HomeMy WebLinkAboutBUSINESS PLAN.~~ rKERN TRANSITION HOME
C_'~_ 4409 RIVER GLEN DRIVE
07/27/2006 14:59 3239813309
- -- - -- -- - -- DDS CCL PAGE 03/03
STAT E OF CALIFORNIA
PORE SAFETY tNSPECTt~?N REQUES"T"
See irtst'I'uC~iotts on rotr~rse,
BTD.a5o(REV. ~aeat
AGENCYCOi~A SNAME TEtLFkONENUMBI:R RE4UE9TOA'I`'E PROGRAM
_ L.A~CC 323 981-3324 07/13!2006 Group Home ~_
EVALUATgR'S NAMC+ REOUESTINGAGEiNCYFACU_I't'YNUMBER REQUE3TCODE
]rzeg7uel Rodriguez,
--- - ----~ 1-5780416 _ lA
cages
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` 1. ORIGINAL A. FIRE CLEARAN
E.iCENSfNG 2. REIJSWAL S. LI1:E SAFETY
AQENCY Deparhnent of Social Services
NRAl1E AND L.US Angeles 3tid Tri-Ghosts! Cou>~tie$ 3. CAPACITY GRANGE
Ai3gRESS Cl>.ildre>a`s Residential Program e. OWNERSHIP CHANGE
1000 Carporatc Center Dr, Suite 200A s. ~>,DRE3s CHANGE
~Montcry Parlc, CA 91754
s. NAME GwANaE
7. OTHER
CAPACVTY - PRE4101lSCAPACITY CltPAC1TY ~ PREVIOU6CAPACITY CAPACITY I PREVIOUS CAPACITY ~
3 _.-.,. 1 ~ ~, _____.I ^-_ 4 -
FAGLI7YNAME~ LIGENSECATEt50RY
Kern TranFi.tion Hot7Te-River Glen __ Gl'-].-730 __ _
STREE?ADDRESS(ANUa1LWSiMnn) ~ ~ ~ .,,.~. ~ -~ t`IUMBFROPAUILbIN~S
4409 River Crl.en Dz. 1
CITY - ----~ --- .,~_.~.._-_~ - ...-_._....-.-.~- ---r. ,. -- - ..._-_..~-.~.... RE9TRAIM' r _
Bakerafic]d,, CA 93308
?AGILITY GON7'AC. f PL-R$PN'S NAME ~ ~ HOUR$ --•
Suzazuae Ash. (661) 213-3800 24/7
$PECI/4LCfjNDITIONS r„
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' ~ CLEARANCElDENIALCODE
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f"4R8 B3lcersfi@1d City :Eire Department 1. FIRE CLEARANC>: CyRANTcD
AUTHORITY prevention Servi.eCs
NAME ANQ 900 TruXt733! Ave., Suite 210 ~t. FIRE CLEARANCE DI~NIcp
ADaRE55 BRllcersfield. CA 93301 A. ExITS
~ B- CONSi'RUCTtpN
C,- FIRE AIARM
INyPECTOR~SNAMEfT.r~adrn'FilnfFdj ___. J ~~-TELEPI-IONENUM6E.R ~ CI-LRSNUMBER OCCUF'ANCYCUIS3 P, SPRI!+IKLERS
' ~ ) E, HOUSEKEEPING
_ F. SPECIAL HA7l4RD
INSPEGTIONDAT@~~ INSPECTOR'S 3IONATURE(TypedorFnlrl~ G. OTHF_R
__
E7SPLAIN DENIALOR LIST SPECIAL CQNO7TlONS -~- ~~~'-~
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07/27!2006 14:59 3239813309 DDS CCL
Sir,
If no one is at the home, please contact Jermaine
VIlatk+ns at 661-8~ 1-74 ~ ~ .
'hank you.
~ -_
PAGE 02/03
~ 07/27!2006 14:59 3239813309
DDS CCL
PAGE 01/03
State a-~ ~a~ifornia f~~~~r~~r~r~t of c~c~~af ~~ervice~
1 ~~~ -Cc~~~c~:r~a~e ~~:r~t~~- ~r~w ~~~~~~
t~~nt~r~~ Park, ~~ J1 ~~~
DATE: 7~~7/06
FAX NUMBER:~G~/~ g~c`~ ~ ~ f ~~
-ro: ~1~: ~,~F~ ~c Y
2~~,~,
... -~~~ r~~ f .
TOT~4,L NUN~BER OF PAC,aES ~inc{uding this cover sheet}: ~..
Regional IUlanag~r: Jaan ~~en.
"telephone (323) 951-330Q
. ~ . . Fax 1323) 981-3309
._a
~:_~
e.~~, _ t' / ~y:"`: ~ -"z-:~5'^"~i<T. ~ Y~~ ~~ f~~'., - ... Y"ter 1~ ~ } ~I
~~ ~,~. ~~~ ` "~ =•~ BAKERSFIELD FIRE DEPT.
~7! _
~~ .. 5~
~= Prevention ervices /~
FARE PREVENTION INSPECTION B EF/1rE I D 900 Truxtun Ave., te. 210 ~~ 1
ARfM T S i
,._,, Bakersfield, CA 93301
' ~ Tel.: (661) 326-3979 ^ Fax: (661) 852-2171
DISTRICT BLOCK NO. DATE ~ ~_~ EE
FACILITY ADDRESS O CITY, STATE, IP
FACILITY NAME ~ _ MANAGE S NAME ~~ F ILITY PHON O~
BUSINESS OWNER'S NAME AND A RESS CITY, STATE, Z OWNER'S PHONE NO.
BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS / /~ ~ ~t~f/ lei( ~ ~ O
, CITY, STATE, ZIP, BILLING PHONE NO.
O ~C TYPE OC L • AD NO. OF
FLOG QG ~ RISER DATE
HIGH RISE BL
~
^ YES NO
CORRECT ALL VIOLATIONS wo~~TioN REQUIREMENTS ~
CHECKED BELOW wo.
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 8 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.)
SIGNS 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height ~~t~iFed~tip(d indow) to
v ~~ ~~JJ
fire escape. (U.F.C.)
o0
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
FIREDOORSI
FIRE SEPARATIONS shall return the surface to its original fire resistive condition. (U.B.C.)
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 the Bakersfield Munici al Cod
ireworks.
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OTHER 18 ~
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' LEGEND:
`"~ Sign ture) (Please Print Name Legibl Title) C.F.C. CALIFORNIA FIRE CODE
U.B.C. UNIFORM BUILDING CODE
~ B.M.C. BAKERSFIELD MUNICIPAL CODE
INSPECTOR: y1 AP NO.: N.F.P.A.. NATIONAL FIRE PROTECTION
(Signature) I
N.E.C. NAT ONAL
ELECTRIC CODE
White - CusfomarlOriginal Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05)
STi~TEOFCALIFORNI~ .~
r
t=iRE 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 05/15/06 Group Home
EVALUATOR'S NAME REQUESTING AGENCY FACILITYNUMBEf2 ^ REQUEST CODE
Esequiel Rodriguez 15780616
------
._ lA
-- ---- - CODES
----~ 1. ORIGINAL A. FIRE CLEARAI
LICENSING 2. RENEWAL B. LIFE SAFETY
AGENCY Department of Social Services
NAME AND Los Angeles and Tri-Coastal Counties 3. CAPACITY CHANGE
ADDRESS Chlldren'S Resideritlal Prograril 4. OWNERSHIP CHANGE
1000 COrpOTate Center DI
SUlte 200A
. 5. ADDRESS CHANGE
Montery Park
CA 91754
,
l ~ 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
Kern Transition Home -River Glen GH-730
STREETADDRESS(Actu~lLoration) - ~ '- NUMBER OF BUILDINGS -
4409 River Glen Dr. 1
CITY -~--- ---- --_--~- ----~--------~ RESTRAINT ---
Bakersfield, CA 93308
FACILITY CONTACT PERSON'S NAME HOURS
Suzanne Ash ~ `~, ~ ..,.~ "~ ~~(g ~.~- 24/7
SPECIAL CONDITIONS
TO BE COMPLETED BY INSPECT{NG AUTHORITY' ~''~
CODES
FIRE Bakersfield Clty Fire Dept. `IRE CLEARANCE GRANTED
AUTHORITY Prevention Services
NAME AND ~ C)O~ TrUXiUri AVe. SUlte 210 2. FIRE CLEARANCE DENIED
ADDRESS Bakersfield, CA 93301 A. EXITS
L_ _~ B. CONSTRUCTION
C. FIRE ALARM
- - ------- - -- -- D. SPRINKLERS
INSPECTOR'SNAME(TypcdorPrinted) TELEPHONE NUMBER CFIRSNUMBER OCCUPANCY CLASS
E. HOUSEKEEPING
,--
~'- ~/~„/~,_,_ F. SPECIAL HAZARD
INS CTInON//D~~ATE INSPECTOR'SS TU E( pedorPrinterl ~ G. OTHER
~AINDENIALORLISTSPECIALCONDI ONS -
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STATE OF CALIFORNIA -HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
F~4CDLiTY SICETCf-I (Yard)
The yard sketch should show all buildings in the yard including the home (with no detail), garage and storage building.
Include walks, driveways, play-area, fences, gates. Show any potential hazardous area such as pools, garbage storage,
anima! pens, etc. Show the overall yard size. Try to keep the sizes close to scale. Use the space below.
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ADDRESS:
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STATE OF CALIFORNIA • HEALTH AND HUMAN SERVICES AGENCY
~/4CILBTI(_SKETCH (floor Plan)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNRY CARE LICENSING
Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard. -The floor sketch must label rooms
such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by staff/residents/clients/children. Door and
window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan}. Show room sizes (e.g. 8.5 x
12). Keep close to scale. Use the space below. See back for yard sketch.
F^^ACILRYNAME{{'': ''. f'~ ADDR(ES~S: ^i~ ~, r.
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