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~~ ~ -,~~? B B R S F I D
FIRE PREVENTION INSPECTION FARE
AIt TM T
BAKERSFIELD FIRE DEPT. ~~
Prevention Services ~~
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979 ^ Fax: (661), 852-2171
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DISTRICT BLOCK NO. DATE -) ~ _~ f'~ ~
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FACILITY ADDRESS D CITY, STATE, ZIP
FACILITY NAME / ~ ~ ME F CILITY PHONE NO.
MANAG
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BUSINESS OWNER'S NAME AND AD
DRESS CITY, STATE, ZIP O NER'S PHONE NO. ~
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
C TxfE OCC
AD NO. OF FLOORS DG ISER D TE
HIGH RISE L
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^ YES NO
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CORRECT ALL VIOLATIONS VIOLATION REQUIREMENTS
CHECKED BELOW No.
B
T
DRY 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.)
COM
USTIBLE WAS
E /
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) ________ __ _ _ or bl ~ xtinguisher to be
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~ ~~~~
immediately accessible for use in (area) __________________ ~F.
.)
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 SEPARATION5 shall return the surface to its original fire resistive condition. (U.B.C.)
t0 Remove/repair (item 8 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.)
Ex1TS 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 1g 1
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CUSTOMER: ` LEGEND:
(Sign tUre) -° (Please Print Name Legibly, Title) C.F.C. CALIFORNIA FIRE CODE
U.B.C. UNIFORM BUILDING CODE
B.M.C. BAKERSFIELD MUNICIPAL CODE
INSPECTOR: 1
AP NO.: N.F.P.A. NATIONAL FIRE PROTECTION
_
4
( ignature) ASSOCIATION
N.E.C. NATIONAL ELECTRIC CODE
71
White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)
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STATE OFC~~'JRNIA ~'` ,~~
FIfr~E SAFETY INSPECTION REQUEST
See /nstructlons on reverse.
srD. esolRev. io•wl
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING 559 243-4584 5-12-06 109
EVAUJATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
MIKE BUSSEY 153806573 7A
RESPONSE REQUIRED coDEs
LICENSING ~TATE DEPT. OF SOCIAL SERVICES ~ 1. ORIGINAL A. FIRECLEARANCE
2. RENEWAL B. LIFE SAFETY
AGENCY'
NAME AND COMMUNITY CARE LICENSING ~ s. cAPACITYCHANGE
ADDRESS 770 E. SHAW, SUITE 3OO 4. OWNERSHIP CHANGE
FRESNO, CA 9370 5. ADDRESS CHANGE
S. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPAGTY PREVOUS CAPAatt CAPACITY PREVIOUS CAPAaTY CAPACITY PREVIOUS CAPACm
14 14
FACILITY NAME
VIGIL-MENDIETA, VICTORIA FCC
sTaEET ~ooRESS (Adw/ Loul'ion)
1700 FREMONT ST. '
UGENSE GATEC30FiY
FAMILY CHILD CARE
NUMBER OF BUILDINGS
1
CfTY RESTRAINT
BAKERSFIELD 93304
FACILITY CONTACT PERSON'6 NAME HOURS
VICTORIA VIGIL-MENDIETA (661) 831-8917 DAYTIME
sI~aAL coNOmaNs
PLEASE INSPECT THE NEW ROOM ADDITION TO USE FOR DAY CARE
~AKERSFIELD FIRE DEPT.
ARE 900 TRUXTON AVE
#210
AUTHORITY .
NAME AND gAKERSFIELD, CA 93301
ADDRESS
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NISPECTai'S NM+
E (TypM d TE
LEPHONE NUMBER
9
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Ml~ECi1pN DA INSPECTORS TU ypd d '
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DtPI/11N DEIWM. OR UST S P'EGAL aTloNs
~Fi1RE CLEARANCE GRANTED
2. FlRE CLEARANCE DENIED
A, EXITS
B. CONSTRUCTION
C. FIRE ALARM
CRRS NUMBER
OCCUPANCY CLACC D. SFRIt:KlER3
E. HOUSEKEEPING
_ '~-~~
J ~ F. SPECIAL HAZARD
G. OTHER