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Home My WebLink AboutBUSINESS PLAN~~ ~~ /~~ ~~ MMES -JADE ~ ~ i~, 3151 JADE AVENUE ___ !~ --- - ~~ .~ . _ _ , i s' # T FIRE PREVENTION INSPECTION a EF/RE t D ARTM T BAKERSFIELD FIRE DEPT. Prevention Services `~~ 900 Truxtun Ave., Ste. 210 ~Y Bakersfield, CA 93301 Tel.: (661) 326-3979 ^ Fax: (66/1) 852-2171 c7"' DISTRICT BLOCK NO. DATE ~~ (\ "'"7 J / EE_ r~ ~-~I /~ ~ ~ C.~ % ` f FACILITY ADDRESS ,r' f'' / d~ { ~ 1 ~ ~ fi`V/ ..~ CITY, STATE, ZIP FACILITY NAME _ j 1 ~ ,~ ~F Q I ~ _.1 ~ Fj'( 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. OCGTYPE..,~ OCC LOAD" N0. OF FLOORS HIGH RISE BLDG A RISER DATE _ ~ ,---~ >/ ^ YES ,O NO 0{q\/;// CORRECT ALL VIOLATIONS VIOLRTION ~ REQUIREMENTS ~ CHECKED BELOW No. 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.} 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 (door/window) to SIGNS fire escape. (U.F.C.) g Provide and maintain appropriate nu ~a Gnjr sting background and visible from the street to indicate the C correct address of the building. (B.M. . )~ 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'. .) 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 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.) 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.) 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 t he Bakersfield M,u~nici al Code B.M.C. re ardin fireworks. // / OTHER 18 , fl ~ // ~{~ f ^ i ~ f ! I - ( f1 ^ ~"^"`"~"°""'- CUSTOMER: ~ I~ U ~ ~~ ~~ LEGEND: (SI r1 8tre) (Please Print Name Legibly , Title) C.F,C. CALIFORNIA FIRE CODE U.B.C. UNIFORM BUILDING CODE , ~~ rE ~ ~,-- ~ ~ ~ ~ B.M.C. BAKERSFIELD MUNICIPAL CODE t ' _' INSPECTOR: ~ AP NO.: / ~''~ N.F.P.A. NATIONAL FIRE PROTECTION (Signature) ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE nor-i~eu White -Customer/original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05) r -,- ~'~' '~` STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST See instructions on reverse. STD. 850 (REV. 10.94) AGENCY CONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM LATCC 323 981-3324 07/19/07 Group Home EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REOU EST CODE Elnora Smith 157806037 lA CODES LICENSING ~ AGENCY Department of SOCIaI Services 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY NAME AND Los Angeles and Tri-Coastal Counties 3. CAPACITY CHANGE ADDRESS Chlldren~S ReSlderitlal Program 4. OWNERSHIP CHANGE 1000 Corporate Center Dr. Suite 200A 5. ADDRESS CHANGE Montery Park, CA 91754 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY ~ PREVIOUS CAPACITY 4 4 FACILITY NAME LICENSE CATEGORY AIMES JADE GH-730 STREET ADDRESS (Actual Location) N UMBER OF BUILDINGS 3151 Jade Avenue 1 CITY RESTRAINT Bakersfield, CA 93306 FACILITY CONTACT PERSON'S NAME HOURS Misty Varner (661) 327-3332 24/7 SPECIAL CONDITIONS TO `BE COM?,LETED BY INSPEC'PING AUTHORITY FIRE Bakersfield City Fire Department AUTHORITY prevention Services NAME AND 900 Truxtun Avenue Suite 210 ADDRESS Bakersfield, CA 90031 L.___. INSPECTOR'S NAME (Typed orPrinfedJ TELEPHONE NUMBER ~5~ O~ra~. ~~6 3~F I ECTION DATE INSPECTOR'SS AT dorPrinfed) -a .~ EXPLAIN DENIAL ORLI TSPECIALCO ITIO S ~NT'D ~ ~! ~. ~ ~ ~~~~` CFIRS NUMBER ~ OCCUPANCYCLASS CODE CODES 1~FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER ~~ .. _ ~`- - STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD.850 (REV.10-94) (REVERSE) INSTRUCTION S This form is designed for use with a window envelope Licensing or Requesting Agencies--Complete the following 19 sections on this form before submitting it to the fire authority having jurisdiction. 1. AGENCY CONTACT, 2. TELEPHONE NUMBER, 5. EVALUATOR. Enter the name and telephone number of agency contact person. 10. FACILITY NAME. Insert the name of the facility as it will appear on the license. List identifying sub name ifkno~vn (i.e., Hacienda CorpJMedina Lodge). 3. PROGRAM. Licensing agency use. 4. REQUEST DATE. Enter date. request vas prepared. 11. LICENSE CATEGORY. Insert the category of license being sought as it will appear on the license certificate. 6. REQUESTING AGENCY FACILITY NUMBER. This 12. ADDRESS. Insert street address and city only. A post is the file number assigned by the licensing agency. office box is not acceptable as only location. 7. REQUEST CODE. Use the seven codes shown and insert 13. NUMBER OF BUILDINGS. Insert the total number of buildings to be used for housing of the occupants covered by the appropriate number in the bo_x following "Request Code". If _the-license. __ __ _ __ __" _ . _ _ NAME CHANGE, please-list previous name. Insert date of ~ - -' - ~-l - original request is other than an original. 14. RESTRAINT. Indicate if physical restraint (locked in a 8. AGENCY NAME AND ADDRESS. Enter the name and room or the building) is to be used in the housing of the address of the licensing facility requesting the inspection. occupants. 9. AMBULATORY--NONAMBULATORY--BEDRID- DEN. Capacity: Insert in the appropriate section, the capacity of licensed ambulatory or nonambulatory oc- cupants covered by this request. 15. FACILITY CONTACT PERSON--TELEPHONE NUMBER. Indicate the name and telephone number of the responsible individual at the facility to be contacted by the fire authority. 16. HOURS. Indicate the number of hours the occupants are housed at the facility (less than 24 or 24+). Previous If request is for renewal or capacity change, 17. SPECIAL CONDITIONS. Indicate any conditions Capacity: insert capacity of previous clearance. unique to this request. As an example, if the inspection Total Show total licensed capacity. If the facility is request is for one building in amulti-building facility. Capacity: intended to house part ambulatory, nonambu- latory, and part bedridden, show the total of the three types of occupants. FIRE AUTHORITY CONDUCTING THE INSPECTION--COMPLETE THE FOLLOWING: 18. FIRE AUTHORITY, NAME AND ADDRESS. Insert 22. OCCUPANCY CLASSIFICATION. Use California the name and address of the fire authority where the facility is Building Code occupancy classifications and insert the located. occupancy determined by the inspector. 1.9. CLEARANCE/DENIAL CODE. Use the two codes: 1 23. INSPECTION DATE. Enter the actual date of the for clearance granted, and 2 for clearance denied. If denied, inspection. also include the appropriate letter code. As an example, Denial 24. INSPECTOR'S SIGNATURE. To be signed by the based upon exiting would be coded 2A. inspector conducting the inspection. 20. INSPECTOR'S NAME. Print the initial of the inspector's first name and full last name; insert the telephone number where the inspector may be contacted. 21. CFIRS LD. NUMBER. Insert the fire department's num- ber assigned by California Fire Incident Reporting System. 25. EXPLAIN DENIAL OR SPECIAL CONDITIONS. If clearance code #2 is used, briefly explain reason. This space is also to be used to specify any additional limitations placed by the fire authority, such as the use of certain floors or sleeping rooms approved for nonambulatory clients. ' ... . ~ STATE OF CAIJFORNA • IfILLlH AJD FUW W : :.S AL38K.Y CHLAFORNN DEPARTUE~IT OF 90CIAl SERVICES - COWAUNfTYGRE LICENSING FACILITY SKETCH (Floor Plan) Applicants are required to provide a sketch of the floor plan of the home or fadliry and outside yard.' The floor sketch must label rooms such as the kitchen, bath, living room, etc. Cirde the names of the rooms that will be used by stafUresidents/dients/dUldren. Door and window opts from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x 11 Keep dose fo scale. Use the space below. See-bads for yard sketch. FACYl1TY NA1AE: ADDRESS: AIMES Jade 3151 Jade Ave Bakersfield, CA. 93306 J 4 (~ Li UC GGG (]NC) - s s .- i~ .: ti STATE of aV.IFORriA • IEALTM APD NUwN s s AGEN(.'Y CALIFORNIA DEPNRTI@fT OF SOCIAL SERVICES . CC-A-1UNfTY CARE LICEhiSING FACILITY SKETCH (Yard) The yard sketch should show all buildings in the yard including the home (with no detail), garage and storage building. Indude walks, driveways, play area, fences, gates. Show any potential hazardous area such as pools, garbage storage, animal pens, etc. Show the overaN yard size. Try to keep the sizes dose to scale. Use the space below. FACILITY 11AIAE: ADORE3S: AIMES Jade 3151 Jade Ave Bakersfield, CA. 93306 J