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Home My WebLink AboutFAI15-0067 Fire Annual Inspection 2014ACCULARM SECURITY SYSTEMS (530)532-0885 QUARTERLY INSPECTION REPORT Location Name: COTTAGE GUEST HOME Address: 1059 NEVADA AVE City: OROVILLE ST: CA Panel Type: FIRELITE Model: MS502 Devices Tested: ZONE 1: MANUAL PULL STATIONS ZONE 2: SMOKE SENSORS IN MAIN HOUSE ZONE 3: WATER FLOWING TO MAIN SPRINKLERS "� ZONE 4: SMOKE DETECTORS IN FRONT HOUSE ✓ ZONE 5: ATTIC HEAT DETECTORS IN MAIN HOUSE LOW BATT „ TELCO #1 OUT ✓ TELCO #2 OUT✓ Technician Notes (If any): Technician's Signature: Customer's Signature. Date of Inspection: — 6 -- 1 FAI15-0067 031-274-006 Situp/ewGrinne// 6E SA FE SHIP TO: COTTAGE REST HOME FIRE EXTINGUISHER INSPECTION 4650 Belbit Dr Sacramento, CA 95838 Lic 802591 State Extinguisher Lic E-2058 P 916-283-0300 F 916-283-0348 TASK # 40879824 1059 NEVADA AVE OROVILLE,CA 95965 530-533-7664 MIKE Type Quantity SR # 28611018 D/C 2 Co2 K -Class Clean Agnt Misc BILL TO OECDC CIO COTTAGE REST HOME PO BOX 2631 OROVILLE,CA96965 QTY PART # DESCRIPTION - LABOR ITEMS PRICE AMOUNT QTY PART # DESCRIPTION - MATERIAL ITEMS PRICE AMOUNT 1 EX2015 Minimum service charge(includes 3 EX) $ 50.00 $ 50.00 EX4009 Valve Rebuild kit Dry chemical $ - Hourly Rate $ - EX4005 Valve stem $ - Contract Price $ - EX4100 Valve retainer seal $ - EX2010 Annual maintenance fire ext $ - EX4004 Tamper indicating device $ - EX2012 Annual maintenance cart -op $ - EX4002 Verification collar $ - EX2032 Annual maintenance wheel unit $ - EX4200 Gauge $ - Additional extinguishers $ - EX4001 Lock pin $ - EX2011 Monthly extinguisher inspection $ - EX4300 Band assembly $ - Extinguisher Hydrotest and re -build $ - EX4412 CO2 safety relief device $ - Extinguisher 6 -year and re -build $ - EX4409 Hose dry chemical $ - EX2100 Conductivity test and label $ - EX5002 Instructional decal $ - EX2052 Valve/handle repair $ - EX5100 Fire extinguisher sign $ - EX2002 Extinguisher hung/relocated $ - EX5200 Fire extinguisher hanger $ - EX2084 Hydrotest stored pressure type $ - EX5300 Fire extinguisher cover $ - EX2080 Hydrotest CO2 (up to 20 lbs) $ - EX5402 Fire extinguisher cabinet - metal $ - EX2089 Hydrotest water type $ - EX5400 Fire extinguisher cabinet - plastic $ - EX2086 Hydrotest cart operatedNVU $ - EX25 Co2/clean agent chemical Ib $ - EX2087 Hydrotest fire hose $ - Cabinet locks $ - EX2087 Hydrotest wheel unit $ - QTY PART # DESCRIPTION - New Extinguishers PRICE AMOUNT EX2060 6 yr maint stored pressure type $ - EX1025 NEW EXT 2Y4 LB. D/C $ - EX3025 Recharge dry chemical 21/2 Ib $ - 1 FX1050 NEW EXT 5 LB. D/C $ 63.00 $ 63.00 EX3050 Recharge dry chemical 5 Ib $ - EX1010 NEW EXT 10 LB. D/C $ - EX3010 Rechar.e dry chemical 10 Ib $ - EX1020 NEW EXT 20 LB. D/C $ - EX3020 Recharge dry chemical 20 Ib $ - EX1150 NEW EXT 5 LB, CO2 $ - Recharge dry chemical Ib $ - EX1110 NEW EXT 10 LB. CO2 $ - EX3021 Recharge CO2 5 Ib $ - FX1115 NEW EXT 15 LB. CO2 $ - EX3110 Recharge CO2 10 Ib $ - EX1120 NEW EXT 20 LB. CO2 $ - EX3115 Recharge CO2 15 Ib $ - EX1121 NEW EXT 2Y2 LB. CLEAN AGENT $ - Recharge CO2 Ib $ - EX1250 NEW EXT 5 LB. CLEAN AGENT $ - EX3449 Recharge clean agent Ib $ - EX1210 NEW EXT 10 LB. CLEAN AGENT $ - EX3200 Recharge water type $ - EX1214 NEW EXT 13 LB. CLEAN AGENT $ - EX3060 Recharge K Class $ - EX1425 NEW EXT 2Y4 GAL. WATER $ - EX2088 Hydrotest air pack/scuba $ - EX1560 NEW EXT K CLASS $ - EX3900 Fire ex demonstration class $ EX50 NEW EXT WATER MIST $ - $ - $ - $ - $ - $ $ $ $ - Please do not pay off this copy. Formal invoice to foTrow. Thank You! $ - cOMMENTS Portable fire extinguishers were maintained in accorance with NFPA 10, state and local standards on the date listed below. ANNUAL FIRE EXT SERVICE IMPORTANT NOTICE TO CUSTOMER: Customer acknowledges and agrees that, in the absence of a Service Agreement between parties, services hereunder are performed pursuant to the terms and conditions on the side of this Service Request. Customer further agrees that the services have been completed to Customers satisfaction and that the system is in good working order and repair, unless services performed were of a nature, in which case Customer acknowledges that part of customer's system may have been bypassed or inoperable until services can be completed. CUSTOMER'S ATTENTION IS DIRECTED TO THE LIMITATION LIABILITY, WARRANTY, INDEMNITY AND OTHER CONDITIONS ON THE REVERSE SIDE. Acceptance of customer or customer's representative reverse temporary HA2 MAT CHARGE NEW FIRE EXTINGUISHERS $ 63.00 TOTAL LABOR $ 50.00 TOTAL MATERIAL $ - is otherwise OF sus TOTAL $ 113.00 TAXI 7.75% $ 4.88 FUEL SURCHARGE $ 30.00 GRAND TOTAL $ 147.88 Service Technician Date PO NUMBER Customer's Authorized Agent ERIC HESEMAN 2/10/2014 SERVICE.AGREEMENT General Terms and Conditions..; . 1. Limitation Of Liability; Limitations Of Remedy. Itis undetste d., ' and agreed by the Customer that Compere, Zs tet ars iastrrer and that insurance coverage, if any, ah be obtained by the Customer and that amounts payable to Company heeelarder are based upon the value of the services and the scope of liability set forth in this Service Request and a� uc elated to the value of the Customer's property and the .property of others located on the premises. Customer arses tolook e wlusively to the Customer's hosier to recover for injuries or damage in the event o_ f any loss or injury and that (finer releases artd_vraives - 'all right of recovery against Comparniarising by gray of:sueii. Company makes no guaranty or Warranty; inciudeerg any impeed Warranty of merchantabrTdy or fitness for a panic ularpwpose that equipment or services supplied by Company w0l detect or ave : occurrences or ee consequences therefrom that the equipment or . service was designed to detect or avert It is impractical and extremely to fix the actual damages, if any, 'Atilt may proximately result from tabu' a an the part of Companp to pe Corm any of its obligations under this Service Request Accordingly; Customer agrees that Company shall be exempt fivm ttablifty for eriy lass, damage or Inpry arising'' or jrxiatectly from occurrences, or the consequences therefrom, which the equipment or service was designed to detect of avert. Should -Company be found liable for any toss, damage or injury arising from a failure of the equipment or service in any respect, Company's liabity shall be /united to an amount equal to the Service Request price (as increased by the - price for any additional work) or where the time and material payment - terrn is selected, Customer's time and material payments to Company. Where this Service Request covets Multiple sites; rrabkty shalt be -• limited to the amount re the payments allocable to the site where the incident occurred. Such sum shalt be complete and -exclusive. if Customer desires Company to:ase ene greater liabllty, the parties shall amend this Service Request by attaching a rider setting forth the amount of additional lability and the additional amount Customer for thea n ti !be assumption by Comp -arse � szic*� rgt�►et fiab�rtp, provided however that such rider shall in no way be interpreted to hold Company as an insurer: IN NO EVENT SHAM COMPANY BE LIABLE FOR ANY DAMAGE, LOSS, INJURY, OR ANY OTHER CLAiM ARISING FROM ANY SERVICING, ALTERATIONS, MODIFICATIONS, CHANGES, - OR MOVEMENTS OF THE COVERED SYSTE M(S)-OR AMY OF 1T5 - COMPONENT PARTS BY THE CUSTOMER OR ANY THIRD PAM. COMPANY SHALL NOT BE LIABLE FOR INDIRECT, INCIDENTAL OR - CONSEQUENTIAL DAMAGES OF ANY KIND, INCLUDING BUT NOT LIMITED TO DAMAGES ARISING FROM THE USE,L.QS.S OF 'THE USE, PERFORMANCE, OR FAILURE OF THE COVERED SYSTEMM(S) TO PERFORM. The Ammitations of Aabi.riy.set forth 5a this Service Request shaft inure to the benefit of alt patents, subsidiaries and affilates of Company, vrtrether direct or indirect, Company's employees, agents, officers and directors. - - 2. Limited Warranty. COMPANY WARRANTS THAT ITS • • WORKMANSHIP AND MATERIAL FURNISHED UNDER THIS SERVICE- - REQUEST WILL BE FREE FROM DEFECTS FOR A PLOD OF NINETY 190) DAYS FROM THE DATE OF FURNISHING. Where Company provides product or equipment of others, Company will errant the • product orequipmentonly-to the extent warranted by such tfzsti Party. . EXCEPT AS EXPRESSLY SET FORTH HEREIN, COMPANY 0JS LAJMS - AWL•WARRAN7IES, EXPRESS ORIMPLIED, JNCLUDINGBUT NOT - - UM tECi TO ANY IMPLIED WARRANTIES OF MERCHAMMILITY OR FITNESS FOR A PARTICULAR PURPOSE WITH RESPECT TO THE SERVICES PERFORMED OR THE PRODUCTS,.SYSTEMS OR - EQUIPMENT, iF ANY, SUPPORTED HEREUNDER. COMPANY MAKES NO WARRANTY OR REPRESEKTi4TION, AND UNDERTAi ES NO - OBLIGATION TO ENSURE BY THE SERVICES PERFORMED UNDER THIS SERVICE REQUEST, THAT COMPANY'S PRODUCTS OR THE - SYSTEMS OR EQUIPMENT OF THE CUSTOMER WILL CORRECTLY : . HANDLE THE PROCESSING OF CALENDAR DATES BEFORE OR - AFTER DECEMBER 31, 1999. - - - - 3. Mdemrdty. Customer agrees to indemnify. hold harmless End - - • defend .Company against any and al losses, damages, costs, including . . 5G4530 -PE -R2 2r 10 Expert fees and costs, a expenses including reasonable defense costs- arises from any and all third party Gams for personal injury, death. property, damage or economic tom, including specifically any damages tesu.Ring from the exposure of workers to Hazardous Conditions whether or not Customer pre -notifies Company of the existence of said hazardous conditions, arising in any way from any act or omission of 6ustomer or Company relating in any way to this Agreement, including but not limiter to the Services under this Agreemrent. whether midi claims are based upon contract, warranty, tort (xictudinglxrt_nol hrnited to active-erpassiye negligence):strict fitly; abil; • . or otheRvise. Company rimt.►t es e fight to select counsel to represent it in any such adian_ . - . .. - 4_ Hazaer ious Material Cult, err rents that, except to The extent that Cornparry has been g.Ven written notice of the following . - hazaeleprior Le the execution of,this Service Request, to the best of Customer's knowieage there is no: • 'permit -confuted space,''as defined by OSHA, - - • risk of chfectious disease.- - - • -need for as monitoring, respiratory protection, or other medical - - risk. • asbestos, asbestos-contairirng material. fonratdehyde or other - potentially toxic or otherwise hazardous material contained in or . on the surface of the floorswalls. ceilings, insulation or other' structivat components of the area of any building where work is - - required to be performed under this Service Request. Alt of the above are hereinafter referred to as "Hazardous Conditions'. - • - Company shall have the rigittto rely on the representations fisted - above. if hazardous conditions are encountered by Company during the .- course of Company's worts, the,discovery of such conditions shall constitute an event beyond Company -s control and Company shall have no oblgatiori to further perform in the area where the hazardous- ' • coriditions exist -until the area has'been made safe by Customer as certified in va_rierig by an independent testing agency, and Customer - shaft pay disruption expenses and re-mobtfitatiori ekpenses as - determined by Company.:. - - This Service Request does riot provide for the cost of capture, -containment or disposed of any haardous waste materials, or hazardous . materials, encountered in any of -the Covered Systern(s) and/or during performance of the Services. Said materials shall at'ali Gmes.remain the responswity-and property of Gustornec Company shall not be responsrbfe for the testing, removal or disposal of such hazardous - - materials. - • •• - 5: Equipment Disoortnections. This reepreS nts Company's notice to- - you that the system(sVdevice(s) .listed on the face of this Service. ' _ ' ' - - Request as temporanly or perm. ratty disconnected are no longer in . serviceand, thus. cannot detect -:perform and/or report occurrences or ' . transmit signals. .- - - - B. Benerat. Unless otherwise specified,.work shat be done between. • - Ute tours Df f00-A&t-nd &0O PM-exilisive of Saturdays, Sundays and Company ho5days. Ai! work is sub ed to review aux! rebilling In - accordance with totems and concretions of Customer's- - agreement/contract with CoMpahy, if One it in effect. Company shall not be responsible -for far'idre to render ser"ices due t� causes beyoind its control. includuxg but not fsnited to material shortages, work stoppages. . - fires: civil disobedience weaiher, fire or any -other- . . ie tbeyond the control of Company_ Ocistomer is aware that tt • - Lbreta:ion of Liability and other provisions set forth in any existing agreement/contract, if one Is in effect, or. set forth above, apply to • services performed and materials supplied. The terms of this Service. Request shall govern notwithstanding any inconsistent or additional terms and donditione in any puctttase order or ether docunierlt ' submitted by Customer_ - FAI15-0067 031-274-006 8002 >.Z Wa at t 1 SSS' Wei4$4.1 etaiS -sulial,ampiErsai 1,1360 40 mow 1 .stuouiwo3 paw 110,360p4041. mss. 1.4 itwase.s Agiptuttds mem =DJ a a, ugalsftS. 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TAM ppv 1 Zfl LrzfrIO?M'u? alua JautiC' :w was Actco Uscosid u,algAg P aequ'+atai r aul 'swats 8-11A J°141-na ;MAIN :UD WUuoiP+t Iat1O3 -- •. fpr '`'` .a r tro 0 _> 86«1.S9-aeS =auoitdatel :puc A :d1Z ` : pa;.S •°N atiOca0 O pow xta1 uaPrws++cri8A1i/ apaegN Mt ply .uo!IguugiUI Al+adad et 011!1`!!33 Aq PePuaag sit 9Z IdUN wow Jam* paUutrualtan Pug ibugh 01 `uopdut 90/1'.0 I) d SA-aXSAS NOL t aloud 31314 izEtsva-lraiwift30 33NVN31N1VYt (INV tt11LLS3I. `2ZOLLD3dEitII EL -St z•d sOZO2L900 x 5 laytnQ doz: WCL fez iotN isino lt7 50b9ZESOES t'T:00 tIK /TT/E0 FAI15-0067 031-274-006 03/11/26014 00:14 5335325405 Mar 2414 01:20p Du -#Tor Fire System ERIC ALMCUIST 2S1cJ87RO2O6 Irsspection, Tasting, and Maintenance Fire Sprinkler System NFPP 26, Chapter 6 an :annnde/I by CCR, Title 19 Date of Inspec11on, Testkrg, loalattmence: 02/19/2014 Property Information: Cottage Rest Home Name - Address: _ 1059 Nevado Ave OrovIlle System River a 1 Type of System: Wet Pipe El Dry Pipe D Preaction D Deluge PAGE 03/05 p:3 Page 1 of 4 Main Brain Teat Results: Initial Static pressure: 60 C0 Residual Pressure:. 47 (Psii Restored Static Prencers: (tom Abbreviation Key: I - Inspection T=Test 1Jf = Malrttenerrce A-0 a After Operation Mt s Per bra Instructions [tern Activity Frsquenc'V 1,1 1 12 Description Daily Preectian/Delute Valves - Enclosure el _„__.Iemperatore 'Iraq 1.3 1.4 1.6 Querrterly Dry Pipe Valves - Enclosure temperature Gauges (fir, Preeetion, Oetuge Systems} NFPA 25 Reference 12.4.9.1 Fi3d1 N/A Paas 12.44.1.1 524.2 524.3 Quarterly Control Valves 12.3.21 Quarterly Alarm Devicess, 5.2.6 1.6 1 Quarterly Gauges (Wel Pipe Systems) 63.4.1 X 1.7 Quarterly Hy:iraurc nameplate 5.2.7 X 1.3 Quarterly 6prinldn!'rt 521 1.9 1 Quarterly Spare Sprrniaers X 1.10 Quarterly Fire Department Connections 1 12.7.1 Quarterly Alam Valves - Exterior Inspection 1 124.1.1 1.12 x Quarterly Ptn(Deluge Valves-- Exterior Inspection 12.4.3.1.6 X 1.13 Quarter* Quarterly Pressure Reducing Valves 1 12.5.1.1 1.14 1 X Q ns terty Dry Pipe Velvee - Exterior Inspection 12.4.4.1.4 X 1.15 Quarterly Backflow Preventers 12.6.1 X 1.16 1 1 Annually PSpe and Fittings 5.22 X 1.17 1 Annually Buildings 52.5 X State Flax Mrd AES 2 June 17, 2008 r 0 . • 03/11/2014 00:14 5305325405 Mar 241401:20p Du -Mor Fire Systems ERIC ALMQUIST PAGE 04/05 5308780206 p.4 Inspection, Testing, and Maintenance Fire Sprinkler System NF1PA 26 ter 6 as amended ' « Title 19 Date of lnspectlon, Testing. Maintenance: 02/19/2014 System fuser ID: 1 Property Information: Name: Cottage Rest Hume Address: 1059 Nevada Avr: C Onmitre Type of System: Ft° Wet Pipe ❑ Dry Pipe 0 Prvection D Deluge Page z Of 4 State Fire Marshal AEB 2 .lane 17". 208 Item Activity --- Frerquuency Description NFPA 26 Fait NIA R ass 1.18 I Annually Hangers 52.3 x 1.19 f Annually Seismic Braces 5.2,.3 X 1.20 1 5 Years Mangan (Accessible concegieed spaces) 52.33 X SaliernIc Braces (Accessible concealed spaces) Pipe and Fittings (Acceseible concealed a1� 62.3.3 5.22_3 X X 1.2_1 I 5 Years 5 Years 1,a 1 1.23 l 5 Years Sprinklers (Accatrable coded spaces) 52.1.1.4 X 1.24 I 5 Years Al mn Valves — Interior Inspection 12.4.12 X 1.25 I 6 Years Alarm Valves -Strainers, fifers, orffc:es 12_432 X 1.26 I 5 Yews Check Valves — interior Inspection 12.42.1 X 127 I 5 Years PreactionfDeluge Valves — Interior inspection 12.4.3.1.7 X 1.28 I 5 Years Pneaction/Deluge Valves - Strainers, fitters. cea 12.4.3.1.8 X 1.29 I 5 Years pry Pipe Vetv411s —interior Inspection 12.4.4.1.5 X 1.30 I 5 Yea Dry Pipe Valves - Strainers. Rims. orifices 12.4.4.1.8 X 2.1 T Annually Alarm Devices (90 Sec) 5.3.3 112.7 X ^-- 2.2 T Ann inlay Main Drain Tet (Enter data on Pagel) 1226 122_6.1 123.3.4 X 2.3 T Annually , Aritifieem Testi 5.3.4 X 2.4 T Annually Control Varve - P'asMon 123.331 X 25 T Annually • Control Valve —Operation 12.3.3.1 X 2.8 T Annuay Supervisory 12.3.3.5 X 2.7 T Annuefy Preaction Valve — Prlrrdrig Water 12_4.32.1 X 2.8 T Annually Prea<tion Valve — Low Air Pnsc*s Alarm 124.3.2.10 X State Fire Marshal AEB 2 .lane 17". 208 03/11/2014 00:14 5305325495 Mer 2414 01:21p DrrMo r Fire Systems ERIC ALMUUIST 53087802A6 PAGE 05/05 p.5 Inspection. Testing, and Nlalntenanccr Flee Sprinkler System NEPA 25, Chapter 5 es emended by CCR, Title 19 Page 3a* Det of Inspection, Testing. Maintenenrw: 02/19/2014 System Rimer ID: 1 -goF- , ..P Or. ! AN 1j,e_.. •I'�'r Property Information: Markt Cottage Rost Horne Type of System: Q 1 Wet Pipe ❑ Dry Pipe i ❑ PrAection ❑ Deluge Address; 1058 Nevada Ave 2.9 OravNe Mrraatly Item AdNlty Frequency Description NRnferen 25 Fall NIA Patty 2.9 T Mrraatly Preadion Valve - Full Flow Trip 'Fest 12.4.322 X 2.10 T Annually Dry Pipe Valve- Prk ring Water 124421 X 2.11 T Annirdly Dry Pipe Wye - Law AR Pressure Alarm 12.4.42.6 X 2.12 T Annually Dry Pipe Valve - Quick -Opening Device 12.4,424 X 2.13 T Annually Dry Pfpa Valve -- Trip Test 12.4,422 X 2.14 T Annually Sackflow Preventer Assemblies 12.6.2 X 2.15 T 3 Years Dry Pipe Valero - Full Fbw Trip Teri 124,4.222 X 2_18 T 5 Yeera Cru 5.3.2 X 2.17 T 5 Years Pressure Reducthq Valve 12.5.12 X 2.18 T 5 Years Fire De rrtrrtent Connection Beckflush 12.7.4 X 2.19 T 5 Years Sprinklers - F_xtrar Hfgh Temperahne 5.3.1.1.1.3 X 220 T 5 Years Sprinklers - Corrosive onvirvr meat or corrosive: water 5.9.1.12 X 2.21 T 10 Years Sprinklers - Dry 5.3.1.1.1.5 X 2.22 T 20 Years Sprinklers - Fast Response 5.3.1.1.1.2 X 2.23 T 50 Years Sprinldors 5.3.1.1.: x 224 T 75 Years Sprinkles 75 years in samba 5,3.1.1.1.4 X 226 T • Sprinklers manufactured prior 4°1970 R 5,3.1.1.1.1 X 3.1 M Annually Control leaves 12.3.4 X 3.2 M Annually Pr tionADeluge Valves 12.4.3.3.2 X 3.3 M Annually ' Dry Pipe Valves/Cluick-OpeMng Devices 12.4.4, 3.2 X 3.4 M Annually Dry Pipe Maitre--LowPotat Drains 12_4.4.13 X 3.5 M 5 Years Obstruction tmestig gion Chapter 13 X State Fire Marshal AES 2 June 17, 2009 03/11/2014 00:14 5305325405 Mar 2414 0121p Du -Mor Fim System ERIC ALMDUIST 5308780206 p.8 PAGE 05/05 Inspection, Testing, and Maintenance Fire SprtnMar System NFPA 2S Ch 6 as amend :. . C - Title 19 Pager 4 end Date of Inion, Testing, Maintenance: 02/19/2014 System Riser Ib: 1 Property Information - flame: Cottage Rest Home Type of System: 6Wet Pipe ❑ Dry Pipe O Preacllon 0 Deluge . A.-flf 1-ie:',, s �' � i It r a -..:\;_e_... _ i • r ' r'�sii S.,�► .' ,..I ,ye is 1 r N•%.,'. Address: 1059 Nevada Ave nroving Iters Deticlencies and Comments: Deticienciss and !Comments [ism number niumt correspond to the Item number of the A • i, listed above: ' All corrections elated, sticker has been placed on riSer O See t PASS4 0 FAILOV..iil Continuagon Page(s) the number of contirruation pages) cc��(indicate 03,24/2014 Signature Date State Fire Marshal AES 2 Jurte 17, 2008