VA LAACC_351 E Temple St_REG4 ANN FA_01-30-24_Redacted 1.pdf

TEST SITE INFORMATION

TEST SITE ADDRESS: (STREET) (CITY) (STATE) (ZIP) TEST SITE PHONE:

351 E TEMPLE ST LOS ANGELES CA 90012-3328

OCCUPANCY TYPE: NUMBER OF STORIES: YEAR BUILT: CONSTRUCTION TYPE: SQUARE FOOTAGE:

B - Business 5 1973 Type II 105000

RESPONSIBLE PARTY

NAME: (LAST, FIRST, MI) TITLE: FIRM OR D.B.A.:

HUNT, EDWARD RESPONSIBLE PERSON VA LAACC

MAILING ADDRESS: (STREET) (CITY) (STATE) (ZIP) PHONE:

351 E TEMPLE LOS ANGELES CA 90012 (818) 891-7711

TEST INFORMATION

INITIAL TEST DATE: TESTING AGENCY: PHONE:

01/30/2024 (

MAILING ADDRESS: (STREET) (CITY) (STATE) (ZIP)

TEST RESULTS

☐ PASS ☒ FAIL

All sections below shall be found in the following pages of this report.

SECTIONS:

I. BUILDING DESCRIPTION

II. SYSTEM DESCRIPTION

III. FINDINGS

IV. TESTING PROCEDURES/WORKSHEETS

I HEREBY CERTIFY THAT THE FIRE PROTECTION EQUIPMENT LISTED ABOVE HAS BEEN FULLY TESTED IN ACCORDANCE WITH THE CHIEF'S REGULATION NO. 4 OF THE LOS ANGELES FIRE CODE AND THAT THE RESULTS ARE ACCURATELY LISTED ABOVE AND THE

EQUIPMENT IS FULLY OPERABLE EXCEPT AS NOTED.

TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: SIGNATURE:

05/31/2026

REPAIR AND RETEST: IF DEFECTS ARE FOUND IN EQUIPMENT TESTED, CORRECTION OF SUCH DEFECTS SHALL COMMENCE FORTHWITH AND SHALL BE COMPLETED AS SOON AS

POSSIBLE, BUT IN EVERY CASE WITHIN 30 DAYS OF INITIAL TEST. THE F-340RT SHALL BE USED TO DOCUMENT THE RETEST OF DEFECTS FOUND IN SCTION III. A COPY OF

SECTION III OF THIS REPORT SHALL BE ATTACHED TO THE F-340RT PRIOR TO SUBMITTING TO THE FIRE DEPARTMENT.

REPORT SUBMITTAL INFORMATION:

ALL REPORTS ARE REQUIRED TO BE SUBMITTED TO THE LOS ANGELES CITY FIRE DEPARTMENT VIA THE COMPLIANCE ENGINE

WITHIN 7 DAYS OF TEST COMPLETION.

ENTERED BY: ENTERED DATE: ENTERED TIME:

02/06/2024 5:35 PM

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

Fire Alarm - Initial Test

Test Report Number

5364932

TRN 5364932 Printed Tue Feb 06 12:31:13 CST 2024

Section I - Building Description:

CHARACTERISTICS

PRIMARY OCCUPANCY TYPE B - Business FIRE CONTROL ROOM: ☐YES ☒NO

SECONDARY OCCUPANCY TYPE I-2 ELEVATOR INFORMATION: CARS BANKS

TYPE OF BUSINESS CONDUCTED PASSENGER 4 1

☐ Apartment/Condo ☐ Museum

☐ Bar/Restaurant ☐ Parking Structure

☐ Church ☒ Office Space

☐ Schools ☐ Repair Garage

☐ Day Care ☐ Retail

☐ Detention Facility ☐ Skilled Nursing

☐ Group Home ☐ Telecommunications

☐ Hospital ☐ Theatre

☐ Hotel/Motel ☐ Warehouse

☒ Medical Office/Clinic ☒ Other: VETERANS

OUTPATIENT CLINIC

FREIGHT

PARKING 2 1

NUMBER OF STAIRWAYS: 5

FIRE PUMP(S): ☒YES ☐NO

LOCATION: P-2

EMERGENCY GENERATOR(S): ☒YES ☐NO

LOCATION: P-1

PARKING STRUCTURE:

☒ UNDERGROUND ☐ DETACHED ☒ ATTACHED

NUMBER OF LEVELS BELOW GROUND: 2

UNIQUE PROPERTY FEATURES: TYPES OF OCCUPANCIES BELOW GROUND:

FULLY SPRINKLERED OUTPATIENT VETERNAS CLINIC

WITH RISER AT SOUTH STAIR #5.

S-2, PARKING

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT

Test Report Number

5364932

INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)

01/30/2024 351 E TEMPLE ST

EQUIPMENT TESTED:

Fire Alarm - Initial Test

The owner/owner(s) representative shall ensure that the appropriate permits have been secured prior to any repairs being performed.

A copy of this section shall accompany the F-340RT in all cases.

Section III - Findings: ☒SYSTEM DEFECTS FOUND ☐NO SYSTEM DEFECTS FOUND

GRAY AREAS SHALL BE FILLED OUT BY CERTIFIED TESTER PERFORMING RETEST

DEFECT # ITEM #

(SECTION IV) DESCRIPTION LOCATION RETEST

ONLY

1 3.2 Battery replacement date is less than 5 years from the date of manufacturer.

Fail

5TH FLOOR ELECTRICAL ROOMS

POWER SUPPLY BATTERIES

OUTDATED @ 2020, NEED TO

REPLACE 4) 12VDC 7AH

BATTERIES

☐PASS

2 4TH FLOOR ELECTRICAL ROOMS

POWER SUPPLY BATTERIES

OUTDATED @ 2020, NEED TO

REPLACE 6) 12VDC 7AH

BATTERIES

☐PASS

3 3RD FLOOR ELECTRICAL ROOMS

POWER SUPPLY BATTERIES

OUTDATED @ 2020, NEED TO

REPLACE 6) 12VDC 7AH

BATTERIES

☐PASS

4 2ND FLOOR ELECTRICAL ROOMS

POWER SUPPLY BATTERIES

OUTDATED @ 2020, NEED TO

REPLACE 4) 12VDC 7AH

BATTERIES

☐PASS

5 1ST FLOOR ELECTRICAL ROOMS

POWER SUPPLY BATTERIES

OUTDATED @ 20202, NEED TO

REPLACE 8) 12VDC 7AH

BATTERIES

☐PASS

6 SEE FA WORD DOCUMENT REPORT

FOR REFERENCE. NFPA CODE

REFERENCE BATTERIES REQUIRE

REPLACING AFTER 3 YEARS OF

MANUFACTURE DATE.

☐PASS

INITIAL TEST PERFORMED BY

TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: SIGNATURE:

05/31/2026

PHONE NUMBER OF TESTING AGENCY: TESTING AGENCY: STATE: ZIP:

RETEST DATE: RETEST PERFORMED BY

RE-TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: RE-TESTER'S SIGNATURE: PHONE NUMBER:

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT

Test Report Number

5364932

INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)

01/30/2024 351 E TEMPLE ST

EQUIPMENT TESTED:

Fire Alarm - Initial Test

All testing procedures below were performed in accordance with the Los Angeles Fire Department Chief's Regulation No. 4 requirements, applicable sections of NFPA 72 and other approved publications.

ITEM # DESCRIPTION

SECTION II - SYSTEM DESCRIPTION: FIRE ALARM

Fire Alarm Control Unit (F.A.C.U.) Information.

Manufacturer:

NOTIFIER

Model #:

AFP 1000 ADDRESSABLE SYSTEM

Location:

GROUND FLOOR LOBBY/ENTRANCE

Fire Alarm Annunciator Panel Location(s) (FAAP):

MAIN ENTRANCE SECURITY STATION

Fire department connection (FDC) locations:

STREETSIDE

Fire Alarm Serves:

☒Entire Building

☐Multiple Buildings

☐Partial Areas

If the Fire Alarm serves multiple buildings, give addresses:

NA

Emergency Voice/Alarm Communication:

No

Built-in Supervising Station Communicator? (If yes, see Item #12)

No

Type of Supervising Station:

☒Central Station

☐Proprietary

Supervising Station Account Information

Account #:

VALLEY ALARM CO. ACT #LZ6303

Phone #:

(818) 787-0999

Address:

804 PICO ST

City:

SAN FERNANDO

State:

TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:

05/31/2026

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT

Test Report Number

5364932

INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)

01/30/2024 351 E TEMPLE ST

EQUIPMENT TESTED:

Fire Alarm - Initial Test

ITEM # DESCRIPTION

CA

Zip code:

91340

Type of Communication Pathway(s): (Check all that apply)

☒Digital Alarm Communicator Transmitter (D.A.C.T.)

☒Digital Cellular (Global Ssytem for Mobile /GSM)

☐Internet Protocol (I.P. D.A.C.T.)

☐Other

Two-Way Telephone Communication (Firefighter Phones):

☐Sound Powered

☐Amplified

Types of Initiating Devices:

☒Smoke Detector

☒Heat Detector

☐Beam Detector

☒Duct Detector

☒Manual Pull

☒Water Flow

☒Tamper Switch

Types of Notification Appliances:

☒Strobes

☐Horns

☐Bells

☐Horn/Strobe

☒Speaker/Strobe

☐Speaker

☐Chimes

☐Mini Horn

☐Chime/Strobe

Fire Alarm Control Auxiliary Function(s):

☒Elevator Recall

☐Fan Shutdown

☒Heating/Ventilation/Air Conditioning (HVAC) Shutdown

☒Magnetic Door Hold Open Device Release

☐Stairwell Pressurization

☐Smoke Management

☐Activation of Stairwell Door(s)

☐Activation of Other Automatic Closing Fire Assemblies tied to Fire Alarm

☐Special Extinguishing Systems

☐Foam Systems

☐Other Systems

TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:

05/31/2026

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT

Test Report Number

5364932

INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)

01/30/2024 351 E TEMPLE ST

EQUIPMENT TESTED:

Fire Alarm - Initial Test

Automatic Closing Fire Assemblies Type(s) & Locations:

24VDC MAGNETICALLY HELD FIRE DOORS THROUGHOUT CORRIDORS

Special Extinguishing Systems Types & Locations:

NA

Foam Systems Type & Locations:

NA

Other Systems Type and Locations:

NA

1.0 NOTIFICATION PASS FAIL N/A

1.1 Fire Department dispatch, supervising station, & building occupants notified prior to the start of the test.

Yes

2.0 INSPECTION - If item 2.3 indicates "fail", the test shall not be performed

PASS FAIL N/A

2.1 An Accurate Sequence of Operation Matrix is provided at the Fire Control Panel. ☒ ☐

2.2 Fire alarm operating instructions within 3 feet of FACP/FACU. ☒ ☐

2.3 Fire alarm control panel free of troubles OR the trouble condition is known. ☒ ☐

3.0 POWER SUPLLIES PASS FAIL N/A

Total Amount:

15)

Amount Tested:

15) THROUGHOUT ALL FLOORS IDF/ELECTRICAL ROOMS

3.1 Batteries are free of physical damage, leaks, loose connection, and corrosion. ☒ ☐ ☐

3.2 Battery replacement date is less than 5 years from the date of manufacturer. ☐ ☒ ☐

3.3 All batteries labeled with manufacture date. ☒ ☐ ☐

3.4 Approved artificial LOAD TESTER may be used. Make:

A.C.T

Model:

INTELLIGENT TESTER

3.5 System was tested on secondary battery power in general alarm for 5 minutes at full load or 15 minutes at full load for systems with voice evacuation. An approved battery load tester may be used instead of testing the system on secondary battery.

3.6 Primary power disconnected and trouble signal verified for loss of power. ☒ ☐ ☐

3.7 Dedicated fire alarm circuit verified and identified. ☒ ☐

3.8 Dedicated fire alarm circuit locked or in a secured room. ☒ ☐

4.0 CONTROL PANEL(S) PASS FAIL N/A

TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:

05/31/2026

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT

Test Report Number

5364932

INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)

01/30/2024 351 E TEMPLE ST

EQUIPMENT TESTED:

Fire Alarm - Initial Test

4.1 The correct identification and location indicated for alarms, supervisory, & trouble signals. ☒ ☐

4.2 Correct receipt of power supply supervision (AC power loss and secondary power loss). ☒ ☐ ☐

4.3 Correct receipt of subsequent alarms. ☒ ☐ ☐

4.4 Signals at remote annunciator panel consistent with the fire alarm panel. ☒ ☐ ☐

4.5 Other Panel Functions: Panel Silence, Lamp test, Signal Silence, Etc. ☒ ☐ ☐

5.0 INITIATING DEVICES TESTED - Initiating devices shall be

tested as intended to operate.

PASS FAIL N/A

Any devices not tested requires an explanation at the end of Section IV. (Minimum of 90% required)

5.1 Manual Pull Stations ☒ ☐ ☐

5.2 System Smoke Detectors ☒ ☐ ☐

5.3 Duct Detector(s) ☒ ☐ ☐

5.4 Air Sampling Detectors ☐ ☐ ☒

5.5 Projected Beam Detectors ☐ ☐ ☒

5.6 Heat Detector: Restorable ☒ ☐ ☐

5.7 Heat Detector: Non Restorable ☐ ☐ ☒

5.8 Water Flow Devices ☒ ☐ ☐

5.9 Valve Supervisory Switches ☒ ☐ ☐

5.10 Water Flow (interior audible) within 20-60 seconds. ☒ ☐ ☐

5.11 Outside Electric Sprinkler Bell Within 90 Seconds. ☒ ☐ ☐

6.0 AUDIBLE AND VISUAL NOTIFICATION APPLIANCES TESTED PASS FAIL N/A

Any devices not tested requires an explanation at the end of Section IV. (Minimum of 90% required).

Prior to 1993 - 10 dba above ambient sound level in the area.

1993 to 2000 - 15 dba above ambient (minimum 75 dba, maximum 120 dba).

2001 and later - 15 dba above ambient (minimum 75 dba, maximum 110dba).

Non-ADA strobes installed prior to 1998 may not have the capability to b synchronized.

6.1 Bells ☒ ☐ ☐

6.2 Chimes ☐ ☐ ☒

6.3 Speakers ☐ ☐ ☒

6.4 Horns ☐ ☐ ☒

6.5 Horn/Strobes ☐ ☐ ☒

6.6 Speaker/Strobes ☒ ☐ ☐

6.7 Mini Horns ☐ ☐ ☒

TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:

05/31/2026

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT

Test Report Number

5364932

INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)

01/30/2024 351 E TEMPLE ST

EQUIPMENT TESTED:

Fire Alarm - Initial Test

6.8 ADA Strobes flashed in synchronization when more than 2 are visible in the field of view. ☒ ☐ ☐

6.9 Non-ADA Strobes ☐ ☐ ☒

6.10 Other ☐ ☐ ☒

6.11 Flash rate between 60 and 120 times per minute. ☒ ☐ ☐

7.0 EMERGENCY VOICE/ALARM COMMUNICATIONS FUNCTION/EQUIPMENT PASS FAIL N/A

7.1 Required Voice communication is clear in all occupiable areas within the structure. ☒ ☐ ☐

7.2 Elevator Lobbies ☒ ☐ ☐

7.3 Elevators ☒ ☐ ☐

7.4 Storage Areas ☒ ☐ ☐

7.5 Mechanical Rooms ☒ ☐ ☐

7.6 Electrical Rooms ☒ ☐ ☐

7.7 Conference Rooms ☒ ☐ ☐

7.8 Restrooms ☒ ☐ ☐

7.9 Balconies & Patios above 1st floor ☐ ☐ ☒

7.10 When microphone is activated voice communications overrides fire alarm audible signals. ☐ ☐ ☒

7.11 A.D.A. Strobes (continue or discontinue) to flash when audible signals are silenced in accordance with approved sequence of operation. ☒ ☐ ☐

☐Continue

☒Discontinue

7.12 Selective Paging Function ☐ ☐ ☒

7.13 All Call Function ☐ ☐ ☒

8.0 TWO-WAY TELEPHONE COMMUNICATION SERVICE (FIREFIGHTER

PHONES)

PASS FAIL N/A

8.1 Minimum six (6) handheld phones. ☒ ☐ ☐

8.2 Five (5) amplified telephone stations were operated simultaneously in common talk mode, voice quality and clarity verified. ☐ ☐ ☒

8.3 "Off-Hook" condition initiated a notification signal at the command center. ☐ ☐ ☒

8.4 Selective Talk Telephone initiated a distinctive visible indicator for each selectable circuit. ☐ ☐ ☒

8.5 Three (3) sound powered telephone stations were operated simultaneously in common talk mode, voice quality and clarity verified. ☒ ☐ ☐

9.0 TWO-WAY TELEPHONE COMMUNICATION SERVICE (TELEPHONE JACKS) PASS FAIL N/A

9.1 In each enclosed stairway at entry-level. ☒ ☐ ☐

9.2 Is the exterior of enclosed exit stairway exiting to a public way. ☒ ☐ ☐

Total # of Elevator Cars. ☐

TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:

05/31/2026

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT

Test Report Number

5364932

INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)

01/30/2024 351 E TEMPLE ST

EQUIPMENT TESTED:

Fire Alarm - Initial Test

6.0

9.3 Total # of the elevator car jacks tested. ☒ ☐ ☐

6.0

9.4 In elevator machine room. ☒ ☐ ☐

Total # of elevator lobbies. ☐

2.0

9.5 Total # of elevator lobby jacks tested. ☒ ☐ ☐

2.0

9.6 In each lobby exiting to a public way. ☒ ☐ ☐

9.7 In the Fire Control Room. ☐ ☐ ☒

9.8 At the Fire Pump Room. ☐ ☐ ☒

9.9 At the Generator Room. ☐ ☐ ☒

10.0 LIFE SAFETY CONTROL FUNCTIONS PASS FAIL N/A

10.1 Elevator lobby smoke detector recalled elevator. ☒ ☐ ☐

10.2 Elevator recalled to the predetermined primary & alternate recall floors. ☒ ☐ ☐

10.3 Elevator machine room smoke detector recalled elevator. ☒ ☐ ☐

10.4 Elevator machine room shunt trip reported back to fire alarm panel. ☒ ☐ ☐

10.5 Elevator hoist-way smoke detector recalled elevator. ☐ ☐ ☒

10.6 Stairwell pressurization activated. ☐ ☐ ☒

10.7 Smoke control system activated. ☐ ☐ ☒

10.8 Heating, ventilation, and air conditioning system and damper control activated. ☒ ☐ ☐

10.9 Fan control activated. ☐ ☐ ☒

10.10 Stairwell doors unlocked. ☐ ☐ ☒

10.11 Magnetic door holders released. ☒ ☐ ☐

10.12 Other activating devices & control functions. ☐ ☐ ☒

11.0 SUPERVISORY SIGNAL INDICATION PASS FAIL N/A

11.1 Fire pump not in automatic mode. ☒ ☐ ☐

11.2 Water tank level indicator switch. ☐ ☐ ☒

11.3 Water tank temperature indicator switch. ☐ ☐ ☒

11.4 Air pressure switch(s). ☐ ☐ ☒

11.5 Valve supervisory switch(s) within 2 turns or 1/5 travel. ☒ ☐ ☐

11.6 Special extinguishing system(s). ☐ ☐ ☒

11.7 Emergency generator not in automatic mode. ☒ ☐ ☐

TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:

05/31/2026

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT

Test Report Number

5364932

INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)

01/30/2024 351 E TEMPLE ST

EQUIPMENT TESTED:

Fire Alarm - Initial Test

12.0 INTEGRATED COMMUNICATOR TRANSMITTER PASS FAIL N/A

Do Not Use This Section For Separate Supervising Station Alarm Control Panels.

12.2 Is Tester certified in supervising station fire alarm.

Yes

12.2 Two (2) means of transmission verified at test site. ☒ ☐ ☐

12.3 Signals sent separately via primary and secondary means of transmission. ☒ ☐ ☐

12.4 Activation and restoration of each type of initiating and supervisory devices verified on-site and at the supervising station within 90 seconds. ☒ ☐ ☐

12.5 Primary communication signal was disconnected and trouble signal indicated on-site and at the supervising station within 200 seconds (4 minutes for DACTS). ☒ ☐ ☐

12.6 Secondary means of communication disconnected and a trouble signal indicated on-site and at the supervising station within 200 seconds (4 minutes for DACTS). ☒ ☐ ☐

12.7 Primary and secondary power loss and restoration indicated a trouble signal within

200 seconds at the test-site. ☒ ☐ ☐

12.8 An open circuit connection to one initiating device and one notification appliance

(when applicable) was opened and indication and restoration was verified on-site and at the supervising station within 200 seconds.

AREAS/DEVICES/APPLIANCES NOT ACCESSIBLE FOR TESTING:

A minimum of 90% of testing is required. If less than 90% testing is conducted, DO NOT SUBMIT THIS REPORT.

Description:

END OF REPORT

ALL FINDINGS INDICATING “FAIL” ARE LISTED IN SECTION III (YELLOW SECTION) AND HAVE BEEN POPULATED WITH THE ITEM

DESCRIPTION, NUMBER AND LOCATION.

I HEREBY CERTIFY THAT THE FIRE PROTECTION EQUIPMENT HAS BEEN FULLY TESTED IN ACCORDANCE WITH THE CHIEF’S REGULATION NO. 4 OF THE LOS ANGELES FIRE CODE AND APPLICABLE SECTIONS OF THE NFPA 72 AND OTHER APPROVED PUBLICATIONS. THE RESULTS ARE ACCURATELY LISTED AND THE EQUIPMENT IS FULLY OPERABLE EXCEPT AS NOTED. YOU ARE A CERTIFIED REGULATION NO. 4 TESTER WITH A VALID CERTIFICATION OR HAVE BEEN AUTHORIZED TO SUBMIT THE INFORMATION

ON BEHALF OF A CERTIFIED CHIEFS REGULATION NO. 4 TESTER.

I ACCEPT

☒Yes

TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:

05/31/2026

LOS ANGELES FIRE DEPARTMENT

FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT

THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT

Test Report Number

5364932

INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)

01/30/2024 351 E TEMPLE ST

EQUIPMENT TESTED:

Fire Alarm - Initial Test