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BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste, 210
Bakersfield,.CA 93301
Tel.: (661) 326 -3979 0 Fax: (661) 852 -2171
DISTRICT BLOCK NO. DATE
10
FACILITY ADDRESS r CITY, STATE, ZIP
FACILITY NAME ` MANAGER'S NAME ., FACILITY PHONE NO.
cl
BUSINESS OWNER'S NAME AND ADDRESS CITY, STATE, ZIP OWNER'S PHONE,NO.
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
OCC TYPE OCC. LOAD NO. OF FLOORS HIGH RISE BLDG RISER DATE
YES O "NO
CORRECT ALL VIOLATIONS' VIOLATION
CHECKED BELOW No.
REQUIREMENTS
COMBUSTIBLE WASTE / DRY
1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.)
VEGETATION 2 Provide non - combustible containers with tight fitting lids for the storage of combustible, waste and rubbish pending Its
safe disposal. (U.F.C.)
COMBUSTIBLE STORAGE 3; Relocate combustible storage to provide at least 3 feet clearance around motor fuse box /fire door (N.E.C.) (U.F.C.)
4 Relocate fire extinguisher(s) so that they will be in a conspicuous location, hanging on brackets with the top to the
extinguisher not more than:5 feet above the floor. (N.F.P.A. No. 10)
EXTINGUISHERS 5 Provide and install (amount) approved (type & size) ________` portable fire extinguisher to be
immediately accessible for use In (area) (U.F.C.)
8 Re- charge all fire extinguishers. Fire extinguishers shall be serviced at least once each year, and /or•after each use,
by a person having a valid license or certificate. (U.F.C.)
SIGNS
7 Provide and maintain "EXIT" sign(s) with letters 5 or more Inches in height over each required exit (door /window) to
fire escape. (U.F.C.)
8 Provide and maintain appropriate numbers on a contrasting background and visible from the street to indicate the
correct address of the building. (B.M.C.) (U.F.C.)
FIRE DOORS ''
9 Repair all (cracks /holes /openings) in plaster in (location) _ . Plastering
shall return the surface to Its original fire resistive condition (U.B.C.)
FIRE SEPARATIONS
10 Remove /repair (item & Iodation) ____ Self> closing
doors shall be designed to close by.gravity, or by the action of a mechanical device, or by an.approved smoke and
heat sensitive device.. Self - closing doors shall have no attachments capable of preventing the operation of the
closing device: (U.F :C.)
EXITS 11 Remove all obstruction from hallways. Maintain all means of egress free of any storage. (U.F.C.).
12 . Provide a. contrasting colored and permanently installed electric light over or near,required exit (location)
to clearly indicate it as an exit. (U.F.C.)
STORAGE 13 Remove all storage and /or other obstructions from fire escape landings and stairways stair shafts. (Fire
escapes /stair shafts are to be maintained free from obstructions at all times.) (U.F.C.)
ELECTRICAL APPLIANCES
14 Extension cords shall not be used in' lieu of. permanent approved wiring. Install additional approved electrical outlets
Where needed. (N.E.C.) (U.F.C.)
15 Remove multiple attachment cords from specific electrical convenience outlet (one plug per outlet) (N.E.C.) (U.F.C.)
OUTDOOR BURNING 16 Violation of Section 1102 dealing with recreational fires or open burning. U.F.C.
FIREWORKS 17 Violations of Section 7802 U.F.C. or 8.49.040 of the Bakersfield Municipal Code B.M.C. regarding fireworks.
OTHER 18
CUSTOMER: l e v6V
Signature) // (P ase Print Name Legibly, Title)
INSPECTOR: c/ 6' 'i AP NO.:
Signature)
LEGEND:
C.F.C. CALIFORNIA FIRE CODE
U.B.C. UNIFORM BUILDING CODE
B.M.C. BAKERSFIELD MUNICIPAL CODE
N.F.P.A. -NATIONAL FIRE PROTECTION
ASSOCIATION
N.E.C. NATIONAL ELECTRIC CODE,
KBF•7320
White - Customer /Original Yellow - Station Copy Pink - Prevention Services FD 2022 (Rev. 09/05)