HomeMy WebLinkAboutF2018-0420 - MiscContractor's Material and Test Certificate for /Aboveground Piping
PROCEDURE f,201Y-04A® 1850 5pmboree Rd
Upon completion of work. inspection and tests shall be made by the Contractor's representative and witnessed by an owner's representative. All defects
shall be corrected an J system left in service before contractor's personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copiesshall be prepared for approving authorities, owners, and contractor. It is
understood the owne 's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to
comply with approving authority's requirements or local ordinances.
PROPERTY ADDRESS' 11850 JAMBOREE RD NEWPORT BEACH
�ci nrvv Diol n. rmtaauNt RtSIUUAL PRESSURE FLOW RATE
REDUCING .FLOOR MODEL (FLOWING)
VALVE TEST
CCEPTED BY APPROVING AUTHORITIES (NAMES) NBFD
ADDRESS
PLANS
I STALLATION CONFORMS TO ACCEPTED PLANS
Z YES
❑ NO
QUIPMENT USED IS APPROVED
Z YES
❑ NO
I NO, EXPLAIN DEVIATIONS
MAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION Z YES
❑ NO
F CONTROL VALVES AND CARE AND MAINTENANCE OF THEIS NEW EQUIPMENT?
I NO, EXPLAIN
INSTRUCTIONS
WAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES
Z YES
❑ NO
1. SYSTEM COMPONENTS INSTRUCTIONS
Z YES
❑ NO
2. CARE AND MAINTENANCE INSTRUCTIONS
Z YES
❑ NO
3. NFPA25
Z YES
❑ NO
YEAR OF ORIFICE
TEMPERATURE
MAKE MODEL MANUFACTURE SIZE
QUANTITY
RATING
SPRINKLERS
YCOTY3131 2018 1/2
185
155
PIPE AND
IYPE OF PIPE DYNA THREAD
FITTINGS
TYPE OF FITTINGS CAST
MAXIMUM TIME TO OPERATE
ALARM VALVE
ALARM DEVICE
THROUGH TEST CONNECTION
OR
TYPE MAKE MODEL
MIN
SEC
FLOW
!A NIA N/A
N/A
NIA
MAKE MODEL SERIAL NO. MAKE
MODEL
SERIAL NO.
/A N/A N/A N/A
N/A
N/A
TIME TO TRIP
TIME WATER
ALARM
DRY PIPE
THROUGH TEST WATER AIR TRIP POINT
REACHED
OPERATED
OPERATING
CONNECTION PRESSURE PRESSURE OLIR PRESSURE
TEST OUTLET
PROPERLY
TEST
MIN SEC PSI PSI PSI
MIN SEC
YES NO
WITH
O.D.
W/O
Q.O.D.
11 NO, EXPLAIN
PERATION 0 PNEUMATIC 7 ELECTRIC HYDRAULIC
IPING SUPERVISED I I YES INQ DETECTING MEDIA SUPERVISED YES
NO
OES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE
DELUGE 8
ONTROL STATIONS
rl YES
I l NO
PREACTION
;� THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO, EXPLAIN M/A
VALVES
Fl OR TESTINGS YES 7 NO
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT
MAXIMUM TIME TO
AKE
MODE
SUPERVISIO LOSS ALARM OPERATE ALVE RELEASE OPERATE RELEASE
YES NO YES NO
MIN
SEC
!A
N/A
PRESSURE
i nn-rv..,
�ci nrvv Diol n. rmtaauNt RtSIUUAL PRESSURE FLOW RATE
REDUCING .FLOOR MODEL (FLOWING)
VALVE TEST
MYOROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static
TEST ressure in excess of 150 psi (10.2 bars) for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent
DESCRIPTION amage. All aboveground piping leakage shall be stopped.
NEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1'h psi (0.1 bars) in 24 hours. Test
ressure tanks at normal water level and air Pressure and measure air Pressure drop which shall not exceed 1Yz psi in 24 hours.
LL PIPING HYDROSTATICALLY TESTED AT 200 FOR 2 HOURS IF NO, STATE REASON
RY PIPING PNEUMATICALLY TESTED ❑ YES ® NO
QUIPMENT OPERATES PROPERLY 5a YES NO
0 YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE
R DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING
YSTEMS OR STOPPING LEAKS' YES M NO "
RAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST
TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI
NOERGROUND MAINS AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE
ONNECTION MADE TO SPRINKLER PIPING.
VERIFIED BY COPY OF THE U FORM NO. 858 ❑ YES ❑ NO OTHER EXPLAIN
LUSHED BY INSTALLER OF UNDERGROUND NIA
PRINKER PIPING 7 YES F1NO
I 7 POWDER DRIVEN FASTENERS. ARE USED IN CONCRETE IF NO, EXPLAIN
AS REPRESENTATIVE SAMPLE TESTING BEEN COMPLETED? DYES NO NIA
3LANK TEST P UMBER USED LOCATIONS NUMBER REMOVED
3ASKETS NIA NIA NIA
WELDEDPIPING n YES M NO
WELDING
DATA
SIGNATURES
Ir -
) YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
ITH THE REQUIREMENTS OF AT LEAST AWS D10.9. LEVEL AR 3? ® YES ❑ NO
> YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE
TH THE REQUIREMENTS OF AT LEAST AWS D10.9. LEVEL AR 3? ® YES ❑ NO
I YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED
IALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS
PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT
E INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? 6'J YES 'NO
I YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS)
E RETRIEVED? I —
® YES ❑ NO
NTROLVALVES OPEN.
TESTS WITNE
TITLE
JED) TITLE O
DATE
x,2018 -040
NEWPORT BEACH FIRE DEPARTMENT 1850 5pmho�ee R�
FIRE PREVENTION DIVISION
P.O. Box 1768, Newport Beach, CA 92658-8915
(949)644-3106
.....................................................................................................................................
Notice of Reinspection
and
Non -Compliance
...................... ................................................................. ..............................................
;
Date
A member of the Newport Beach Fire Department conducted a fire and life safety
inspection at the following location/ business on
Business Name:
Business Address:
At that time, a violation notice was issued indicating the corrections required to gain
compliance with the applicable codes, regulations, and ordinances pursuant to the 1998
California Fire Code, Section 103.2.1.
This notice is to inform you that your business is entitled to one more fire company
reinspection, which will occur on or after i"f 1 ` ' ,' ; '1 If all
violations are not corrected at that time, your business will be referred to the Fire
Prevention Division. The Fire Prevention Division will perform a subsequent
reinspection of your business at the prevailing fee schedule set forth by City Council.
Your prompt attention in this matter is appreciated.
Responsible Party:
Inspector's Name:
Phone Number:
O Left with Responsible Party
❑ Fax Number
Original - Owner/Responsible Party Yellow - Fire Company/FPD
�yoRTB�9 NEWPORT BEACH FIRE DEPARTMENT
�w - . h FIRE PREVENTION DIVISION
j l PvO. Box 1768, Newport Beach, CA 92658-8915
(949) 644-3106
\dEae h"
-:,..................................................................................................................................._,
Notice of Referral
to the
Fire Prevention Division
.....................................................................................................................................
Date
A member of the Newport Beach Fire Department conducted a fire and life safety
inspection at the following location/ business on
Business Name:
Business Address:
At that time, a violation notice was issued indicating the corrections required to gain
compliance with the applicable codes, regulations, and ordinances pursuant to the 1998
California Fire Code, Section 103.2.1.
A second inspection was conducted on j t " in an attempt to
verify compliance with the written Notice of Reinspection and Non -Compliance.
During this inspection, it was found that some or all of the violations had not been
corrected.
This notice is to inform you that your business is being referred to a member of the
Newport Beach Fire Department's Fire Prevention Division. They will perform a
reinspection of the above business at the prevailing fee schedule set forth by City
Council.
If the necessary corrections have not been completed, the Fire Prevention Division will
deliver to you a Final Notice and Notice of Intent to Prosecute.
Your prompt attention in this matter is appreciated.
Responsible Party:
Inspector's Name:
Phone Number:
a
O Left with Responsible Party ❑ Fax Number
Original - Owner/Responsible Party Yellow - Fire Company/FPD
� Z()1 0 Vrt/FV
18517 50m6oree Rd
Picoco,LLC B
Name: Occupancy/use:
Address: 4343 Von Karman ave Construction Type: Type II -B
OF CA<7�G
Newport Beach ca
p Beach,ca
3
y
City: Stones:
ZIP: 92660 Year Constructed: 1974
Contact: Josh Davies
Telephone: (949) 955-2131
P
E M
} gg
Name: Red Hawk Fire & Security (CA) LLC
Copy sent to:
Address: 1640 N. Batavia Street
El owner Date:
City: Orange
❑ Fire AHJ Date:
State: CA
❑ Contractor Date:
714
Telephone: ( ) 685-8100
NOTES:
1) For specific inspection, testing, and maintenance
713099
requirements and information, see NFPA 25, 2011
CA License#:
edition as amended by California Code of Regulations,
Title 19, §901 to §906.
Job # 3517357
:
Robert Lomeli
2) Inspection items may be performed by the owner in
Performed by:
accordance with California Code of Regulations, Title 19,
§904.1(a)
�ALLy�'i nr. •�dx
+�.v✓�`}+Rei. n«.t.wri 1.`xi kti�
Forms Included with this Report NFPA 25
�4F ISu1AtvZv `3":
ON 1a
Number Forms NIA Fail* Pass
Chapter
❑X Automatic Sprinkler System 5
of
0 ❑ ❑X Q
❑ Standpipe and Hose System
6
0
❑ Private Water Supply System
7
0
1:1
❑
❑ Fire Pump
8
0
FX -1
❑
❑
❑ Water Storage Tank
9
0
❑
❑
❑ Water Spray System
10
0
❑
❑
❑ Foam Water Sprinkler System
11
01:1
El
❑ Water Mist System
12
0
❑
❑
❑ 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
Includes ALL p
1=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=NotApplicable
Riser Information
Location
Riser
Diameter
.Main Drain,
.Diameter =
Initial Static
Pressure
Residual
Pressure
Final Static
Pressure
p F, N/A
1.1
r parking garage inside fence area.
3"
2"
100psi
85
100
P
443rd
evel @ stairwell (A)
3"
1-1/4"
95
75
95
P
Waterflow Alarm Devices
level @stair well (A)
3"
1-1/4"
85
72
85
P
5.2.5
evel @ stairwell (A)
3"
1-1/4"
80
68
80
P
3/15/19
P
1.6
1
Hydraulic Design Information Sign
(For Hydraulically Designed Systems)
5.2.6
3/15/19
❑ This building has more than 5 risers. See additional AES 2.9 form attached.
Number of AES 2.9 forms attached:
1.7
Includes ALL p
1=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=NotApplicable
Item
Description
NFPA25CA-
ad.
zReference
Date -
Comments Only
P, F, N/A
1.1
1
Control Valves — Identification Sign
13.3.1
3/15/19
P
1.2
1
Control Valves — Inspection
13.3.2
3/15/19
P
1.3
1
Waterflow Alarm Devices
5.2.5
3/15/19
F
1.4
1
Supervisory Devices
5.2.5
3/15/19
F
1.5
1
Gauges (Wet Pipe Systems)
5.2.4.1
3/15/19
P
1.6
1
Hydraulic Design Information Sign
(For Hydraulically Designed Systems)
5.2.6
3/15/19
N/A
1.7
1
Enter Water Supply Pressure Below Riser Check
5.2.4.1
3/15/19
psi
N/A
1.8
1
Enter Water Supply Pressure Above Riser Check
5.2.4.1
3/15/19
psi
N/A
1.9
I
Pressure Readings Acceptable
5.2.4.1
3/15/19
P
1.10
I
General Information Sign
(Not Required for System Prior to 2007 Edition NFPA 13)
5.2.8
3/15/19
P
1.11
I
Heat Tape
5.2.7
N/A
1.12
1
Spare Sprinklers
5.2.1.4
3/15/19
P
1.13
1
Fire Department Connections
13.7
3/15/19
P
1.14
1
Alarm Valves — Exterior Inspection
13.4.1
N/A
1.15
1
Pressure Reducing Valves
13.5.1.1
N/A
1.16 1
1
Backflow Preventers
13.6.1
N/A
Form AES 2.2
Sept. 3, 2013
Include ALL, A
=Inspection T =Test M = Maintenance P=Pass F=Fail N/A=Not Applicable
Item
Description
NFPA 25 CA ad.
d,
:Reference
Date
CbmmentsOntyPF,N/A
1.17
1
Small Hose Connections - Hose Valve`
5.1.6, 13.5.2
13.5.5.1
3/15/19
N/A
1.18
1
PRV — Fire Sprinkler Systems
13.5.1.1
3/15/19
N/A
1.19
1
Buildings (Freeze Protection)
4.1.1.1
3/15/19
Owner's Responsibility
N/A
1.20
1
Sprinklers
5.2.1
3/15/19
F
1.21
1
Sprinklers -Accessible Concealed Space
5.2.1.1.6
3/15/19
P
1.22
1
Pipe and Fittings
5.2.2
3/15/19
P
1.23
1
Pipe and Fittings - Accessible Concealed Space
5.2.2.3
3/15/19
P
1.24
1
Hangers
5.2.3
3/15/19
P
1.25
1
Hangers - Accessible Concealed Space
5.2.3.3
3/15/19
P
1.26
1
Seismic Braces
5.2.3
3/15/19
P
1.27
1
Seismic Braces - Accessible Concealed Space
5.2.3.3
3/15/19
P
1.28
1
Unsprinklered Areas
CFC 901.4
3/15/19
®Yes ❑ No
2.1
T
Field Service Test Required
Send Report to Fire Code Official
5.3.1
3/15/19
If REQUIRED, Enter'F' until
results are returned from Lab
P
2.2
T
Recalled Sprinklers
If not Present= Pass; If present = Fafl
Title 19
904.1(c)
3/15/19
P
2.3
T
Water Flow Alarm Devices
90 secs max. Enter time
5.3.3
13.2.6
3/15/19
45 sec.
P
2.4
T
Main Drain Test
(Enter data on Page 1 of this form)
13.2.5
13.3.3.4
3/15/19
P
2.5
T
Control Valve - Position
13.3.3.2
3/15/19
P
2.6
T
Control Valve — Operation
13.3.3.1
3/15/19
P
2.7
T
Supervisory Devices
13.3.3.5
3/15/19
F
2.8
T
Backflow Preventer Assemblies
13.6.2
3/15/19
N/A
2.9
T
Small Hose Connections'
w/PRV Hose Valves — Partial Flow Test
13.5.2.3
13.5.3.3
3/15/19
N/A
2.10
T
PRV — Fire Sprinkler Systems
13.5.1.3
3/15/19
N/A
2.11
T
Pressure Gauges - Calibration
5.3.2
3/15/19
P
2.12
T
Small Hose Connections
13.5.6.2.2
3/15/19
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.
Form AES 2.2 Sept. 3, 2013
D = Def lency C = Comment (indicate
type)
=Inspection T =Test M=Maintenance P=Pass F=Fail NIA =Not Applicable
-ftem
Riser
Description -- -
NFPA 26 CA ad:
Reference
-
Date
Comments Only
PF,N/A
3.1
M
Check Valves - Internal inspection
13.4.2
3/15/19
3/15/19
N/A
3.2
M
Control Valves
13.3.4
3/15/19
P
3.3
M
FDC - Backflush
14.3.2.3
3/15/19
X
P
2nd level -(1) chrome 401 escutcheon missing -location @ Janitors closet
1.20
3/15/19
14.3.2.4
1 X
1st level (2pcs) reliableG4 concealed cover plate while ,are painted need to replace .@ mens restroom by stair A
3.4
M
Internal Pipe Inspection - See Deficiencies and
Yes
3/15/19
2,3,4
m
Comments Section for Results.
.
142
3/15/19
x No
a
P
3.5
M
Obstruction Investigation Required. If "Yes", See
14.3
3/15/19
3/15/19
P
X
Deficiencies and Comments Section for Results
3/15/19
X
FDC was flushed and replaced (2) 4' Rubber gaskets.
X
3.6
M
System Returned to Service
4.5.3
3/15/19
Nos
P
1.28
D = Def lency C = Comment (indicate
type)
Hem
_ Date
Riser
D
C
'
Deficiencies and Comments
- - Indicate all equipment, devices and parts that were mpaired or replaced
1.20
3/15/19
4
X
3rd level ,1 pc. 1/2" 165' one piece central head missing chrome escutcheon -Location closet to access to roof.
1.20
3/15/19
4
X
3rd level (1) 1/2" 165' reliable concealed G4 at office space /head is over spaced its at 10'-9"off wall
needs to get relocated to make it code/location south side ,south of mens restroom.
1.20
3/15/19
3
X
2nd level -(1) chrome 401 escutcheon missing -location @ Janitors closet
1.20
3/15/19
2
1 X
1st level (2pcs) reliableG4 concealed cover plate while ,are painted need to replace .@ mens restroom by stair A
1.20
3/15/19
2
1st level (1 pc) reliable G4concealed cover plate white ,are painted need to replace@ womans restroom by stair A
3/15/19
2,3,4
X
Recommendation (3) risers at control valves need chain & breakable locks
1.3
3/15/19
3
X
2nd level riser/flow switch is not wired at all ,needs to get wire (alarm tech needed to determine whats needed)
1.4
3/15/19
3
X
2nd level riser/3" butterfly is not wired at all ,needs to get wire (alarm tech needed to determine whats needed
3/15/19
X
FDC was flushed and replaced (2) 4' Rubber gaskets.
X
NOTE: Alarm panel located at lower garage inside Electrical room.
X
potter on site Ricardo 714-333-5473.
1.28
3/15/19
X
At lower garage telephone room next to electrical RM. thats 10'x 25' has no sprinkler coverage at all
note: Recommendation add sprinklers / need to investigate how to run piping possible hole needs to get cored.
❑ Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
❑ 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.
Print Name Robert Lomeli
Signature Date 3/15/19
Form AES 2.2
Sept. 3, 2013