B08_Attachment_4_Fire_Inspection_Documentation_0001.pdf

AES 1 Sept. 3, 2013

Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19

Property Information:

Name: Residence

Occupancy/Use:

Choose an item.

Address: VaQ 0010

Construction Type: Choose an item.

City: Valley

No. Stories:

ZIP: 95389

Year Constructed:

Contact: Tim Modjeski

Telephone: 303-819-9916

Contractor Information:

Number of System Risers 1

Copy sent to:

Name: Owner Date:

Address

Fire AHJ Date:

City:

Contractor Date: 8/22/2024

State:

NOTES:

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 edition as amended by California Code of Regulations, Title 19, §901 to §906.

2) Inspection items may be performed by the owner in accordance with California Code of Regulations, Title 19, §904.1(a)

Telephone:

CA License#: 905493

Job #: SV2407120072

Performed by: J Johnson & Donavan

Check box for each system inspected and enter the number of forms used for inspection. Check boxes (Fail or Pass) to indicate status of inspected system at end of inspection.

Forms Included with this Report

NFPA 25

Chapter

Number of Forms N/A Fail* Pass

Automatic Sprinkler System 5 1

Standpipe and Hose System 6

Private Water Supply System 7

Fire Pump 8

Water Storage Tank 9

Water Spray System 10

Foam Water Sprinkler System 11

Water Mist System 12

Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas) Yes No

*See "Deficiencies and Comments" section at end of each respective form.

Wet Pipe Fire Sprinkler System

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report

Property Information

Contractor or Licensed Owner Information

Building Residence

Address VaQ 0010

City Valley License # 905493 Contact Tim Modjeski SFM Job # SV2407120072

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

P,F,N/A

1 Laundry Room 1” 1” 86 8 55 P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

Quarterly Inspections I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 86 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

N/A

1.10 I

General Information Sign (Not Required for System prior to 2007 Edition of NFPA 13)

5.2.8

N/A

1.11 I Heat Tape 5.2.7 N/A

1.12 I Spare Sprinklers 5.2.1.4 F

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections - Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems.

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Name

Address VaQ 0010 Job # SV2407120072 City Valley Misc.

ANNUAL INSPECTION, TESTING, AND MAINTENANCE

Include ALL Quarterly Inspections

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item

Description NFPA 25 CA ed.

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/22/24 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/22/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/22/24 P

1.22 I Hangers 5.2.3 8/22/24 P

1.23 I Seismic Braces 5.2.3 8/22/24 P

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter 'F' until results

are returned from Lab N/A

2.2 T

Recalled Sprinklers

If not present = Pass; If present = Fail Title 19 904.1(c) 8/22/24

F

2.3 T

Water Flow Alarm Devices 90 sec. maximum - (Enter Time ) 5.3.3

13.2.6 8/22/24 18 sec. P

2.4 T

Main Drain Test (Enter Data on Page 1 of this Form)

13.2.5

13.3.3.4 8/22/24

P

2.5 T Control Valve - Position 13.3.3.2 8/22/24 P

2.6 T Control Valve – Operation 13.3.3.1 8/22/24 P

2.7 T Supervisory Devices 13.3.3.5 N/A

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T

Small Hose Connections* w/PRV Hose Valves – Partial Flow Test

13.5.2.3 13.5.3.3

2.10 T PRV – Fire Sprinkler Systems 13.5.1.3 N/A

3.1 M Control Valves 13.3.4 N/A

3.2 M Small Hose Connections* 13.5.6.3 N/A

3.3

M Obstruction Investigation required

(If “Yes”, see Deficiencies and Comments Section for Results.)

14.3

Yes No

N/A

3.4 M System Returned to Service 4.5.3 8/22/24

Yes No

P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0010 Job # SV2407120072

D = Deficiency C = Comment (Indicate type )

Item Date Riser D C Deficiencies and Comments Indicate all equipment, devices and parts that were repaired or replaced

*****ANNUAL FIRE SPRINKLER INSPECTION*****

1.5 8/22/24 1 X UL listed fire protection gauge out dated on riser & gauge ball valve kit

1.12 8/22/24 1 X Add 3 capacity head box with ½” white residential 155* pendants, white ½” residential HSW & wrench(es) to fit heads.

2.2 8/22/24 1 X 7 recalled white CSC LF ½” semi recessed pendants installed.

1.19 8/22/24 1 X Missing 1 white semi recessed escutcheon at kitchen.

1.1 8/22/24 1 X Add Control Valve & Test/ Drain signs to valves on riser.

END OF REPORT

Check here if additional Deficiencies and Comments are listed on Form AES9.

See Correction Form AES 10 for corrected deficiencies.

Number attached

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter

Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual

Date 8/22/24

Print Name Jeremy Johnson

Signature J.Johnson

Address: VaQ 0012 requirements and information, see NFPA 25, 2011

Forms Included with this Report

NFPA 25

Chapter

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0012

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

1 Kitchen Water heater closet 1” 1” 71 25 73 P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 71 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

N/A

1.10 I

General Information Sign

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections - Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0012 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/22/24 P

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/22/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/22/24 P

1.22 I Hangers 5.2.3 8/22/24 P

1.23 I Seismic Braces 5.2.3 8/22/24 P

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter 'F' until results

are returned from Lab N/A

2.2 T

Recalled Sprinklers

Water Flow Alarm Devices 90 sec. maximum - (Enter Time ) 5.3.3

13.2.6 8/22/24 sec. F

2.4 T

Main Drain Test (Enter Data on Page 1 of this Form)

2.6 T Control Valve – Operation 13.3.3.1 8/22/24 P

2.7 T Supervisory Devices 13.3.3.5 N/A

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T

Small Hose Connections* w/PRV Hose Valves – Partial Flow Test

N/A

3.4 M System Returned to Service 4.5.3 8/22/24

Yes No

P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0012 Job # SV2407120072

1.1 8/22/24 1 X Add Control Valve, Test/Drain, & 911 bell signs to system.

1.5 8/22/24 1 X UL listed fire protection gauge out dated.

1.12 8/22/24 1 X No spare head box found. Add 3 capacity box, 3- white 155* ½” residential pendants & Socket style wrench to fit heads.

2.2 8/22/24 1 X 7 CSC LF recalled semi recessed ½” white pendants installed.

2.3 8/22/24 1 X Waterflow Failed the alarm test. Troubleshoot flow switch.

See Correction Form AES 10 for corrected deficiencies.

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter

Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual

Date 8/22/24

Address: VaQ 0013 requirements and information, see NFPA 25, 2011

Forms Included with this Report

NFPA 25

Chapter

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0013

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

1 Laundry Room 1” 1” 84 10 66 P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 84 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

N/A

1.10 I

General Information Sign

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections - Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0013 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/22/24 P

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/22/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/22/24 F

1.22 I Hangers 5.2.3 8/22/24 P

1.23 I Seismic Braces 5.2.3 8/22/24 P

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter 'F' until results

are returned from Lab N/A

2.2 T

Recalled Sprinklers

Water Flow Alarm Devices 90 sec. maximum - (Enter Time ) 5.3.3

13.2.6 8/22/24 13 sec. F

2.4 T

Main Drain Test (Enter Data on Page 1 of this Form)

2.6 T Control Valve – Operation 13.3.3.1 8/22/24 P

2.7 T Supervisory Devices 13.3.3.5 N/A

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T

Small Hose Connections* w/PRV Hose Valves – Partial Flow Test

N/A

3.4 M System Returned to Service 4.5.3 8/22/24

Yes No

P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0013 Job # SV2407120072

1.1 8/22/24 1 X Add Control Valve, Test/Drain & 911 bell signs to system.

1.5 8/22/24 1 X UL listed fire protection gauge out dated on riser.

1.12 8/22/24 1 X Add 1 white 155* residential HSW & socket style wrench for V2730 heads to spare box.

2.3 8/22/24 1 X Waterflow time 13 secs – adjust waterflow to 30-90 seconds

1.21 8/22/24 1 X Add broken ½” residential head to drain outlet.

See Correction Form AES 10 for corrected deficiencies.

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter

Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual

Date 8/22/24

Address: VaQ 0042 requirements and information, see NFPA 25, 2011

Forms Included with this Report

NFPA 25

Chapter

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0042

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

1 Water Heater Closet 1” 1” 140 5 110 P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 140 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 F

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

N/A

1.10 I

General Information Sign

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections - Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0042 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/22/24 P

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/22/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/22/24 P

1.22 I Hangers 5.2.3 8/22/24 P

1.23 I Seismic Braces 5.2.3 8/22/24 P

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter 'F' until results

are returned from Lab N/A

2.2 T

Recalled Sprinklers

Water Flow Alarm Devices 90 sec. maximum - (Enter Time ) 5.3.3

13.2.6 8/22/24 28 sec. P

2.4 T

Main Drain Test (Enter Data on Page 1 of this Form)

2.6 T Control Valve – Operation 13.3.3.1 8/22/24 P

2.7 T Supervisory Devices 13.3.3.5 N/A

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T

Small Hose Connections* w/PRV Hose Valves – Partial Flow Test

N/A

3.4 M System Returned to Service 4.5.3 8/22/24

Yes No

P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0042 Job # SV2407120072

1.1 8/22/24 1 X Add 2 Control Valve, 1 Test/Drain, & 1 911 bell sign to system.

1.12 8/22/24 1 X 2 Central Omega Recalled heads & wrench in spare head box. Replace with white ½” 155* Residential pendants and socket style head wrench.

2.2 8/22/24 1 X 15 Recalled white CSC LF semi recessed 155* pendants installed.

1.5 8/22/24 1 X UL listed fire protection gauge outdated on riser. Sowing excessive pressure.

See Correction Form AES 10 for corrected deficiencies.

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter

Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual

Date 8/22/24

Name: Residence Apts

Address: VaQ 0046

Number of System Risers 4 requirements and information, see NFPA 25, 2011

Forms Included with this Report

NFPA 25

Chapter

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Building Residence Apts

Address VaQ 0046

City License # 905493

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

P,F,N/A

1 Apt 46-A Water Heater Closet 1” 1” 140 9 90 P

2 Apt 46-B Water Heater Closet 1” 1” 102 23 85 P

3 Apt 46-C Water Heater Closet 1” 1” 92 10 86 P

4 Apt 46-D Water Heater Closet 1” 1” 260 155 215 F

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi * psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 F

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

N/A

1.10 I

General Information Sign

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections - Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0046 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/22/24 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/22/24 Owner’s Responsibility P

P1.21 I Pipe and Fittings 5.2.2 8/22/24 P

1.22 I Hangers 5.2.3 8/22/24 P

1.23 I Seismic Braces 5.2.3 8/22/24 P

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter 'F' until results

are returned from Lab N/A

2.2 T

Recalled Sprinklers

Water Flow Alarm Devices 90 sec. maximum - (Enter Time ) 5.3.3

13.2.6 8/22/24 sec. F

2.4 T

Main Drain Test (Enter Data on Page 1 of this Form)

2.6 T Control Valve – Operation 13.3.3.1 8/22/24 P

2.7 T Supervisory Devices 13.3.3.5 N/A

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T

Small Hose Connections* w/PRV Hose Valves – Partial Flow Test

N/A

3.4 M System Returned to Service 4.5.3 8/22/24

Yes No

P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0046 Job # SV2407120072

1.1 8/22/24 1-4 X Add 2 Control Valve, 1 Test/ Drain, & 1 911 bell sign to each riser.

1.5 8/22/24 1-4 X UL listed fire protection gauge out dated on each riser.

1.8 8/22/24 4 X UL listed fire protection gauge showing excessive pressure.

1.12 8/22/24 2-4 X Spare head box missing. Add 3 capacity box with 3 white 155* ½” residential pendants & Socket style head wrench to fit heads to water heater closets in B, C, & D

1.12 8/22/24 1 X Spare head box missing socket style head wrench for TY2234 heads.

2.2 8/22/24 1-4 X White recalled CSC LF 155* ½” semi recessed pendants installed. A (8), B (7), C (7), D (8).

1.19 8/22/24 4 X 1 Damaged white semi recessed recalled residential 155* pendant in Apt 46-D.

2.3 8/22/24 1,2,4 X Electric bell not ringing during water flow for Apts A, B, C, & D. Ran ITVs 2 minutes each.

See Correction Form AES 10 for corrected deficiencies.

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter

Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual

Date 8/22/24

Address: VaQ 0061 requirements and information, see NFPA 25, 2011

Forms Included with this Report

NFPA 25

Chapter

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0061

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

1 Laundry Room 1” 1” 48 10 50 P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 48 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

N/A

1.10 I

General Information Sign

1.12 I Spare Sprinklers 5.2.1.4 P

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections - Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0061 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/22/24 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/22/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/22/24 P

1.22 I Hangers 5.2.3 8/22/24 P

1.23 I Seismic Braces 5.2.3 8/22/24 F

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter 'F' until results

are returned from Lab N/A

2.2 T

Recalled Sprinklers

Water Flow Alarm Devices 90 sec. maximum - (Enter Time ) 5.3.3

13.2.6 8/22/24 sec. F

2.4 T

Main Drain Test (Enter Data on Page 1 of this Form)

2.6 T Control Valve – Operation 13.3.3.1 8/22/24 P

2.7 T Supervisory Devices 13.3.3.5 N/A

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T

Small Hose Connections* w/PRV Hose Valves – Partial Flow Test

N/A

3.4 M System Returned to Service 4.5.3 8/22/24

Yes No

P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0061 Job # SV2407120072

1.1 8/22/24 1 X Add Control Valve sign to control valve.

1.5 8/22/24 1 X Replace out dated UL listed fire protection gauge on riser.

2.2 8/22/24 1 X 14 recalled CSC LF white semi recessed 155* ½” pendants installed.

2.3 8/22/24 1 X Unable to locate bell. Ran ITV for 2 minutes. No alarm activation.

1.23 8/22/24 1 X Reattach existing Unistrut clamp to existing Unistrut.

1.12 8/22/24 1 X Add 3 capacity head box, 3 white ½” TY2234 pendants & socket style head wrench to fit Tyco heads.

See Correction Form AES 10 for corrected deficiencies.

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter

Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual

Date 8/22/24

Form AES 2.1 Sept. 3, 2013

Name: Yosemite National Park Occupancy/Use:

Address: VAQ 049 Residence Valley Construction Type:

City: Yosemite National Park No. Stories:

ZIP: 95389 Year Constructed:

Contact:

Tim Modjeski

303-819-9916

Contractor Information: Number of System Risers: 1

Name: HCI Systems, Inc.

Address: 3742 W. Gettysburg Ave Ste. 102

X Owner Date:

City: Fresno

Fire AHJ Date: N/A

State: CA

X Contractor Date: 8/22/2024

Telephone: 559-233-2008

CA License #: 905493

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 edition as amended by California Code of Regulations, Title 19, §901 to §906

2) Inspection items may be performed by the owner in

Performed by: Jeremy Johnson

Check box for each system inspected and enter the number of forms used for inspection.

Check boxes (Fail or Pass) to indicate status of inspected system at end of inspection.

Forms included with this Report

NFPA 25

Chapter

Number of Forms N/A Fail* Pass

Automatic Sprinkler System 5 2 X

Standpipe and Hose System 6 0

Private Water Supply System 7 0

Fire Pump 8 0

Water Storage Tank 9 0

Water Spray System 10 0

Foam Water Sprinkler System 11 0

Water Mist System 12 0

Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas) Yes X No

*See “Deficiencies and Comments” section at end of each respective form.

California Code of Regulations – Title 19

Inspection, Testing, and Maintenance Quarterly and

Building Name Yosemite National Park Name HCI Systems, Inc.

Address VAQ 049 Residence Valley Address 3742 W. Gettysburg Ave Ste. 102

City Fresno St. CA Zip 93722

City Yosemite National Park License # 905493 Phone 559-233-2008

Contact Person Tim Modjeski SFM Job # SV2407120072

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

WF

sec

P,F, N/A

1 Downstairs Water Heater Closet 1” 1” 105 30 90 7 P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached 1

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not applicable

Item Description NFPA 25 CA ed.

Reference

Date

8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 105 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 P

1.9 I

Hydraulic Design Information Sign (For hydraulically Designed Systems)

5.2.6 F

1.10 I

General Information Sign (Not Required for System prior to 2007 Edition of NFPA 13)

5.2.8 N/A

1.11 I Heat Tape 5.2.7 N/A

1.12 I Spare Sprinklers 5.2.1.4 F

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 P

1.15 I Pressure Reducing Valves 13.5.1.1 P

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections – Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems.

California Code of Regulations – Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report

Address VAQ 049 Residence Valley Job # SV2407120072

City Yosemite National Park

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not applicable

Item Description

NFPA 25

CA ed.

Referenc e

8/22/24 Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 P

1.22 I Hangers 5.2.3 P

1.23 I Seismic Braces 5.2.3 P

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter “F” until results are

returned from Lab.

NA

2.2 T

Recalled Sprinklers If not present = Pass; If present = Fail

Title 19 904.1(c)

F

2.3 T

Water Flow Alarm Devices 90 sec. maximum – (Enter Time)

5.3.3 13.2.6

F

2.4 T

Main Drain Test (Enter Data on Page 1 of this Form)

13.2.5 13.3.3.4

P

2.5 T Control Valve – Position 13.3.3.2 N/A

2.6 T Control Valve – Operation 13.3.3.1 N/A

2.7 T Supervisory Devices 13.3.3.5 N/A

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T

Small Hose Connections* W/PRV Hose Valves – Partial Flow Test

13.5.2.3 13.5.3.3

N/A

2.10 T PRV – Fire Sprinkler Systems 13.5.1.3 N/A

3.1 M Control Valves 13.3.4 N/A

3.2 M Small Hose Connections* 13.5.6.3 N/A

3.3 M

Obstruction Investigation required (If “Yes”, see Deficiencies and Comments Section for Results.)

14.3 Yes

No N/A

3.4 M System Returned to Service 4.5.3

Yes

No P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III

D = Deficiency C = Comment (Indicate type)

Item Date Riser D C Deficiencies and Comments

Indicate all equipment, devices and parts that were repaired or replaced

2.3 8/22/24 1 X Waterflow time 7 secs. – adjust between 30-90 seconds as required

1.1 8/22/24 1 X No control valve sign on sprinkler system ‘Previous Deficiency’

1.9 8/22/24 1 X No hydraulic signage ‘Previous Deficiency’

1.1 8/22/24 1 X Missing Main Drain sign or sticker on Riser

1.5 8/22/24 1 X Riser gauge expired (1995) – replace 1 qty wet gauge

California Code of Regulations – Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report

Address VAQ 049 Residence Valley Job # SV2407120072

Deficiencies and Comments (cont.)

Indicate all equipment, devices and parts that were repaired or replaced

1.12 8/22/24 1 X Missing Spare Box & wrench for ½” 155* Semi White RES Pendants in spare head box & spares (3 qty ½” 155* RES White Pendants

1.19&2.2 8/22/24 1 X Recalled Central sprinklers – replace 9 qty downstairs & 4 upstairs – ½” 155* RES Pendants

Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached: 0

See Correction Form AES 10 for corrected deficiencies. Number attached: 0

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Quarter 1st – Annual 2nd – Annual 3rd – Annual 4th – Annual

Date 8/22/2024

Name: Yosemite National Park Occupancy/Use:

Address: VAQ 062 Residence Valley Construction Type:

City: Yosemite National Park No. Stories:

ZIP: 95389 Year Constructed:

Contact:

Tim Modjeski

303-819-9916

Contractor Information: Number of System Risers: 1

Name: HCI Systems, Inc.

Address: 3742 W. Gettysburg Ave Ste. 102

X Owner Date:

City: Fresno

Fire AHJ Date: N/A

State: CA

X Contractor Date: 8/22/2024

Telephone: 559-233-2008

CA License #: 905493

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 edition as amended by California Code of Regulations, Title 19, §901 to §906

2) Inspection items may be performed by the owner in

Performed by: Jeremy Johnson

Check box for each system inspected and enter the number of forms used for inspection.

Check boxes (Fail or Pass) to indicate status of inspected system at end of inspection.

Forms included with this Report

NFPA 25

Chapter

Number of Forms N/A Fail* Pass

Automatic Sprinkler System 5 2 X

Standpipe and Hose System 6 0

Private Water Supply System 7 0

Fire Pump 8 0

Water Storage Tank 9 0

Water Spray System 10 0

Foam Water Sprinkler System 11 0

Water Mist System 12 0

Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas) Yes X No

*See “Deficiencies and Comments” section at end of each respective form.

California Code of Regulations – Title 19

Inspection, Testing, and Maintenance Quarterly and

Address VAQ 062 Residence Valley Address 3742 W. Gettysburg Ave Ste. 102

City Fresno St. CA Zip 93722

City Yosemite National Park License # 905493 Phone 559-233-2008

Contact Person Tim Modjeski SFM Job # SV2407120072

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

WF

sec

P,F, N/A

1 Water Heater Closet by Back Door 1” 1” 95 30 80 F P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached 1

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not applicable

Item Description NFPA 25 CA ed.

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 95 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 P

1.9 I

Hydraulic Design Information Sign (For hydraulically Designed Systems)

5.2.6 F

1.10 I

General Information Sign (Not Required for System prior to 2007 Edition of NFPA 13)

5.2.8 N/A

1.11 I Heat Tape 5.2.7 N/A

1.12 I Spare Sprinklers 5.2.1.4 F

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 P

1.15 I Pressure Reducing Valves 13.5.1.1 P

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections – Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III

California Code of Regulations – Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report

Address VAQ 062 Residence Valley Job # SV2407120072

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not applicable

Item Description

NFPA 25

CA ed.

Referenc e

8/22/24 Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 P

1.22 I Hangers 5.2.3 P

1.23 I Seismic Braces 5.2.3 P

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter “F” until results are

returned from Lab.

NA

2.2 T

Recalled Sprinklers If not present = Pass; If present = Fail

Title 19 904.1(c)

F

2.3 T

Water Flow Alarm Devices 90 sec. maximum – (Enter Time)

5.3.3 13.2.6

F

2.4 T

Main Drain Test (Enter Data on Page 1 of this Form)

13.2.5 13.3.3.4

P

2.5 T Control Valve – Position 13.3.3.2 N/A

2.6 T Control Valve – Operation 13.3.3.1 N/A

2.7 T Supervisory Devices 13.3.3.5 N/A

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T

Small Hose Connections* W/PRV Hose Valves – Partial Flow Test

13.5.2.3 13.5.3.3

N/A

2.10 T PRV – Fire Sprinkler Systems 13.5.1.3 N/A

3.1 M Control Valves 13.3.4 N/A

3.2 M Small Hose Connections* 13.5.6.3 N/A

3.3 M

Obstruction Investigation required (If “Yes”, see Deficiencies and Comments Section for Results.)

14.3 Yes

No N/A

3.4 M System Returned to Service 4.5.3

Yes

No P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III

Deficiencies and Comments

Indicate all equipment, devices and parts that were repaired or replaced

2.3 8/22/24

1 X No Waterflow alarm while testing – replace waterflow device 1”

1.1 8/22/24

1 X No control valve sign on sprinkler system ‘Previous Deficiency’

1.9 8/22/24

1 X No hydraulic signage ‘Previous Deficiency’

1.1 8/22/24

1 X Missing Main Drain sign or sticker on Riser

1.5

1 X Riser gauge expired (1994) – replace 1 qty wet gauge

California Code of Regulations – Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report

Address VAQ 062 Residence Valley Job # SV2407120072

Deficiencies and Comments (cont.)

Indicate all equipment, devices and parts that were repaired or replaced

1.12 8/22/24 1 X Missing Spare Box & wrench for ½” 155* Semi White RES Pendants in spare head box & spares (3 qty ½” 155* RES White Pendants

1.19&2.2 8/22/24 1 X Recalled Central sprinklers – replace 12 qty total – ½” 155* RES White Pendants

Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached: 0

See Correction Form AES 10 for corrected deficiencies. Number attached: 0

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Quarter 1st – Annual 2nd – Annual 3rd – Annual 4th – Annual

Date 8/22/2024

Name: Nurses Dorm

Address: VaQ 0064 requirements and information, see NFPA 25, 2011

Forms Included with this Report

NFPA 25

Chapter

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Building Nurses Dorm

Address VaQ 0064

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

1 Apartment G kitchen closet 1” 1” 55 10 45 P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 55 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

N/A

1.10 I

General Information Sign

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A

1.16 I Backflow Preventers 13.6.1 P

1.17 I Small Hose Connections - Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0064 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/22/24 P

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/22/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/22/24 P

1.22 I Hangers 5.2.3 8/22/24 P

1.23 I Seismic Braces 5.2.3 8/22/24 P

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter 'F' until results

are returned from Lab N/A

2.2 T

Recalled Sprinklers

Water Flow Alarm Devices 90 sec. maximum - (Enter Time ) 5.3.3

13.2.6 8/22/24 4 sec. F

2.4 T

Main Drain Test (Enter Data on Page 1 of this Form)

2.6 T Control Valve – Operation 13.3.3.1 8/22/24 P

2.7 T Supervisory Devices 13.3.3.5 N/A

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T

Small Hose Connections* w/PRV Hose Valves – Partial Flow Test

N/A

3.4 M System Returned to Service 4.5.3 8/22/24

Yes No

P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0064 Job # SV2407120072

1.12 8/22/24 1 X Socket style wrench missing for TY5231 heads in spare head box.

1.5 8/22/24 1 X UL listed fire protection gauge on riser out dated.

1.1 8/22/24 1 X Add signage to riser: 4 Control Valve, 1 911 bell, & 1 Test/ Drain.

2.3 8/22/24 1 X Waterflow time 4 secs – adjust waterflow time 30-90 seconds.

X Inspectors Test Valve & Riser located bottom floor water heater closet.

See Correction Form AES 10 for corrected deficiencies.

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter

Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual

Date 8/22/24

NFPA25 as amended by CCR, Title 19

Property Information:

Name:

VaQ 0598 YNP Exploration Center Occupancy/Use: R1

Address: Valley Construction Type: Type III-A

City: Yosemite, CA No. Stories: 1

ZIP: 95389 Year Constructed:

Contractor Information: Number of System Risers 1

Name:

Owner Date: 8/22/2024

Address Fire AHJ Date:

City: Contractor Date:

State: NOTES:

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011

§904.1(a)

Telephone:

CA License#: 905493

Job #: SV2407120072

Performed by: Jeremy Johnson & Donavan

Check box for each system inspected and enter the number of forms used for inspection. Check boxes (Fail or Pass) to indicate status of inspected system at end of inspection.

Forms Included with this Report NFPA 25 Chapter Number of Forms N/A Fail* Pass

Automatic Sprinkler System 5 1

Standpipe and Hose System 6

Private Water Supply System 7

Fire Pump 8

Water Storage Tank 9

Water Spray System 10

Foam Water Sprinkler System 11

Water Mist Systemz 12

Fire Sprinkler System

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report

Building VaQ 0598 YNP Exploration Center

Address Valley

City Yosemite, CA License # 905493 Contact Jeff McBride SFM Job # SV2407120072

Phone 410-668-8000 Ext 1087 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No. Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure P,F,N/A

1 INSIDE BLDG. 2 ½” 1 ¼” 65 35 55 P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

Description NFPA 25 CA ed.

Date Date Date Date 8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 P

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 P

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi * psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 65 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 P

1.9 I Hydraulic Design Information Sign

(For Hydraulically Designed Systems) 5.2.6 P

1.10 I

General Information Sign (Not Required for System prior to 2007 Edition of NFPA 13)

5.2.8 N/A

1.11 I Heat Tape 5.2.7 N/A

1.12 I Spare Sprinklers 5.2.1.4 P

1.13 I Fire Department Connections 13.7 P

1.14 I Alarm Valves – Exterior Inspection 13.4.1 N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

Fire Sprinkler System

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report

Name J.Johnson

Address Valley Job # SV2407120072

City Yosemite, CA Misc.

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/22/24 P

1.20 I Buildings (Freeze Protection) 4.1.1.1 Owner’s Responsibility N/A

1.21 I Pipe and Fittings 5.2.2 P

1.22 I Hangers 5.2.3 P

1.23 I Seismic Braces 5.2.3 P

2.1 T Field Service Test Required (Send

Report to Fire Code Official) 5.3.1 If REQUIRED, Enter 'F' until results are returned from Lab N/A

2.2 T Recalled Sprinklers

If not present = Pass; If present = Fail Title 19 904.1(c) N/A

2.3 T Water Flow Alarm Devices 90

sec. maximum - (Enter Time )

5.3.3 13.2.6

38 sec. P

2.4 T Main Drain Test

(Enter Data on Page 1 of this Form)

13.2.5 13.3.3.4

P

2.5 T Control Valve - Position 13.3.3.2 P

2.6 T Control Valve – Operation 13.3.3.1 P

2.7 T Supervisory Devices 13.3.3.5 P

2.8 T Backflow Preventer Assemblies 13.6.2 N/A

2.9 T Small Hose Connections* w/PRV Hose

Valves – Partial Flow Test

13.5.2.3 13.5.3.3

N/A

2.10 T PRV – Fire Sprinkler Systems 13.5.1.3 N/A

3.1 M Control Valves 13.3.4 P

3.2 M Small Hose Connections* 13.5.6.3 N/A

3.3 M

Obstruction Investigation required (If “Yes”, see Deficiencies and Comments Section for Results.)

14.3 Yes

No N/A

3.4 M System Returned to Service 4.5.3 Yes

No P

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

Fire Sprinkler System

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report

Name J.Johnson

Address Valley Job # SV2407120072

City Yosemite, CA Misc.

*****ANNUAL SPRINKLER INSPECTION*****

1.5 8/22/24 1 X RISER GAUGE DATED:2015 NEEDS TO BE REPLACED

Notes:

See Correction Form AES 10 for corrected deficiencies.

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter

Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual

Date 8/22/2024

Address: VaQ 0003 requirements and information, see NFPA 25, 2011

Forms Included with this Report

NFPA 25

Chapter

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0003

Phone 303-819-9916 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

1 Laundry Room 1” 1” 84 10 66 P

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

8/22/24

1.1 I Control Valves – Identification Sign 13.3.1 F

1.2 I Control Valves – Inspection 13.3.2 P

1.3 I Waterflow Alarm Devices 5.2.5 P

1.4 I Supervisory Devices 5.2.5 N/A

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1 F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 84 psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

N/A

1.10 I

General Information Sign

1.13 I Fire Department Connections 13.7 N/A

1.14 I Alarm Valves – Exterior Inspection 13.4.1 N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A

1.16 I Backflow Preventers 13.6.1 N/A

1.17 I Small Hose Connections - Hose Valve*

5.1.6, 13.5.2

13.5.5.1 N/A

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1 N/A

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and

Address VaQ 0003 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/22/24 P

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/22/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/22/24 F

1.22 I Hangers 5.2.3 8/22/24 P

1.23 I Seismic Braces 5.2.3 8/22/24 P

2.1 T

Field Service Test Required (Send Report to Fire Code Official)

5.3.1 If REQUIRED, Enter 'F' until results

are returned from Lab N/A

2.2 T

Recalled Sprinklers

Water Flow Alarm Devices 90 sec. maximum - (Enter Time ) 5.3.3

13.2.6…