Building Reports Attachment 1.pdf

Wet Pipe California Code of Regulations - Title 19 Annual 1 of 3 Fire Sprinkler System Inspection, Testing, and Maintenance Report

Property Information � o.f..£-¾1.t- Contractor or Licensed Owner Information i��

�I Building Bldg. 9

.;, Address 3801 Miranda Ave

Palo Alto, CA. �Fie tJI�

:::ity 94550 License#

Contact □ SFM Job#

Phone [g1 CSLB Misc.

Main Drain Test (Annual) Riser

Location Riser Main Drain Initial Static Residual Final Static

P,F,N/A No. Diameter Diameter Pressure Pressure Pressure

1 Inside - FACP room 2-1/2" 2" 115 78 90 p his buildin as o e than 5 r'sers. S e add.ti nal AE r atta h d r:JIU,fa l■L.... •

I = Inspection T = Test M = Maintenance

Item Description NFPA 25 CA ed. n .. + .. . In .. + .. . I n .. + .. .In .. + ..

Reference 02-15-25 5-14-25 08-6-25

1.1 I Control Valves - Identification Sign 13.3.1 p p p

1.2 I Control Valves - Inspection 13.3.2 p p p

1.3 I Waterflow Alarm Devices 5.2.5 p p p

1.4 I Supervisory Devices 5.2.5 p p p

1.5 I Gauges (Wet Pipe Systems} 5.2.4.1 F F F

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 p p p

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 p p p

1.8 I Pressure Readings Acceptable 5.2.4.1 p p p

1.9 I Hydraulic Design Information Sign 5.2.6 p p p

(For Hydrou/ical/y Designed Systems)

General Information Sign

1.10 I {Not Required for System prior to 2007 Edition of NFPA 5.2.8 p p p

13)

1.11 I Heat Tape 5.2.7 N/A N/A N/A

1.12 I Spare Sprinklers 5.2.1.4 p p p

1.13 I Fire Department Connections 13.7 p p p

1.14 I Alarm Valves - Exterior Inspection 13.4.1 N/A N/A N/A

1.15 I Pressure Reducing Valves 13.5.1.1 N/A N/A N/A

1.16 I Backflow Preventers 13.6.1 p p p

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

N/A N/A N/A 13.5.5.1

Form AES 2.2 Sept. 3, 2013

Building ddress

Wet Pipe California Code of Regulations - Title 19 Annual 1 f 3 Fire Sprinkler System Inspection, Testing, and Maintenance Report 0

Property Information Contractor or Licensed Owner Information

80l Miranda Ave e ""�

4550 License#1------+P_a_lo_A_l_to_,_C_A_. -----------

Contact 0 SFM Job#

Phone � CSLB Misc.

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

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

NFPA 25 CA ed.

Item Description Reference Date Comments Only P,F,N/A

1.1 ontrol Valves - Identification Sign 13.3.1 08-1-25 p

1.2 Control Valves - Inspection 13.3.2 08-1-25 p

1.3 aterflow Alarm Devices 5.2.5 08-1-25 p

1.4 upervisory Devices 5.2.5 08-1-25 p

1.5 Gauges (Wet Pipe Systems) 5.2.4.1 08-1-25 F

.... 6 Hydraulic Design Information Sign {For 5.2.6 08-1-25 p

Hydraulically Designed Systems)

1.7 Enter Water Supply Pressure Below Riser Check 5.2.4.1 08-1-25 p

1.8 Enter Water Supply Pressure Above Riser Check 5.2.4.1 08-1-25 p

1.9 Pressure Readings Acceptable 5.2.4.1 08-1-25 p

1.10 eneral Information Sign 5.2.8 08-1-25 p

(Not Required for System Prior to 2007 Edition NFPA 13}

1.11 5.2.7 08-1-25 N/A

1.12 pare Sprinklers 5.2.1.4 08-1-25 p

1.13 Fire Department Connections 13.7 08-1-25 p

1.14 larm Valves - Exterior Inspection 13.4.1 08-1-25 N/A

1.15 Pressure Reducing Valves 13.5.1.1 08-1-25 N/A

1.16 Backflow Preventers 13.6.1 08-1-25 p

Property Information

Bldg. 520

3801 Miranda Ave

Palo Alto, CA.

1.17 Smail Hose Connections - Hose Valve*

1.18 PRV - Fire Sprinkler Systems

1.19 Buildings (Freeze Protection)

1.20 prinklers

1.21 prinklers - Accessible Concealed Space

1.22 Pipe and Fittings

1.23 Pipe and Fittings - Accessible Concealed Space

1.24 Hangers

15 Hangers - Accessible Concealed Space

1.26 eismic Braces

1.27 eismic Braces - Accessible Concealed Space

1.28 Unsprinklered Areas

2.1 T Field Service Test Required Send

Report to Fire Code Official

2.2 T Recalled Sprinklers

If not present = Pass; If present = Fail

2.3 T ater Flow Alarm Devices 90

secs max. Enter time

2.4 T Main Drain Test

(Enter data on Page 1 of this form)

2.5 T ontrol Valve - Position

2.6 T ontrol Valve - Operation

2.7 T upervisory Devices

2.8 T Backflow Preventer Assemblies

2.9 T mall Hose Connections*

w/PRV Hose Valves - Partial Flow Test

2.10 T PRV - Fire Sprinkler Systems

2.11 T Pressure Gauges - Calibration

12 T * mail Hose Connections

5.1.6, 13.5.2 13.5.5.1 13.5.1.1

4.1.1.1

5.2.1

5.2.1.1.6

5.2.2

5.2.2.3

5.2.3

5.2.3.3

5.2.3

5.2.3.3

CFC 901.4

5.3.1

Title 19 904.l(c)

S.3.3 13.2.6 13.2.5

13.3.3.4 13.3.3.2

13.3.3.1

13.3.3.5

13.6.2

13.5.2.3 13.5.3.3

13.5.1.3

5.3.2

13.5.6.2.2

Contractor or Licensed Owner Information

08-1-25

08-1-25

Name

Job#

Misc.

08-1-25 Owners Responsibility

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

08-1-25

0 YES cgj NO

If REQUIRED, Enter 'F' until results are returned from Lab

90 sec.

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

N/A

N/A

N/A

F p p p p p p p

N/A

N/A p p p p p p p

N/A

N/A p

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

Signature Date 08-6-25

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

Signature Date 08-6-25

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

Property Information:

Name: Occupancy/Use:

Address: Construction Type:

City: No. Stories:

ZIP: Year Constructed:

Contact:

Telephone:

Contractor Information: Number of System Risers

Name: Copy sent to:

Address: Owner Date:

City: Fire AHJ Date:

State: Contractor Date:

Telephone:

NOTES:

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

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

CA License#:

Job #:

Performed by:

Forms ncluded with this eport NFPA 25 Chapter Number of Forms N/A Fail* Pass

Automatic Sprinkler System 5

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.

AES 1 September 3, 2013

VAPA - Bldg. 10

3801 Miranda Av.

Palo Alto

94304

I2

Type I-A

✔ 08/23/24

✔ 1 ✔

Wet Pipe Fire Sprinkler System

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

Quarterly and Annual Report 1 of 3

Property Information Contractor or Licensed Owner Information

Building Name Name

Address Address

City St. Zip License # PhoneContact Person

SFM Job # CSLB Misc.

Main Drain Test (Annual) Riser No. Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure P,F,N/A

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

1.1 I Control Valves – Identification Sign 13.3.1

1.2 I Control Valves – Inspection 13.3.2

1.3 I Waterflow Alarm Devices 5.2.5

1.4 I Supervisory Devices 5.2.5

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1

1.6 I Enter ater upply ressure elow iser heck 5.2.4.1 psi psi psi psi

1.7 I Enter ater upply ressure bove iser heck 5.2.4.1 psi psi psi psi

1.8 I Pressure eadings cceptable 5.2.4.1

1.9 I Hydraulic Design Information Sign

(for hydraulically designed systems) 5.2.6

1.10 I General Information Sign

(not required for system prior to 2007 edition of NFPA 13) 5.2.8

1.11 I Heat Tape 5.2.7

1.12 I Spare Sprinklers 5.2.1.4

1.13 I Fire Department Connections 13.7

1.14 I Alarm Valves – Exterior Inspection 13.4.1

1.15 I Pressure Reducing Valves 13.5.1.1

1.16 I Backflow Preventers 13.6.1

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

13.5.5.1

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1

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

Form AES 2.1 Sept. 3, 2013

City

VAPA - Bldg. 10 3801 Miranda Av.

Palo Alto 758796

94538

1 Outside - closet in back of building 1-1/2" 1" 115 70 85 P

08/23/24 P

P

P

P

P

P

P

N/A

N/A

P

P

N/A

N/A

P

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

Quarterly and Annual Report 2 of 3

Property Information Contractor or Licensed Owner Information

Building Name Name

Address Job #

City

ANNUAL INSPECTION, TESTING, AND MAINTENANCE

nclude 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

1.20 I Buildings (Freeze rotection) 4.1.1.1 Owner’s Responsibility

1.21 I Pipe and Fittings 5.2.2

1.22 I Hangers 5.2.3

1.23 I Seismic Braces 5.2.3

2.1 T Field Service Test Required

(Send Report to Fire Code Official) 5.3.1 If REQUIRED, Enter 'F' until results are returned from Lab

2.2 T Recalled Sprinklers

If not present = Pass; If present = Fail

Title 19 904.1(c)

2.3 T Water low Alarm Devices

90 sec. maximum - (Enter Time )

5.3.3

13.2.6 sec.

2.4 T Main Drain Test

(Enter data on Page 1 of this form)

13.2.5 13.3.3.4

2.5 T Control Valve - Position 13.3.3.2

2.6 T Control Valve – Operation 13.3.3.1

2.7 T Supervisory Devices 13.3.3.5

2.8 T Backflow Preventer Assemblies 13.6.2

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

3.1 M Control Valves 13.3.4

3.2 M Small Hose Connections* 13.5.6.3

3.3 M

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

14.3 Yes No

3.4 M System eturned to ervice 4.5.3

Yes No

* 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

Form AES 2.1 Sept. 3, 2013

VAPA - Bldg. 10

3801 Miranda Av.

Palo Alto

08/23/24 P

N/A

P

P

P

N/A

P

30 P

P

P

P

P

P

N/A

N/A

P

N/A

N/A

✔ P

✔ NOTE: Last 5 year was performed in 2011

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

Quarterly and Annual Report 3 of 3

Property Information Contractor or Licensed Owner Information

Building Name Name Address Job #

City

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

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

See Correction Form AES 10 for corrected deficiencies.

Number attached Number attached

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR Title 19 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 tems are ompleted in the ndicated Quarter

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

Date

Print Name

Signature

Form AES 2.1 Sept. 3, 2013

VAPA - Bldg. 10 3801 Miranda Av.

Palo Alto

08/23/24