HomeMy WebLinkAboutBUSINESS PLAN:; , _ _
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~;~~IRE PREVENTION INSPECTION a Ei~RE' D
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BAKERSFIELD FIRE DEPT.
Prevention Services ~~~
900 Truxtun Ave., Ste. 210
Bakersfield, CA 93301
Tel.: (661) 326-3979 ^ Fax: (661) 852-2171
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DISTRICT BLOCK NO. DATE M~ ~, EE ry
FACILITY ADDRESS (' ~
~p TY, STATE, ZIP 3~'~i
FACILITY NAME MANAGER'S AME ~ FACILITY PHONE NO. ~
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BUSINESS OWNER'S NAME AND ADDRESS CITY, ST TE, ZIP OWNER'S PHONE NO.
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
O~G jYPE
~'. )G--" OCC LOAD NO. OF FLOORS HIGH RISE BLDG RISER DATE
^ YES ^ NO
CORRECT ALL VIOLATIONS VIOLATION
CHECKED BELOW No. REQUIREMENTS
MBUS
WASTE /DRY
C 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.)
O
TIBLE
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.)
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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 inches in height over each required exit (door/window) 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.)
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: t«,~.
(SI ~ f`e) (Please Print Name Legibly, Title)
INSPECTOR: AP NO.: "~
( igna ure) 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 - CustamerlOriginal Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)
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STATE Of ALIFORNIA
'FIRE SAFETY INSPECTION REQUEST
STD. 850(REV.10-94) See instructions on reverse.
AGENCY CONTACT'S NAME TELEPHONE NUMBER ~ REQUEST DATE PROGRAM
LATCC ~ 323 981- 3329 04/07/06 Group Home
EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
CJ Quitoriano 157806013
CODES
~--- --- 1. ORIGINAL A. FIRE CLEARANCE
LICENSING
2. RENEWAL B. LIFE SAFETY
AGENCY Department of Social Services
NAME AND Los Angeles and Tri-Coastal Counties 3. CAPACITY CHANGE
ADDRESS Children's Residential Program 4. OWNERSHIP CHANGE
1000 Cor
orate Center Dr
Suite 200A
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. 5. ADDRESS CHANGE
Montery Park, CA 91754 I
L__ -J 6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY '~ PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY
FACILITY NAME LICENSE CATEGORY
Sails X GH-730
STREETADDRESS (ActualLocation) NUMBER OF BUILDINGS
7617 Indian Gulch Street 1
CITY RESTRAINT
Bakersfield, CA 93313
FACILITYCONTAC7PERSON'SNAME '~ HOURS
Psyche Madden (661)665-9784 24/7
SPECIAL CONDITIONS
TO BE COMPLETED BY INSPECTING AUTHORITY
CLEARANCE/D AL CODE
CODES
_
FIRE Bakersfield City Fire Department _
_
_
1. FIR CLEARANCE GRANTED
AUTHORITY prevention Services
NAME AND 2. FIRE CLEARANCE DENIED
900 Truxtun Ave., SUlte 210
ADDRESS Bakersfield, CA 93301 A. EXITS
-
~J B. CONSTRUCTION
C, FIRE ALARM
-- ( p- ) ----
INSPECTOR'S NAME Tv =d orPdn!ed ~ ~~. 7F.LEPHONENUMBER ----- ---------
-T CFIRS NUMBER 7 OCCUPANCYCLASS D. SPRINKLERS
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E. HOUSEKEEPING
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F. SPECIAL HAZARD
INS ECTIONDATE
INSPECTOR'S ( pedorPri ! d) G. OTHER
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ECIAL COND IOPCS
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STaTE OF CAUiO~IA- F~I36TFiMm ~All1b-KS AG'ENGY C~lfWw-ha~ggRT~rror~ soGAt seivlces
Cai~Rlfa7"1' CgHE LiCEWS~i(3
FAClLlTY SKETCH (Haar Plan)
Appitcants are rsqufred ~ provide a sketch of the t~ ¢I2ui of the hams or facility drld outside yard. The floorsketch must: label rooms
such as the k3chen, bath, Uvftlg room, e~. Ctrcte the narltas of tits rooms that y-iq be u~d try daft`hesid~ttslG#tentstchiltfren. t]oor and
viitncou~r 8x~ ttnm the rooms must be shown to case of art emergency {sae Errtecgency Disaster Ptan)_ Show room ssr~ (a.g. 8.5 x
12). Keep close to state : Use_tha s~2ic~ below. Sea back for r~arci sketch.
SA}l_S X :7617 tndie~n Gulch St. BekersAcld, Ca. 933'! 8
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STATE OF CALIFORNIA -HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPART'MEN7 OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
FACILITY SKETCH (Floor Plan)
Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard. The floor sketch must label rooms
such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by staff/residents/clients/children. Door and
window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x
12). Keep close to scale. Use the space below. See back for yard sketch.
FACILITY NAME: ~/ ~ ADDRESS:
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37ATE ~ CPLa+OFW~- ~-'AtM~HUM~ut SER~CES?G[MCr
~AGiLlTY 5lCET~H (Yarxlj
cAtu~tN DEVARt7t6xiOP",~dtiu. sFRVk;E3
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The yard Sketch should show all buitdings in the yard including the home ~wwith na detaiq, garage and storage building.
Include walks, drtveways, pl2y area. fends, gates. Shaw any potential hazarzinus area such as pools, gt+sba~e storage.
anim8l pens. e~. Shaw the overall yard size, Try to keep the sixes close to sgie. Use the space below
FACtl.T'NAME: :--v.. _._ _. _,~.._.r. ~. _..-~. _ _ . _~-.-:. MONE85 ~._. ..___._~ _ _ -__~... _. =_r --~.r ._ .
SAILS X :7'647 Indkm dutch 3t 8akerslleld, Ca. 83313
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