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HomeMy WebLinkAbout850s Comm Care Lic & Inspections,, ~~`"~ ~~' BAKERSFIELD FIRE DEPT. ~~ ~~~ ~ ~ Prevention Services ~~ ~~ s ,IRE PREVENTION INSPECTION a eP~1[E I D 900 Truxtun Ave., ste. 2io ARTM T ~ / Bakersfield, CA 93301 I '~ TeL: (661) 326-3979 ^ Fax: (661) 852-2171 DISTRICT s ~ .,~ BLOCK NO. DATE ~~ '~ ~- - ~'x ~ ~ ~ ~ EE '~ / FACILITY ADDRESS `'-` '" CITY, STATE, ZIP !- ~ ..... / ; ~ '" ` FACILITY~NAME ~' ~ 6R'S NAME FACI ITY PHONE NO. M N BUSINESS OWNER'S NAME AND ADDRESS , ` ~ '... '"""'n Q ~ ....- ITY, STATE, ZIP OW R' P NE NO. BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO. OCC TYPE Q ~ ~i rr_i 1 I/I : ,' c; ~~ s1 r ~ l .~ ~- OCC LOAD NO. OF FLOORS HIGH RISE BLDG RISER DATE ^ YES f].~N©^'` ___----•.____-._._ CORRECT ALL VIOLATIONS vioi~riox CHECKED BELOW xo. REQUIREMENTS COMBUSTIBLE WASTE /DRY 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.) 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) __________________ portable fire extinguisher to be immediately accessible for use in (area) _____________________________ (U.F.C.) 6 Re-charge all fire extinguishers. Fire extinguishers shall be serviced at le stt1a11ct~ ,and/or after each use, by a person having a valid license or certificate. (U.F.C.) UV~~`V1 SIGNS 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inche height over each required exit (doorlwindow) to 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.) FIRE DOORS/ FIRE SEPARATIONS g Repair all (cracks/holes/openings) in plaster in (location) ______________________________________. Plastering 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.) EXITS 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.) ELECTRICALAPPUANCES 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.) 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 G..' +:~'c J ~ 1~ ~~Yr~,d~'v~-~ T- c.~rT'y" CUSTOMER: ~ (Signature) (Please Print Name Legibly, Title) INSPECTOR: ~` /"/G !GG•c ~_"7iih!.1+,.~/ AP NO.: ~ Tc. (Signature) r LEGEND: 7a 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 N.E.C. NAT ONIALIELECTRIC CODE White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09105) ` ~~"'w. - ~ ~ ~~ ` _ - ~ BAKERSFIELD FIRE DEPT. i ~~ Prevention Services ~I ~. l FIRE PREVENTION INSPECTION B. EF/RE I ~ D 900 Truxtun Ave.,"`Ste. 210 . I ~erM t Bakersfield, CA 93301 ~~" '' ~ ~ Tel.: (661) 326-3979 0 Fax: (661) 852-2171 DISTRICT BLOCK NO. DATE , ~ r. ~ ~ EE ~ ~/ / ~'~- ~ ~ ( ~j --- i FACILITY ADDRESS / ~ f rl ~ .. n CITY, STATE, ZIP FACILITY NAME ~/ ~ ( ~ /) ~ ~/ MANAGER'S NAME FACILITY PHONE NO. BUSINESS OWNER'S NAME AND ADDRESS '~ CITY, STATE, ZIP OWNER'S PHONE NO. BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS . CITY, STATE, ZIP, BILLING PHONE NO. OCC'LYPE OCC LOAD ` NO. OF FLOORS HIGH RISE BLDG ,tRISER DA-TfE ' ` - ~~ ~ - ~""~ ~ ! ^ YES ,^ NO /~_ ! i f l CORRECT ALL VIOLATIONS wo~nr~oN ~ REQUIREMENTS CHECKED BELOW Ko. COMBUSTIBLE WASTE I DRY 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 c,,,. Relocate combustible storage to provide at least 3 feet clearance around motor fuse boxlfire 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) __________________ 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 (doorlwindow) to SIGNS 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.) 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 8 location) ____________ _ _ __________________________________. Self-closing doors shall be designed to close by gravity, rb,~~CC the action of a echanical device, or by an approved smoke and heat sensitive device. Self-closing doors s~~F~a~ na ~t~hl~e'~s c~~~ of preventing the operation of the closing device. (U.F.C:) LLL 11 v rr~r EXITS 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.) 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 1$ CUSTOMER: ~<« c -~ ~ /.-t.,~}G~ LEGEND: , C.F.C. CALIFORNIA FIRE CODE (Signature) r (Please Print Name Legibly, Title) rj~ ,~~ U.B.C. UNIFORM BUILDING CODE B.M.C. BAKERSFIELD MUNICIPAL CODE , INSPECTOR: ~ /j( ,/,~f.~----•-"- AP NO.: f' ~--~ N.F.P.A. NATIONAL FIRE PROTECTION _ _ / (Signature v ` ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE K8F-7320 White -Customer/Original Yellow -Station Copy Pink -Prevention Services ~ FD ZOZZ (ReV. O9/OS) w<% !! ~• STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST sTn. eso (REV. ~ae~) See fnstructJons on reverse. AOENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM COMMUNITY CARE LICENSING 559 243-8080 006/05/07 109 EVAUTATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE #0229 THERESA # 157203376 1A RESPONSE REQUIRED coDEs 1. ORIGINAL AFIRE CLEARANCE LICENSING STATE DEPT OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY AGENCY NAME AND Community Care Licensing Branch 3. CAPACITY CHANGE ADDRESS 770 E. Shaw Avenue, Suite 330 4. OWNERSHIP CHANGE Fresno CA 93710 5. ADDRESS CHANGE , 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY Btrl)RIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY --0-- -0- -6- -0- -0- -0- 6 FACILITY NAME LICENSE CATEGARY .~ ABLE CARE HOMES #1 ~ ~ ~ '` ~='~ ~"'~~~ 740 RCFE STREET ADDRESS (Actual Location) NUMBER OF BUILAINGS 10005 COBBLESTONE AVENUE 1 caY RESTTTUNT BAKERSFIELD CA. 93311 NONE FACILITY CONTACT PERSONS NAME Nouns ALICIA MATANGUIHAN---ADM: - - 24 HOURS sPEaAL coNDmoNs TELEPHONE: 1-661-858-0385 FACILITY IS REQUESTING A HOSPICE WAIVER FOR 1 RESIDENT rCITY OF BAKERSFIELD ~ FlRE 1600 TRUXTON AVE STE 401 AUTHORITY . NAME AND BAKERSFIELD, CA. 93301 ADDRESS J IPISPECTOR'S NAME (ljpMor TELEPHONE NUMBER Pr cad f ~3~6• DATE INSPECTORS TU aP CRRS NUMBER OCCUPANCY CLASS ~~ ~~ IRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER N DENIAL OR TJS7 SPECIAL