software revision date: Revision completed by: ❑ A copy of the site -specific software is stored on site. Location: 3.5 Off -Premises Signal Transmission Name of organization receiving alarm signals with phone numbers: Alarm: National Monitoring Center Supervisory: National Monitoring Center Trouble: National Monitoring Center Entity to which alarms are retransmitted: Method of retransmission: Digital Dialer ❑ This system does not have off -premises transmission. Phone: 877-311-8579 Phone: 877-311-8579 Phone: 877-311-8579 Phone: If Chapter 26, specify the means of transmission from the protected premises to the supervising station: DACT If Chapter 27, specify the type of auxiliary alarm system: ❑ Local energy ❑ Shunt ❑ Wired ❑ Wireless NFPA 72, Fig 10 18 2 1 1 (p 2 of 12) Copyright © 2009 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. 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 1 Quantity: 1 (See NFPA 72, Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: 0 Description: N/A 4.1.3 Device Power Pathways ® No separate power pathways from the signaling line pathway ❑ Power pathways are separate but of the same pathway classification as the signaling line pathway ❑ Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: 0 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 1 Quantity: 1 (See NFPA 72, Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: 0 Description: N/A 4.2.3 Device Power Pathways ❑ No separate power pathways from the initiating device pathway ❑ Power pathways are separate but of the same pathway classification as the initiating device pathway ❑ Power pathways are separate and different classification from the initiating device pathway 4.3 Non -Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: B Survivability level: 1 Quantity: 1 (See NFPA 72, Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: 0 Description: N/A 4.3.3 Appliance Power Pathways ® No separate power pathways from the notification appliance pathway ❑ Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑ Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig 10 18 2 1 1 (p 3 of 12) Copyright © 2009 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. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes Type and number of devices: Addressable: 1 Other (specify): 5.1.2 Other Alarm Boxes Description: Type and number of devices: Addressable: Other (specify): 5.2 Automatic Initiating Devices ❑ This system does not have manual fire alarm boxes. Conventional: Coded: Transmitter: ® This system does not have other alarm boxes. Conventional: Coded: Transmitter: 5.2.1 Smoke Detectors ❑ This system does not have smoke detectors. Type and number of devices: Addressable: 4 Conventional: Other (specify): Type of coverage: ❑ Complete area ® Partial area ❑ Nonrequired partial area Other (specify): Above FACP, by elevator Type of smoke detector sensing technology: ❑ Ionization ® Photoelectric ❑ Multicriteria ❑ Aspirating ❑ Beam Other (specify): 5.2.2 Duct Smoke Detectors ® This system does not have alarm -causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other (specify): Type of coverage: Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 5.2.3 Radiant Energy (Flame) Detectors Type and number of devices: Addressable: Other (specify): Type of coverage: 5.2.4 Gas Detectors Type of detector(s): Number of devices: Addressable: Type of coverage: ® This system does not have radiant energy detectors. Conventional: Conventional: ® This system does not have gas detectors. 5.2.5 Heat Detectors ❑ This system does not have heat detectors. Type and number of devices: Addressable: 2 Conventional: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ Linear ❑ Spot Type of heat detector sensing technology: ❑ Fixed temperature ❑ Rate -of -rise ❑ Rate compensated NFPA 72, Fig 10 18.2 1 1 (p 4 of 12) Copyright © 2009 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. S. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules Number of devices: 10 5.2.7 Waterflow Alarm Devices Type and number of devices: Addressable: 1 5.2.8 Alarm Verification Number of devices subject to alarm verification: 5.2.9 Presignal Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence (PAS) Describe PAS: 5.2.11 Other Initiating Devices Describe: ❑ This system does not have monitoring modules. ❑ This system does not have waterflow alarm devices. Conventional: Coded: Transmitter: 1 6. SUPERVISORY SIGNAL -INITIATING DEVICES ❑ This system does not incorporate alarm verification. Alarm verification set for seconds ® This system does not incorporate pre -signal. ® This system does not incorporate PAS. ❑ This system does not have other initiating devices. 6.1 Sprinkler System Supervisory Devices ❑ This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: 2 Conventional: Coded: 1 Transmitter: Other (specify): 6.2 Fire Pump Description and Supervisory Devices ® This system does not have a fire pump. Type fire pump: ❑ Electric pump ❑ Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other (specify): 6.2.1 Fire Pump Functions Supervised ❑ Power ❑ Running ❑ Phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other (specify): 6.3 Duct Smoke Detectors (DSDs) ❑ This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: Conventional: 1 Other (specify): Type of coverage: Type of smoke detector sensing technology: ® Ionization ❑ Photoelectric ❑ Aspirating ❑ Beam 6.4 Other Supervisory Devices ® This system does not have other supervisory devices. Describe: NFPA 72, Fig 10 18.2 1 1 (p 5 of 12) Copyright © 2009 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. 7. MONITORED SYSTEMS 7.1 Engine -Driven Generator ® This system does not have a generator. 7.1.1 Generator Functions Supervised ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel ❑ Other (specify): 7.2 Special Hazard Suppression Systems Description of special hazard system(s): 7.3 Other Monitoring Systems Description of special hazard system(s): 8. ANNUNCIATORS 8.1 Location and Description of Annunciators Location l: Main Entry Location 2: Location 3: 9. ALARM NOTIFICATION APPLIANCES ❑ This system does not monitor special hazard systems. ❑ This system does not monitor other systems. ❑ This system does not have annunciators. 9.1 In -Building Fire Emergency Voice Alarm Communication System ® This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound -processing equipment: Location of paging microphone stations: Location l: Location 2: Location 3: 9.2 Nonvoice Notification Appliances Horns: With visible: 1 Chimes: With visible: Visible only: Other (describe): 9.3 Notification Appliance Power Extender Panels Quantity: Locations: ❑ This system does not have nonvoice notification appliances. Bells: With visible: ® This system does not have power extender panels. NFPA 72, Fig 10.18 2 1.1 (p 6 of 12) Copyright © 2009 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. I , I 10. MASS NOTIFICATION CONTROLS, APPLIANCES, AND CIRCUITS ® This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High -Power Speaker Arrays Number of HPSA speaker initiation zones: Location 1: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other (describe): Supervision class: 10.3.1 Special Hazard Notification ❑ This system does not have special suppression predischarge notification. ❑ MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ® This system does not have a two-way telephone system. Number of warden stations installed: ❑ Sound powered 11.2 Two -Way Radio Communications Enhancement System ❑ This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm Donor antenna isolation is: dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright © 2009 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. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge (Area of Rescue Assistance) Emergency Communications Systems ® This system does not have an area of refuge (area of rescue assistance) emergency communications system. Number of stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ® This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two -Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ❑ Hold -open door releasing devices ❑ Smoke management ® HVAC shutdown ❑ F/S dampers ❑ Door unlocking ❑ Elevator recall ❑ Fuel source shutdown ❑ Extinguishing agent release ❑ Elevator shunt trip ❑ Mass notification system override of fire alarm notification appliances Other (specify): 12.1 Addressable Control Modules Number of devices: 6 Other (specify): 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120VAC Overcurrent protection: Type: Circuit Breaker Location (of primary supply panel board): Disconnecting means location: 13.1.2 Engine -Driven Generator Location of generator: Location of fuel storage: ❑ This system does not have control modules. Control panel amps: 3.0 AMPS Amps: 15 ® This system does not have a generator. Type of fuel: NFPA 72, Fig 10 13 2 1 1 (p 8 of 12) Copyright © 2009 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. 13. SYSTEM POWER (continued) 13.1.3 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): 13.1.4 Batteries Location: FACP Type: GEL CELL Nominal voltage: 12vdc Amp/hour rating: 7 AH 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 ❑ Battery calculations are attached 13.2 In -Building Fire Emergency Voice Alarm Communication System or Mass Notification System ® This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: Overcurrent protection: Type: Location (of primary supply panel board): Disconnecting means location: 13.2.2 Engine -Driven Generator Location of generator: Location of fuel storage: EVACS or MNS panel amps: Amps: Type of fuel: ® This system does not have a generator. 13.2.3 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): 13.2.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture Nominal voltage: In alarm mode (minutes): ❑ Battery calculations are attached Amp/hour rating: NFPA 72, Fig 10 18 2 1 1 (p. 9 of 12) Copyright © 2009 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. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels 13.3.1 Primary Power Input voltage of power extender panel(s): 120vac Overcurrent protection: Type: Circuit Breaker Location (of primary supply panel board): Disconnecting means location: 13.3.2 Engine -Driven Generator Location of generator: Location of fuel storage: ❑ This system does not have power extender panels. Power extender panel amps: 3.0 AMPS Amps: 15 Type of fuel: ® This system does not have a generator. 13.3.3 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): 13.3.4 Batteries Location: Type: Calculated capacity of batteries to drive the system: In standby mode (hours): ❑ Batteries are marked with date of manufacture 14. RECORD OF SYSTEM INSTALLATION Nominal voltage: In alarm mode (minutes): ❑ Battery calculations are attached Amp/hour rating: Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. This is a: ® New system ❑ Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: 2010 ® Manufacturer's published instructions Other (specify): System deviations from referenced NFPA standards: Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig 10 18 2 1 1 (p. 10 of 12) Copyright © 2009 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. I , i 16. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ® New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements for the following: ❑ Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of, the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of the following.• ® NFPA 72, Edition: 2010 ® NFPA 70, National Electrical Code, Article 760, Edition: 2010 ® Manufacturer's published instructions Other (specify): ❑ Individual device testing documentation [Inspection and Testing Form (Figure 14.6.2.4) is attached] Signed: Printed name: Date: Organization: Title: 16. CERTIFICATIONS AND APPROVALS Phone: 16.1 System Installation Contractor: This system, as specified herein, has been installed and tested according to all NFPA standards cited herein. Signed: /jam A— Printed name: `7FfyZ��,� Date: ']/l r i4/ Organization. 40Z- riZ.— Title: '7 —4j4 Phone: �j461-4416.60S 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name:-7jVc.6„Z-2;� vwj�SC,+J Date: `y/!//1� Organization. (GAR- t tr?J' Title.-?&t4 Phone: �i�c�.2`f(o•6(�$ 16.3 Supervising Station: This system, as specified herein, will be monitored according to all NFPA standards cited herein. Signed: �^- Printed name: `7��2-;Z*4> 0�,j Date: 7///1�' Organization: IP44a' 16Zx" Title:-04-rf Phone: acfaj_Z#6.6� NFPA 72, Fig. 10.18 2 1.1 (p. 11 of 12) Copyright © 2009 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. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: "i`41 Printed name: 491{^/ "IA11kVVY2�, Date: "7 Organization: 1)1t` aF)EW aA-� Title: SlUefit**"�OeA-r Phone: IS7-1 'I5"1 39 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications, with its approved sequence of operations, and with all NFPA standards cited herein. Signed: N Printed name: iV OE �-\O 11NDate: % 'f l Organization: Title: ' ��"(� jZ Phone: Iv (PL( ((f((,3/Ur NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) copyright © 2009 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. * ft/2014 ) 10:48:21 Activity By Event Code Report Page 1 of 5 CS# 863495 to 863495 Installing Co. to Date CS# 863495 Oper Zone Dates 07/09/2014 to 07/09/2014 Location to SG039 CALL to Event Location Site Name Chase Bank Address 1470 Jamboree Rd NEWPORT BEACH, CA 92660 SG039 CALLER ID 07/09/2014 06:52:27 CALLID CallerlD: (949) 640 - 0866 07/09/2014 06:52:28 21 07/09/2014 06:52:30 17 07/09/2014 06:52:34 19 07/09/2014 06:52:39 OE311 07/09/2014 06:52:42 R311 07/09/2014 06:54:08 CALLID CallerlD: (949) 640 - 0866 07/09/2014 06:54:09 OXO 07/09/2014 06:54:12 17 07/09/2014 06:54:16 17 07/09/2014 06:54:18 LJR taylor 07/09/2014 06:54:25 LJR KOR FIRE & SECURITY 07/09/2014 06:54:33 LJR Cat: 08 Expires: 07/09/2014 14:54:00 All Zones 07/09/2014 06:54:45 CALLID CallerlD: (949) 640 - 0866 07/09/2014 06:54:46 17 07/09/2014 06:54:49 17 07/09/2014 06:55:30 CALLID CallerlD: (949) 640 - 0866 07/09/2014 06:55:30 21 07/09/2014 06:55:35 21 07/09/2014 06:55:37 17 07/09/2014 06:55:41 17 07/09/2014 06:55:44 19 07/09/2014 06:55:47 19 07/09/2014 06:55:53 17 07/09/2014 06:55:55 17 07/09/2014 06:55:59 R333 07/09/2014 06:56:31 CALLID CallerlD: (949) 640 - 0866 07/09/2014 06:56:32 21 07/09/2014 06:56:35 21 07/09/2014 06:56:39 17 07/09/2014 06:56:43 17 07/09/2014 06:57:22 CALLID CallerlD: (949) 640 - 0866 07/09/2014 06:57:25 21 07/09/2014 06:57:30 21 07/09/2014 06:57:30 17 07/09/2014 06:57:34 17 07/09/2014 06:57:37 21 07/09/2014 06:57:43 21 07/09/2014 06:57:46 17 07/09/2014 06:57:50 17 07/09/2014 06:58:00 19 07/09/2014 06:58:00 19 07/09/2014 06:58:10 21 07/09/2014 06:58:13 21 07/09/2014 06:58:15 17 07/09/2014 06:58:15 17 07/09/2014 06:58:42 CALLID CallerlD: (949) 640 - 0866 07/09/2014 06:58:43 21 07/09/2014 06:58:48 21 CIE380 SENSOR TROUBLE AC4 DUCT DETECTOR CIE380 SENSOR TROUBLE AC2 DUCT DETECTOR CIE380 SENSOR TROUBLE AC3 DUCT DETECTOR CIE311 BATTERY MISSING CIR311 RESTORE BATTERY MISSII� SG039 CALLER ID CIE333 EXPANSION MODULE FAILL CIR380 RESTORE SENSOR TROUB AC2 DUCT DETECTOR CIE380 SENSOR TROUBLE AC2 DUCT DETECTOR IC INCOMING CALL 1999 CODE VERIFIED ONTEST PLACED ON TEST 'Test SG039 CALLER ID *Test CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR SG039 CALLER ID *Test CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC4 DUCT DETECTOR CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR CIR380 RESTORE SENSOR TROUB *TestAC3 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC3 DUCT DETECTOR CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR CIR333 RESTORE EXPANSION MOI *Test SG039 CALLER ID *Test CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC4 DUCT DETECTOR CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR SG039 CALLER ID *Test CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC4 DUCT DETECTOR CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC4 DUCT DETECTOR CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR CIR380 RESTORE SENSOR TROUS *TestAC3 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC3 DUCT DETECTOR CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC4 DUCT DETECTOR CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR SG039 CALLER ID *Test CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR CIE380 SENSOR TROUBLE *TestAC4 DUCT DETECTOR Alt ID Scheduled CS# 863495 Pagel of 6 7/9/2014 10:48:21 Activity By Event Code Report Page 2 of 5 CS# 863495 to 863495 Installing Co. to Date CS# 863495 07/09/2014 06:58:49 07/09/2014 06:58:52 07/09/2014 06:58:57 07/09/2014 06:59:00 07/09/2014 06:59:03 07/09/2014 06:59:07 07/09/2014 06:59:13 07/09/2014 06:59:16 07/09/2014 06:59:19 07/09/2014 06:59:23 07/09/2014 06:59:28 07/09/2014 06:59:31 07/09/2014 07:00:02 CailerlD: (949) 640 - 0866 07/09/2014 07:00:05 07/09/2014 07:00:06 07/09/2014 07:00:12 07/09/2014 07:00:15 07/09/2014 07:53:24 CallerlD: (949) 640 - 0866 07/09/2014 07:53:27 07/09/2014 07:53:31 07/09/2014 07:53:34 07/09/2014 07:53:35 07/09/2014 07:53:41 07/09/2014 07:54:08 CailerlD: (949) 640 - 0866 07/09/2014 07:54:09 07/09/2014 07:54:12 07/09/2014 07:54:17 07/09/2014 07:54:20 07/09/2014 07:54:47 CailerlD: (949) 640 - 0866 07/09/2014 07:54:49 07/09/2014 07:54:52 07/09/2014 07:54:54 07/09/2014 07:54:59 07/09/2014 07:55:02 07/09/2014 07:55:07 07/09/2014 07:55:48 CallerlD: (949) 640 - 0866 07/09/2014 07:55:49 07/09/2014 07:55:52 07/09/2014 07:56:25 CallerlD: (949) 640 - 0866 07/09/2014 07:56:27 07/09/2014 07:56:29 07/09/2014 07:56:33 07/09/2014 07:57:13 CailerlD: (949) 640 - 0866 07/09/2014 07:57:14 07/09/2014 07:57:17 07/09/2014 07:57:20 07/09/2014 07:57:24 07/09/2014 07:57:28 07/09/2014 07:57:32 07/09/2014 07:57:36 07/09/2014 07:58:21 CallerlD: (949) 640 - 0866 07/09/2014 07:58:21 Dates 07/09/2014 to 07/09/2014 CIR380 RES1 to Location to Oper Zone Event Location Site Name Chase Bank Address 1470 Jamboree Rd NEWPORT BEACH, CA 92660 17 CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR 17 CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR 19 CIR380 RESTORE SENSOR TROUB *TestAC3 DUCT DETECTOR 19 CIE380 SENSOR TROUBLE *TestAC3 DUCT DETECTOR 21 CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR 21 CIE380 SENSOR TROUBLE *TestAC4 DUCT DETECTOR 19 CIR380 RESTORE SENSOR TROUB *TestAC3 DUCT DETECTOR 19 CIE380 SENSOR TROUBLE *TestAC3 DUCT DETECTOR 17 CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR 17 CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR 21 CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR 21 CIE380 SENSOR TROUBLE *TestAC4 DUCT DETECTOR CALLID SG039 CALLER ID *Test 17 CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR 17 CIE380 SENSOR TROUBLE *TestAC2 DUCT DETECTOR 19 CIR380 RESTORE SENSOR TROUB *TestAC3 DUCT DETECTOR 19 CIE380 SENSOR TROUBLE *TestAC3 DUCT DETECTOR CALLID SG039 CALLER ID *Test 2 101 FIRE- DISP 1ST *Test FRONT END PULLSTATION 2 CIR115 RESTORE FIRE MANUAL PL *Test FRONT END PULLSTATION 17 CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR 19 CIR380 RESTORE SENSOR TROUB *TestAC3 DUCT DETECTOR 21 CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR CALLID SG039 CALLER ID *Test 2 101 FIRE- DISP 1ST *Test FRONT END PULLSTATION 23 CIE380 SENSOR TROUBLE *TestAC5 DUCT DETECTOR 2 CIR115 RESTORE FIRE MANUAL PL *Test FRONT END PULLSTATION 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR CALLID SG039 CALLER ID *Test 23 CIE380 SENSOR TROUBLE *TestAC5 DUCT DETECTOR 21 CIR380 RESTORE SENSOR TROUB *TestAC4 DUCT DETECTOR 17 CIR380 RESTORE SENSOR TROUB *TestAC2 DUCT DETECTOR 19 CIR380 RESTORE SENSOR TROUB *TestAC3 DUCT DETECTOR 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR 23 CIE380 SENSOR TROUBLE *TestAC5 DUCT DETECTOR CALLID SG039 CALLER ID *Test 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR 23 CIE380 SENSOR TROUBLE *TestAC5 DUCT DETECTOR CALLID SG039 CALLER ID *Test 28 503 OS&Y VALVE TAMPER *Test OS&Y CHECK VALVE 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR 23 CIE380 SENSOR TROUBLE *TestAC5 DUCT DETECTOR CALLID SG039 CALLER ID *Test 28 CIE380 SENSOR TROUBLE *Test OS&Y CHECK VALVE 28 CIR200 RESTORE FIRE SUPERVIS( *Test OS&Y CHECK VALVE 28 503 OS&Y VALVE TAMPER *Test OS&Y CHECK VALVE 28 CIR200 RESTORE FIRE SUPERVIS( *Test OS&Y CHECK VALVE 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR 23 CIE380 SENSOR TROUBLE *TestAC5 DUCT DETECTOR 28 CIR380 RESTORE SENSOR TROUB *Test OS&Y CHECK VALVE CALLID SG039 CALLER ID *Test 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR Alt ID Scheduled CS# 863495 Page 2 of 5 7/9/2014 10:48:21 Activity By Event Code Report CS# 863495 to 863495 Dates 07/09/2014 to 07/09/2014 Location to Installing Co. to CIE380 SEN: to Date Oper Zone Event Location CS# 863495 Site Name Chase Bank Address 1470 Jamboree Rd NEWPORT BEACH, CA 92660 07/09/2014 07:58:24 23 CIE380 SENSOR TROUBLE *TestAC5 DUCT DETECTOR 07/09/2014 07:59:02 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 07:59:04 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR 07/09/2014 07:59:06 23 CIE380 SENSOR TROUBLE *TestAC5 DUCT DETECTOR 07/09/2014 07:59:47 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 07:59:48 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR 07/09/2014 07:59:52 23 CIE380 SENSOR TROUBLE *TestAC5 DUCT DETECTOR 07/09/2014 08:02:19 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0881 07/09/2014 08:02:22 OE608 CIE608 PERIODIC TEST- TRBL PRE *Test 07/09/2014 08:02:47 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 08:02:48 OE608 CIE608 PERIODIC TEST- TRBL PRE *Test 07/09/2014 08:26:46 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 08:26:46 4 501 FIRE SUPERVISORY *Test FC1 DUCT DETECTOR 07/09/2014 08:26:50 4 CIR200 RESTORE FIRE SUPERVIS( *Test FC1 DUCT DETECTOR 07/09/2014 08:30:39 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 08:30:39 4 501 FIRE SUPERVISORY *Test FC1 DUCT DETECTOR 07/09/2014 08:30:43 4 CIR200 RESTORE FIRE SUPERVIS( *Test FC1 DUCT DETECTOR 07/09/2014 08:32:16 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 08:32:17 17 501 FIRE SUPERVISORY *TestAC2 DUCT DETECTOR 07/09/2014 08:32:21 17 CIR200 RESTORE FIRE SUPERVIS( *TestAC2 DUCT DETECTOR 07/09/2014 08:32:25 19 501 FIRE SUPERVISORY *TestAC3 DUCT DETECTOR 07/09/2014 08:33:06 CALLID SG039 CALLER ID *Test Called D: (949) 640 - 0866 07/09/2014 08:33:06 19 CIR200 RESTORE FIRE SUPERVIS( *TestAC3 DUCT DETECTOR 07/09/2014 08:34:24 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 08:34:25 15 501 FIRE SUPERVISORY *TestAC1 DUCT DETECTOR 07/09/2014 08:34:28 15 CIR200 RESTORE FIRE SUPERVIS( *TestAC1 DUCT DETECTOR 07/09/2014 08:47:59 CALLID SG039 CALLER ID *Test CailerlD: (949) 640 - 0866 07/09/2014 08:48:01 OE308 CIE308 SYSTEM SHUTDOWN *Test 07/09/2014 08:49:02 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 08:49:05 OE308 CIR308 RESTORE SYSTEM SHUTD *Test 07/09/2014 08:51:10 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 08:51:10 6 501 FIRE SUPERVISORY *Test FC1 DUCT DETECTOR 07/09/2014 08:51:16 6 CIR200 RESTORE FIRE SUPERVIS( *Test FC1 DUCT DETECTOR 07/09/2014 09:50:09 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 09:50:10 OE308 CIE308 SYSTEM SHUTDOWN *Test 07/09/2014 09:50:45 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 09:50:48 OE308 CIR308 RESTORE SYSTEM SHUTD *Test 07/09/2014 09:51:55 CALLID SG039 CALLER ID *Test CailerlD: (949) 640 - 0866 07/09/2014 09:51:58 1 101 FIRE- DISP 1ST *Test FACP SMOKE ABOVE PANEL 07/09/2014 09:52:33 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 09:52:36 2 101 FIRE- DISP 1ST *Test FRONT END PULLSTATION 07/09/2014 09:52:38 3 101 FIRE- DISP 1ST *Test 1ST FLOOR ELEVATOR LOBBY SMOKE 07/09/2014 09:53:40 CALLID SG039 CALLER ID *Test CailerlD: (949) 640 - 0866 07/09/2014 09:53:42 4 501 FIRE SUPERVISORY *Test FC1 DUCT DETECTOR 07/09/2014 09:54:48 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 Scheduled Aft ID Page 3 of 5 CS# 863495 Page 3 of 6 7/9/2014 10:48:21 a Activity By Event Code Report CS# 863495 to 863495 Dates 07/09/2014 to 07/09/2014 Location to Installing Co. to 601 FIRE SUI to Date Oper Zone Event Location CS# 863495 Site Name Chase Bank Address 1470 Jamboree Rd NEWPORT BEACH, CA 92660 07/09/2014 09:54:51 6 501 FIRE SUPERVISORY *Test FC1 DUCT DETECTOR 07/09/2014 09:54:54 4 CIR200 RESTORE FIRE SUPERVIS( *Test FC1 DUCT DETECTOR 07/09/2014 09:54:57 6 CIR200 RESTORE FIRE SUPERVIS( *Test FC1 DUCT DETECTOR 07/09/2014 09:57:14 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 09:57:14 8 101 FIRE- DISP 1ST *Test2ND FLOOR ELEVATOR LOBBY -SMOKE 07/09/2014 09:57:17 9 101 FIRE- DISP 1ST *Test ELEVATOR MACHINE ROOM SMOKE 07/09/2014 09:57:20 10 101 FIRE- DISP 1ST *Test ELEVATOR MACHINE ROOM HEAT 07/09/2014 09:57:25 26 501 FIRE SUPERVISORY *Test SHUNT TRIP MONITOR 07/09/2014 09:58:45 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 09:58:45 15 501 FIRE SUPERVISORY *TestAC1 DUCT DETECTOR 07/09/2014 09:58:47 15 CIR200 RESTORE FIRE SUPERVIS( *TestAC1 DUCT DETECTOR 07/09/2014 09:59:23 CALLID SG039 CALLER ID *Test Caller) D: (949) 640 - 0866 07/09/2014 09:59:25 17 501 FIRE SUPERVISORY *TestAC2 DUCT DETECTOR 07/09/2014 09:59:26 17 CIR200 RESTORE FIRE SUPERVIS( *TestAC2 DUCT DETECTOR 07/09/2014 10:00:00 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 10:00:00 19 501 FIRE SUPERVISORY *TestAC3 DUCT DETECTOR 07/09/2014 10:00:03 21 501 FIRE SUPERVISORY *TestAC4 DUCT DETECTOR 07/09/2014 10:00:06 19 CIR200 RESTORE FIRE SUPERVIS( *TestAC3 DUCT DETECTOR 07/09/2014 10:00:12 21 CIR200 RESTORE FIRE SUPERVIS( *TestAC4 DUCT DETECTOR 07/09/2014 10:00:59 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 10:01:02 23 501 FIRE SUPERVISORY *TestAC5 DUCT DETECTOR 07/09/2014 10.01:03 23 CIR200 RESTORE FIRE SUPERVIS( *TestAC5 DUCT DETECTOR 07/09/2014, 10:05:31 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 10:05:33 27 101 FIRE- DISP 1 ST *Test WATERFLOW 07/09/2014 10:06:55 CALLID SG039 CALLER ID *Test CailerlD: (949) 640 - 0866 07/09/2014 10:06:58 28 503 OS&Y VALVE TAMPER *Test OS&Y CHECK VALVE 07/09/2014 10:07:00 28 CIR200 RESTORE FIRE SUPERVIS( *Test OS&Y CHECK VALVE 07/09/2014 10:07:39 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 10:07:39 2 CIR115 RESTORE FIRE MANUAL Pt *Test FRONT END PULLSTATION 07/09/2014 10:07:41 27 CIR113 RESTORE SPRINKLER WAT *Test WATERFLOW 07/09/2014 10:07:44 1 CIR111 RESTORE SMOKE DETECT( *Test=FACP SMOKEABOVE PANEL 07/09/2014 10:07:49 3 CIR111 RESTORE SMOKE DETECTi *TeSY1ST FLOOR ELEVATOR LOBBY SMOKE 07/09/2014 10:07:53 8 CIR111 RESTORE SMOKE DETECT, *Test 2ND FLOOR ELEVATOR LOBBY SMOKE 07/09/2014 10:07:55 9 CIR111 RESTORE SMOKE DETECTI *Test ELEVATOR MACHINE ROOM SMOKE 07/09/2014 10:08:01 10 CIR114 RESTORE HEAT DETECTOF *Test ELEVATOR MACHINE ROOM HEAT 07/09/2014 10:08:04 26 CIR200 RESTORE FIRE SUPERVIS( *Test SHUNT TRIP MONITOR 07/09/2014 10:08:09 26 501 FIRE SUPERVISORY *Test SHUNT TRIP MONITOR 07/09/2014 10:08:12 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR 07/09/2014 10:08:45 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 07/09/2014 10:08:47 OE311 CIE311 BATTERY MISSING *Test 07/09/2014 10:08:50 E321 CIE321 TROUBLE ON BELL 1 *Test 07/09/2014 10:11:02 CALLID SG039 CALLER ID *Test Caller) D: (949) 640 - 0881 07/09/2014 10:11:03 LINEO CIE351 TELCO 1 FAULT *Test 07/09/2014 10:11:05 26 CIR200 RESTORE FIRE SUPERVIS( *Test SHUNT TRIP MONITOR 07/09/2014 10:11:10 R311 CIR311 RESTORE BATTERY MISSIl, *Test 07/09/2014 10:11:13 R321 CIR321 RESTORE TROUBLE ON BE *Test 07/09/2014 10:11:42 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0881 07/09/2014 10:11:45 23 CIR380 RESTORE SENSOR TROUB *TestAC5 DUCT DETECTOR 07/09/2014 10:14:46 CALLID SG039 CALLER ID *Test CalleriD: (949) 640 - 0866 Alt ID Scheduled Page 4 of 5 CS# 863495 Page 4 of 5 7/9/2014 10:48:21 Activity By Event Code Report Page 5 of 5 i I 1 4 CS# 863495 to 863495 Installing Co. to Date Oper CS# 863495 Dates 07/09/2014 to 07/09/2014 CIE352 TELC to Zone Event Location Site Name Chase Bank Address 1470 Jamboree Rd NEWPORT BEACH, CA 92660 07/09/2014 10:14:48 LINEO CIE352 TELCO 2 FAULT *Test 07/09/2014 10:14:51 E322 CIE322 TROUBLE ON BELL 2 *Test 07/09/2014 10:14:55 R351 CIR351 RESTORE TELCO 1 FAULT *Test 07/09/2014 10:14:58 R322 CIR322 RESTORE TROUBLE ON BE *Test 07/09/2014 10:15:45 CALLID SG039 CALLER ID *Test Caller) D: (949) 640 - 0866 07/09/2014 10:15:46 OE308 CIE308 SYSTEM SHUTDOWN *Test 07/09/2014 10:15:49 R352 CIR352 RESTORE TELCO 2 FAULT *Test 07/09/2014 10:17:39 CALLID SG039 CALLER ID *Test CallerID: (949) 640 - 0866 07/09/2014 10:17:40 OE308 CIR308 RESTORE SYSTEM SHUTD *Test 07/09/2014 10:19:02 ASA 1999 CODE VERIFIED KOR FIRE & SECURITY 07/09/2014 10:19:05 ASA IC INCOMING CALL taylor 07/09/2014 10:22:02 ASA TR TEST RESULTS GIVEN 07/09/2014 10:38:31 SLR 1999 CODE VERIFIED KOR FIRE & SECURITY 07/09/2014 10:38:40 SLR IC INCOMING CALL Taylor 07/09/2014 10:38:45 SLR CHTEST CHANGE TEST Cat:08 Expires: 07/09/201417:00:00 *Test Location to Scheduled Alt ID CS# 863495 Page 6 of 6 NEWPORT BEACH FIRE "DEPARTMENT Phone: (949) 644-3106 FAX (949) 644-3 120 Fire Inspection Violation Form Business Na e: Building Name: Inspection D e: 0 Address: Business Phone: D e "No ce.of Reinspection" �i Lc GtLilrt 75, was Issued: Suite: Inspecting.!F:�e Unit: Date "Notice of Referral" " C was Issued: Violation Notice As a result of an inspection by the Newport Beach Fire Department, the violation(s) listed below were noted. See reverse side for violation descriptions. D ORDER TO COMPLY: You are hereby required to correct the above condition(s) immediately upon receipt. Noncompliance with the foregoing order before the date of reinspection may render you liable to the penalties provided by law for such violation(s). A reinspection visit will be scheduled no less t 4 days from the date of this inspection. Signature of Responsible Party: Date: 3 :V Inspected By: Reinspection Date: SELF -CLEARING: Due to the relatively minor nature of the violation(s) noted above, you may take corrective action on your own and certify that the violation(s) have been corrected within 14 days of the issuance of this notice. I hereby certify that the above violation(s) have been corrected. Name: �� % �1�—, Address:. ) Signature: Date: ------ When self-cle in violations have been completed, lease mail this form to: Newport Beach Fire Department Fire Prevention Division P. O. Box 1768 Newport Beach, CA 92658-8915 Tfl ate Cleared Original — FPD Yellow —Owner Pink —Station GENERAL PROVISIONS FOR FIRE SAFETY Newport Beach Municipal Code, Section 9.04.010 A. Common Violations AA Provide extinguisher(s) with a minimum rating of 2-A:10-B:C. [906.1] AB Mount extinguishers where readily available, with top not to exceed 5' from floor level. [906.9] AC Service and tag each extinguisher annually and after each use. [906.2] AD Post signs indicating location of extinguishers. [906.6] AE Remove obstruction(s) from exits, aisles, corridors, and stairways. [1028] AF Provide approved safety cans for dispensing flammable liquids. [3404.3] AG Open burning. [307] AH Discontinue use of extension cords in lieu of permanent wiring. [605.5] AI Remove extension cords running through openings or attached in series, cords placed under rugs, furniture, or where subject to damage. [605.5] AJ Maintain wiring in good condition and protect from damage. [605.5.3] AK Discontinue use of multi -plug adapters. (605.41 AL Provide appropriate sign on Fire Department Connection. [912.4] AM Post street address numbers on front of building. Min. 4" in height. [505.1] AN Fire hydrant clearance is to maintain a 3' circumference. [508.5.5]] AO Commercial dumpsters are to maintain a 5' separation from buildings. [304.3.31 AP Class K commercial kitchen extinguisher required. [904.11.5.2] AQ Outdoor barbecues. (308.3.1]] B. Fire Protection Systems BA Provide Knoxboxfor fire department access. [506] BB Extinguishing systems shall be maintained and operable at all times. [901,61 BC Service and tag hood and duct extinguishing system semi-annually & after each activation. [904.5.1] BD Clean grease filters over cooking appliances. [904.11.6.3] BE Provide central station supervision of fixed fire sprinkler system greater than 20 heads. [903.4] BF Inspect, test, and provide 5-year certification on sprinkler/standpipe system(s). [901.6.1] BG An approved occupant voice notification system shall be provided. [907.2.12.2] C. Maintenance of Exit Ways CA Remove all other locks or latches from doors and replace with panic hardware. [1008.1.91 CB Unlock all exit doors during business hours. [1008.1.8.3] CC Post approved sign "THIS DOOR TO REMAIN UNLOCKED WHEN BUILDING IS OCCUPIED." [1008.1.8.3] CD Post occupant load sign. [1004.3] CE Means of egress shall be illuminated when occupied. [1006.1] D. Flammable and Combustible Liquids DA Provide approved storage cabinet or inside storage room for all flammable liquids. [3404.3.2] DB Flammable liquids shall be dispensed by approved pumps taking suction through top of the container. [3405.2.4] E. Storage EA Reduce storage to 18" (36" for storage over 12') below level of sprinklers or 24" below ceiling in un-sprinklered building. [315.2.1] EB Good housekeeping. Arrange storage in an orderly manner and provide for exiting & fire department access. [315.2] EC Remove combustible storage in boiler, mechanical, or electrical rooms. [315.2.3] ED Proper storage of oily rags and similar materials. [304.3.1] EE Remove storage under exit stairways. [315.2.2] F. Electrical FA Provide cover plates. [605.1] FB Identify breakers in panel box. [605.3.1] FC Electrical panel and equipment shall have a minmum clearance of 36". [605.31 FD Discontinue use of extension cords. Use only for portable appliances. [605.5] G. Hazardous Materials GA Provide approved cabinet or inside storage room for all hazardous materials. [2703.8.7] GB Secure and identify compressed gas cylinders with name of product. [3003.5.31 GC Provide MSDS information for products. [2703.4] GD Mark all fixed storage facilities in accordance with NFPA 704M. [2703.51 GE Update hazardous materials inventory & site plan annually. [2701.5.2] H. Permits Required HA Candles and open flames in assembly areas. [105.6.32] HB Combustible material storage greater than 2,500 cubic feet. [105.6.29] HC Dry cleaning plant. [105.6.12] HD Dust producing plant. [105.6.6] HE Storage of more than 5 gallons inside or more than 10 gallons outside of a Class I flammable liquid. (105.6.16] HF Storage of more than 25 gallons inside or more than 60 gallons outside of a Class II or Class III combustible liquid. [105.6.16] HG Repair garage for repairing motor vehicles. [105.6.39] HH Ovens for industrial baking or drying. (105.6.24) HI Place of Assembly - to operate a place of assembly. [105.6.34] HK Spraying or dipping of flammable liquids. [105.7.111 HL Hot work operations including cutting, welding, and similar operations. [105.6.23] HM Other UFC Article 1 permits. I. Combustible Materials IA Remove all cut or uncut dead and dying weeds from the property. [304.1.2] IB Cut and remove trees and shrubs in wildland hazard reduction area. [318.31 Z. Miscellaneous Violations ZZ Other unlisted code violation. STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST See instructions on reverse. AGENCY CONTACTS NAME TELEPHONENUMBER REQUESTDATE PROGRAM Julia Phelps 916 327-3107 4/5/16 Residential Detox EVALUATOR'SNAME REQUESTING AGENCY FACILITY NUMBER REQUESTCODE Julia Phelps 300649AP IA CODES 1. ORIGINAL A. FIRE CLEARANCE � LICENSING Department of Health Care Services AGENCY Substance Use Disorder Compliance Division 2. RENEWAL B. LIFE SAFETY NAME AND Licensing and Certification Section 3. CAPACITY CHANGE ADDRESS P.O. Box 997413, MS 2600 4. OWNERSHIP CHANGE Sacramento, CA 95899-7413 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 6 0 0 6 FACILITY NAME LICENSE CATEGORY Novation Res-Detox STREETADDRESS (ActualLocatlon) NUMBER OF BUILDINGS 1707 East Bay Avenue 1 CITY RESTRAINT NeNewport Beach �'P none FACILITY CONTACT PERSON'S NAME HOURS Betsy Starman- (818) 326-7793 24+ ' ........., ,:r, ... �...-,,.._ y TO 'BE COMP,LE." TED`•BY dNSPECTINGAUTHtjRITY, _ .. ."c 1 CLEARANCE/DENIALCODE 1 Newport Beach Fire Department CODES 1. FIRE CLEARANCE GRANTED FIRE Life Safety Services AUTHORITY 100 Civic Center Drive NAME AND Newport Beach, CA 92660 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS L I B. CONSTRUCTION —1 C. FIRE ALARM D. SPRINKLERS INSPECTOR'S NAME (TypedorPrinted) TELEPHONENUMBER CFIRS NUMBER OCCUPANCYCLASS E. HOUSEKEEPING A C) C) (—�1�1 < 949 ) 644-3105 30055 R-3 F. SPECIAL HAZARD G. OTHER INSPECTIONDATE INSPECTOR'S SIGNATURE , 07-07-2016 CA _K GVA� M EXPLAIN DENIAL OR LIST SPECIALCONDITIONS 2013 California Fire Code defines alcoholism or drug abuse recovery homes (ambulatory only) as a R-3 Residential Group occupancy. This facility was inspected as a R-3 single family dwelling with no additional code requirements. 0 i. .. .w .. 't'�'`+•+w +..w.Mx..pa«o- ...." .,•.+q„?PxJes^R-,r.,.-rr..»wy�w+,a.�. <,rseuy3�.�r+-;.v,V� . n*r*«gw ,,,..,,, +ra1'a+�w,'+xesk"3".��"""r yrt9"v.+.e��..Yw:^�.,+wuw;V^/.�nt rpu...... .,�r++vw�^°,•w FA . ,- ma = xw momw nm ' 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 May 19, 2016 RE: Novation 1707 E. Bay Avenue, Newport Beach, CA 92661 044-223-29 Dear Ms. Starman: The above referenced property is located within the Single -Unit Residential Zoning District (R-1) and is designated as Single -Unit Residential Detached within the Land Use Element of the General Plan (RS-D). This Zoning District allows for single-family dwellings. Residential Care Facilities, Limited (6 or fewer beds) licensed by the State of California are a permitted use within the R-1 Zoning District. Based on the pending State License and the information provided, found attached, the proposed Residential Care Facility, Limited (6 or fewer beds) Licensed is a use that complies with the R-1 Zoning District. However, operation of the facility shall not commence until you have submitted to the City a copy of the necessary State license and the Newport Beach Fire Department has given the necessary Fire Clearance. Staff will maintain the contact number for Novation, Roger Cosgrove 909-648-8423 for public and/or City contact. Should you have any further questions, please contact me at 949-644-3221 or mwhelanCa.newportbeachca.aov Sincerely, Kimberly Brandt, AICP, Community Development Director By: Melinda Whelan Assistant Planner Enclosures: Operation information for 1707 E. Bay Avenue 1707 East Bay Avenue, Newport Beach, CA 92661 May 12, 2016 Melinda Whelan Planning Division City of Newport Beach 100 Civic Center Drive Newport Beach, CA 92660 Re: Novation Pending License No. 300649AP Dear Melinda, Novation is defined as an integral facility per Zoning Code. Novation is a single facility located on a single lot with no other affiliated facility located within the city of Newport Beach. The property address is 1707 E. Bay Avenue, Newport Beach, CA 92551 The zoning of the property is R-1 The bed count at the address will be six (6) and will be all male. Licensing is being pursued with DHCS and our pending license number with DHCS is 300649AP. We are requesting a date of occupancy for July 1, 2016. The owner / contact person for this property is Roger Cosgrove. Mr. Cosgrove can be reached at 909.648.8423. If you need any additional information or have any questions, please feel free to contact me at 818.326.7793 or via email at bkstarman()-gmail.com. Thank you for all your help with this matter. Sincerely, Betsy K. Starman Compliance Coordinator 1. CO detector. Do we need just one for the house, or do we need one on each floor? I believe some were recently installed as an upgrade to the network of connected smoke detectors, but I will double check that. In the event I need to install one or more, I wanted to understand the rule for how many are required and where they need to be. 2. Smoke detectors. There are a lot of them already and they are all interconnected, so I'm pretty sure this will be OK. 3. Garage self -closing door. I retrofitted the only pertinent door with a self -closer and also weather stripped it to be smoke -proof. 4. Fire extinguisher. Do I need one for the entire house, or one per floor, or is there some other rule? For example, there are two cooking areas, a wok burner on the first floor and the main kitchen is on the second floor. Fire extinguishers should be the A/B/C type? And do they need to be of a certain size? I will be at the house to meet you. If you want to reach me for any reason, please call or text my cell, 909-648-8423, or you can email me. If you get spam-blocked, I'll see that and unblock you. Thanks for your attention to this, and I look forward to seeing you on Thursday. Rodger Cosgrove 909-648-8423 ;J MII Morris, Nadine From: Morris, Nadine Sent: Wednesday, July 6, 2016 3:50 PM To: 'Rodger Cosgrove' Subject: RE: fire inspection at 1707 East Bay Avenue Good afternoon Rodger, Yes, the inspection is scheduled for Thursday, 7/7 at 1:00 PM. Your points below are addressed as follows: 1) CO detectors are required to be installed outside each sleeping area of the home. Manufacturer's installation instructions should also be followed. 2) Smoke detectors are required outside sleeping areas, inside bedrooms, and on every floor of the home. 3) Garage door —description is acceptable. 4) It is recommended fire extinguishers be provided in the garage and kitchen areas. See you tomorrow, thank you. Nadine NADINE MORRIS I Life Safety Specialist Newport Beach Fire Department 100 Civic Center Drive, Newport Beach, CA 92660 (949) 644-3105 1 (949) 723-3505 FAX 1 nmorris@nbfd.net r� Safety, Service, Professionalism From: Rodger Cosgrove[maiIto: rodgercosgrove(c0earthlink.net] Sent: Wednesday, July 6, 2016 10:49 AM To: Morris, Nadine Subject: FW: fire inspection at 1707 East Bay Avenue Hi, I sent this to a wrong address! See below, please. From: Rodger Cosgrove fmailto:rodgercosgrove@earthlink.net] Sent: Tuesday, July 5, 2016 5:50 PM To: 'morris@n bfd. net' <morris@nbfd.net> Subject: fire inspection at 1707 East Bay Avenue Hello Nadine, My name is Rodger Cosgrove and I am writing about the upcoming inspection of 1707 East Bay Avenue to be sure everything is in order. This inspection is part of the licensing process with the State of California for a residential treatment center. I also want to confirm that the time is 1:00 PM on Thursday, July 7th, and to be sure I'm clear on a few points: .-Jjj IL V� V BAY AVE E 0 h1a ot -4—t BALBOA BLVD E l F- Am 0 it . j M XV /IEN 1, SO i lit PLAZA DEL NORTE 4Y Newport Disclaimer: Every reasonable effort has been made -to assure the Beach accuracy of the data provided, however, The City of GIS Newport Beach and its employees and agents disclaim any and all responsibility from or relating to any results obtained in its use. 0 100 200 Imagery: 2009-2013 photos provided by Eagle M Imaging www.eagleaedal.com Feet 11FOlt ` 1 7/7/2016