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'' ~ ~"''~~ BAKERSFIELD FIRE DEPT. O
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s E R S F I L D Prevention Services
FIRE PREVENTION INSPECTION ~iM T 900 Truxtun Ave., Ste. 210 ~j
--- Bakersfield, CA 93301 6
Tel.: (661) 326-3979 ^ Fax: (661) 52-2171
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DISTRICT
~ BLOCK NO. DATE ~,,, EE /`,1 ~
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FACILITY ADDRESS t I ~
/.1 i w _ CITY, STATE, ZIP r ~ v
FACILITY NAME ~ MANAGER'-S'NAME FACILITY PHONE NO.
BUSINESS OWNER'S NAME AND ADDRESS !° `""~ `"~ ` I '~ CITY, STATE, ZIP OWNER'S PHONE NO.
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
O^CC TYPE
I "~ OCC LOAD
~ NO. OF FLOORS HIGH RISE BLDG RISER DA~~ _ -
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NO
CORRECT ALL VIOLATIONS VIOLATION REQUIREMENTS r , _ '
CHECKED BELOW eo.
-
COMBUSTIBLE WASTEIDRY 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_.co_m_bustible-waste and rubbish pending its
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safe disposal. (U.F.C.) ~
COMBUSTIBLE STORAGE 3 Relocate combustible storage to provide at least 3 feet clearance~arbund motor fuse box/fire door (N. E.C.) (U.F.C.)
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4 Relocate fire extinguisher(s) so that th ~~ in conspicuous~ocation, hanging on brackets with the top to the
extinguisher n.ot more than 5 feet above the f~Ao P.A. No. 10)
EXTINGUISHERS 5 Provide and install (amount) _____ approved (type 8 slz _ ~ _______ portable fire extinguisher to be
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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 background and visible from the street to indicate the
correct address of the building. (B. M.C.) (U.F.C.)
9 Repair all (crackslholeslopenings) in plaster in (location) ______________________________________. Plastering
FIRE DOORS/
FIRE SEPARATIONS shall return the surface to its original fire resistive condition. (U.B.C.)
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 1g 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 electrical 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 1g
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111 1
CUSTOMER: LEGEND:
(SI natur ),} (Please Print Name Legibly, Title) C.F.C. CALIFORNIA FIRE CODE
U.B.C. UNIFORM BUILDING CODE
B.M.C. BAKERSFIELD MUNICIPAL CODE
INSPECTOR: AP NO.: ~~ N.F.P.A. NATIONAL FIRE PROTECTION
"(Signature ~ ASSOCIATION
N.E.C. NATIONAL ELECTRIC CODE
White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)
STATE OF CALIFORNIA
F~Sd~ETY INSPECTION REQUEST
sm. eso /aEV. Tae~J
See lnstructlons on reverse.
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING 559 248-2885 6-7-07 109
EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
PATRICIA MENDOZA 0378 153904790 5A
RESPONSE RE
UIRED coDEs
Q
~
~ 1. ORIGINAL A. FIRE CLEARANCE
LICENSING
TATE DEPT. OF SOCIAL SERVICES 2. RENEWAL B. uFESAFETY
AGENCY
NAME AND COMMUNITY CARE LICENSING a. cAPACITYCHANGE
ADDRESS 77O E. SHAW, SUITE 3OO 4. OWNERSHIP CHANGE
FRESNO
CA 93710 5. ADDRESS CHANGE
, 6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY PREVOUS CAPACITY CAPACITY PREVICUS CAPACITY CAPACITY PREVIOUS CAPACITY
i4 - - - - - 'i4
FACILTY NAME LICENSE GATEC3aFiY
RUIZ, SANTOS FCC FAMILY CHILD CARE
STREET ADDRESS (Actwl Lotafion) NUMBER OF BUILDINGS
3216 ARNOLD ST. 1
CITY RESTRAINT
BAKERSFIELD 93305 NO
FACILITY CONTACT PERSON'S NAME HOURS - -
SANTOS RUIZ (661) 477-1812 CELL, 871-1461 DAYTIME
sPEaALCONDmoNs
PLEASE CHECK ALL ROOMS INCLUDING THE GARAGE
.~ '":, >.__ .Is ,_I. ~ .~.,T.O ~~GOMP~.~TEQ,~Y INSP~T~t~tp AEIT~ .. #_ ~ . a, :.~_ /. _
!DENIAL CODE
BAKERSFIELD FD-PREVENTION SERV~
FlRE 1600 TRUXTON AVE
#401
AUTHORRY .
NAMEAND BAKERSFIELD, CA 93301
ADDRESS
MISPECTORS NAME (Typed a Prlnhd)
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DATE INSPECTORS SN
/3 -~/ ` -(~ ~ Q`o /
TELEPHONE NUMBER
~~IRE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. EXITS
8. CONSTRUCTION
C. FIRE ALARM
CFlRS NUMBER , OCCUPANCY CLASS D. SPRirIKLERS
~~~` E. HOUSEKEEPING
F. SPECIAL HAZARD
G. aTHER