B08_Attachment_5_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: Day Care

Occupancy/Use:

Choose an item.

Address: EPB 0717

Construction Type: Choose an item.

City: El Portal

No. Stories:

ZIP: 95389

Year Constructed:

Contact: Tim Mojeski

Telephone: 303-819-9166

Contractor Information:

Number of System Risers 1

Copy sent to:

Name: Owner Date:

Address

Fire AHJ Date:

City:

Contractor Date: 8/9/2024

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 & D Reyna

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 Day Care

Address EPB 0717

City El Portal License # 905493 Contact Tim Modjeski SFM Job # SV2407120072

Phone 303-819-9166 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” ½” 115 N/A

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

8/9/24

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 F

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 N/A psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi 115 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 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 EPB 0717 Job # SV2407120072 City El Portal 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 8/9/24 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/9/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/9/24 P

1.22 I Hangers 5.2.3 8/9/24 P

1.23 I Seismic Braces 5.2.3 8/9/24 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) 8/9/24

P

2.3 T

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

13.2.6 8/9/24 sec. F

2.4 T

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

13.2.5

13.3.3.4 8/9/24

2.5 T Control Valve - Position 13.3.3.2 8/9/24 P

2.6 T Control Valve – Operation 13.3.3.1 8/9/24 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 8/9/24

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 EPB 0717 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*****

1.3 8/9/24 1 X Add 911 bell sign to electric bell.

1.1 8/9/24 1 X Add Control Valve & Test/Drain signs to riser.

1.19 8/9/24 1 X Replace missing white semi recessed Tyco escutcheon in North side room.

1.12 8/9/24 1 X Add socket style head wrench for Globe GL 4110 pendants. Note: Please provide Carrie Quote for 3 additional of each type of socket style head wrenches for each Fire truck.

2.3 8/9/24 1 X Waterflow failed to report – Troubleshoot 1” waterflow device.

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 8/9/24

Print Name Jeremy Johnson

Signature J.Johnson

Name: River View Apts

Address: EPQ 0740

Contact: Tim Modjeski

Number of System Risers 4

Contractor Date: 8/13/2024 requirements and information, see NFPA 25, 2011

Performed by: J Johnson & Donavan

Forms Included with this Report

NFPA 25

Chapter

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

Quarterly and

Building River View Apts

Address EPQ 0740

Phone 303-819-9166 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 Basement 1” ½” 85 10 70 P

2 Basement 1” ½” 84 10 69 P

3 Basement 1” ½” 66 10 52 P

4 Basement 1” ½” 60 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

8/13/24

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 F

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 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 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

P

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 EPQ 0740 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/13/24 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/13/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/13/24 P

1.22 I Hangers 5.2.3 8/13/24 P

1.23 I Seismic Braces 5.2.3 8/13/24 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

Title 19 904.1(c) 8/13/24

F

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

13.2.6 8/13/24 sec. N/A

2.4 T

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

13.3.3.4 8/13/24

2.5 T Control Valve - Position 13.3.3.2 8/13/24 P

2.6 T Control Valve – Operation 13.3.3.1 8/13/24 N/A

2.7 T Supervisory Devices 13.3.3.5 8/13/24 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

3.1 M Control Valves 13.3.4 8/13/24 N/A

N/A

3.4 M System Returned to Service 4.5.3 8/13/24

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 EPQ 0740 Job # SV2407120072

1.5 8/13/24 1-4 X All 4 UL listed fire protection gauges outdated.

1.12 8/13/24 1 X Socket style head wrench missing for TY2234 heads at spare head box.

1.1 8/13/24 1-4 X Add Test/Drain & Control Valve signs to all 4 risers.

1.12 8/13/24 1 X Add 1 chrome 155* ½” QR HSW to spare head box.

1.19 8/13/24 1 X Replace missing chrome semi recessed escutcheon in basement.

1.19 8/13/24 1 X Replace both chrome semi recessed 155*QR ½” HSWs in basement dated 2000.

1.3 8/13/24 1 X Add 911 bell sign to electric bell cover.

1.19 8/13/24 1 X Replace missing white semi recessed escutcheon in Apt D kitchen.

2.2 8/13/24 1-4 X CSC LF recalled ½” semi recessed 155* pendants installed in apartments: D (8); H (7);

C (10); B (12); G (12); F (10); A (8); E (9).

2.3 8/13/24 1-4 X Waterflow times – A&E 22 SEC, B&F 22 SEC, D&H 23 SEC, C&G 21 SEC

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 8/13/24

Name: Residence

Address: EPQ 0874

Contractor Date: 8/8/2024 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

Address EPQ 0874

Phone 303-819-9166 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 1” 1” 142 N/A

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

8/8/24

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 142 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

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 EPQ 0874 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/8/24 F

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

1.21 I Pipe and Fittings 5.2.2 8/8/24 N/A

1.22 I Hangers 5.2.3 8/8/24 N/A

1.23 I Seismic Braces 5.2.3 8/8/24 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

Title 19 904.1(c) 8/8/24

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

13.2.6 8/8/24 47 sec. P

2.4 T

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

13.3.3.4 8/8/24

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

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

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 EPQ 0874 Job # SV2407120072

2.2 8/8/24 1 X 16 chrome on white CSC LF recalled 155* ½” semi recessed pendants installed.

1.5 8/8/24 1 X UL listed fire protection gauge outdated & damaged on riser.

1.12 8/8/24 1 X Spare head box missing 3 chrome 155* ½” residential pendants & socket style head Wrench to fit heads.

1.19 8/8/24 1 X Painted 155* chrome recalled semi recessed residential pendant in restroom.

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

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 8/8/24

Address: EPQ 0867 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 EPQ 0867

Phone 303-819-9166 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 1” 1” 70 N/A

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

8/8/24

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 70 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

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 EPQ 0867 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/8/24 P

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

1.21 I Pipe and Fittings 5.2.2 8/8/24 N/A

1.22 I Hangers 5.2.3 8/8/24 N/A

1.23 I Seismic Braces 5.2.3 8/8/24 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 8/8/24 40 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 8/8/24 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 8/8/24

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 EPQ 0867 Job # SV2407120072

2.2 8/8/24 1 X 17 chrome on white CSC LF recalled 155* ½” semi recessed pendants installed.

1.5 8/8/24 1 X UL listed fire protection gauge outdated on riser.

1.12 8/8/24 1 X Spare head box missing 3 chrome 155* ½” residential pendants & socket style head Wrench to fit heads.

2.3 8/8/24 1 X Audibles did not activate during waterflow test.

1.1 8/8/24 1 X Signs missing from riser. Add Control valve & Test/Drain signs.

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 8/8/24 enueInspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19

Name: Wawona Residential 4047 Occupancy/Use: R1

Address: Wawona Construction Type: Type III-A

City: Yosemite, CA No. Stories: 1

ZIP: 95389 Year Constructed:

Telephone: 303-819-9916

Contractor Information: Number of System Risers 1

Name:

Owner Date: 8/16/2024

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 Wawona Residential 4047

Address Wawona

City Yosemite, CA 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 Under House – Crawl Space 1” 1 ¼” 165 20 133 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.

Reference

Date Date Date Date 8/16/24

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 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 165 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 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 Wawona 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 8/16/24 F

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

1.21 I Pipe and Fittings 5.2.2 8/16/24 P

1.22 I Hangers 5.2.3 8/16/24 P

1.23 I Seismic Braces 5.2.3 8/16/24 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) 8/16/24 F

2.3 T Water Flow Alarm Devices 90

sec. maximum - (Enter Time )

5.3.3 13.2.6

8/16/24 sec. F

2.4 T Main Drain Test

(Enter Data on Page 1 of this Form)

13.2.5 13.3.3.4

8/16/24 P

2.5 T Control Valve - Position 13.3.3.2 8/16/24 P

2.6 T Control Valve – Operation 13.3.3.1 8/16/24 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

N/A

2.10 T PRV – Fire Sprinkler Systems 13.5.1.3 N/A

3.1 M Control Valves 13.3.4 8/16/24 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 8/16/24 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

Fire Sprinkler System

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

Quarterly and Annual Report

Name J.Johnson

Address Wawona Job # SV2407120072

City Yosemite, CA Misc.

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

1.1 8/16/24 1 X CONTROL VALVE SIGN MISSING FROM RISER

1.5 8/16/24 1 X RISER GAUGE DATED:1995 NEEDS TO BE REPLACED

1.9 8/16/24 1 X HYDRAULIC PLATE MISSING FROM RISER

2.3 8/16/24

1 X

NO WATERFLOW ALARM AFTER 2 MINUTES TESTING – TROUBLESHOOT/REPLACE

DEVICE

2.2 8/16/24 1 X SPRINKLERS RECLLED CENTRAL HEADS – 8 QTY ½” RES 155* PENDANTS

REPLACE SPRINKLERS ABOVE

1.12 8/16/24 1 X NO SPARE HEADS BOX – INSTALL WITH HEADS & WRENCH

Notes:

THIS PROPERTY DOES NOT HAVE A FIRE PANEL AND IS NOT MONITORED

END OF REPORT

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

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 8/16/24

Name: Mountain View Apts

Address: EPQ 0745

Number of System Risers 3 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 Mountain View Apts

Address EPQ 0745

Phone 303-819-9166 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 Basement 1” N/A 50 10 45 P

2 Basement 1” N/A 51 10 48 P

3 Basement 1” N/A 50 10 47 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

8/13/24

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 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 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

P

1.10 I

General Information Sign

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

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

Quarterly and

Address EPQ 0745 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/13/24 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/13/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/13/24 P

1.22 I Hangers 5.2.3 8/13/24 P

1.23 I Seismic Braces 5.2.3 8/13/24 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 8/13/24 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 8/13/24 P

2.7 T Supervisory Devices 13.3.3.5 8/13/24 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

3.1 M Control Valves 13.3.4 8/13/24 P

N/A

3.4 M System Returned to Service 4.5.3 8/13/24

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 EPQ 0745 Job # SV2407120072

1.5 8/13/24 1 X 3 outdated UL listed fire protection gauges at risers

1.12 8/13/24 1 X Add 1 white ½” TY2234 pendant, & socket style head wrench to fit it as well as Star LD2 Style heads for spare head box.

1.19 8/13/24 1 X Missing 1 white semi recessed escutcheon in hallway of apt E.

1.19 8/13/24 1 X Painted 155* ½” white residential semi recessed pendant in apt E dining room.

2.3 8/13/24 1-3 X Waterflow times – 1) 45 sec 2) 45 sec 3) 32 sec

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 8/13/24

Address: EPQ 0858

Contact:

Tim Modjeski 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 EPQ 0858

Phone 303-819-9166 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

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

8/8/24

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 70 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

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 EPQ 0858 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/8/24 F

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

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

1.22 I Hangers 5.2.3 8/8/24 N/A

1.23 I Seismic Braces 5.2.3 8/8/24 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 8/8/24 1 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 8/8/24 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 8/8/24

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 EPQ 0858 Job # SV2407120072

1.19 8/8/24 1 X Painted white ½” semi recessed 155*QR pendant at entry.

1.19 8/8/24 1 X White Tyco or Central semi recessed escutcheon missing at entry.

1.12 8/8/24 1 X Spare head box missing socket style head wrench for 1994 Star LD2 style 155* QR heads.

1.1 8/8/24 1 X Signs missing from riser. Add Control valve & Test/Drain signs.

1.12 8/8/24 1 X Replace 3- 155* SR heads in spare head box with 3- white Star 155* QR ½” pendants.

1.5 8/8/24 1 X UL listed fire protection gauge outdated on riser.

1.19 8/8/24 1 X Basement white 155*QR pendant missing both parts of the white semi recessed Escutcheon.

1.21 8/8/24 1 X 1” gate valve (Main Drain) on riser frozen. Unable to operate.

2.3 8/8/24 1 X Waterflow alarm activated too soon. Need to adjust flow switch to retard timing.

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 8/8/24

Form AES 2.1 Sept. 3, 2013

Name: Yosemite National Park Occupancy/Use:

Address: EPQ 0850 Residence Construction Type:

City: Yosemite National Park No. Stories:

ZIP: 95389 Year Constructed:

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: 8/8/2024

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 &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 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 EPQ 0850 Residence 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 303-819-9166 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 Storage Rm by Stairs 1” 1” 100 - - 16 F

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

8/8/24

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 100 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 EPQ 0850 Residence 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

8/8/24 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)

NA

2.3 T

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

5.3.3 13.2.6

P

2.4 T

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

13.2.5 13.3.3.4

F

2.5 T Control Valve – Position 13.3.3.2 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 standpipe systems.

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

2.4 8/8/24

1 X Static PSI is 100’ when running water through ½” orifice PSI is 10. Should inspect underground

‘Previous Deficiency’

1.1 8/8/24

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

1.9 8/8/24

1 X No hydraulic signage ‘Previous Deficiency’

1.1 8/8/24

1 X Missing Main Drain & Inspector’s Test valve signs

1.5

1 X Riser gauge expired (1993) – replace 1 qty wet gauge

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

Quarterly and Annual Report

Address EPQ 0850 Residence Job # SV2407120072

City Yosemite National Park

D = Deficiency C = Comment (Indicate type)

Item Date Riser D C Deficiencies and Comments (cont.)

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

1.19 8/8/24

1 X Missing escutcheon White for ½” RES Pendant 155* located upstairs bathroom

1.19 8/8/24

1 X Corroded sprinkler 1 qty ½” White RES Pendant 155* - upstairs bathroom

1.19 8/8/24

1 X Corroded sprinkler 1 qty ½” White RES Pendant 155* - downstairs hallway

1.12

1 X Missing wrench for ½” 155* Semi RES Pendant & add 1 qty ½” White RES Pendant 155* to box

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 8/8/2024

Main Drain Test California Code of Regulations - Title 19

Continuation Form Inspection, Testing, and Maintenance

Building Name Mountain View Apts Name HCI Systems, Inc.

Address EPQ 0746 Address 3742 W. Gettysburg Ave.

City Fresno St. CA Zip 93722

City El Portal License # 905493 Phone (559)233-2008

Contact Person Tim Modjeski SFM Job # SV2407120072

Phone 303-819-9166 ✔ CSLB Misc.

Riser Information Main Drain Test

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

6 West End Basement 1" N/A N/A

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

Print Name Jeremy Johnson

Signature Jeremy Johnson Date 08/13/2024

Form AES 2.9 Sept. 3, 2013

Name: Mountain View Apts

Address: EPQ 0743 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 EPQ 0743

Phone 303-819-9166 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 Basement 1” 1” 78 10 64 P

2 Basement 1” 1” 87 10 70 P

3 Basement 1” 1” 72 10 60 P

4 Basement 1” 1” 72 10 60 P

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

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

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

8/13/24

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 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 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

P

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 EPQ 0743 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/13/24 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/13/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/13/24 P

1.22 I Hangers 5.2.3 8/13/24 P

1.23 I Seismic Braces 5.2.3 8/13/24 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 8/13/24 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 8/13/24 N/A

2.7 T Supervisory Devices 13.3.3.5 8/13/24 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

3.1 M Control Valves 13.3.4 8/13/24 P

N/A

3.4 M System Returned to Service 4.5.3 8/13/24

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 EPQ 0743 Job # SV2407120072

1.5 8/13/24 1 X All 4 UL listed fire protection gauges outdated.

2.2 8/13/24 1 X Chrome ½” semi recessed 155* CSC LF recalled pendants installed: Basement (12);

B (12); C (10); F (12); G (11); A (9); E (9); D (9); H (9).

2.3 8/13/24 1 X Waterflow times – 1) 48 sec, 2) 37 sec, 3) 63 sec, 4) 40 sec

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 8/13/24

Address: EPQ 0871 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 EPQ 0871

Phone 303-819-9166 CSLB Misc.

Riser Information Main Drain Test (Annual)

Riser No.

Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure

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

8/8/24

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 F

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 70 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

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 EPQ 0871 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/8/24 P

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

1.21 I Pipe and Fittings 5.2.2 8/8/24 N/A

1.22 I Hangers 5.2.3 8/8/24 N/A

1.23 I Seismic Braces 5.2.3 8/8/24 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 8/8/24 42 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 8/8/24 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 8/8/24

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 EPQ 0871 Job # SV2407120072

1.12 8/8/24 1 X Spare head box empty. Add 3 chrome ½” 155* residential pendants & socket style head Wrench to fit heads to spare head box.

2.2 8/8/24 1 X 11 chrome on white CSC LF recalled 155* ½” semi recessed pendants installed.

2.3 8/8/24 1 X Horn strobes not activating during waterflow test.

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

1.5 8/8/24 1 X UL listed fire protection gauge on riser outdated.

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 8/8/24

Name: River View Apts

Address: EPQ 0741 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 EPQ 0741

Phone 303-819-9166 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 Basement 1” ½” 62 10 55 P

2 Basement 1” ½” 59 10 52 P

3 Basement 1” ½” 60 10 54 P

4 Basement 1” ½” 60 10 55 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

8/16/24

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 F

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 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 P

1.9 I

Hydraulic Design Information Sign (For Hydraulically Designed Systems) 5.2.6

P

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 EPQ 0741 Job # SV2407120072

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1 8/16/24 F

1.20 I Buildings (Freeze Protection) 4.1.1.1 8/16/24 Owner’s Responsibility P

1.21 I Pipe and Fittings 5.2.2 8/16/24 P

1.22 I Hangers 5.2.3 8/16/24 P

1.23 I Seismic Braces 5.2.3…