HomeMy WebLinkAboutFIRE SAFETY INSP 7/20/2007
~ SAN JOAQUIN COMM HOSPITAL
:2615 CHESTER AVENUE ~~~~
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STATE OF CALIFORNIA -FORESTRY AND FIRE PROTECTION
FIRE SAFETY INSPECTION REQUEST
STD. 850 (REV. 4-2000)
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See instructions on reverse. ~~i
AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
Cheryl Fuller; AGPA (661) 336-0543 7;20;2007 Licensing and Certification
EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
Karen Grounds, I-IFES Facility LD. 120000411 lA
CODES
LICENSING f California Department of Public Health ~ 1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY-
AGENCY Licensing and Certification
NAME AND 1200 Discovery Plaza, Suite 120 ?~ ~ ~ ~oQ7
RE
~ 3. CAPACITY CHANGE
ADD
41
SS BakerSfleld, CA 93309 E19 1 D ~ 4. OWNERSHIP CHANGE
5. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY
17$
FACILITY NAME ~ ~ ~ LICENSE CATEGORY
San Joaquin Community Hospital GACH
STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS
2615 Chester Avenue
CITY RESTRAINT
Bakersfield, CA 93301 .
FACILITY CONTACT PERSON'S NAME FACILITY CONTACT PERSON'S TELEPHONE NUMBER HOURS
Martha Samora, RN (661) 703-9394 24
SPECIAL GUNDITIONS
Fire clearance needed for addition of Mobile Unit CT Scanner.
TO BE COMPLETED BY INSPECTING AUTHORITY
CLEARANCE /DENIAL CODE
CODES
FIRE
1. FIRE CLEARANCE GRANTED
AUTHORITY
NAME AND 2. FIRE CLEARANCE DENIED
ADDRESS A. ExlTs
L- B. CONSTRUCTION
C. FIRE ALARM
ERS
INSPECTOR'S NAME (Typed orPrinfed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS D. SPRINKL
/ E. HOUSEKEEPING
d,/ t ~ (.~e,~v- ~ 6- 3?~ Jo _
~~ ~ S ~ F. SPECIAL HAZARD
INSPECTION DATE INS CTO SIGNATURE (7 o Printed) ~
l G. OTHER
EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS