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LIGHT HOUSE GROUP HOMES
' L~ li 9102 GOLDEN HAWK COURT
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~-~ ~ BAKERSFIELD FIRE DEPT. , ,
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- a R S F I D evention Services
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°~IRE PRE--~EN~TION INSP TI W, ~ . ~ rM r 9o Truxtun Ave., ste. Rio
;: ~~ ~~ ak rsfield, CA 93301
'~ ~ ~ ~ .• (661) 326-3979 ^ Fax: (661) -2171
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DISTRICT BLOCK NO DAT .~ ~~,
FACILITY ADDRESS ' Q.'O ~
f CITY, STATE, ZIP ~ ~ 2 ~ /
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FACILITY NAME HONE NO
MA ER'S AME FA LI
BUSINESS OWNER'S NAME AND ADDRESS CITY, STATE, ZI OWNER'S PHONE NO.
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
OCC P OCC L D NO. OF FLOORS HIGH RISE B G I DATE
^ YES NO
CORRECT ALL VIOLATIONS v~o~~Tion REQUIREMENTS
CHECKED BELOW so.
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 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 No. 10)
EXTINGUISHERS 5 Provide and install (amount) _____ approved (type 8 siz _p~ _______ 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 on '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.)
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correct address of the building. (B.M.C.) (U.F.C.)
g Repair all (cracks/holes/openings) in plaster in (location) ______________________________________. Plastering
FIREDOORSI
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, or by the action of a mechanical device, or by an approved smoke and
heat sensitive devicei 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 cohtrasting colored and permanently installed electric light over or near required exit (location)
to clearly indicate it as an exit. (U.F.C.)
------------------------------
STORAGE 1g 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.)
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14 x
ension cords shall not be used in lieu of permanent approved wiring.
nstall additional approved electrical outlets
ELECTRICAL APPLIANCES where needed. (N.E.C.) (U.F.C.) ,.;U,. ,
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5 emove mu
tiple attachm
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cords from specific eleclrical 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 a Code B.M.C. re ardin fireworks.
OTHER 18 r y
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CUS-COMER: LEGEND:
i atureY (Please Print Name Legibly Title) C.F.C. CALIFORNIA FIRE CODE
U.B.C. UNIFORM BUILQING CODE
~ ~~ B.M.C. BAKERSFIELD MUNICIPAL CODE
INSPECTOR:
AP NO.: N.F.P.A. NATIONAL FIRE PROTECTION
(Signatur ASSOCIATION
if
N.E.C. NATIONAL ELECTRIC CODE
White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)
.~- ~.
STATE OF ~F~,,f?iiw
t=tAE SAFETY INSPECTION REQUEST
s% eso IREV. ~ae~>
See Instructions on reverse.
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING 559 243-8080 11/15/06 109
EVAU7ATOR5 NAME REOUESTINQ AGENCY FACILITY NUMBER REQUEST CODE
LORI BECK 157203465 1 A
RESPONSE REQUIRED coDEs
LICENSING ~TATE DEPT. OF SOCIAL SERVICES ~ 1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY
AGENCY
NA6AEAND COMMUNITY CARE LICENSING
3. CAPACITY CHANGE
ADDRESS 770 E. SHAW, SUITE 33O 4. OWNERSHIPCHANGE
FRESNO, CA 93710-778 5. ADDRESS CHANGE
6. NAME CHANGE
7, OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY PREYIOUS CAPAgTY CAPACITY PREVIOUS CAPACITY CAPACITY PREVICUS CAPACITY
3 0 0 0 0 0 3
FACILITY NAME ucxn~t c;witcfcx~r
LIGHTHOUSE GROUP HOMES ADULT RESIDENTIAL
STREET ADDRESS (Adwl LoeANOn) NUMBER OF BUILDINGS
9102 GOLDEN HAWK CT. 1
crrv RESTRaNr
BAKERSFIELD, CA 93312 NONE
FACILITY CONTACT PERSON'S NAME HOURS
RANDY SPINK (661) 829-1834 24 HOURS
sPECaL coNDmoNs
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FlRE BAKERSFIELD CITY FIRE PREVENTION
AUTHORITY
NAOiEAND g00 TRUXTON AVENUE
ADDRESS BAKERSFIELD, CA 93312
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MfL~CTOR'SN.*:.IE?~iadorPii' TELEPHONENUMSER
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DATE INSPECTORS NATO ypod a P ' eyj
-- !~a
EXPWN DENIAL OR LIST SPECUIL CONbITIONS
CFIRS NUMBER OCCUPANCY CLASS
1. 61RE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
D. SPRlNKLER3
E HOUSEKEEPING
F. SPECIAL HAZARD
G. OTHER