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Ffi1~E PREVENTION INSPECTION
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BAKERSFIELD FIRE DEPT.
>t ~ R s F t o Prevention Services ~~`i" ~~5 ~ _
F/RE 900 Truxtun Ave., Ste. 210 ''~ I ^] - ~ 2-l
AItTM T Bakersfield, CA 93301
Tel.: (661) 326-3979 ^ Fax: (661) 852-2`171
DISTRICT BLOCK NO. DATE _ '~/1.- EE
FACILITY ADDRESS q CITY, STATE, ZIP
FACILITY NAME ~ " ' - r~ ~~
~` M~~IA~GER~ME FACILITY PHONE NO.
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BUSINESS OWNER'S NAME AND ADDRESS TY, STATE, ZIP OWNER'S PHONE NO.
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BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
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% NO. OF FLOORS HIGH RISE BLDG RI-SER~ATE
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CORRECT ALL VIOLATIONS wo~~riox REQUIREMENTS
CHECKED BELOW Ho.
1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.)
COMBUSTIBLE WASTE /DRY
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.)
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.)
g Repair all (cracks/holes/openings) 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 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 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
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CUSTOMER: / "~f LEGEND:
C.F,C. CALIFORNIA FIRE CODE
(S'gflat (Please Print Name Legibly, Title) 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)
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STATE OF ::i..~FORNIA
FIi~E SAFETY INSPECTION REQUEST
sm. eso(REV.,aw1 See lnstructlons on reverse.
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING 559 243-4023 3-21-06 109
EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
PATRICIA POLANCO 153902821 3A
RESPONSE REQUIRED coDEs
LICENSING ~TATE DEPT. OF SOCIAL SERVICES ~ 1. ORIGINAL A. FIRECLEARANCE
2. RENEWAL B. LIFE SAFETY
AGENCY
NAME AND COMMUNITY CARE LICENSING a. cAPACITYCHANGE
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
CAPAGTY PREVOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY
14 $ 14
FACILITY NAME LICENSE GATEC30f,Y
JAMES, ROSIE FCC FAMILY CHILD CARE
STREET ADDRESS (Actwl Location) NUMBER OF BUILDINGS
9912 BATH CT. 1
CITY RESTRAINT
BAKERSFIELD 93311
FACILITY CONTACT PERSON'S NAME HWRS
ROSIE JAMES (661) 664-6955 DAYTIME
SPECIAL ca+DmoNs
' ~ nT'O BE COMPL BY IH8Pl¢G71lXi AIITI'fORITY; I :A ~ ` ~ ~ `' a
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DDENIAL CODE
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~AKERSFIELD FIRE DEPT. ~ ~ coDEs
FlRE g00 TRUXTON AVE. #210 1, RECIEARANCEGRANTED
AUTHORITY
NAME AND ggKERSFIELD, CA 93301 z. FlRECLEARANCEDENIED
ADDRESS ~, ply
B. CONSTRUCTION
C. FIRE ALARM
MISPECTORS NAME (Typal or P TELEPHONE NUMBER CF,RS NUMBER OCCUp/vtCY ~g D. SPRINKLERS
)r / E. HOUSEKEEPING
~~~1(`~ ~•? ~ C~ \ ~~''~ ~y".G~ ~~. ~ ~ ~~~Cx~ ~~ F. SPECIAL HAZARD
R1SPE(.'TION DATE INSPECTORS NA YPb or G. OTHER
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DENIAL oR LIST sPECIAL TK,NS