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~~ NORMA BARRIOS _ _ --- }- -_ -
- - '~ 8315 ROCKPORT DRIVE _ _~ ~
TATE OF CALIFORNIA
=IRE SAFETY INSPECTION REQUEST
TD. B50 (REV. 10.94)
See lnstructlons on reverse.
GENC CONTACTS NAM
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VALUATOR'S NAME ~
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AGENCY 1 2. RENEWAL B. LIFE SAFETY
NAME AND ~; ~!~ ~+`~ 11.f 1 "~- •`~_ 3 c~ ~ ' r~
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6. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY
APACITY PREVIOUS CAPAGTY CAPACITY PREVIOUS CAPAGTY CAPACITY PREVIOUS CAPAGTY
>CILITY NAME. UCH ATEGORY 'Y
MEET ADDRESS (Actual Location~~ ~ -!
i \ NUM IER OF BU LDINGS
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\CIUTY CONTACT PERSON'S NAME H R
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~ECIAL CONDITIONS
`TO BE COMPLETED BY INSPECTING AUTHORITY ~~~'
CLEARANCE IAL CODE
FIRE ~ 1~'"a,...1''K-~. ~ 131 ~.J~ ~'~ ~ 1 ~ ~ t../~.. ~„~ V~
AUTHORITY lq ~`f-~ ~~~`- ~ ~ ('~ i
NAME AND ~ Vl_ l.~ \'~ ~ L3 ~~ ~ ~ ~~~ ~_ ~ ~ `~-~ 1
ADDRESS 1 ~
SPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER
S~TION DATE INSPECTOR'S S t~A'TLRE orP " ed)j
1~FfRE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
D. SPRINKLERS
OCCUPANCY CIASS
~ E. HOUSEKEEPING
F
SPECIAL H
` .
AZARD
G. OTHER
PLAIN DENIAL OR UST SPECIAL CONDITIONS
B A K E R S F I E L D
FAX Transmittal
COVER SHEET
FIRE DEPARTMENT
PREVENTION SERVICES
1600 Truxtun Avenue, Suite 401, Bakersfield, CA 93301
Business Phone (661) 326-3979 • FAX (661) 852-2171
TO:~~~ m~~-~-p ~ NO.OF PAGES: 2
COMPANY: CC,. I,_ FAX NO.: (S~~
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FROM: ~~~~ 1cJV1rO.i~--~
COMMENTS:
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,;-•.. FIRE PR VEN'TION IN'SPE..CTION FIRE 900 ~'r-uxtun Ave., Ste. 21O
ARTM T s
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~; 2, (,-, ~' ~ \pz, ~" ~ ~ Tel,; (661) 326-3979 0 Fax: (661) 2-2171
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'DISTRICT - BLOCK NO. ~ - DATE~,~ EEC` ~' ~~'~="
FACILITY ADDRESS~~ ~~ ~~`~/~.~. i ~~ i ~ ~~ 1 t CITY, STATE, ZIP
FACILITY NAME o 1 ,._ / /
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BUSINESS OWNER'S NAME~AND ADDRESS ~ CITY, STATE, ZIP ~ ~ OWNER'S PHONE NO.
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BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS `~. ~ CITY, STATE,~ZIP, ~ _ .BILLINGPHONE~NO:
OCC-TYPE OGC LOAD
~-~ NO. OF FLOORS `'
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~ t HIGH RISE BLDG
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CORRECT ALL'~VIOLATIONS wo~nnoN REQUIREMENTS ~ -
CHECKED BELOW ~ eo. - ~ - ~ ~ ~ ~ ~ - - -
1 II hazardous refuse and dry vegetatidn on the above premises.(U;F.G:)
Remove and safely dispose of_a
COMBUSTIBLE WASTE I DRY _
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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.)
OMBUSTIB
E STO
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Relocate combustible storage to provide at least 3 feet clearance: around motor fuse boxlfire dpor (N
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q Relocate fire extinguisher(s) so that they will be in a conspicuous location, hanging on brackets with the top to the
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^F extinguisher not more than 5 feet above the floor. (N.F.P.A. No. 10) _.- - ""
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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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Re`=charge all fire extinguishers. Fire. extinguishers shall be serviced at least once each year, and/or after each-use,
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person having a valid license or certificate. (U.F.C.)
by a
' 7 Provide and maintain "EXIT" sign(s) with letters 5 or more inches in height over each required exit (door/window) to
sIGNS 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 SEPARA
IONS shall return the surface to its original fire resistive condition. (U. B. C.) ~
~ - ~ -
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10 Remove/repair (item & location) ________________ ________ __ ____. _______
__ _________ ~If-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:) 'y;
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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 (I~cation)
______________ _______________ 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.)
~q Extehsion 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 1 _,
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.
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FIREWORKS 17 `Violations of Section 7802 U:F.C. or 8.49.040 of the Bakersfield Munici al Code B.M.C. to ardin fireworks.
OTHER 18 ~
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CUSTOMER: ~~C~•~. (',111"2
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' ``(Signature) ^`~. (Please Print Name Legibly,, Tllle)
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~ C.F.C. CALIFORNIA FIRE CODE '
•U.B.C. UNIFORM BUILDING CODE. `
B.M.C... BAKERSF`IELD MUNICIPAL.CODE
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INSPECTOR: .,. .Jf,!'"a.~w._. AP NO.:
_,,_. N.F.P.A. .NATIONAL FIRE:PROTECTION
t ~ (SlgnatUre) ASSOCIATION
N.E.C. NATIONAL ELECTRICCODE
White -Customer/Original Yellow -Station Copy Pink.- Prevention Services ~ FD 2022 (Rev.' 09/05)
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INSPECTION $1=,11"'c'T'^"'
Business Address:
Contact Name:
Ro ~~~~ ~~~ds
Telephone No.: ~~ ~ 7 6 ~
Cell No.:
FSI Type: ~ ~Y ,C
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Assigned to fnspector•~y ~~"'~ '
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