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FIRE PREVENTION INSPECTION a EF/RE I ~ D
ARTM T
BAKERSFIELD FIRE DEPT. ~~
Prevention Services l~
900 Truxtun Ave., Ste. 210 .~ti
Bakersfield, CA 93301
Tel.: (661) 326-3979 ^ Fax: (661) 852-2171
DISTRICT BLOCK NO. DATE \,,.., /~ ,,q~
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FACILITY ADDRESS
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CITY, STATE, ZIP
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FACILITY NAME MANAGER'S NAME FACILITY PHONE NO.
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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 ^ NO
CORRECT ALL VIOLATIONS VIOLATION REQUIREMENTS
CHECKED BELOW No.
AS
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O
S
/ 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.)
C
MBU
TIBLE W
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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 (doorlwindow) to
SIGNS fire escape. (U.F.C.)
g Provide and maintain appropriate numbers on a~ r ti kg u d an visible from the street to indicate the
correct address of the building. (B. M.C.) (U.F.
g Repair alt (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 8 location) _ ____________. Self-closing
doors shalt 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.)
ouTDOORBURNING 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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CUSTOMER: r'
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(Signature) ~ (Please Pr~:t Name Legibly, Tltle) C.F.C. CALIFORNIA FIRE CODE
U.B.C. UNIFORM BUILDING CODE
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~ B.M.C. BAKERSFIELD MUNICIPAL CODE
INSPECTOR: ~»~l
~.~~ AP NO.: N.F.P.A. NATIONAL FIRE PROTECTION
(SlgflatUre) ASSOCIATION
N.E.C. NATIONAL ELECTRIC CODE
White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)
STATEME:~TT`.OF ACCOUNT PAGE 1
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P O BOX 2057
~9N^_~,~„~Bge~ BAKERSFIELD, CA 93303-2057
(661) 326-3678
DATE: 11/15/06
TO: LA PALOMA MARKET
811 E 3RD ST
BAKERSFIELD, CA 93307
CUSTOMER NO: 19969/93603 TYPE: FI - FIRE STATE FIRE INSP
----------------------------------------------------------------------------
CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT
------ -------- ------------------------- ---------- -------- --------------
0/00/00 BEGINNING BALANCE .00
10/20/06 PAYMENT 30.00-
ANNUAL STATE FIRE INSPECTION FEE
IF BILL HAS BEEN PAID CALL (661) 326-3678
-------------- -------------- -------------- --------------
CURRENT OVER 30 OVER 60 OVER 90
-------------- -------------- -------------- --------------
DUE DATE: 12/05/06 PAYMENT DUE: 30.00-
TOTAL DUE: $30.00-
PLEASE DETACH AND SEND THIS COPY WITH REMITTANCE
DATE: 11/15/06 DUE DATE: 12/05/06 NAME: LA PALOMA MARKET
CUSTOMER NO: 19969/93603 TYPE: FI - FIRE STATE FIRE INSP
.- _
D KE CHECK PAYABLE T0:
CITY OF BAKERSFIELD
PO BOX 2057
BAKERSFIELD CA 93303-2057
(661) 326-3678
TOTAL DUE:
$30.00-
PLEASE DO NOT STAPLE,. PAPERCLIP OR TAPE CHECK.TO REMITTANCE:
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