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i : SECTION RECORD
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Bakersfield Fire Dept.
.1715 Chester Ave.
Bakersfield, CAM9330J1
DATE:
-~ -c~t~ FACILITY ADDRESS:
~ ZIP:
~~ ~33~~ FEE:
~~~ ~~
FACILITY NAME: ~~.s l~l f~I~n. -.-- ~C~
MANAGER NAME: °""'°' ~^s"- °---
BUSINESS OWNER NAME, ADDRESS, ZIP CODE,^ FACILITY PHONE ~ "' ~1,~
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BILL TO: (IF DIFFERENT FROM ABOVE}-NAME, ADDRESS, ZIP CODE, PHONE No. ~ `~ ~ ~ ~'/~
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OCC TYPE OCC LOAD No. OF FLOORS HI RISE BLDG.
YES O NO RISER
ATE
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VIOLATION NOTICE CORRECTION:
1. DATE bF REINSPECTION
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2.
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NOTES
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CUSTOMER: ~.
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INSPECTOR: ~ ~, J~ tA„Lr AP No.
-~~~ FIRE PREVENTION SERVICES
(661 326-3979
WHITE ORIGINAL-OWNER YELLOW-INSPECTOR'S COPY PINK-FILE
FD1952
,.~ r_.
STATE 4F (.K..FOfiNIA
FiAE SAFETY INSPECTION REQUEST
See Jnstruct/ons on reverse.
STD. 850 (REV. 1D64)
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING 559 243-4584 1-18-06 109
EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
MIKE BUSSEY 153902769 3A
RESPONSE REQUIRED coDEs
S
~ t. ORIGINAL A. FIRECLEARANCE
LICENSING
TATE DEPT. OF SOCIAL SERVICES 2. RENEWAL B.IIFESAFETv
AGENCY `
NAME AND COMMUNITY CARE LICENSING s, cAPACIrvcHANGE
ADDRESS 770 E. SHAW, SUITE 3O0 4. OWNERSHIP CHANGE
FRESNO, CA 93710 5. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPAGTY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY
14 8 14
FAGLITY NAME LICENBE CATEGORY
SEYMENS, TAMIKO FCC FAMILY CHILD CARE
STREET ADDRESS (Adw/ Location) NUMBER OF BUILDINGS
7000 AUBURN ST. #F7 1
CITY RESTRAINT
BAKERSFIELD 93306
FAGLITY G>r(TACT PERSON'S NAME HOURS
TAMIKO SEYMENS (661) 717-9329 DAYTIME
sPEGAL CONDmoNs
.< ~ _..
TO BE Cold?LETEa BY INSPECTINQ AUTHORITY `* -'
s a ~,~
ENIAL CODE
BAKERSFIELD FIRE DEPT ~ coDEs
.
FlRE g00 TRUXTON AVE. #210
AUTFIOR(TY 1. RE CLEARANCE GRANTED
-NAME AND BAKERSFIELD, CA 93301
ADDRESS 2. FIRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTK)N
C. FIRE ALARM
MISPECTOR'S NAME (Tjpad a PrhN~ TELEPHONE NUMBER CFlRS NUMBER OCCUPANCY CLASS D. SPRINKLtRS
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l4/(.Jll :_ ~ f (,
.,)a'tC?--.~~~0' r ,,..
~~\~~~ :' .?
~' E. HOUSEKEEPING
F. SPECIALHAZ~IRD
NSPECTION DATE INSPECT (rypad R,rntad) G. OTHER
DENIAL OR U SPECIAL a