HomeMy WebLinkAboutFAI15-0062 030-462-009 CF FS 2023 . CR t ic:_0062 030 -"'Lth2 —Cal
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Name: Roseleaf Oroville Occupancy/Use: Care Home
Address: 1900 20th Street Construction Type: N/A
City: Oroville No, Stories:
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A7
ZIP: 95965 Year Constructed:
A7RE t40—
Contact: Diana Bingham
Telephone: (530)813-6217
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Name: Foothill Fire Protection,Inc. Copy sent to:
Ell Address: Owner Date: 04-07-2023
170 Erma Court
Ei City: Chico
Fire AHJ Date:
0
State: Contractor Date:
California
NOTES:
Telephone: (530)826-3013
1)For specific insptesting,ection,tinn,see
A 5 aNnFdpma2in,2tenoainice
CA License requirements and
#: 783132 edition as amended by California Code of
Regulations,Title 19,§901 to§906
Job#: 28522192
• Performed 2 in)accordance Inspection i Cmaalyanbrenipaecrfnodrmeendf Rbyegthnelatoiwonnse,r
by: Enrique Ramostwemiths
Title 19,§904.1(a)
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' AVENESIRSNOMPNIPPONVMMITNEM4 i tiVriZiaiiii,15,44;11:.:4.',' n"'r:'"4"Pr;"*"'4"A" ''''a°4''' '4' 'Forms included with this Report . Pass
N/A Fail*- Number of Forms Chapter
Ej Automatic Sprinkler System 5 1 El El [Z.
Ell Standpipe and Hose System 6 0 0 Li 0
Ej Private Water Supply System 7 0 0 0 0
0 Fire Pump 8 0 El 0 0
ri Water Storage Tank 9 0 El El El
CI Water Spray System 10 0 El CI 0
Ell Foam Water Sprinkler System 11 0 Lii 0 0
Eli Water Mist System 12 0 El 1:-.] 0
Concerns that are Not Deficiencies(i.e. Non-Sprinklered Areas) ,, „ ,,,,,,,,,,,,, ,,,,, posY:s 0 No
105,,
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,e440,..;;;i',A1:1 'K',,,c..•'!:7 ,
Form AES 2 1 April 7,2023
Wet Pipe California Code of Regulations-Title 19 Quarterly and 2 of 4
Fire Sprinkler System Inspection,Testing and Maintenance Annual Report
Property Information -Of c.at.4+ Contractor or Licensed Owner Information
ProName Roseleaf Oroville if�' o Name: Foothill Fire Protection,Inc
Building Name: Roseleaf Oroville is' \, Address: 170 Erma Court
Address: 1900 20th St. ` ...--- City: Chico St:CA Zip:95928
City: Oroville I License#:783132 I Phone:
Contact Person: Diana Bingham 0 SFM Job#: 28522192
Phone: (530)813-6217 0 CSLB C-16 Misc.
,:. ✓ ,;J'i,v �a�/y � ,//✓1i9�.;.!1" �: y
�ia3�m �„H-/lyii�.,. . �1�y„� 1f�, � t y9�./��fi„�f�Hsu!I'�'G�/%�'� „�'.�����i„i�i5�i " ,, ��r,h/i ,�s, .�'�,`. . ,- �i�.�a✓� �,'
1 Laundry Room 4 2 104
El This building has more than 5 risers.See additional AES 2.9 form attached. Number of AES 2.9 forms attached:
Quarterly Inspections
I=Inspection T=Test M=Maintenance P=Pass F=Fail NJA=Not Applicable
,; 3" d "'''a it
1.1 I Control Valves-Identification Sign 13.3.1 P
1.2 i Control Valves-Inspection 13.3.2 P
1.3 I Waterflow Alarm Devices 5.2.5 P
1.4 I Supervisory Devices 5.2.5 N/A
1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 P
1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 0 psi psi psi psi
1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 0 psi psi psi psi
1.8 I Pressure Readings Acceptable 5.2.4.1 P
1 9 I Hydraulic Design Information Sign 5 2 6 P
(for hydraulically designed systems)
1.10 I General Information Sign 5 2 8 N/A
(not required for system prior to 2007 edition of NFPA 13)
1.11 I Heat Tape 5.2.7 N/A
1.12 I Spare Sprinklers 5.2.1.4 P
1.13 I Fire Department Connections 13.7 P
1.14 I Alarm Valves-Exterior Inspection 13.4.1 P
1.15 I Pressure Reducing Valves 13.5.1.1 P
1.16 I Backflow Preventers 13.6.1 N/A
1.17 I Small Hose Connections-Hose Valve' 5.1.6,13.5.2 N/A
13.5.5.1
1.18 I PRV-Fire Sprinkler Systems 13.5,1.1 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 Ill
standpipe systems.
Form AES 2.1 April 7,2023
Wet Pipe California Code of Regulations-Title 19 Quarterly and 3 of 4
Fire Sprinkler System Inspection,Testing,and Maintenance Annual Report
Property Information f ' \cot Contractor or Licensed Owner Information
i 4r(Name:9 Roseleaf Oroville % Name: Foothill Fire Protection,Inc
Address: 1900 20th St. I I% ,s I Job# 28522192
City: Oroville I %'
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
i1 ; :g 4
e3o q "
9 " e ,F f. i_ - 6,
ear ,„ �i c /aNl>
e c �z�
1.19 I Sprinklers 5.2.1 N/A N/A N/A
1.20 1 I Buildings(Freeze Protection) 4.1.1.1 N/A Owner's Responsibility N/A
1.21 1 I Pipe and Fittings 5.2.2 N/A N/A N/A
1.22 1 I Hangers 5.2.3 N/A N/A N/A
1.23 1 I Seismic Braces 5.2.3 N/A N/A N/A
2.1 T Field Service Test Required 5.3.1 N/A If REQUIRED,Enter"F"until results are N/A
(Send Report to Fire Code Official) returned from Lab.
2.2 T Recalled Sprinklers Title 19 N/A N/A N/A
If not present=Pass; If present=Fail 904.1(c)
2.3 T Water Flow Alarm Devices 5.3.3 N/A N/A N/A
90 sec.maximum-(Enter Time) 13.2.6
2.4 T Main Drain Test 13.2.5 N/A N/A N/A
(Enter data on Page 1 of this form) 13.3.3.4
2.5 T Control Valve-Position 13.3.3.2 N/A N/A N/A
2.6 T Control Valve-Operation 13.3.3.1 N/A N/A N/A
2.7 T Supervisory Devices 13.3.3.5 N/A N/A N/A
2.8 T Backflow Preventer Assemblies 13.6.2 N/A N/A N/A
2 9 T Small Hose Connections* 13.5.2.3 N/A N/A N/A
w/PRV Hose Valves-Partial Row Test 13.5.3.3
2.10 T PRV-Fire Sprinkler Systems 13.5.1.3 N/A N/A N/A
3.1 M Control Valves 13.3.4 N/A N/A N/A
3.2 M Small Hose Connections* 13.5.6.3 N/A N/A N/A
Obstruction Investigation required
3.3 M IIf"Yes",see Deficiencies and Comments Section for 14.3 N/A N/A N/A
Results.)
3.4 M System Returned to Service I 4.5.3 N/A 1 N/A N/A
I"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 2.1 April 7,2023
•
Wet Pipe California Code of Regulations-Title 19 Quarterly and 4 of 4
Fire Sprinkler System Inspection,Testing,and Maintenance Annual Report
Property Information of Cg4,rY Contractor or Licensed Owner Information
Building /to11
o:re ,z t'
Name: Roseleaf Oroville (� Name: Foothill Fire Protection,Inc
Address: 1900 20th Street It Job# 28522192
City: Oroville Mp
D=Deficienc C=Comment Indicate t •e
Item Date Riser D C Deficiencies and Comments
Indicate ail equipment devices and parts that were rem:red 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.
Check box if Annual Inspection,Testin• &Maintenance items are completed in the indicated Quarter
Date I 04/07/23
Print Name I Enrique Ramos
Signature Ewrcquer t crs I I
Form AES 2.1 April 7,2023