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FIRE PREF~E~NTION INSPECTION >3 EP~RE t
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BAKERSFIELD FIRE DEPT. ^~~
Prevention Services ' ~(,~
900 Truxtun Ave., Ste. 210 C
Bakersfield, CA 93301.
Tel.: (661) 326-3979 ^ Fax: (661) - 171
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DISTRICT BLOCK NO. DATE ~/~ ,e ~ ~ ~/ EE ~ ~ ~-~ i
FACILITY ADDRESS ') ~~~1 ~ (^ ~.,~
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~ CITY, STATE, ZIP
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FACILITY NAME MANAGER'S NAME ~~ FACILITY PHONE NO. Q
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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.
Ot;~C TYPE OCC LOAD
~~'' NO. OF FLOORS HIGH RISE BL G 'RISER DATE
^ YES ~NO
CORRECT ALL VIOLATIONS VIOIRTION
CHECKED BELOW no. ( REQUIREMENTS
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.)
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 & size) __________________ portable fire extinguisher to be
immediately accessible for use in (area) _____________________________ (U.F.C.)
6
I Re-charge all fire extinguishers. Fire extinguishers shall be serviced at least once each year, and/or after each use,
j by a person Having a valid license or certificate. (U.F.C.)
.SIGNS i 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/
I ~
9
~ ~ Re air all. cracks/holes/o enin s m taster in location Plasterin
P ( P 9 )~ P ( )-------------------------------- g
shall return the surface to its original fire resistive condition. (U.B.C.)
F
RE SEPARATIONS
10 I
~
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 ~ I or /or other obstructions from fire escape landings and stairways stair shafts. (Fire
p~s/~ja~s a e to be maintained free from obstructions at all times.) (U. F. C.)
~ ELECTRICAL APPLIANCES I
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 i 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 Muni i al Code B.M.C. re ardin fireworks.
OTHER 18 ~7
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CUSTOMER: .~~C~1-=( -~"ar'.('~_~~
" SI natul'el ~ Please Print Name Le I
g ~ ( g' .y, Title)
INSPECTOR: _ _ ~ ~/~_/f.~ AP NO.:
~ 14 ~(SlgnatUfe) V 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
KBF-7320
White -Customer/Original Yellow -Station Copy Pink -Prevention Services
FD 2022 (Rev. 09/05)
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STAFF OF CAUFCiM IA' `f~
FI tE SAFETY INSPECTION REQUEST
sn aso (REV. ~o-a~)
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See lristructlons on reverse.
AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM ~'~
COMMUNITY CARE LICENSING 559 243-4023 10-13-06 109
EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER RECIUEST CODE
PATRICIA POLANCO 153904066 5A
RESPONSE REQUIRED coDEs
~
~ 1. ORIGINAL A. FIRE CLEARANCE
LICENSING
TATE DEPT. OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY
AGENCY
NAME AND COMMUNITY CARE LICENSING s. CAPACITYCHANGE
ADDRESS 770 E. SHAW, SUITE 3OO 4. OWNERSHIP CHANGE
FRESNO, CA 9371 O 5. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER
AMBULATORY• NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY
14 $ - - - - 14
FACILITY NAME LICENSE CATEGORY
SCHULTZ/BEATY FCC FAMILY CHILD CARE
STREET ADDRESS (Adwl LxatlatJ NUMBER OF BUILDINGS
11220 PRAIRIE STONE PLACE 1
Cmr RESTRaNr
BAKERSFIELD 93311 NO
FACILITY CONTACT PERSONS NAME NDURS
TERESA SCHULTZ 661 663-0882 DAYTIME
sPEC~AL coNOmoNs
PLEASE CHECK ALL ROOMS INCLUDING THE GARAGE
I~ ;,e ~ ~;,~~ ti4tY ~~i-' t(.tl' _ t~ ~t "'~,:utl~~' ',' ~"'' ~?~s "i ,x. a~,'.
. _ .., ~ ~,~ f£; - ~'rQ~BE COMPLEfED~ BY IN8PECT(FKi AUTHORITY." ~ ~' ~ ~ ~ _ . _ ..
BAKERSFIELD FIRE DEPT.
FlRE
AUTHORITY g00 TRUXTON AVE. #210
NAIAEAND BAKERSFIELD, CA 93301
ADDRESS
L-
M~lSPECTOR'SNAME (Tj~paCaPrhbd) TELEPHONE NUMBER
WSPECTION DATE INSPECTORS TU E • ypad a P e~
EXPLALN DENIAL OR LIST SPECIAL CONDITIONS
CFlRS NUMBER OCCUPAnCY CLASS
CLEARANCE /DENIAL CODE
../
-TCODES
/IRE CLEARANCE GRANTED
\`2. FlRE CLEARANCE DENIED
A. EXITS
8. CONSTRUCTION
C. FlRE ALARM
D. S~'RINKLERS
E. HOUSEKEEPING
F. SPECIAL HAZARD
c. oTHER