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FIRE PREVENTION INSPECTION ,a E~/RE I D
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BAKERSFIELD FIRE DEPT. q~~
Prevention Services 3~v
900 Truxtun Ave., Ste. 210 ~~j
Bakersfield, CA 93301
Tel.: (661) 326-3979 ~ax: (661) 852-2171
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FACILITY NAME
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BUSINESS OWNER'S NAME AND ADDRESS J NE NO.
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CITY, STATE, ZIP
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
O YPE OCC LOAD NO. OF FLOORS HIGH RISE BLDG RISER DATE
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CORRECT ALL VIOLATIONS VIOLATION REQUIREMENTS
CHECKED BELOW No.
COMBUSTIBLE'WASTE IDRY >> 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.)
q 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 visibl ~r I icate the
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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.)
Exlrs 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 18
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CND. CALIFORNIA FIRE CODE
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U.B.C. UNIFORM BUILDING CODE
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N.E.C. NATIONAL ELECTRIC CODE
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White -Customer/Original Yellow -Station Copy Pink -Prevention Services
FD 2022 (Rev. 09/05)
,Ebony Counseling Center
'~'~ 1301 California Avenue
'~~~ i~ Bakersfield, CA 93304
X6611324-4756
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062S0000774693
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Ebon Counselin Center
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1301-1317 California Avenue Bakersfield, California 93304
Phone: (661) 324-4756 Fag: (661) 324-1652
Teri McClanahan
Executive Director
May 16, 2006
Bakersfield Fire Deparhnent
Prevention Services
900 Truxtun Ave., Suite 210
Bakersfield, CA 93301
RE: Fire Clearance
Ebony Counseling Center is currently cleared to provide substance abuse counseling services in the
administrative building at 1301-1309 California Ave. We are applying with the State of California Alcohol and
Drug Prevention Program to expand services into buildings two and three located at 1311 and 1317 California
Ave. Attached you will find the instructions from the State as well as a sample form for your completion.
Your immediate attention to this requiest is greatly appreciated.
Sincerely,
Teri cClanahan
Executive Director
BOARD OF DIRECTORS:
Jerry Shipman-President Diane McClanahan-Vice President Linda Factory Michael Roberson Curtis Jenkins Grinnell Griffin
Dr. Ron Claiborne Gloria Patterson, Irma Carson, Art Powell
Funded By: Kern County Mental Health United Way of Kern County California Health and Human Services Agency
Department of Health Services Office of Family Planning .
STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY ARNOLD SCHWARZENEGGER, GOVERNOR
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS
1700 K STREET
SACRAMENTO, CA 95814-4037
TDD (916) 445-1942 ~ ~o
(916) 322-2911
TO: LOCAL FIRE AUTHORITY
FROM: RESIDENTIAL AND OUTPATIENT
PROGRAMS COMPLIANCE BRANCH
DEPARTMENT OF ALCOHOL AND DRUG PROGRAMS
SUBJECT: FIRE CLEARANCE
The Department of Alcohol and Drug Programs (ADP) licenses and certifies
residential alcohol and/or other drug treatment programs and certifies outpatient
programs. In an effort to promote program safety, these programs are required
by state regulations and certification standards to obtain a fire clearance from
local fire authorities.
The Department requires the Std. 850 form for residential programs. However,
for outpatient programs, any clearance issued on official stationary or fire
department forms is acceptable. Attached is a sample form, which may also be
used. Please feel free to copy the form onto your letterhead when requests are
received by your office for fire clearance, or you may use the form as typed and
affix an official seal.
Thank you for your cooperation and assistance to these programs and to ADP in
our efforts to keep our programs fire-safe. If you have any questions, please
contact the Residential and Outpatient Programs Compliance Branch at ____ _
(916) 322-2911.
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