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HomeMy WebLinkAboutBUSINESS PLANFARE PREVENTION INSPECTION a EF~RE' A /r fM T BAKERSFIELD FIRE DEPT. Prevention Services 900 Truxtun Ave., Ste. 210 Bakersfield, CA 93301 Tel.: (661) 326-3979 ^ Fax: (661) 2- 1:~ i DISTRICT BLOCK NO. DATE EE FACILITY ADDRESS' ~~© CITY, STATE, ZIP FACILITY NAME ~ MANA ER'S NAME _- ~ F I PHO E O. a BUSINESS OWNER'S NAME AND ADDRESS ~ CITY, STATE, ZIP ~~ OWNER'S PHONE NO. BILL TO: (IF DIFFERENT FROM ABOVE) NAME, ADDRESS CITY, STATE, 21P, ~",'r BILLING PHONE NO. OCC TYPE OCC LOAD NO. OF FLOORS HIGH RISE BLDG RISER DATE y~r YES D NO CORRECT ALL VIOLATIONS VIOLATION REQUIREMENTS CHECKED BELOW No. >.i~ COMBUSTIBLE WASTE I DRY ~ r Remove and safely dispose of all hazardous refuse and dr tat non the above premises (U.F.C.) , VEGETATION 2 lids or th rage of combustible waste and rubbish pending its Provide non-combustible containers with tight fitting safe disposal. (U.F.C.) ~' COMBUSTIBLE STORAGE 3 r Relocate combustible storage to provid~at least 3 f t clearance around motor fuse box/fire doo (N.E.C.) (U.F.C.) q Relocate fire extinguisher(s) so thal~they will a In c nspicuous location, hanging on brac is with the top to the extinguisher not more than 5 feetra'b e t ' to N.F.P.A. No. 10 EXTINGUISHERS 5 Provide and install (amount) '~ ~apprbv ,d type & size) o le fire extiriguisher to be _ ~ _ ____ ___ _________ immediately accessible fo~use In~( a (U.F. ________________ _ ___ __ g Re-ch rg all fire tinguish~~s. Fie xtinguishers shall be,s r iced t le o e each year, and/or after each use, " by a rson havi ~,a vali e e or certificate. (U.F.C.) 7 rovid i to ai I "sign )with letters 5 or mor the i hei er each required exit (door/window) to SIGNS esc pe. ,(U.F.C. g vide nd maint in a ropri t tiers on a c trasting bac rou d nd visible from the street to indicate the or ct~a`ddres of building. .C.) (U.F.C.) ` g R pair all ( r sl o slope ings 'n piaster in (location} ______________________________________. Plastering ~ FIRE DOORS/ FIRE SEPARATIONS shall ret r he rfac to its rigin l fire resistive condition. (U.B. C.) ' 10 ,. ,Remo r it (item to ation~_________________________________________________________. Self-closing ,! door s II a design to, ose by gravity, or by the action of a mechanical device, or by an approved smoke and ~~ heat e ' ive device. If-closing doors shall have no attachments capable of preventing the operation of the ,.' Closin evice. (U. C. .~' EXITS r 11 Remove all ob ruc ' n from hallways. Maintain all means of egress free of any storage. (U.F.C.) ,i 1 Provid a nt ling colored and permanently installed electric light over or near required exit (location) ~ __ _ __________________ to clearly indicate it as an exit. (U.F.C.) STORAGE 3 Re v al storage and/or other obstructions from fire escape landings and stairways stair shafts. (Fire esca s/stair shafts are to be maintained free from obstructions at all times.) (U.F.C.) 14 t ~sion cords shat) not be used in lieu of permanent approved wiring. Install additional approved electrical outlets ELECTRICAL APPLIANCES e e 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 CUSTOMER: LEGEND` C.F.C. CALIFORNIA FIRE CODE (Signature) (Please Print Name Legibly, Title) U.B.C. UNIFORM BUILDING CODE B.M.C. BAKERSFIELD MUNICIPAL CODE INSPECTOR: AP NO.: N.F.P.A. NATIONAL FIRE PROTECTION (Signature) ASSOCIATION N.E.C. NATIONAL ELECTRIC CODE Ktlh-73LU White -Customer/Original Yellow -Station Copy Pink -Prevention Services FD 2022 (Rev. 09/05) ~= - - -- ._ 12!08/2006 10:43 FAX 66163167x4 DHS f~j042/003 ,, STATEOFCALIFORNU. FlRE SAFETY INSPECTION REQUEST sro, eaoF,EV.,o.ey See iestruction9 an rllfrlerse. A6ENCfO0N7ACr9wwtE --- i TELEPFWNENYMBER W ~ REOUE&i OAT[ 1 PROGRAM KCDI'15 =Licensing Unit ~ 661 631-6781 _ ~ ` Fuste_r Family I'loene :.L.-----~------ ~ .., fivALUATOirSNAME _.. _ __.. ; REpIJEgTINCpG'EN4MFACILfTYN~AH[R -• ---- ~ REONESTGODE l.aura$rittain ~ 150006296 i lA _..^ . ._ cao~s ~, ORI(~yNAL ~ RIRE CLEARANCE LICENSING i Licensiag Unit 2350 ~ z. RENEWAL ~ uFe SAFETY AGENCY KeesT County Dept. of IiuTTlaa SesviGCS 3. CAPAGfiY CHANGE irAA98 AND P.Q. i3ox 511 ADDRESS l3aketsfield, Gs 93302 4. bNMiERSHIP CHANGE s, aDDRES5 cEIANGE 1 - J 6. NAME CHANI'3E I 7. OTHER CAPAgTY PfiEV10.1SGAPYK77T Ca1FAGRY i r1cc~iwa~.rwn ~i i 4 S 1 FAauIYNAIUe $asha & 1Viicbael Biacoe (Poster Family Home) STREET ACt[1RE33 rAduer~pluglr} 10303 w®two~ Ct y .___ ~- 13akersfield, cA~urr CONTACT PFJiSONS NAME 5asha Hisooe (561)663-9862 SPCCIKCONOmONB SEORIOOE7~1 ~ TOTAL c~wwem ~ FRE,npuse~wAem ; 5 ~CENSECATI 711-FFH N1IMBEROFBULLDIN69 it .. _ ~. ~ r+ouRa 24/7 .. .... .. .. ... ... ~ .TQ' ~' G~PLETFD 8Y'./II$P~'"t1616 /IIi1~ORIF1'" ....... ... ... .. ...... . - - - ,. _ ~ I ~y1RANCEIOENIALCOOE '-- FlRE t. FIRE CLEARANCE GRANTED AUTHORITY ~~ AND 2. FlRE CLEARANCE OQIIEO aDDRESS a. mars 1 I B. CONSTRUCTIDN I. . C. FlRE ALARM D. SPRINKLERS IN$PECTOR•3NM/Ef77P7dcIWPIhIMO) TEt_^~=NUMlEp , CFIRSNU~ER I OCGIPANCYCIA'18v ' ' E. HOUSEKEEPING i ; } •_ - _-- ~ F. 3PECtAL HAZARD IN9PECTIONOATE ~ INSPECTOR'831ANA7ugE ~ G. OTHER -- - El(PLAIN DENALOw u6rSrEC1A1.CONDITIDNS .12/06!2046 10:43 FAX 6616316734 DHS f~003/003 STATEOFG~UFOFNIA FIRE SAFETY INSPECTION REQUEST S'°.B'°~".'°s`~~E"°~v INSTRUCTIONS This corm is designed far use with a window envelope Licenelrrg or tiequar'ling p~epeles-~ompl$be Mlefalbwing 19 a~eC6ons ors 4his fnmi (7e(ore su6mflflng It m the fire authority having lurlsdtctlon. 1. AGENCY CONTACT, 2. TELEPHONE NUMBER, 5. EVALUATpR. Bitter the name and telephone number of agency contact person. 3. PROGRAM. Licensing ageaay use. 4. REQUEST DATE. Enter lots request was prepared. 6, REQUESTING AGENCY FACILTTY N[IMBER. Thin is the f Ie number assigtLed by the lid agency. 7. REQUEST CODE. Use the seven nodes shown and insert the appropriate number inthe box following "Request Code". If NAME CHANGE, please fist previous [canes. Insert date of ongiml request is other than an angina]. S. AGENCY NAME AND ADDRESS. Enter flip na~nc and address of the licensing facility requesting the inspection. 9. AMBULATORY--NQNAMBULATQRX--BEDRID- DEN. Capacity Insert in the appropriate section, the capacity of licaused auebu]atory or nonanubulatory oc- enpams covered by this request. 10. FACQ.ITY NAME. Inscr't the name of the facility as it will appear on the license. List identifyigg sub name if Irnawn (i.e., Hacienda Corp/1Vledina Lodge). 11, LICENSE CATEGORY. Insert the category of license being sought as it will appear on the license certificate. 12. ADDRESS, Insert sane[ address and city only, A post office box is not acfleptable as a~nly ]acation. 13. NUMBER OF BUILDINGS. Insert the total relember of bue7dmgstobeused forhoelsingoftheoccupants coveredby the license. !4. RESTRAINT. indicate ifphysital restraint pocked in a [nom or the building) is to be used in the housing of the occupants. 15. FACILITY -CONTACT PERSON-TELEPHONE NUMBER, Indicate the twine and telephone number of the responsible itad~rvidual at the facility to be contacted by the fire authority~ 16. HOURS. Indicate the number of hours the occupants arc housed at the facility (less [hare 24 or 24+). Previous ff trgeeest is fur renewal pr capacity change, !7. SPECIAL CQNDITIONS. Indicate airy conditions Capacity insert capacity of previous clearance. unique to this request. As as example, if the inspection Total Show wtal liaeaaed capacity. If the f~c7ity is request is for ems building in amult;_building facility. Capacity: intended to house part ambulatory, noaambu- latoay, and part bedridden, show the total of the throe types of occupants. FIRE AUTHORITY CUNDUCTIl1TG THE INSPECTION--COMPLETE THE FOLLOWING: 18. FIRE AUTHORh I'Y, NAME AND ADDRESS. Insert 22.000UPANCY CLASSIFICATIQN. Use California the name and address of the f ro vuthgrity where the ~cility is l3uild~g Code occupancy classifications and insert the located. occupancy determined by the inspector. 19, CLEARANCE/DENIAL CODE. Use the two codes' 1 for Clearance gtaated, and 2 for clearance denied- If denied, also include the appropriattc letter code. AS an example, Denial based upon etdtileg would be coded 2A. ZU. INSPECTOR'S NAME. Print flee initial of the inspectot"e first Heine and full last name; insert the telepho~ number whet+e the inspector may be contacted. 21. CF1tRS I.D. N[TMBER. Insert the fire depasaneett's mua- berassigned by California Fire Incideett Reporting System. 23. INSPECTION DATE. Eater the actual date of the inspection. 24, INSPIICTOIlZ'S SIGNATURE. To be signed by the inspector conducdngthe inspector. 25. EXPLAIN DENIAL OR SPECIAL CONDITIQN$. If clearance code #2 is used, briefly explain reasoie. This space is also to be used to specify any additional limitationsplacedbytbefircanthority, auchas the use of pertain flpprs or sleeping rooms apgroved for aoteambulatory clients. ~~ ;_,12/08/2006 10:42 FA}€ 6616316754 R BEVERl.1f BEA~EY JOHN$4N, Jf? DirecEor pate; ~ ~- ~ ~ d DHS ~~ ~~ t~:.w FACSIN(ILE COVER SHEET X001/003 p. O. Box 571 Bakerefleld, CA 93302 m t~elay i-soa73s~sz9 Q5 a - alb ~ PLEASE ROUTE AS SOON AS POSSIBLE: To: (~e,t fa'f~-vim ~ re, ~-r+S NAME, aEPARTMENT. CaL FRAM: ~~~ ~ ~ _ _ CIL: ~ 1CJ FIRST AND LAST NAME QUR FAX NUMBER (661) 639-6751 NUMBER OF PAGES {including cover sheet). IF YQU HAVE ANY PRQBL MS, PLEASE CALL (6B7] ~ ~( SPECIAL. INSTRUCT/ `~ j ~. ti n ~ ~~ dV~ n C~vu c.7`1`~ The information contained in this transmittal may be ca~idential. k is intended only for the e,se of the individual to whom it is addressed. ff you are not the intended nu:ipient ar agent rasponslble for the dellYery, please be aware that any use, disssminatian, distribution or evpying of this commuttication is pnahibited. 100 E. Cafifomia Avenue ~ Bakersfield, CA 93307 • (661}631-6000 ~ Fax (661) 631-BEi31