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r#"FIRE PREVENTION INSPECTION
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BAKERSFIELD FIRE DEPT.
e ~ R S F- D Prevention Services
P/RE 900 Truxtun-Ave., Ste. 210 '. ,
AB1M T Bakersfield, CA 93301 ``"~'
Tel.: (661) 326-3979 ^ Fax: (661) 852-2171
DISTRICT BLOCK NO. DATE ... ~ ~~ EE
FACILITY ADDRESS ~/ ~ CITY, STATE, ZIP ~ j ~
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FACILITY NAME ~ G S N ME FAC LITY HON
E N ~~
BUSINESS OWNER'S NAME AND ADDRESS C ,STATE, ZIP OWNER'S PHONE NO.
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, 21 P, BILLING PHONE NO.
OCC OCC L AD NO. OFF OORS HIGH RISE BLDG
^ YES 'rN0 S DATE
CORRECT ALL VIOLATIONS VIOLATION
CHECKED BELOW eo. REQUIREMENTS
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OMBUSTIBLE WASTE /DRY 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.)
C
VEGETATION 2 Provide non-combustible containers with tight fitting lids for the storage of combustible waste and rub h pending it
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 i
Provide and install (amount) _____ approved (type 8 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.)
SIGNS 7 Provide and maintain "EXIT" sign(s) with letters 5 or more[~tr~q in height over each required exit (door/window) to
fire escape. (U.F.C.) ~ ~ ['Y
g Provide and maintain appropriate numbers on a contrasting background and is le ~ie street to indicate the
correct address of the building. (B. M.C.) (U. F.C.)
FIRE DOORS/
FIR
EPARATION g Repair all (cracks/holes/openings) in plaster in (location) ______________________________________. Plastering
shall return the surface to its original fire resistive condition. (U.B.C.)
E S
S
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 i
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.)
ELECTRICAL APPLIANCES 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
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CUSTOMER: /,+~7 /t
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(S'g ~ture) (Please Print Name Legibly, Title)
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INSPECTOR: AP NO.: ~'
ignature) LEGEND: --
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
ASSOCIATION
N.E.C. NATIONAL ELECTRIC CODE
White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)
f~ ~~F~EALIFORNIA
E SAFETY INSPt~CTiON REQUEST
stn eso ~aev. law)
See Instructions on reverse.
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING 559 243-8080 7/19/06 109 .
EVAWATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
MELAINE LINARES 157203444
cones
RESPONSE REQUIRED
~
~ t. ORIGINAL A. FIRECLEARANCE
LICENSING
TATE DEPT. OF SOCIAL SERVICES 2. RENEWAL s. LIFE SAFETY
AGENCY
NAwiEAND COMMUNITY CARE LICENSING _ s. cAPACITYCHANCE
ADDRESS 770 E, SHAW, SUITE 33O 4. OWNERSHIP CHANGE
FRESNO, CA 93710-778 5. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY PREVIOUS CAAAGTY CAPACITY PREVIOUS CAPAGTY CAPACITY PREVIOUS CAPAGTY
6 5 0 0 0 0 6
FAGLITY NAME
HASKELL RESIDENTIAL HOME #1
STREET N~DRESS (Adwl LoaRon)
4512 HAHN AVENUE
CITY
gAKERSFIELD, CA 93309
FACILITY CONTACT PERSON'S NAME
JUDI HASKELL (661) 323-9494
UGENSE GATEQQiT
ADULT RESIDENTIAL
NUMBER OF BUILDINGS
1.
RESTRNNT
NONE
HWRS
24 HOURS
sPECULCONDmoNs
1 ~ ~
~
1 E.. 8P ~
iDEwuv. coDE
y
CODES
FlRE gAKERSFIELD FIRE DEPARMENT ~IRECLEARANCEGRANTED
AUTHORRY
NAVE AND 1715 C H E ST E R AV E N U E 2: FlRE CLEARANCE DENIED
ADDRESS ~AKERSFIELD, CA 93301 "' °"~
B
CONSTRUCTION
.
C. FIRE ALARM
NiSPECTOR'B NAME (Tjpd aPrlnt~ TELEPHONE NUMBER CFlRS NUMBER OCC UPANCY CLA88 D' SPRINKLERS
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I E. HOUSEKEEPING
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V C -~,... F. SPECIAL FIAZARO
lISPECIION DATE INSPECT _~~RE (T a G. OTHER
E~LNN GENIAL OR LIST SPECUIL CONDITIONS