2016-2-8 - 5-YR SPK CERT - PASSTestitig,
and MaintenAnte,
CoveyInspect)",
NFPA25
property Infosxtialion:
-as amended. by CCR,T10e IS
•
wl
ti: r
Name:
One Eleven La Quinta Center
Occupancy/Use: M
Address:
78700, 78710, & 78982 Hwy 111
Construction Type: Type II-B
OF CA
{� - �4r
City.
La Quinta
0
No. Stories:
ZIP:
92253
Year Constructed: 2003
Luann
►�Ill�'`
Contact:
Telephone:
(760) 771-3354
Contractat
tnfaren�ytio�i; ` ;-'' _? �lturiiar of 5ysem FfiSers
Name:
Desert Fire Extinguisher Co., Inc
Copy sent to:
Address:
558 E Industrial Place
E] Owner Date:
City:
Palm Springs
❑ Fire AHJ Date:
State:
CA
❑ 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)
Cbedik boKf6r'bkh System inspected and etiter the number. of forms. used
.3iacl :poxes (i 3i-ar (&ss) #.n indiCate.atatµs af,irtspepted system 4t end
Forms Includedwab this Reporte
Chapter
iJ Automatic Sprinkler System 5 3
for Inapvctien. -
of i ns ctlon.
❑ Standpipe and Hose System
6
0
EL
❑ 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
1:1
EL
❑ Water Mist System
12
0
El
1:1
❑ Concerns that are not deficiencies (i.e. Non-Sprinklered Areas)
❑ Yes
® No
L.ataw urrnotpnumm..;Priq- QinmeniS NC110n ai:2ntl. OT.eaCh ►e$P..0CUVe for n..
AES 1 September 3, 2013
,�v ss
Rlser
No,
r
Main Drain'
Di.arneter
Initial Static Residual Final Static P i' IVIA 1
Pressure Pressure Pressure
Location
Riser
Diameter
1
Big 5- south east
4"
2"
80
75
80
P
2
AT&T- north west
3"
1 1/4"
90
80
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:
"�i•. ,.Sky �er��•����•.�,' }�� '�� � '�f,:
' .
= Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable
T
Item
Description
NFPA 25 CA
0&
Reference
Date
Comments Orgy ..
P, F, NIA;
1.1
1
Control Valves — Identification Sign
133.1
02/08/16
P
1.2
1
Control Valves — Inspection
133.2
P
1,3
1
Waterflow Alarm Devices
5.2.5
P
1.4
I
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
(For hydraulically designed systems)
5 2 6
P
1.7
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
5.2,4.1
P
1.10
1
General Information Sign
(not required for system prior to 2007 Edition NFPA 13)
5.2 8
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
I
Backflow Preventers
13.6.1
P
Form AES 2.2 Sept. 3. 2013
= Inspection T = Test M = Maintenance
P =
Pass F = Fail N/A = Not Applicable
item
Dosc►lptinn
NFPA 25 CA ed.
Reference
pate
comments Only P,F,NIA
1.17
1
Small Hose Connections - Hose Valve`
5.1.6, 13.5.2
02/08/16
N/A
13.5.5.1
1.18
I
JPRV — Fire Sprinkler Systems
13.5.1.1
N/A
1.19
1
Buildings (Freeze Protection)
4.1.1.1
Owner's Responsibility N/A
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
Hangers
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
5.3.1
If REQUIRED, Enter'F' until
Send Report to Fire Code Official
results are returned from Lab
2.2
T
Recalled Sprinklers
Title 19
If not present = Pass; If present = Fail
904.1(c)
P
2.3
T
Water Flow Alarm Devices
5.3.3
90 secs max. Enter time
13.2.6
45 sec. P
2.4
T
Main Drain Test
13.2.5
(Enter data on Page 9 of this form)
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"
13.5.2.3
w/PRV Hose Valves — Partial Flow Test
13.5.3.3
NIA
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*
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, II, or III
standpipe systems.
Form AES 2.2 Sept. 3, 2013
Property Information '
CAS Contractor or Licensed Owner Information
a
uilding Name One Eleven La Quinta Center
r Name Desert Fire Extinguisher CO., INC
ddress 78700, 7810 & 78982 Hwy 111 iah #
ity La Quinta
- :,': Ct"' � r•.... .:,�.,y �' -,y::•:_ „�'-
r a•
•'v?- x.:y
� r. I;
:�.-� Y:.:�;
.-� • - - 4Y ram.
:rig`
'"-3'r 'f
i.c :cam="`-.?' :�:
=Inspection+ T = Test M =Maintenance
P = Pass
F = Fail N/A = Not Applicable
Item
Description
P
NFPA 25 CA ed.
Reference
Bate
Comments Only
i ,t',fFiA
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
14.3.2.4
P
3.4
M
Internal Pipe Inspection - See Deficiencies and
Comments Section for Results.
14.2
,/
Yes
P
No
3.5
M
Obstruclion 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
1 No
P
i hereby certify that the fire protection equipment listed above has been Ailly 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 Date 2016082509s6320700' Date 02/08/16
Form AES 2.2
Sept. 3, 2013