2016-2-8 5-YR FIRE SPK CERT - PASSProperty Information:
Name: One Eleven La Quinta Center Occupancy/Use: M
Address: 78700, 78710, & 78982 Hwy 111 Construction Type; Type II-BOF_CRC�,�
0
C;ty: La Quinta No. Stories: 1
ZIP. 92253 Year Constructed: 2003
Contact: Luann 'fie M�
Telephone: (760) 771-3354
Coy ract r Information:
Number of System Risers
Name:
Desert Fire Extinguisher Co., Inc
Copy sent to:
Address:
558 E Industrial Place
El Owner Date:
City:
Palm Springs
❑ Fire AHJ Date:
State:
CA
n Contractor Date: 02/08/16
Telephone:
(760) 322-0995
NOTES:
1) For specific inspection, testing, and maintenance
C16-563921
requirements and information, see NFPA 25, 2011
CA License#:
Edition as amended by California Code of Regulations,
Title 19, §901 to §906.
Job #:
5 year
2) Inspection items may be performed by the owner in
Performed by:
Paul Smith
accordance with California Code of Regulations, Title 19,
§904.1(a)
Check box for each system €nspeved and enter thn�irner.a'Vart+i: uaesf for lasfreotton
Chft� boxes (Fail oe Pass)fo indicate status.of Oiwated.system o end of inspection.
0 Automatic Sprinkler System
5
3
�
�
✓❑
❑ 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
m No
*See "Deficiencies *Ard.Comments"'Section at 40d of each respective form..
AES 1 September 3, 2013
Riser
No.
Location
Riser
Diameter
Main grain
Diameter
Inittal Static
Pressure
Residual-
Pressure
F1 nai Static
Pressure
P. F, NIA
1
Big 5- south east
4!'
2"
80
75
80
P
2
AT&T- north west
3"
1 1/4"
90
so
90
P
3
Ross- South West
4"
2"
95
85
95
P
This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached.
'k
K
I= Inspection T = Test M = Maintenance P=Pass F=Fail NIA =Not Applicable
Item
Description
NFPA 25 CA
scil.
Refarence-
Date
Comments Only
P. F, NIA
1.1
1
Control Valves — Identification Sign
13.3.1
02/08/16
P
1.2
1
Control Valves — Inspection
13.3.2
P
1.3
1
Waterflow Alarm Devices
5.2.5
P
1.4
1
Supervisory Devices
5.2.5
P
1.5
1
Gauges (Wet Pipe Systems)
5.2.4.1
P
1.6
1
Hydraulic Design Information Sign
1 (For hydraulically designed systems)
5.2.6
P
1.7
1
1 Enter Water Supply Pressure Below Riser Check
5.2.4.1
psi
NA
1.8
1
Enter Water Supply Pressure Above Riser Check
5.2.4.1
psi
P
1.9
1
Pressure Readings Acceptable
524.1
P
1-10
1
General Information Sign
(not required for system prior to 2007 Edition NFPA 13)
51218
NA
1.11
1
Heat Tape
5.2.7
NA
1.12
1
Spare Sprinklers
5.2.1.4
P
1.13
1
Fire Department Connections
13.7
P
1.14
1
Alarm Valves — Exterior Inspection
13.4.1
NA
1.15
1
Pressure Reducing Valves
13.5.1.1
NA
1.16
1
Backflow Preventers
13.6.1
P
Form AES 2.2 Sept. 3, 2013
Property Information
Building Name One Eleven La Quinta Center
Address 78700, 7810 & 78982 Hwy 111
ity La Quinta
Contractor or Licensed Owner Information
\7-
a(% Name Desert Fire Extinguisher CO., INC
N;�a Job #
''
i. --1� - 71I 'tJO'�,r.
- - - �..,, A.cam, �. •�,:u�:5, ��`::tr `-i:;
I = Inspection T = Test M = Maintenance P = Pass F = Fail` N/A = Nd Applicable
Item Description
NFPA 26 CA ed.
Reference
pate
Cornmerits only
P.F.NIA
1.17 1 Small Hose Connections - Hose Valve*
5.1.6, 13.5.2
13.5.5.1
02/08/16
N/A
1.18 1 PRV - Fire Sprinkler Systems
13.5.1.1
N/A
1.19 1 Buildings (Freeze Protection)
4.1.1.1
Owner's Responsibility
NIA
1.20 1 Sprinklers
5.2.1
P
1.21 1 Sprinklers - Accessible Concealed Space
5.2.1.1.6
P
1.22 1 Pipe and Fittings
5.2.2
P
1.23 1 (Pipe and Fittings - Accessible Concealed Space
5.2.2.3
P
1.24 1 Mangers
5.2.3
P
1.25 1 Hangers - Accessible Concealed Space
5.2.3.3
P
1.26 1 Seismic Braces
5.2.3
P
1.27 1 Seismic Braces - Accessible Concealed Space
5.2.3.3
P
1,28 1 'Unsprinklered Areas
CFC 901.4
[]Yes ® No
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)
P
2.3 T Water Flow Alarm Devices
90 secs max. Enter time
5.3.3
13.2.6
45 sec.
P
2.4 T Main Drain Test
(Enter data on Page 1 of this form)
13.2.5
13.3.3.4
P
2.5 T Control Valve - Position
13.3.3.2
P
2.6 T Control Valve - Operation
13.3-3.1
P
2.7 T ,Supervisory Devices
13.3.3.5
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
13.5.2.3
13.5.3.3
N/A
2.10 T PRV - Fire Sprinkler Systems
13.5.1.3
N/A
2.11 T (Pressure Gauges - Calibration
5.3.2
P
2.12 T ;Small Hose Connections* .---F
13.5.6.2.2
N/A
* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, 11, or III
standpipe systems.
Form AES 2.2 Sept. 3, 2013
Property Information
Building Name One Eleven La Quinta Center
Address 78700, 7810 & 78982 Hwy 111
City La Quinta
Lip C�[!-O Contractor or Licensed Owner Information
R�
y Name Desert Fire Extinguisher CO., INC
•. Job #
t iii' is w•'4"
F
`T
= _ i,' .: .•
�_ ...-.t a.
--�
= Inspection = Test M = Maintenance
P = ila
F = Fail N/A = Notjlppl,rahie
item
Description
e Ced.
NFReference
Refeerr encc e
Date
Comments Ont y
P.F,NIA
3.1
M
Check Valves - Internal inspection
13.4.2
02/08/16
P
3.2
M
Control Valves
13.3.4
P
3.3
M
FDC - Backflush
14.3.2 3
P
14.3.2.4
3.4
M
Internal Pipe Inspection - See Deficiencies and
Yes
Comments Section for Results.
14.2
HNo
P
3.5
M
Obstruction Investigation Required. If "Yes", see
Deficiencies and Comments Section for Results
14.3
P
3.6
M
System Returned to Service
4.5.3
Yes
HNo
P
D = Deflciency C = Comment Indlcate i e
Item Date Riser D C Deficiencies and Comments
Indicafu all a e mart devices mdparts rimt vmsp repulrad at replaced
t�J Check here if additional Deficiencies and Comments are listed on Form AES 9 Number attached
r } 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 Paul Smith
Signature Paul Smith Digitally signed by Paul Smith
Date- 2016 oe 25 0356-32 -ornn' Date 02/08/16
Form AES 2.2 Sept. 3, 2013