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BUSINESS OWNER'S NAME,AND ADDRESS NO.
CITI/, STATE, ZIP OWNER'S PHONE
`BILCTO: '(IF DIFFERENT FROM ABOVE) NAME; ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
OCC TYPE OCC LOAD NO. OF FLOORS HIGH RISE BLDG RISER DATE .' ••
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QORRECT'ALL V10LATIONS ' yioi~noN
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BUS 1': r Remoye.,and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.) '
COM
TIBLE WAS '
VEGETATION
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Provide non-combustible contairiers witH tight fitting lids for the storage of combustible, waste and rubbish pending its
safe disposal. (U.F.C,)
COMBUSTIBLE STORAGE 3 Relocate combustible storege'fo provide'at least 3 feet clearance around'.motor fuse'_box/fire door:(N.E.,C.) (U:F.C; )
4 Relocate fire extiriguisher(s) so .that they will be in a conspicuous location, hanging on brackets with the top. to,tfie
extinguisher riot more than 5, feet above the floor. (N.F.P.A. No. 10)
`EXTINGUISHERS 5 Provide 'and install (amount) _____ approved (type & size) __________________ portable fire extinguisherto be.
immediately accessible for use ih (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 a,nd maintain'"EXIT"sign(s) with letters 5 or more inches'iri height over each required exit,(door/window) to '
SIGNS fire escape. (U.F.C.)
8 Provide and maintain a rr~~~~ ,c~l,1 0r~ ® back round and visible from the street to indicate the
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correct address of the b BIl1E1ff(lJ?F)
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• :g Repair: all (cracks/holes/openingS)~in plasternn (location) ________ ___ __________. ,Plastering ..
FIRE DOORS/
FIRE SEPARATIONS Shall return the surface to its orig(hal fire r@sistive condition. (U.B.C.) ~
`, 10 Remove/repair (item &location).~_____~__~_______~_______~_______~___________. Self-closing-'
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doors.shall be designed to close by gravity, or by the actioh of a mechanical device, or by an approved smoke
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heat sensitive device. Self-closing doors shall :have no attachments capable of preveriting the operation of the
closing device.. (,U.F:C.) - v
EXITS ~ 11 Remove all obstruction from Hallways. Maintain all means of egress-free of any sforager (U.F.C.)
12 Provide a cohtrasting.colored and permariantly installed electric light over ornear required, exit'(location) .
______________________________ to cleaFly indicate it as an exit. (U.F.:C.) ,
STORAGE 13. ; Remove all storage and/or other obstructions from fire escape laritlirigs ahd stairways stair shafts: (Fire.,
escapes/stair shafts are to be maintained free from obstruction's 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 Violatiori of Section 1102 dealin with recreatiohal 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.
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CUSTOMER: .~,`JN-
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(Signature) ~ (Please Print Name Legibly; Title)
INSPECTOR: r' ~~i,~~~>+r`~" ;. AP NO.: . • ~~ C.FC. CALIFORNIA FIRE CODE
U.B C UNIFORM.BUILDING CODE
B.M C `~ BAKERSFIELD MUNICIPAL CODE '
N.F P.A. NATIONAL FIRE PROTECTION
t ", (SlgnatU~B) :ASSOCIATION.
N.E C .' NATIONAL ELECTRIC CODE
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White -Customer/Original Yellow - StationCopy Pink -Prevention Services F~ 20Q2 (R@V. ~9/Q5)
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`TATE OF CAL:XORNIA ~
FIRE SAFETY INSPECTION REQUEST
STD. Bs0 (REV. Io-a~l .
See lnstructlons on reverse.
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING 559 243-8080 10/19/06 109
EVALUATORS NAME REpUESTING AGENCY FACILITY NUMBER REgUEST CODE
#222 ANDY XIONG # 157203375 1A
coDEs
RESPONSE REQUIRED
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S t. ORIGINAL A. FIRE CLEARANCE
LICENSING
TATE DEPT OF SOCIAL SERVICE 2. RENEWAL B. LIFE SAFETY
AGENCY
NAIAEAND Community Care Licensing Branch 3. CAPACITY CHANGE
ADDRESS 770 E. Shaw Avenue, Suite 330 4. OWNERSHIPCHANGE
Fresno, CA 9371 O 5. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY PREVIOUS CAPACRY CAPACITY PREYIOUS CAPACITY CAPACITY PREVIOUS CAPAgTY
-0- -0- -6- -0- -0- -0- 6
FAGtJTY NAME LICENSE CATEGORY
CANDICE HOME CARE ! 740 RCFE
STREET ADDRESS (Adw! LCCatbn) NUMBER OF BUILDINGS
5801 COCHRAN DRIVE 1
CRY RESTRAINT
BAKERSFIELD CA. 93309 NONE
FACILRY CONTACT PERSON'S NAME HOURS
FLORINA I. SMITH-TURALLO ADM 24 HOURS
sPEC~ALCONDRTDNs
TELEPHONE: 661-324-5198
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/DENW. CODE
BAKERSFIELD FIRE DEPARTMENT ~
FlRE ATTN: ESTHER DURAN
AUTHORITY
NAIAEAND g00 TRUXTON, SUITE 210
ADDRESS I gAKERSFIE~LD, CA. 93301
!___
MLSPECTOR'6 NAME (Tjpad,~a P TELEPHONE NUMBER
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DJ1TE INSPECTOR'S (Typcf Pnnf~d)
~~IRE CLEARANCE GRANTED
2. FlRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FlRE ALARM
CFIRS NUMBER OCCUPANCY CLASS D. SPRINKLERS
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~ E. HOUSEKEEPING
F. SPECIAL HAZARD
G. OTHER
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The following job has been successfully delivered to the
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---------------- Original message header ------------------
From: BFD HazMat 900 Truxtun - 10.1.17.55
Date: Wednesday, November 08, 2006 3:59:48 PM
Subject:
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15592438070 [successful transmission]