HomeMy WebLinkAboutBUSINESS PLANI'i '~ ~! COVENANT GUEST HOME
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FIRE PREVENTION INSPECTION B ~F,RE'
D ARTM T
BAKERSFIELD FIRE DEPT.
Prevention Services t ~~
900 Truxtun Ave., Ste. 210 ~~ (O
Bakersfield, CA 93301
Tel.: (661) 326-3979 ^ Fax: (66 852-2171
DISTRICT BLOCK NO. DATE ~ ~ ~~ . ~\ '~J
~ l f EE ~ .may ~ C
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FACILITY ADDRESS ~"~~ ^~/ ~~~,~,/~., ~~ ~``,~ CITY, STATE, ZIP Cy~'~(r'1 / r
FACILITY NAME _ 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.
OC¢,~TYPE`
,.--- OCC LOAD
.~.,,., NO. OF FLOORS
% HIGH RISE B fDG
^ YES l~l NO RISER DATE
OUP
CORRECT ALL VIOLATIONS VIOLATION
CHECKED BELOW No. ~~ REQUIREMENTS ~
IBLE WASTE /
Y 1 Remove and safely dispose of all hazardous refuse and dry vegetation on the above premises (U.F.C.)
COMBUST
DR
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.)
q 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 8 size) __________________ portable fire extinguisher to be
immediately accessible for use in (area) __________________________ __ (U.F.C.)
g Re-charge all fire extinguishers. Fire extin r~ e~e is east once each year, and/or after each use,
by a person having a valid license or cer ( ~ '•.
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.)
FIREDOORSI
FIRE
EP
RATIONS g Repair all (cracks/holes/openings) in plaster in (location) ______________________________________. Plastering .
shall return the surface to its original fire resistive condition. (U.B.C.)
A
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 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: ~"Ci~~.-~-~'- ~~ UC~W`,..a~ (~ l~Gf ~'~%~,`M fL
! ~ (Signature) (Please Print Name Legibly, Title)
`,!~ ~ I ~t ~/)
INSPECTOR: ;` ,~.f~i I ~ r^~ ~_._ _ AP NO.: y' ~
(Signature) 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
ncr-r~eu
white -Customer/Original ~ Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)
`~~ INSPECTION RECORD
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Bakersfield Fire Dept.~~ ~~,
1715 Chester Ave. '!'gi1/0
Bakersf field, CA 93301 4?p06
~~~15 I i
DATE:
"` " V FACIL~I'}TtY ADrDRESS},:.~,~ ~`
CSI? ~'P L ~~-~L~ti' ~ ~ I D
~' ""~'~-~ ZIP:
~~~ ~ ~° FE
~.c~y
FACILITY NAME:
MANAGER NAME:
BUSINESS OWNER NAME, ADDRESS, ZIP CODE ~ ~--~-~ FACILITY PHONE ~~ ~ ~" ~ ~ ~,,,
BILL TO: (IF DIFFERENT FROM ABOVE}-NAME, ADDRESS, ZIP CODE, PHONE No.
OCC E OCC LOAD No. OF FLOORS
e HI RISE BLDG.
YES O NO n RISER DATE
~/ ~"'-
VIOLATION NOTICE CORRECTION:
1. DATEbFREINSPECTIOIV
~~
3.
4.
5.
6.
7.
8.
9.
10.
11. ~
12.
13.
14.
15.
NOTES
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y
CUSTOMER:
/~~"~~/~- ~ ~~'~'~---
(
INSPECTOR:
t _ __._. ,Q
AP No. I ~ FIRE PREVENTION SERVICES
(661) 326-3979
WHITE ORIGINAL-OWNER YELLOW-INSPECTOR'S COPY PINK-FILE
FD1952
.,-
STATE OF CALIFORNIA
Fli~t'SAFETY INSPECTION REGIUEST
sTO. eso IREV. laws
See Instructions on reverse.
AGENCY CONTACTS NAME ~ TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING 559 243-8080 12/06/05 109
EVALUATOR'S NAME REQUESTING AOENCV FACILITY NUMBER REQUEST CODE
SHELLY KINKEAD 157203253 7A
RESPONSE REQUIRED coDEs
LICENSING ~ STATE DEPT. OF SOCIAL SERVICES ~ 1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. UFESAFETY
AGENCY
NAME AND COMMUNITY CARE LICENSING 3. CAPACITY CHANGE
ADDRESS 770 E. SHAW, SUITE 33O 4. OWNERSHIP CHANGE
FRESNO, CA 93710-778 5. ADORESSCHANGE
6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPAGTY PREVIDUS CAPACITY CAPACITY PflEVIDUS CAPACITY CAPACITY PREVIDUS CAPACITY
0 4 6 2 0 0 6
FACILITY NAME ~ LICENSE GATECiGHY
COVENANT GUEST HOME ELDERLY
STREET ADDRESS (Adw/ LoCaNon) NUMBER OF BUILDINGS
2626 KAIBAB AVENUE 1
CITY RESTRAINT
BAKERSFIELD, CA 93306. NONE
FAGUTY CONTACT PERSON'S NAME _ HWRS
ELSIE DEL VALLE 661 871-8172 ?~~7-~~±~s01 24 HOURS
sPEGAL coNOmONS
CHANGE IN AMBULATORY STATUS.
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FlRE gAKERSFIELD FIRE DEPARTMENT
AuTHORm
NA~IEAND g00 TRUXTON AVE., SUITE 210
ADDRESS gAKERSFIELD, CA 93301
MISPECTORS NAME (Tjyad a PrnrtW) TELEPHONE NUMBER
p~ISPECTION DAT'EG~~ INSPECTORS SKi RE a Primtrd)
~ EXPLAIN GENIAL OR UST SPECIAL CAN T10NS ~
CLEARANCE IAL CODE
CODES
1. F E CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. EXITS
8. CONSTRUCTION
C. FIRE ALARM
CFlRS NUMBER OCCUPANCY CLASS D. SFR11vKLER9
E. HOUSEKEEPING
~vCJs `~C~-~ F. SPECIAL HAZARD
G. OTHER