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BAKERSFIELD FIRE DEPT.
Prevention Services
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979 ^ Fax: (661) 852-2171
DISTRICT BLOCK N0. DATE ... R
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FACILITY ADDRESS ~ 71 ~
(/ CITY, STATE, ZIP ~ ~O
FACILITY NAME
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f-- MANAGER'S NAME FACILITY PHONE NO. f
10
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.
O~ CpTYP
' OCC L NO. OF FLOORS HIGH RISE BL G RISE ~D TE
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.,,,. ~ ^ YES 'NO
CORRECT ALL VIOLATIONS VIOLATION REQUIREMENTS ~
CHECKED BELOW Ho.
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 8 size) __________________ portable fire extinguisher to be
immediately accessible for use in (area) _____________________________ (U.F.C.)
g 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.)
7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height over each required exit (door/window) to
SIGNS fire escape. (U.F.C.) ~
g Provide and maintain appropriate numbers on a contrasting ro n !, ~i~ fle street to indicate the
correct address of the building. (B. M.C.) (U.F.C.)
g Repair all (crackslholeslopenings) in plaster in (location) ______________________________________. Plastering
FIREDOORSI
FIRE SEPARAT
ONS shall return the surface to its original fire resistive condition. (U.B.C.)
I
10 Remove/repair (item & location) _________________________________________________________. 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.)
14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved electrica{ outlets
ELECTRICAL APPLIANCES 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 dealin with recreational fires or o en burnin U.F.C.
FIREWORKS 17 Violations of Section 7802 U.F.C. ,or 8.49.040 of the Bakersfield Munici al Code B.M.C. re ardin fireworks.
OTHER 18 / ,,. _ ~~
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(Signature') r (Please Print Name Legibly, Title) C.F.C. CALIFORNIA FIRE CODE
U.B.C. UNIFORM BUILDING CODE
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INSPECTOR: `~ ~ dot f/I/ ~ AP NO.: ~ B.M.C. BAKERSFIELD MUNICIPAL CODE
N.F.P.A. NATIONAL FIRE PROTECTION
~SlgnatUre) ASSOCIATION
0
N.E.C. NATIONAL ELECTRIC CODE
Kl31--73LU
White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (ReV. 09/05)
STATE OF,CAF1*FORNIA
PARE SA'F~TIr''~INSPECTION REQUEST
s.TD. aso IREV. To-e4>
See instructions on reverse.
i`GENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING 559 243-4584 1-22-07 109
EVALUATOR'S NAME REQUESTING AGENCY FACILfTY NUMBER REQUEST CODE
MIKE BUSSEY 153806655 3A
RESPONSE RE
UIRED Cooes
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~ 1. ORIGINAL A. FIRECLEARANCE
LICENSING
TATE DEPT. OF SOCIAL SERVICES 2. RENEWAL B.UFESAFETY
AGENCY
NAME AND COMMUNITY CARE LICENSING 3. CAPACITY CHANGE
ADDRESS 770 E. SHAW, SUITE 3OO 4. OWNERSHIP CHANGE
FRESNO
CA 93710 5. ADDRESS CHANGE
, 6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY
14 8 - - - - 14
FACILITY NAME
KNAAK, CASEY FCC
STREET ADDRESS (Adwl toeafi0n)
3008 AGATE ST.
crrY
BAKERSFIELD 93304
FACILITY CONTACT PERSONS NAME
CASEY KNAAK (661) 836-8266
sPEaa coNDmoNs
PLEASE CHECK ALL ROOMS INCLUDING THE GARAGE
CLEARANCE IDENIAL CODE
BAKERSFIELD FIRE DEPT ~ cones
FlRE .
g00 TRUXTON AVE
#210 i. RE CLEARANCE GRANTED
AUTHORITY .
NAME AND BAKERSFIELD, CA 9330 2. FlRE CLEARANCE DENIED
ADDRESS A. EXITS
B. CONSTRUCTION
C. FlRE ALARM
D. SPRINIaER3
NSPEC'TOR'B NAME (Tjp~d aPri~ TELEPHONE NUMBER CFlRS NUMBER OCCUp pagg
~-"' E. HOUSEKEEPING
l ~ ~ F. SPECIAL HAZARD
DATE INSPE yp~d a ) G. OTHER
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E7Wt1JN DEexxAL OR u SPECIAL aTIONS