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C i .TRACY COONTZ FCC t
~_,_ ~ 5514 EL PALACIO
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FIRE PREVENTION INSPECTION
` B E R S F- D
• F/RE
ARTM T
BAKERSFIELD FIRE DEPT.
Prevention Services /~
900 Truxtun Ave., Ste. 210 ~~~ - `
Bakersfield, CA 93301
Tel.: (661) 326-3979 ^ Fax: (661) -2171
DISTRICT BLOCK NO. DATE. ~ / `7,~j~"')
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FACILITY ADDRESS ~~ / / ` ~Gt~ Q C t (
"'7 / ~~ ~
CITY, STATE, ZIP ~
FACILITY NAME
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~ l 'l' MANAGER'S NAME FACILITY PHONE NO.
BUSINESS OWNER'S NAME AN~ ADDRESS CITY, STATE, ZIP OWNER'S PHONE NO.
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
OCC'T~' E OCC LOAp
4/7F/ NO. OF~LOORS HIGH RISE ~LD~. RISER DATE
^ YES . _~ NO
CORRECT ALL VIOLATIONS VIOLATION
CHECKED BELOW No. ~ REQUIREMENTS r
- ~ - ~ ~ ~ -
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 tie 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.)
SIGNS 7 Provide and maintain "EXIT" sign(s) with letters 5 or more. inches in height over each required exit (door/window) to
fire escape. (U.F.C.)
8 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.) /
FIREDOORS/ g Repair all (cracks/holes/openings) in plaster in (location) ~. ________________. Plastering
-------------
shall return the surface to its original fire resistive o it -~. .C.)
FIRE SEPARATIONS
10 -
Removelrepair (item & location) ____ _ _____ _________________________ ___________. Self-closing
doors shall be designed to close by i y~r by the action of a mechanical device, or by an approved smoke and
heat sensitive device. Self-closing d s shall have no attachments capable of preventing the operation of the
closing device. {U. F. C.)
EXITS 11 Remove all obstruction from hallways. Maintain alt 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.)
ELECTRICAL APPLIANCES 14 Extension cords shall not be used in lieu of permanent approved wiring. Install additional approved electrical outlets
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
18 I
~ ~
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CUSTOMER: _..._.----~-_ ~
(cSigna ure) (Please Print Name Legibly, Title)
n
INSPECTOR: C: l/ AP NO.: ~
r ~ Signatures vv LEGEND:, "
C:F.C. CALIFORNIA FIRE:CODE '
U.B.C. UNIFORM BUILDING-CODE
B.M.C. BAKERSFIELD'MUNICIPAL CODE
N.F.P:A. NATIONAL FIRE PROTECTION
ASSOCIATION
N.E.C. NATIONAL ELECTRIC CODE
White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)
STA3E'OF, CALIFORNIA
FIRS SAFETY INSPECTION RE('IUEST
s% eso (REV. Tae~l
1r a 1~~ i ., y e
See lnstructlons on reverse.
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COM1l4UNITY CARE LICENSING 559 ) 243-4584 4-27-07. -109
EVAUUITOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
MIKE BUSSEY 0354 153904651 3A
RESPONSE REQUIRED cones
LICENSING ~ ~TATE DEPT. OF SOCIAL SERVICES ~ 1. ORK3INAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY
AGENCY
NAME AND COMMUNITY CARE LICENSING ~
s. cAPACITYCHANGE
ADDRESS 77O E. SHAW, SUITE 3OO 4. OWNERSHIP CHANGE
FRESNO, CA 9371 O 5. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER ,
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY , PREVIDUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY • PREVIDUS CAPACITY
14 8 - - - - 14
FACILITY NAME ~ - LICENSE CATEGORY
COONTZ, TRACY FCC FAMILY CHILD CARE
STREET AUuiESs (Aawi LoadionJ ~ NUMBER OF BUiLDIYGS
5514 EL PALACIO ~ 1
CffY RESTRAINT
BAKERSFIELD 93307 NO
FACILITY CONTACT PERSON'S NAME HOURS
TRACY COONTZ 661 366-7409 DAYTIME.
sPEaa coNDmoNs
PLEASE CHECK ALL ROOMS INCLUDING THE GARAGE '
IAL coDE
rBAKERSFIELD FIRE DEPT.
FlRE PREVENTION SERVICES
AUTHORITY
NAIREAND 1600 TRUXTON AVE..#401
ADDRESS gAKERSFIELD, CA 93301
MSPECTOR'S NAME ITypd a Prf7Nd) TELEPHONE NUMBER
9~PECTION DATE INSPECT NA (Typo
~.
EXPLAIN DENIAL OR LIST SPECIAL DITIONS
1 ° ~ AY ~ ~' 2007
~~~ D
CFin3 NUMBti4 OCCUPANCY CLASS
~~~~ ~ ~~
CODER
1. E CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. ExlTs
8. CONSTRUCTION
C. FIRE ALARM
D. SPRINi4ER3
E. HOUSEKEEPING
F. SPECIAL HAZARD
G. OTHER