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Home My WebLink AboutFAI15-0039 056-030-030 FS 2022 Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19 Property Information: Name: Occupancy/Use: Youth with a Mission Main Building 1y Address: 15850 Richardson Springs Rd Construction Type: �4 ��gC",p0�l1 City: Chico No. Stories: 6 od�„ F a ZIP: 95973 Year Constructed: I/c\ %r,� Contact: �t+ t'`'igF MPS' Telephone: Contractor Information: Number of System Risers Name: Foothill Fire Protection, Inc. Copy sent to: Address: 170 Erma Court ❑✓ Owner Date: 12-01-2022 City: Chico ❑J Fire AHJ Date: 12-01-2022 State: California ❑ Contractor Date: NOTES: Telephone: (530)826-3013 1)For specific inspection,testing,and maintenance CA License requirements and information,see NFPA 25,2011 #: 783132 edition as amended by California Code of Job#: Regulations,Title 19,§901 to§906 27333774 Performed 2)Inspection items may be performed by the owner by: Stephen Rampenthal in accordance with California Code of Regulations, Title 19,§904.1(a) Check box for each system inspected and enter the number of forms used for inspection. Check boxes (Fail or Pass)to indicate status of inspected system at end of inspection. Forms included with this Report Chapter Number of Forms NI' Pass ❑✓ Automatic Sprinkler System 5 4 ❑ ❑ ❑✓ ❑ Standpipe and Hose System 6 0 ❑✓ ❑ ❑ ❑ Private Water Supply System 7 0 ❑✓ ❑ ❑ ❑ Fire Pump 8 0 Q ❑ ❑ ❑ Water Storage Tank 9 0 Q ❑ ❑ n Water Spray System 10 0 ❑✓ ❑ ❑ ❑ Foam Water Sprinkler System 11 0 ❑✓ ❑ ❑ ❑ Water Mist System 12 0 0 ❑ ❑ Concerns that are Not Deficiencies(i.e. Non-Sprinklered Areas) ❑ Yes ❑./ No *See"Deficiencies and Comments"section at end of each respective form. Wet Pipe California Code of Regulations—Title 19 Quarterly and 2 of 4 Fire Sprinkler System Inspection,Testing and Maintenance Annual Report Property Information o �4 f. Contractor or Licensed Owner Information at:."` Building Name: Youth with a Mission Main Building I7 fa Name: Foothill Fire Protection, Inc Address: 15850 Richardson Springs Rd � Address: 170 Erma Court EIO City: Chico St: CA Zip:95928 City: Chico License#:783132 Phone: (530)826-3013 Contact Person: 0 SFM Job#: 27333774 Phone: ❑✓ CSLB C-16 Misc. RiInformation Riser Riser Main Drain Initial Residual Final Static No. Location Diameter Diameter Static Pressure Pressure P,F,N/A Pressure 1 South East Exterior Riser 2 2 75 60 75 P ❑ This building has more than 5 risers.See additional AES 2.9 form attached. Number of AES 2.9 forms attached: 5-Year INSPECTION,TESTING AND MAINTENANCE Includes ALL Quarterly and Annual Inspections,Tests,and Maintenance I= Inspection T=Test M =Maintenance P=Pass F=Fail N/A =Not Applicable NFPA 25 CA Item Description ed. Date iiii Comments Only P,F,N/A Reference 1.1 I Control Valves—Identification Sign 13.3.1 12-01-2022 N/A P 1.2 I Control Valves—Inspection 13.3.2 12-01-2022 N/A P 1.3 I Waterflow Alarm Devices 5.2.5 12-01-2022 N/A P 1.4 I Supervisory Devices 5.2.5 12-01-2022 N/A P 1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 12-01-2022 N/A P 1.6 I Hydraulic Design Information Sign 5.2.6 12 01 2022 N/A P (For hydraulically designed systems) 1.7 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 12-01-2022 psi N/A 1.8 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 12-01-2022 psi N/A 1.9 I Pressure Readings Acceptable 5.2.4.1 12-01-2022 N/A P General Information Sign 1.10 I (not required for system prior to 2007 Edition NFPA 5.2.8 12-01-2022 N/A N/A 13) 1.11 I Heat Tape 5.2.7 12-01-2022 N/A N/A 1.12 I Spare Sprinklers 5.2.1.4 12-01-2022 N/A P 1.13 I Fire Department Connections 13.7 12-01-2022 N/A P 1.14 I Alarm Valves—Exterior Inspection 13.4.1 12-01-2022 N/A P 1.15 I Pressure Reducing Valves 13.5.1.1 12-01-2022 N/A P 1.16 I Backflow Preventers 13.6.1 12 01 N/A N/A 2022 Wet Pipe California Code of Regulations -Title 19 5 Year 3 of 4 Fire Sprinkler System Inspection,Testing, and Maintenance Report Property Information Contractor or Licensed Owner Information Building Name:Youth with a Mission Main Building , .,k-y v Name: Address: 15850 Richardson Springs Rd Job#:27333774 City: Chico ANNUAL INSPECTION,TESTING,AND MAINTENANCE Include ALL Quarterly Inspections(See Previous Page) I=Inspection T=Test M=Maintenance P=Pass F=Fail N/A =Not Applicable Item Description It NFPA 25 CA Date Comments Only P,F,N/A ed.Reference 1.17 I Small Hose Connections-Hose Valve* 5.1.6, 13.5.2 12-01-2022 N/A N/A 13.5.5.1 1.18 I PRV—Fire Sprinkler Systems 13.5.1.1 12-01-2022 N/A N/A 1.19 I Buildings(Freeze Protection) 4.1.1.1 12-01-2022 Owner's Responsibility P 1.20 I Sprinklers 5.2.1 12-01-2022 N/A P 1.21 I Sprinklers-Accessible Concealed Space 5.2.1.1.6 12-01-2022 N/A P 1.22 I Pipe and Fittings 5.2.2 12-01-2022 N/A P 1.23 I Pipe and Fittings-Accessible Concealed Space 5.2.2.3 12-01-2022 N/A P 1.24 I Hangers 5.2.3 12-01-2022 N/A P 1.25 I Hangers-Accessible Concealed Space 5.2.3.3 12-01-2022 N/A P 1.26 I Seismic Braces 5.2.3 12-01-2022 N/A P 1.27 I Seismic Braces-Accessible Concealed Space 5.2.3.3 12-01-2022 N/A P 1.28 I Unsprinklered Areas CFC 901.4 12-01-2022 ❑Yes ONo 2.1 T Field Service Test Required 5.3.1 12-01-2022 If REQUIRED,Enter"F"until N/A Send Report to Fire Code Official results are returned from Lab 2 2 T Recalled Sprinklers Title 19 12-01-2022 N/A P If not present=Pass; If present=Fail 904.1(c) 2.3 T Water Flow Alarm Devices 5.3.3 12-01-2022 30 sec P 90 secs max. Enter time 13.2.6 2.4 T Main Drain Test 13.2.5 12-01-2022 N/A P (Enter data on Page 1 of this form) 13.3.3.4 2.5 T Control Valve-Position 13.3.3.2 12-01-2022 N/A N/A 2.6 T Control Valve—Operation 13.3.3.1 12-01-2022 N/A P 2.7 T Supervisory Devices 13.3.3.5 12-01-2022 N/A P 2.8 T Backflow Preventer Assemblies 13.6.2 12-01-2022 N/A N/A 2 9 T Small Hose Connections* 13.5.2.3 12-01-2022 N/A N/A w/PRV Hose Valves—Partial Flow Test 13.5.3.3 2.10 T PRV—Fire Sprinkler Systems 13.5.1.3 12-01-2022 N/A N/A 2.11 T Pressure Gauges-Calibration 5.3.2 12-01-2022 N/A P 2.12 T Small Hose Connections* 13.5.6.2.2 12-01-2022 N/A 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. Wet Pipe California Code of Regulations -Title 19 Quarterly and 4 of 4 Fire Sprinkler System inspection,Testing,and Maintenance Annual Report Property Information `off Alt Contractor or Licensed Owner Information Budding Youth with a Mission Main Building ;�[ 5,0 Name: Foothill Fire Protection,Inc Name: . I Address: 15850 Richardson Springs Rd tj Ji 4 I Job# 27333774 I City: Chico \, F--- ANNUAL INSPECTION,TESTING,AND MAINTENANCE Include ALL Quarterly Inspections(See Previous Page) I=Inspection T=Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Item escrip ion dFReference a e P,F,N/A 3.1 M Check Valves-Internal inspection 13.4.2 12-01-2022 N/A N/A 3.2 M Control Valves 13.3.4 12-01-2022 N/A P 3.3 M FDC-Backflush 14.3.2.3 12-01-2022 N/A P 14.3.2.4 Internal Pipe Inspection 3.4 M If"Yes"-See Deficiencies and Comments Section for 14.2 12-01-2022 yes Results. Obstruction Investigation Required. 3.5 M If"Yes"-See Deficiencies and Comments Section for 14.3 12-01-2022 no Results. 3.6 M System Returned to Service 4.5.3 12-01-2022 yes D = Deficienc C= Comment Indicate t •e Deficiencies and Comments Indicate all equipment,devices and parts that were repaired or replaced ❑ 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 I Stephen Rampenthal Signature Date 12-01-2022