Reports Alarm And Sprinklers.pdf
PDF 42 MB Posted
- Attached to
- H342--Fire Alarm Inspection
- Solicitation number
- 36C26226Q0840
About this file
This is a Fire Protection Equipment Performance Report documenting the initial fire alarm system inspection conducted at the VA Outpatient Clinic located at 351 E Temple Street, Los Angeles, CA 90012 on August 28, 2025. The facility is a five-story business occupancy building constructed in 1973 with 105,000 square feet, featuring a fully sprinklered outpatient veterans clinic with secondary occupancy as parking (S-2). The building includes two levels below ground, four passenger elevators, two freight elevators, five stairways, a fire pump, and an emergency generator.
The fire alarm system utilizes a Notifier 30-30 Fire Alarm Control Unit located in the FACP room with an annunciator panel in the lobby. The system is monitored by Valley Alarm central station (Account #LZ6303, Phone: 818-787-0999) via a separate cell dialer. The initial test identified seven defects requiring correction within 30 days: (1) no Sequence of Operations matrix posted at the fire control panel; (2) no breaker identified for the fire alarm panel during secondary battery power testing; (3) dedicated fire alarm circuit not verified or identified; (4) dedicated circuit not locked or secured; (5) RPS signal continuing to display supervisory and "other" status despite normal panel operation, requiring troubleshooting; (6) a broken butterfly valve supervisory switch in room 211; and (7) a failed horn/strobe in the second floor elevator lobby. Corrections must be documented on Form F-340RT and submitted to the Los Angeles Fire Department via the Compliance Engine within 30 days of the initial test completion.
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Other files
| File | Type | Posted |
|---|---|---|
| 16111 Plummer St_Bldg 103_ INS Q-FS_12-19-25_Redacted 1.pdf | ||
| 16111 Plummer St_Bldg 202_ANN FA_08.22.25_Redacted 1.pdf | ||
| S06 36C26226Q0840 0004.pdf | ||
| LAACC Notifier FA Pointlist.pdf | ||
| 16111 Plummer St_Bldg 201_ANN FA_09.15.2025_Redacted.pdf | ||
| Bldg Reports count.pdf | ||
| 16111 Plummer St_Bldg 202_INS Q-FS_1-23-26_Redacted 1.pdf | ||
| 16111 Plummer St_Bldg 201_INS Q-FS_1-23-26_Redacted.pdf | ||
| 36C26226Q0840_6.docx | DOCX document | |
| S06 36C26226Q0840 0003.pdf | ||
| 36C26226Q0840_4.docx | DOCX document | |
| 36C26226Q0840_3.docx | DOCX document | |
| Q and A 36C26226Q0840.pdf | ||
| 36C26226Q0840 0001_1.docx | DOCX document | |
| S02 Solicitation 36C26226Q0840_Revised SOW A.2.pdf | ||
| S06 36C26226Q0840 Ammendment 0001.pdf | ||
| 36C26226Q0840_2.docx | DOCX document | |
| S02 Solicitation 36C26226Q0840_1.pdf | ||
| 36C26226Q0840.docx | DOCX document |
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Text version
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.:
BOLDEN, JOEY RESPONSIBLE PERSON VA OUTPATIENT CLINIC
MAILING ADDRESS: (STREET) (CITY) (STATE) (ZIP) PHONE:
351 E TEMPLE STREET LOS ANGELES CA 90012 (310) 261-6445
TEST INFORMATION
INITIAL TEST DATE: TESTING AGENCY: PHONE:
08/28/2025
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:
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:
LOS ANGELES FIRE DEPARTMENT
FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT
Fire Alarm - Initial Test
Test Report Number
7901276
TRN 7901276 Printed Thu Aug 28 06:01:34 CDT 2025
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
7901276
INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
08/28/2025 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 2.1 An Accurate Sequence of Operation Matrix is provided at the Fire Control Panel.
Fail
NO SEQUENCE OF OPS POSTED ☐PASS
2 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.
Fail
NO BREAKER IDENTIFIED FOR
FIRE ALARM PANEL ☐PASS
3 3.7 Dedicated fire alarm circuit verified and identified.
Fail
NONE VERIFIED ☐PASS
4 3.8 Dedicated fire alarm circuit locked or in a secured room.
Fail
NONE VERIFIED ☐PASS
5 4.1 The correct identification and location indicated for alarms, supervisory, & trouble signals.
Fail
RPS CONTINUED TO GO INTO
SUPERVISORY AND 'OTHER'
STAYED ON PANEL EVEN THOGH
PANEL IS NORMAL . RPS NEED
TROUBLESHOOTING
☐PASS
6 5.9 Valve Supervisory Switches
Fail
BUTTERFLY VALVE IN A 211
NEEDS IS BROKEN ☐PASS
7 6.5 Horn/Strobes
Fail
HORNSTROBE IN 2ND FL ELEV
LOBBY FAILED ☐PASS
INITIAL TEST PERFORMED BY
TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: SIGNATURE:
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
7901276
INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
08/28/2025 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 #:
30-30
Location:
FACP ROOM
Fire Alarm Annunciator Panel Location(s) (FAAP):
LOBBY
Fire department connection (FDC) locations:
TEMPLE STREET
Fire Alarm Serves:
☒Entire Building
☐Multiple Buildings
☐Partial Areas
If the Fire Alarm serves multiple buildings, give addresses:
Emergency Voice/Alarm Communication:
No
Built-in Supervising Station Communicator? (If yes, see Item #12)
No
Comment: SEPERATE CELL DIALER
Type of Supervising Station:
☒Central Station
☐Proprietary
Supervising Station Account Information
Account #:
VALLEY ALARM -LZ6303
Phone #:
818-787-0999
Address:
NA
City:
TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:
LOS ANGELES FIRE DEPARTMENT
FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT
THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT
Test Report Number
7901276
INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
08/28/2025 351 E TEMPLE ST
EQUIPMENT TESTED:
Fire Alarm - Initial Test
ITEM # DESCRIPTION
NA
State:
NA
Zip code:
NA
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):
TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:
LOS ANGELES FIRE DEPARTMENT
FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT
THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT
Test Report Number
7901276
INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
08/28/2025 351 E TEMPLE ST
EQUIPMENT TESTED:
Fire Alarm - Initial Test
☒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
Automatic Closing Fire Assemblies Type(s) & Locations:
NA
Special Extinguishing Systems Types & Locations:
NA
Foam Systems Type & Locations:
NA
Other Systems Type & 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:
Amount Tested:
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:
SDI
TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:
LOS ANGELES FIRE DEPARTMENT
FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT
THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT
Test Report Number
7901276
INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
08/28/2025 351 E TEMPLE ST
EQUIPMENT TESTED:
Fire Alarm - Initial Test
Model:
CELL CHECKER
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
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).
TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:
LOS ANGELES FIRE DEPARTMENT
FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT
THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT
Test Report Number
7901276
INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
08/28/2025 351 E TEMPLE ST
EQUIPMENT TESTED:
Fire Alarm - Initial Test
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 ☐ ☐ ☒
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. ☐ ☐ ☒
TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:
LOS ANGELES FIRE DEPARTMENT
FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT
THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT
Test Report Number
7901276
INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
08/28/2025 351 E TEMPLE ST
EQUIPMENT TESTED:
Fire Alarm - Initial Test
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. ☒
9.3 Total # of the elevator car jacks tested. ☐ ☐ ☒
9.4 In elevator machine room. ☐ ☐ ☒
Total # of elevator lobbies. ☒
9.5 Total # of elevator lobby jacks tested. ☐ ☐ ☒
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. ☐ ☐ ☒
TESTER'S NAME: CERTIFICATE #: EXPIRATION DATE: PHONE NUMBER OF TESTING AGENCY:
LOS ANGELES FIRE DEPARTMENT
FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT
THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT
Test Report Number
7901276
INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
08/28/2025 351 E TEMPLE ST
EQUIPMENT TESTED:
Fire Alarm - Initial Test
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. ☐ ☐ ☒
12.0 INTEGRATED COMMUNICATOR TRANSMITTER PASS FAIL N/A
Do Not Use This Section For Separate Supervising Station Alarm Control Panels.
12.1 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:
LOS ANGELES FIRE DEPARTMENT
FIRE PROTECTION EQUIPMENT PERFORMANCE REPORT
THIS PAGE BY ITSELF IS NOT A COMPLETE REPORT
Test Report Number
7901276
INITIAL TEST DATE: TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
08/28/2025 351 E TEMPLE ST
EQUIPMENT TESTED:
Fire Alarm - Initial Test
| 351 Temple St INS ANN EPG_FAIL Report 7900890_Redacted (6) |
| 351 Temple St INS ANN REG 4 FA_ Report 7901276_Redacted |
| 16111 Plummer St_Bldg 1_ANN FA_ 08.28.25_Redacted (2) |
| 16111 Plummer St_Bldg 1_INS Q-FS_2-9-26_Redacted (4) |
| 16111 Plummer St_Bldg 7_ANN FA_08.20.25_Redacted (12) |
| 16111 Plummer St_Bldg 7_INS Q-FS_2-9-26_Redacted (2) |
| 16111 Plummer St_Bldg 10_ANN FA_08.28.25_Redacted (2) |
| 16111 Plummer St_Bldg 10_INS Q-FS_2-9-26_Redacted (4) |
| 16111 Plummer St_Bldg 20_ANN FA_08.20.25_Redacted (14) |
| 16111 Plummer St_Bldg 20_INS Q-FS_2-9-26_Redacted (4) |
| 16111 Plummer St_Bldg 22_ANN FA_08.19.25_Redacted (4) |
| 16111 Plummer St_Bldg 22_INS Q-FS_2-9-26_Redacted (5) |
| 16111 Plummer St_Bldg 23_INS Q-FS_2-9-26_Redacted (1) |
| 16111 Plummer St_Bldg 24_ANN FA_PASS 08.13.25 |
| 16111 Plummer St_Bldg 25_ANN FA_08.19.25_Redacted (1) |
| 16111 Plummer St_Bldg 25_INS Q-FS_2-9-26_Redacted |
| 16111 Plummer St_Bldg 44_INS Q-FS_1-23-26_Redacted |
| 16111 Plummer St_Bldg 45_INS Q-FS_1-23-26_Redacted |
| 16111 Plummer St_Bldg 46_INS Q-FS_1-23-26_Redacted |
| 16111 Plummer St_Bldg 47_INS Q-FS_1-23-26_Redacted |
| 16111 Plummer St_Bldg 62_ANN FA_08.13.25_Redacted |
| 16111 Plummer St_Bldg 62_INS Q-FS_1-23-26_Redacted |
| 16111 Plummer St_Bldg 99_ANN FA_08.28.25_Redacted |
| 16111 Plummer St_Bldg 99_INS Q-FS_1-23-26_Redacted |
| 16111 Plummer St_Bldg 200_ANN FA_08.28.2025_Redacted |
| 16111 Plummer St_Bldg 200_INS Q-FS_1-23-26_Redacted (2) |
File details come from the government source that posted it. Updated .