HomeMy WebLinkAboutBUSINESS PLAN
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E.J. GUEST HOME
, 2418NOBLEA~E~,
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~\~ECTION RECORD
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FACILITY NAME:
MANAGER NAME:
BUSINESS OWNER NAME, ADDRESS, ZIP CODE
BILL TO: (IF DIFFERENT FROM ABOVE}-NAME, ADDRESS, ZIP CODE, PHONE No.
1.
2.
3.
4.
5.
6.
7.
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I Bakersfield Fire Dept.
1715 Chester Ave.
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ZIP:
"?30(o
FE:C(3~
_FACILITY PHONE '57:2.. - ~5 ??
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HI RISE BLDGi./ RISER A
YES [J NO 7'\ I
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DATE OF REINSPECTION
9.
oov JAN3 0 2006
10.
11.
12.
13.
14.
15.
NOTES
CUSTOMER:
APNo.
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INSPECTOR:
FIRE PREVENTION SERVICES
(661) 326-3979
WHITE ORIGINAL-OWNER YELLOW-iNSPECTOR'S COpy PINK-FILE
FD1952
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FIRE SAFETY INSPECTION REQUEST
sro ll!lO (REV. 11>-94)
See Instructions on reverse.
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
COMMUNITY CARE LICENSING (559 .) 243-8080 01/11/06 109
EVAlUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST COOE
#134 DIXIE WRIGHT # 157203269 1A
RESPONSE REQUIRED CODES
rsT A TE DEPT OF SOCIAL SERVICES I 1. ORIGINAL A. FIRE CLEARANCE
UCENSlNG 2. RENEWAL B. LIFE SAFETY
AGENCY
NAME AND Community Care Licensing Branch 3. CAPACITY CHANGE
ADDRESS 770 E, Shaw Avenue, Suite 330 4. OWNERSHIP CHANGE
Fresno, CA 93710 5. ADDRESS CHANGE
L ,.-J 6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY
-6- -0- -0- -0- -0- -0- 6
FAClUTY NAME UCENSE CATEGORY
E. J, GUEST HOME 735-ARF
STREET ADDRESS (Actual Loc/JIion) NUMBER OF BUILOlNGS
2418 NOBLE AVENUE 1
CITY RESTIWNT
BAKERSFIELD. CA.93306 NONE
FAClUTY CONTACT PERSON'S NAME HOURS
CONRADO MANABAT & EDITH ADM/L 24 HOURS
SPECIAL CONDITIONS
TELEPHONE: 661-872-6599
ARE
AUTHORITY
NAME AND
ADDRESS
rpREVENTION SERVICES
900 TRUXTON AVENUE, STE 210
BAKERSFIELD, CA. 93301
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0,/RE CLEARANCE GRANTED
; FIRE CLEARANCE DENIED
A. EXITS
B. CONsmucTlON
C. FIRE ALARM
D. SPRINI<l.fRS
E. HOUSEKEEPING
F. SPECiAl HAZARD
G. OTHER
INSPCCtOR'& NAME (Typed or PmNd)
E-sli-u- OV//J--
lElEPHONE NUMBER CARS NUMBER OCCUPANCY ClASS
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