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~~~ KERN ADULOT PROGRAM z
~~~ 2900 EYE STREET _ _-
2900 Eye Street (661) 323-4700
Bakersfield, CA 93301 FAX (661) 323-030
I: - Kerr ~~
Adult
program
SHERRIL BEATY Program Director
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BAKERSFIELD FIRE DEPARTMENT
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Inspector 5
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i INSPECTIO.i{ CORD
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Ba'~ersfiel~ Fire Dept.
17'15 Chester Ave.
Bakersfield, CA 93301
CUSTOMER I.D. # . ENTERED
DATE:
/_ /~,,,~ FACILITY ADDRESS ZIP:
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~-'' FEE:" ~°CITY
O COUNTY
FACILITY NAME: ~ ~ L ?
. MANAGER NAME:
BUSINESS OWNER NAME, ADDRESS, ZIP CODE ~ FACILITY PHONE,~c~ ~^ ~ ~~
BILL TO: (IF DIFFERENT FROM ABOVE)-N, ADDRESS, ZIP CODE, PHONE N !
OCC TYPE OCC LOAD
~~~_ No. OF FLOORS
O HI RISE BLDG.
YES O N0~7^ EQ
YES O NQ~---- RISER DATE
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VI LAT N ICE CORRECTION: DATE OF REI1dSPECTION
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CUSTOMER: `` FIRE SAFETY CONTROL
INSPECTOR:
~~----
_ (805) 326-3951
WHITE ORIGINAL-OWNER YELLOW-INSPECTOR'S COPY PINK-FILE.
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STATE OF CALIFORNIA- ~--~«aey~. -. ..'
FIRE~SAFETY I~NSP~CTI~N REQUEST '~ ~~
f , STD. 850 (REV. 10-94) T
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See instructions on reverse.
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
Community. Care. Licens~~ng 559 -445-5691 12 14 99 109
EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
Bxian Finnigan 0130 15720x963 lA-'
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RE'S
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. -1: ORIGINAL A. FIRE CLEARANCE
LICENSING 2. RENEWAL ~B: LIFE SAFETY
AGENCY STATE DEPARTMENT OF
SOCIAL SE1C
ICES
NAME AND 3. CAPACITY CHANGE
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Y
,: C~~UNITY CARE LICENSING BRANCH
ADDRESS
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770 E. Shaw Avenue, Suite 330
'r ~ " 4. OWNERSHI
CHANGE
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Fresno
Ca 93710-7785
`~" 5. ADDRESS CHANGE
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P ~
,
_ 6. NAME CHANGE
' 7. OTHER
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AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY - PREVIOUS CA_P,.ACITY
~ CAPACITY PREVIOUS CAPACITY CAPACITY ~ PREVIOUS CAPACITY
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35 35
FACILITY NAME
Kern,~A~~i~t Program, Ino.
STREET ADDRESS (Actual Location)
'2900 Bye St. , ~akers'field,F~ .
clTv
Bakersfield, Ca. 93301
FACILITY CONTACT PERSON S NAME ~ ~' ~
erald Da2~~"~landa °~°~'
SPECIAL CONDITIONS ~ Y
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LICENSE CATEGORY
ADC .,~
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NUMBER OF BUILDINGS
9 3 3 01 ~c~ "' ~ ~~~ 2 s
~ RESTRAINT
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? atone
~ ;~ ,~ HOURS
`TO BE COMPLETED BY INSPECTING AUTHORITY
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..FIRE - ~ . ~Ba~e~sf field Fire De artme~ht ~ , ~ ,T'~i
AUTHORITY: ~,..1 Z15: C}lE!S.'~C'~-: 'Ai7E'_., '. ~ ~°...
NAME AND ~~~ ~ - •*
,; Bakersfield, 'ca. 93301 ,DEC 2 .~ 1999 •
.-<- ADDRESS
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INSPEG OR'S NAME,(T Rb~_or Printed } . TELEPHONE NUMBER .' CFIRS NUMBER OCCUPANCY CLASS
"~-- mil) ~~~' ~ ~~ d
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:LEf~BANCE _ L CODE
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1.~11RE CLEARANCE GRANTED
2: ' FIRECLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
D. SPRINKLERS
E. HOUSEKEEPING
F. SPECIAL HAZARD
G. OTHER
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GOLDEN WEST MASTER SYST$MS
S00 E. 18th Street
Bakersfield, Ca. 93305
805-395-1174
CSCL #603357
Sire alarm System Inspection a.nd To~tinq
Date:~l ~Time:_,~~~J~
Servi a Organization:Golden West Master System
500 E. 18th St.
Bakersfield, Ca. 93305
(661)345-1174
Representative:Randy Smith
License No:C10 60335~7~ ~ n
Premise:_ ~,~,~,,, f} ~ ~
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Approving Agency:_ Q C F1~
Service : ~,t,,~,,,,,y,~'
Panel Manufacture:_~,~o3~es~a.
Model No:
Circuit Style: ~
Na. Of Circuits: Z
Last Date System Had Any Service Preformed:_ ~is.
Alarat~Initiatin Devises and Circuit Ir~tormatioa
__.Y ircui ty a ev~.ces
Alarm-Notifiaa.tion Applianaa and CirCUit
Q_~ Circuit Style Devices
1 ~H~~~~
~ ~ ~ ~~~.s
No. Of Alarm Indicating Circuits:_ r
sor Si nal-Initiating D
"~ircu y e suites
N,L9--
~vice9 and Chou
Systss~ Poaor $u~ liae
Overcurrent Protection:_ i3~,f~-~"f~
Location: /y~{...~`n/
Disconnect Location:_ /y,4„~
Calculated Capacity o Operate System:_ ~y~
Battery Type:_ ~£~ ~~~
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GOLDEN WEST MASTER SYSTEMS
500 E. 18th Street
Bakersfield, Ca. 93305
$05-395-1179
CSCL #603357
Prior To Tsstin~~qq
0 1 ications ~3ade
ui ing Occupan s :_ ~~ ~ ~,
Building Management:
_ Gc~~
S stem Test And gas ctions
isual Functional Comments
. ~. .,
Control Panel: ~ ~
Interface Equipment:
Lamps/CEOs:
Fuses: ~
~
Primary Power Supply: ~ ~/
Trouble Signals: /
Disconnect Switches:
Graund Fault Monitoring: ~ ~
~..~
Battery Condition: ~ ~,
Load Voltage:
Discharge Test. ~s' ~.
Charger Test: ,r/
~
Transient Suppressor: ,/ -•-~
Remote Annunciators:
Audibles:
Visuals:
Speakers: - •
Sntexfsas ~ i a~tient
cscri ion Visual Operational Simulated
aN F
Nottification That Testin
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Leto
~ ui ing ccupan s : ~~ ~,
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Building Management: ~
~~~
2nitiatin And Su erviso Device Fasts Aad Zns actions
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ua ~ unc xona as ail
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