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~''~ KC MENTAL HEALTH DEPT
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~-~ 1401.E STREET
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BAKERSFIELD FIRE DEPT ;
Prevention Services ~~
FIRE PREVENTION INSPECTION B EF~RE I ~ 90o Truxtun Ave., ste. 210 ~i
ARrM t Bakersfield, CA 93301
Tel.: (661) 326-3979 ^ Fax: (661) 852-2171
DISTRICT BLOCK NO. DATE ~ ~ ~~ EE ~.C.~, /~"
FACILITY ADDRESS Lf ~ I C°?
'' CITY, STATE, ZIP ?i'
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77 J I ~ S
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FACILITY NAME //
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MANAGERS NAME
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BUSINESS OWNER'S
NAME AND ADDRESS CITY, STAATE, ZIP OWNER'S PHONE NO.
BILL TO: (IF FFE ENT FROM ABOVE) NAME, ADDRESS CITY, STATE, ZIP, BILLING PHONE NO.
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OCC TYPE OCC LOAD NO. OF FLOORS HIGH RISE BLDG RISER DATE
^ YES ^ NO
CORRECT ALL VIOLATIONS VIOLATION 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.)
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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,
~'4 by a person having a valid license or certificate. (U.F.C.)
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~ 7!~ Provide and maintain ",EXIT" sign(s) with letters 5 or more inches in height over each required exit (door/window) to
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SIGNS p` 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.)
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.C.)
10 Remove/repair (item & location) ____________________ _____ _ ________
__ ___________ Self-closing
_
doors shall be designed to close by gravity, or by the action f nical device or by an approved smoke and
s heat sensitive device. Self-closing doors shall have aE~a~m is capable of preventing the operation of the
closing device. (U.F.C.) ~ 4+
EXITS 11 Remove all obstruction from hallways. a 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 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.)
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 the Bakersfield Munici al Code B.M.C. re ardin fireworks.
OTHER 18
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CUSTOMER: ~ •-- LEGEND:
C.F.C. CALIFORNIA FIRE CODE
,' (Signature) (Please Print Name Legibly, Titie) U.B.C. UNIFORM BUILDING CODE
~ B.M.C. BAKERSFIELD MUNICIPAL CODE
INSPECTOR: `
~€ _ AP NO.: ~ N.F.P.A. NATIONAL FIRE PROTECTION
(.51 attire) ASSOCIATION
N.E.C. NATIONAL ELECTRIC CODE
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White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)