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HomeMy WebLinkAbout040-150-026dip AP 40-15-26 BLl1SER, Robert ¢�¢-.•t�2u r�i Robert Blaser 1134-67B - �` 040-150-026`MUP 00-09 Esquon Rd., Durham 1743-67P SUZANNE THOMAS JESSEN j 0= 77E) M1 0 Q T j 0-15_ PO BOX 1179 w/s Esquon Rd. a DURHAM, CA. 95938 app. -L no. of Durham -Oro. w Hwy.;' Durham (new�.single family;)F-13 t BLASER, Robert 911-69B 721-69E E , 381243E* 784-69P 0-15-2 F w s Es uon / q 3/8 mi , no . of Durha�-oro . Hwy. , F Durham (meter service) ding, windows, paneling & partial demo; it - -- O_(c, L- nstall meter k for ex. bldg.) P.� N 0 f l r rw ;•�,_;:�,_; has-. 3;:. - , July 26, 2000 o ...Sutte Cun t LAND OF NATURAL WEALTH AND BEAUTY PLANNING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE • OROVILLE, CALIFORNIA 95965-3397 TELEPHONE: (530) 538-7601 FAX: (530) 538-7785 Suzanne Thomas Jessen P.O. Box 1179 Durham, CA 95938 .ERTIFI .D MAI . Re: Minor Use Permit, AP 040-80-026 Dear Ms. Jessen: Enclosed is your validated Minor Use Permit No. MUP 00-09 to allow Minor Use Permit to convert a small family daycare into a large family daycare,. Should you have any questions regarding this matter, please contact this office between 8:00 a.m. and 4:00 p.m., Monday through Friday. Sincerely, -6 Lynn Richardson Planning/Administrative Support Service Assistant Enc. cc: Land Development D sion Building Division ✓ Environmental Health Department of Forestry NIINOR USE PERMIT BUTTE COUNTY BOARD OF SUPERVISORS 5111���.�a; DATE: (Certified Mail Receipt) MUP 00-09 PERMIT NO. 040-150-026 ASSESSOR'S PARCEL NUMBER Pursuant to the provisions of the Zoning Ordinance of the County of Butte and the special conditions set forth below: Suzanne Thomas Jessen is hereby granted a Minor Use Permit in accordance with the application filed January 20, 2000;. to allow a large family day care facility for 12 or fewer children. Failure to comply with the conditions specified herein as the basis for approval of application and issuance of Permit, constitutes cause for the revocation of said permit in accordance with the procedures set forth in the Butte County Zoning Ordinance, including Butte County Code Sec. 24-45.65. 2 Unless otherwise provided for in a special condition to this use permit, all conditions must be completed by the Permittee within 12 months of the delivery of the countersigned permit to the Permittee. 3. If any use for which a use permit has been granted is not established within one year of the date of receipt of the countersigned permit by the Permittee, the permit shall become null and void and reapplication and a new permit shall.be required to establish the use. . 4. The terms and conditions of this permit shall run with the land and shall be binding upon and be to the benefit of the heirs, legal representatives, successors, and assigns of the Permittee. Minor chanes may be approved administratively by the Directors of Development Services; Environmental Health, or Public Works upon receipt of a substantiated written request by the applicant and only as to those conditions or requirements recommended by their respective departments. Prior to such approval, verification shall be made by each Department or Division that the modification is consistent with the application, fees paid and environmental determination as conditionally approved. Changes deemed to be major or sl;miticant. in nature shall require a formal application for amendment. Conditions of Approval: ' ,rl$ 6 •� The large day care facility shall -be closed during agricultural spraying events on surrounding parcels upon notice by the agricultural operators. ?. The facility is a single family residence that shall be the principal residence of the provider and the large day care facility shall be clearly incidental and secondary to the use of the residence. 3. A minimum of four'(4) off-street parking spaces shall be provided, consisting of - (a) Two (2) off-street parking spaces for the residents of the dwelling. (b) One (1) off-street parking space for each employee. The two (2) required residential spaces may not be used for employees. (c) One (1) off-street parking space/loading area. 4. One sign, not to exceed 3 square feet, is allowed. This sign shall not be placed in the front yard building setback. 5. The large family day care home shall be licensed by the California Department of Social Services, Community Care Licensing. 6. 'Meet all California Building Code regulations pertaining to large family day care facilities, including, but not limited to, the installation of smoke detectors,.a device for sounding alarm, fire extinguishers, and exit doors openable from the inside without the use of a key or any special knowledge or effort. Prior to issuance of the Minor Use Permit the large day care facility shall be inspected by the . Butte County Fire Department/CDF to meet minimum fire code requirements.. The septic system shall be maintained in a manner that complies with the Butte County Sewage Ordinance. 9. Prior to. issuance of the Minor Use Permit, the Butte County Environmental Health Department shall. sample the well and clear it for use by the large family day care facility. R u11d ui<- Division 10. Building permits may be required for the change of occupancy. Applicant shall contact the Buildinz Division to determine the need for building permits. Prior to issuance of the Minor I `s�: Permit, obtain any required buildin`, permits from the Building Division. 2 r C• Other 11. Applicant shall also comply with all other applicable federal, state and local statutes, ordinances, and regulations. NOTE: Isstance of this permit does not waive thhit of obtaining Bn_ `ld Division and Environmental Health Division permits before starting construction, nor does it waive any other r uirements of federal, sta nda�aw air, utte ouAy Board of Supervisors cc: Building Division Environmental Health Division Butte County Fire Department/CDF Agricultural Commissioner 3 MINOR USE PERMIT BUTTE COUNTY BOARD OF SUPERVISORS DATE: (Certified Mail Receipt) PERMIT NO. AS%ESSOR'S PAROL. NUMBER Pursuant to the provisions of the Zoning Ordinance of the County of Butte and the special conditions set forth below: Suzanne Thomas Jessen is hereby granted a Minor Use Permit in accordance with the application filed January 20, 2000, to allow a large family day care facility for 12 or fewer children. 1. Failure to comply with the conditions specified herein as the basis for approval of application and issuance of Permit, constitutes cause for the revocation of said permit in accordance with the procedures set forth in the Butte Comity Zoning Ordinance, including Butte County Code Sec. 24-45.65. 4 2. Unless otherwise provided for in a special condition to this use permit, all conditions must be completed by the Permittee within 12�months of the delivery of the countersigned permit to the Permittee. 3. If any use for which a use permit has been granted is not established within one year of the date of receipt of the countersigned permit by the Permittee, the permit shall become null and void and reapplication and a new permit shall be required to establish the use. 4. The terms and conditions. of this permit shall run with the land and shall be binding upon and be to the benefit of the heirs, legal representatives, successors, and assigns of the Permittee. 5. Minor changes may be approved administratively by the Directors of Development Services, Environmental Health, or Public Works upon receipt of a substantiated written request by the applicant and only as to those conditions or requirements recommended by their respective departments. Prior to such approval, verification shall be made by each Department or Division that the modification is consistent with the application, fees paid and environmental determination as conditionally approved. Changes deemed to be major or significant in nature shall require a formal application for amendment. ti Conditions of Approval: The large day care facility shall be closed during agricultural spraying events on surrounding parcels upon notice by the agricultural 'operators. 2. The facility is a single family residence that shall be the principal residence of the provider and the large day care facility shall be clearly incidental and secondary to the use of the residence. 3. A minimum of four (4) off-street parking spaces shall be provided, consisting of: (a) Two (2) off-street parking spaces for the residents of the dwelling. (b) One (1) off-street parking space for each employee. The two (2) required residential spaces may not be used for employees. (c). One (1) off-street parking space/loading area. 4., One sign, not to exceed 3 square feet, is, allowed. This sign shall not be placed in the front yard building setback. 5. The large family day care home, shall be licensed by the California Department of Social Services, Community Care Licensing. Fire Department/CDF 6. Meet all California Building Code regulations pertaining to large family day care facilities, -including, but not limited to, the installation of smoke detectors, a device for sounding alarm, fire extinguishers, and exit doors openable from the inside without the use of a key or any special knowledge or effort. - 7. Prior to issuance of the Minor Use Permit the large day care facility shall be inspected by the Butte County Fire Department/CDF to meet minimum fire code requirements. The septic system shall be maintained in a manner that complies with the Butte County Sewage Ordinance. 9. Prior to issuance of the Minor Use Permit, the Butte County Environmental Health Department shall sample the well and clear it for use by the large family day care facility. 10. Building permits may be required for the `change of occupancy. Applicant shall contact the Building Division -to determine the need for building permits. Prior to issuance of the Minor Use Permit, obtain any required building permits from the Building Division. K Other 11. Applicant shall also comply with all. -other applicable -federal, state and local statutes, ordinances, and regulations. NOTE: Issuance of this permit does net waive the requirement of obtaining Building Division and Environmental Health Division permits before starting construction, nor does it waive any other requirements of federal; state, and local law. air, Butte Cou ty Board of Supervisors cc: Building Division Environmental Health Divisi Butte County Fire Department/CDF Agricultural Commissioner . 3 0 l Suzanne Jessen Family Day Care 1662 Blaser Lane Durham, CA 95938 Attn: Suzanne Jessen I;u tte Co LAND OF NATURAL WEALTH AND BEAUTY BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397 TELEPHONE: (916) 538-7541 FAX: (916) 533-2140 April 14, 1998 RE: Day Care Fire Inspection A.P. #040-15-0-026 The Department of Social• Services Community Care Licensing in Chico has made a request to this office for a fire safety inspection of your proposed day care facility (maximum capacity, 12) at 1662 Blaser Lane, Durham Your property is located within an A-10 zone which requires a use permit from the .Butte County Planning Department prior to business operation. Please contact them at (916)538-7601 between 8:00 a.m. and 4:00' p.m. for information on how to proceed. When you have made the application for the use permit and paid the appropriate fees, you may apply to this office for a Special Inspection for. the fire inspection. For the Special Inspection, we will require a plot plan showing the building location on the property, a floor plan showing room uses, windows, doors, mechanical equipment etc., and the appropriate fee and the application signed by the property owner. After we make the Special Inspection, we will write a letter advising you of any improvements and building permits that may -be required. We will not notify the Department of Social Services of any clearance until you have been issued a use permit and complied with both the Planning and Build- ing Department requirements. Should you have any questions concerning this matter, please contact this office. MCV:dms cc: Department of Social Services Planning Department You s very truly, Micha1 C. ieira, C.B.O.. Manag r, Building Inspection STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 10.94) See instructions on reverse. 0-1,5----?� A—/ O AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DSS COMMUNITY CARE LICENSING 530 895-5033 4/10/98 EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0101/SEXTON 045400038 3A CODES 3e RESPONSE REQUESTED F 1. ORIGINAL A. FIRE CLEARANCE LICENSING DEPARTMENT OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY AGENCY NAMEAND COMMUNITY CARE LICENSING 3. CAPACITY CHANGE ADDRESS 520 COHASSET ROAD, SUITE 6 4. OWNERSHIPCHANGE CHICO, CA 95926 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 14 6 0 0 0 0 14 FACILITY NAME LICENSE CATEGORY JESSEN SUZANNE FAMILY DAY CARE FDC — 810 STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 1662 BLASER LANE 1 CITY RESTRAINT DURHAM NO FACILITY CONTACT PERSON'S NAME HOURS SUZANNE JESSEN (530) 891-6827 DAYS SPECIAL CONDITIONS °g"i 1u S��C. �. CLEARANCE /DENIAL CODE CODES E FIRBUTTE COUNTY -BUILDING DEPARTMENT AUTHORITY 7 COUNTY CENTER DRIVE 1. FIRE CLEARANCE GRANTED NAME AND OROVILLE , CA 95965 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS B. CONSTRUCTION C. FIRE ALARM INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD INSPECTION DATE INSPECTOR'S SIGNATURE (Typed or Printed) G. OTHER EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 10-94) See instructions on reverse. A -/O AGENCY CONTACTS'NAME' "--TEt=EPHONENUMBER REOUEST-,DATE PROGRAM DSS/CO14MUNITY CARE LICENSING (530 ) 895-5033 4/10/98 EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0101/SEXTON 045400038 3A CODES RESPONSE REQUESTED 71 1. ORIGINAL A. FIRE CLEARANCE LICENSING2. DEPARTMENTOF SOCIAL SERVICES RENEWAL B. LIFE SAFETY .AGENCY -NAME AND3. —COMMUN.TTY.-CARE, LICENSING 1" CAPACITY CHANGE AODRESS-"--,;-4 'lp�„--520-',GOHASSE T-' ROAD -i—SUITE-, 6— '4.^OWNERSHIP CHANGE-;- CHICO, CA 95926 .5. ADDRESS CHANGE 6. NAME CHANGE 7. OTHER AMBULATORY,- NONAMBUILATORY BEDRIDDEN A TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 4 6 0 0 0 0 14 FACILITY NAME LICENSE CATEGORY RITZANNF, FAMTT.Y T)AY C.ARF, FT)(1 - 810 STREET A6639ss Act6al Lodti6hf '' NUMBER 6F BUILDINGS 1662 BLASER LANE CITY RESTRAINT `DURIM NO FACILITY CONTACT PERSON'S NAME HOURS • SUZANNE JESSEN (530) 891-6827 -.X"DAYS SPECIAL CONDITIONS W NAM FIRE BUTTE COUNTY BUILDING DEPARTMENT.,_1 AUTHORITY 7 OOUNTY CENTER DRIVE NAMEAND OROVILLE, CA -95965 ADDRESS .,CLEARANCE /DENIAL CODE CODES 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIREALARM INSPECTOR'S NAME,(TyObd or Printed) TELEPHONE NUMBER- CFIRS NUMBER OCCUPANCY CLASS D. SPRINKLERSE. HOUSEKEEPING F. SPECIAL HAZARD INSPECTION DATE I INSPECTORS SIGNATURE (Typed or Pfinted) G. OTHER OD . ' - - EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS - ye STATE OF CALIFORNIA -, FIRE SAFETY INSPECTION REQUEST STD. 850(REV.10.94)(REVERSE) INSTRUCTIONS _ This form is designed for use with a window envelope Licensing or Requesting Agencies --Complete the following 19 sections on this form before submitting it to the fire authority having jurisdiction. 1. AGENCY CONTACT, 2. TELEPHONE NUMBER, 5. EVALUATOR. Enter the name and telephone number of agency contact person. 3. PROGRAM. Licensing agency use. 4. REQUEST DATE. Enter date request was prepared. 6. REQUESTING AGENCY FACILITY NUMBER. This is the file number assigned by the licensing agency. 7. REQUEST CODE. Use the seven codes shown and insert the appropriate number in the box following "Re- quest Code". If NAME CHANGE, please list previous name. Insert date of original request is other than an original. 8. AGENCY NAME AND ADDRESS. Enter the name and address of the licensing facility requesting the inspection. 9. AMBULATORY—NONAMBULATORY—BEDRIDDEN. Capacity: Insert in the appropriate section, the capacity of licensed ambulatory or nonambulatory oc- cupants covered by this request. Previous If request is for renewal or capacity change, Capacity: insert capacity of previous.clearance. Total Show total licensed. capacity. If the facility is Capacity: intended to house part ambulatory, nonambu-, ,r — latory,..and part bedridden, show the totarof the three types of occupants. 10. FACILITY NAME. Insert the name of the facility as it will appear on the license. List identifying sub name if known (i.e., Hacienda Corp/Medina Lodge). 11. LICENSE CATEGORY. Insert the category of license being sought as it will appear on the license certificate. 12. ADDRESS. Insertstreet address and city only. A post office box is not acceptable as only location. 13. NUMBER OF BUILDINGS. Insert the total number of buildings to be used for housing of the occupants covered by the.license. 14. RESTRAINT. Indicate if physical restraint (locked in a room or the building) is to be used in the housing of the occupants. 15. FACILITY CONTACT PERSON—TELEPHONE NUM- BER. Indicate the name and telephone number of the responsible individual at the facility to be contacted by the fire authority. 16. HOURS. Indicate the number of hours the occupants are housed at the facility (less than 24 or 24+). 17. SPECIAL CONDITIONS. Indicate any conditions unique to this request. As an example, if the inspection request is for one building in a multi -building facility. FIRE AUTHORITY CONDUCTING THE INSPECTION—COMPLETE THE FOLLOWING: 18. FIRE AUTHORITY, NAME AND ADDRESS. Insert the name and address of the fire authority where the facility is located. 19. CLEARANCE/DENIAL CODE. Use the two codes: 1 for clearance granted, and 2 for clearance denied. If denied, also include the appropriate letter code. As an example, Denial based upon exiting would be coded 2A. 20. INSPECTOR'S NAME. Print the initial of the inspector's first name and furl last name; insert the telephone number. where the inspector may be contacted. 21. CFIRS I.D. NUMBER. Insert the fire department's num- berassigned by California Fire Incident Reporting System. 22.00CUPANCY CLASSIFICATION. Use California Building Code occupancy classifications and insert the occupancy determined by the inspector. 23. INSPECTION DATE. Enter the actual date of the inspection. 24. INSPECTOR'S SIGNATURE. To be signed by the inspector conducting the inspection. 25. EXPLAIN DENIAL OR SPECIAL CONDITIONS. If clearance code #2 is used, briefly explain reason:'This space is also to be used to specify any additional limitations placed by the fire authority, such as the use of certain floors or sleeping rooms approved for nonambulatory clients. 94 85531 STATE OF CALIFORNIA A-10 FIRE SAFETY INSPECTION REQUEST STD. Bso (REV. 10-94) See instructions on reverse. AGENCY CONTACTS NAME ' . % - - , ti _ ?TEtEP.kIBNE;NUMBER f - - - .1 REOUEST-DATE -- PROGRAM DSSICOMMUNITY CARP. LICENSING 530 t395-5033 4 10 8 EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0101/SEXTON 045400038 3A CODES RESPONSE REgLFeSTED � ' T. ORIGINAL A. FIRE CLEARANCE LICENSING" � �� T JL b© IAL S RV10ES 2. RENEWAL B. LIFE SAFETY AGENCY . NAME AND COr� J ITY CARE LICENSING 3 CAPACITYCHANGE, A .'�S�-Rfl.,. 11%1C EADDRESSS� � �4. OWNERSHIP CHANGE ---- CHICO CA 95926 • S. ADDRESS CHANGE 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 4 14 6 0 0 0 0 14 " FACILITY NAME LICENSE CATEGORY JESSEN, STREET ADDRESS ActualLocatio4�" ,.-_� .� __.,_;=..__.::._ __.--�._-_.-.�_:__•- •...--_ .<-_. � .T, r =_-, ' n _ , ----^-C--wa:.. NUMBER OF BUILDINGS � 1662 BLASER LANE y i CITY RESTRAINT, " DURIWI NO FACILITY CONTACT PERSON'S NAME ;HOURS - SUZASNE JESSEN 530 831-6827 +•` "DAYS SPECIAL CONDITIONS 7, .CLEARANCE YDENIALCODE- x . _CODES ' FIRE BUTTE COUNTY BUILDING DEPARTMENT ,. FIRE CLEARANCE GRANTED AUTHORITY 7 OOUNTY CENTER DRIVE NAME AND OROVILLE, CA 95965 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS B. CONSTRUCTION C. FIRE ALARM INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER' CFIRS NUMBER i OCCUPANCY CLASS ' D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD INSPECTION DATE INSPECTOR'S SIGNATURE (Typed or Printed) G. OTHER EXPLAIN DENIAL OR UST SPECIAL CONDITIONS _ , 4. STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD. 950 (REV. 10-94) (REVERSE) INSTRUCTIONS -This form is designed for use with a window envelope Licensing or Requesting Agencies --Complete the following 19 sections on this form before submitting it to the fire authority having jurisdiction. 1. AGENCY CONTACT, 2. TELEPHONE NUMBER, 5. EVALUATOR. Enter the name and telephone number of agency contact person. 3. PROGRAM. Licensing agency use. 4. REQUEST DATE. Enter date request was prepared. 6. REQUESTING AGENCY FACILITY NUMBER. This is the file number assigned by the licensing agency. 7. REQUEST CODE. Use the seven codes shown and insert the appropriate number in. the box following "Re- quest Code". If NAME CHANGE, please list previous name. Insert date of original request is other than an original. 8. AGENCY NAME AND ADDRESS. Enter the name and address of the licensing facility requesting the inspection. 9. AMBULATORY—NONAMBULATORY—BEDRIDDEN. Capacity: Insert in the appropriate section, the capacity of licensed ambulatory or nonambulatory oc- cupants covered by this request. Previous If request is for renewal or capacity change, Capacity: insert capacity of previous clearance. Total Show total licensed capacity. If the facility is Capacity: intended to house part ambulatory, nonambu- latory, and part bedridden, show the total of the three types of occupants. 10. FACILITY NAME. Insert the name of the facility as it will appear on the license. List identifying sub name if known (i.e., Hacienda Corp/Medina Lodge). 11. LICENSE CATEGORY. Insert the category of license being sought as it will appear on the license certificate. 12. ADDRESS. Insertstreet address and city only. A post office box is not acceptable as only location. 13. NUMBER OF BUILDINGS. Insertthe total number of buildings to be used for housing of the occupants covered by the license. 14. RESTRAINT. Indicate if physical restraint (locked in a room or the building) is to be used in the housing of the occupants. 15. FACILITY CONTACT PERSON—TELEPHONE NUM- BER. Indicate the name and telephone number of the responsible individual at the facility to be contacted by the fire authority. 16. HOURS. Indicate the number of hours the occupants are housed at the facility (less than 24 or 24+). 17. SPECIAL CONDITIONS. Indicate any conditions unique to this request. As an example, if the inspection request is for one building in a multi -building facility. FIRE AUTHORITY CONDUCTING THE INSPECTION—COMPLETE THE FOLLOWING: 18. FIRE AUTHORITY, NAME AND ADDRESS. Insert the name and address of the fire authority where the facility is located. 19. CLEARANCE/DENIAL CODE. Use the two codes: 1 for clearance granted, and 2 for clearance denied. If denied, also include the appropriate letter code. As an example, Denial based upon exiting would be coded 2A. 20. INSPECTOR'S NAME. Print the initial of the inspector's first name and full last name; insert the telephone number where the inspector may be contacted. 21. CFIRS I.D. NUMBER. Insert the fire departments num- ber assigned by California Fire Incident Reporting System. 22. OCCUPANCY CLASSIFICATION. Use California Building Code occupancy classifications and insertthe occupancy determined by the inspector. 23. INSPECTION DATE. Enter the actual date of the inspection. 24. INSPECTOR'S SIGNATURE. To be signed by the inspector conducting the inspection. 25. EXPLAIN DENIAL OR SPECIAL CONDITIONS. If clearance code #2 is used, briefly explain reason. This space is also to be used to specify any additional limitations placed by the fire authority, such as the use of certain floors or sleeping rooms approved for nonambulatory clients. 94 85531 n .�- � a } f r' / rT- `." �vU / 3 � / i6 4 STATE OF CALIFORNIA COPY DISTRIBUTION: FIRE SAFETY INSPF[_TInN RFnIIFCT SEE REVERSE OF COPIES 2 AND 5 FOR INSTRUCTIONS FOR COMPLETION - -- - i -o -o I h I c rinc IVIAMOMAL STD 850 (REV. 3.93) 2 --FIRE AUTHORITY 1- REQUEST DATE 2. PROGRAM 4 -5 -LICENSING AGENCY 3/20/96 3. AGENCY CONTACT t 4. TELEPHONE NO. S. EVALUATOR ' CDSS COMMUNITY CARE LICENSING (916)'895-5033 0101-BETHELL 6. SFM REGION 7. SFM I.D. NO. 8: REQUESTING AGENCY FACILITY NO. 9. REQUEST CODE 045400038 3-A CODES 1. ORIGINAL A. FIRE CLEARANCE RESPONSE REQUIRED 2. RENEWAL B. LIFE SAFETY ----------------- 10. AGENCY 3. CAPACITY CHANGE 4. OWNERSHIP CHANGE t+,�n .+��wpg�g NAME DEPARTMENT Oir e7VL . �l�i}_Fay, m p� ry ��q {. /�Eb 2 AND C0MVAJNITY•CsIR�iLiCE I � ¢e� ^ Ap Yi ADDRESS .AGO CO42$I$AL S3C� -C,:"R S. ADDRESS CHANGE 6. NAME CHANGE PREVIOUS NAME 7. OTHER DATE OF ORIGINAL REQ. 11. AMBULATORY NONAMBULATORY TOTAL CAP. DATE OF LAST FIRE CLEARANCE CAPACITY MEDICAL CARE PREVIOUS CAPACITY CAPACITY MEDICAL CARE PREVIOUS CAPACITY 19. FACILITY CODE 16 12 ❑ YES ® NO 6 0 ❑ YES ❑ NO 12 12. FACILITY NAME 13. NO. BLDGS. CODES , FAMILY DAY CARE 1. GACH 9. ADHC 2. GACH/R 110. CLINIC 3. SH 11. JAIL 4. APH 12. ICF/DDN 14. STREET ADDR SS (ACTUAL LOCATION) 1662 BLASER LANE P.O. BOX 15. RESTRAINT NONE CITY ZIP CODE 16. HOURS DURHAM, CA R 95938 DAYS S. PHF 13. RCF 6, SNF 14. CCF 7. ICF/OT 15. DAF S. ICF/DD 113. OTHER 17. FACILITY CONTACT PERSON JESSEN, SUZANNE PHONE NO. M16)891-6827 16A. SPECIAL TO BE COMPLETED BY INSPECTING AUTHORITY 18. FIRE ��� 26. CLEACODE RANCE AUTHOR e(II(G � yip NAME BUTTE COUNTY BLDG. DEPT. MAR 1 r CODES 1. FIRE CLEAR, GRANTED AND 7 COUNTY CENTER DRIVE. % 1996 ADDRESS L OROVILLE,'-CA 95965 2. FIRE CLEAR, DENIED 3. FIRE CLEAR WITHHELD 27. DENIAL CODE TO BE COMPLETED BY INSPECTING AUTHORITY CODES 21. INSPECTOR'S NAME TELEPHONE NO. 22. CFIRS23. ID NO. T-19 OCC. CLASS 1. EXITS 2. CONSTRUCTION 3. FIRE ALARM 4. SPRINKLERS 24. INSP. DATE 25. INSPECTOR'S SIGNATURE 5. HOUSEKEEPING 8. SPECIAL HAZARD 28. EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS 7. OTHER STATE FIRE MARSHAL USE ONLY DEPARTMM 07 SOCIAL SEHYIW COMi' MITY CURE LICENSING 20. REGION, 5,0 COhaSs®i Road, SUlte 6 OFFICE Cbi C o , C 969SM AND ADDRESS 6 STATE OF. CALIFORNIA 1 , FIRE SAFETY INSPECTION RFOLIFST Y* COPY DISTRIBUTION: SEE REVERSE OF COPIES 2 AND 5 FOR INSTRUCTIONS FOR COMPLETION I -J -J I A I r rimr Mimi? IAL 1. REQUEST DATE 2. PROGRAM STD 850 (REV. 3.93) 2 -FIRE AUTHORITY 4 -5 -LICENSING AGENCY 3/20/961 3. AGENCY CONTACT 4. TELEPHONE NO.S. EVALUATOR CDSS COMMUNITY CARE LICENSING (91'6)"895-5033 0101-BETHELL 6. SFM REGION 7. SFM I.D. NO. S. REQUESTING AGENCY FACILITY NO. 9. REQUEST CODE 045400038 3-A CODES " 1. ORIGINAL A. FIRE CLEARANCE RESPONSE REQUIRED 2. RENEWAL B. LIFE SAFETY 3. CAPACITY CHANGE f0. AGENCY 4. OWNERSHIP CHANGE DEPARTMENT OF SOCIAL SERVICES S. ADDRESS CHANGE NAME�,T p� r L �r COMMUNITY .CARE LICEMING 6. NAME CHANGE AND 520 COhas88t Rom. Qr4so it QW PREVIOUS NAME ADDRESS ���• 7. OTHER DATE OF ORIGINAL REQ. 11. AMBULATORY NONAMBULATORY TOTAL CAP. DATE OF LAST FIRE CLEARANCE CAPACITY MEDICAL CARE PREVIOUS CAPACITY MEDICAL CARE PREVIOUS CAPACITY - CAPACITY 4 19 FACILITY 12 El'YES EX NO 6 0 ❑ YES ❑ 1 2 .NO 16 12. FACILITY NAME - 13. NO. BLDGS. CODES JESSEN, SUZANNE FAMILY DAY CARE 1 1. GACH 9. ADHC 2. GACH/R 10. CLINIC 14. STREET ADDRESS (ACTUAL LOCATION) P.O. BOX 1S. RESTRAINT 1662 BLASER LANE NONE 3. SH 11. JAIL 4. APH 12. ICF/DDN CITY - ZIP COD E 16. HOURS DURHAM, CA 95938 'DAYS S. PHF 13. RCF 6. SNF 14. CCF 7• ICF/OT 15. DAF 17� FACILITY CONTACT PERSON a TELEPHONE NO. 16A. SPECIAL JESSEN, SUZANNE r� ry (916) 89,1-682 / 8. ICF/DD a 16. OTHER • - - TO BE COMPLETED BY INSPECTING AUTHORITY F " 26. CLEARANCE 18. FIRE � CODE AUTHOR CODES NAME BUTTE COUNTY BLDG. DEPT. 1. FIRE CLEAR, GRANTED AND COUNTY DRIVE -7 _CENTER I ADDRESS OROVILLE, CA 95965 2. FIRE CLEAR, DENIED J 3. FIRE CLEAR WITHHELD 27. DENIAL �.. CODE _TO BE. COMPLETED, BY,,INSPECTING AUTHORITY _.,_. ,__ _ _ __,- CODES 21. INSPECTOR'S NAME TELEPHONE NO. 22. CFIRS 23. T-19 OCC. 1. EXITS ID NO. CLASS ' 2. CONSTRUCTION 3. FIRE ALARM 4. SPRINKLERS 24. INSP. DATE 25. INSPECTOR'S SIGNATURE • S. HOUSEKEEPING 6. SPECIAL HAZARD 28. EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS 7. OTHER STATE FIRE MARSHAL USE ONLY DEPARTMENT 01 SOCIAL SF 0ge COMMUNITY CARE LICENM ` 20. REGION, 62,0 COhasset Road,U & •• 't• OFFICE Osi*Q. CA 95926 AND ADDRESS STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD 850 (REV. 3-93) (Reverse) ` ` INSTRUCTIONS This form is designed for die Wth a window envelope..T Licensing or Requesting Agencies—Complete -the following 20 sections on this form before submitting it to the State Fire Marshal (SFM) 1. REQUEST DATE. Enter the date request was prepared. 12. FACILITY NAME. Insert the name of the facility as it will appear on the license. List identifying sub name if 2. PROGRAM. Licensing agency use. known (i.e., Hacienda Corp/Medina Lodge).. 3. AGENCY CONTACT, 4. TELEPHONE NO., 5. EVALUATOR. Enter the name and telephone number of agency contact person. 6. SFM REGION. Insert one of, the following 3 numbers for the SFM Regional Office in whose area the facility is located: 350 Coastal, 330 Northern, 370 Southern. 7.. SFM ID NO. This is the SFM Identification Number and initially, will be assigned by the State Fire Marshal. Licensing Agency—Insert this number on all clearance requests subsequent to the initial request. 8. REQUESTING AGENCY FACILITY NO. This is the file number assigned by the licensing agency. 9. REQUEST CODE. Use the (seven codes shown and insert the appropriate number in the box following "Request Code". If NAME CHANGE, please list previous name. Insert date of original request when request is other than an original. 10. AGENCY NAME AND ADDRESS. Enter the name and address of the licensing facility requesting the inspection. 11. AMBULATORY—NON-AMBULATORY. Capacity: Insert, in the appropriate section, the capacity of licensed ambulatory or .non-ambulatory occupants covered by this request. Medical Indicate if medical care will be provided to Care: client. Previous If request is for renewal or capacity change, Capacity: insert capacity of previous clearance. Total Show total licensed capacity. If the facility is Capacity: intended to house part ambulatory and part non-ambulatory, show the total of the two types of occupants. ` 13. NO. BLDGS. Insert the total number of buildings to be used for housing of the occupants covered by the license. 14..ADDRESS: -.Insert street:,:addcess and city only. A post office'•t Ox is-n$t, acceptabie..a$ only location. 15. RESTRAINT. �Indicate-.if p"h4"dical restraint (locked in a room or the building is to be used in the housing of the occupants. 16. HOURS. Indicate the number of hours the Qccupants are housed at the facility (less than 24 or 24+). 16a. SPECIAL. Use to' designate persons who , are determined to be non-ambulatory for reasons other than a physical handicap. 17. FACILITY CONTACT PERSON—TELEPHONE NO. Tridicafe-the�namd"and–f6I6-0 'on -d , nuth&yr W3 the responsible individual at the facility to be contacted. by the fire authority. 18. FIRE AUTHORITY, NAME AND ADDRESS. Insert the name and address of the fire authority where the facility is located. 19. FACILITY CODE. (1) General Acute Care Hospital (GACH), (2) General Acute Care Hospital/Rehab (GACH/R), (3) Special Hospital (SH), (4) Acute Psychiatric Hospital (APH), (5) Psychiatric Health Facility (PHF), (6) Skilled Nursing Facility (SNF), (7) Intermediate Care Facility/.Other (ICF./OT), (8) Intermediate Care FAcilitylDevelopmentally Disabled Habilitative (ICF/DDH), (9) Adult Day Health -Care (ADHC), (10) Clinic, (11) Jail, (12),Intermediate'Care Facility/ Developmentally Disabled Nursing (ICF/DDN), or (13) Residential Care Facility (RCF), (14) Community Corrections Facility, (15) Drug and Alcohol Facility, (16) Other. 20. REGION, 'OFFICE AND ADDRESS. Insert the name and address of the State. Fire Marshal Regional Office in whose area the facility is located. FIRE AUTHORITY CONDUCTING THE INSPECTION -COMPLETE THE FOLLOWING: 21. INSPECTOR'S NAME. Print the initial of the in- spector's first name and full last name; insert the telephone number where the inspector may be contacted. 22. CFIRS ID. NO. Insert the fire department's number assigned by CFIRS. 23. OCCUPANCY. Use California Building Code 'occupancy classifications and' insert the occupancy determined by the inspector. 24. INSPECTION DATE. Enter the actual date of the inspection. 25. INSPECTOR'S SIGNATURE. To be signed by in- spector conducting the inspection. 26. CLEARANCE CODE. Use the three codes shown and insert the appropriate number in the box following "Clearance Code". NOTE: If Code 2 (Denied) is used, explain. 27. DENIAL CODE. Use only the seven codes shown and insert the appropriate number in the box follow- ing "Denial Code". If No. 7 "Other" is used, explain at Item 28., t' NOTE.,,rF,ire.Clearance cannot•be deniad`iad"F t4r than lack of conformance with the ,provisions .otJitle. t9�CCR;,�afiflunie Building Code: California Fire 28. EXPLAIN DENIAL. If Glearance Code No. 2 or 3 is used, briefly explain reason. This space is also to be used to explain Denial Code item noted. 93 95589 STATE OF CALIFORNIA FIRE SAFETY INSPFr-TIAN AM IFAT COPY DISTRIBUTION: W SEE REVERSE OF COPIES 2 AND 5 FOR INSTRUCTIONS FOR COMPLETION -Q i M i C rinC MrinanML STD 850 (REV. 3-93) 2 -FIRE AUTHORITY 1. REQUEST DATE 2. PROGRAM 4 -5 -LICENSING AGENCY 3/20/96 3. AGENCY CONTACT 4. TELEPHONE NO. 5. EVALUATOR -CDSS/CO14MUNITY CARE LICENSING . (916) 895-5033 0101-BETHELL 6. SFM REGION 7. SFM I.D. NO. S. REQUESTING AGENCY FACILITY NO. 9. REQUEST CODE 045400038 • 3-A CODES 1. ORIGINAL A. FIRE CLEARANCE - i RESPONSE REQUIRED 2. RENEWAL B. LIFE SAFETY • 3. CAPACITY CHANGE 10. AGENCY 4. OWNERSHIP CHANGE • NAME DEPARDIM Oy Soe,- S�� 5. ADDRESS CHANGE B.. NAME AR * ICEMY I AND Co? *"ITV CARE ihaaseet7�ilRi'+oadL V• CHANGE PREVIOUS NAME ADDRESS � 5r2+07✓f7CVo SUI,&� / 7. OTHER � C*10e. CA 96989 x DATE OF ORIGINAL REQ. _ 11. AMBULATORY NONAMBULATORY TOTAL CAP. DATE OF LAST FIRE CLEARANCE CAPACITY MEDICAL CARE PREVIOUS CAPACITY MEDICAL CARE PREVIOUS CAPACITY CAPACITY 12 r ❑ YES LrI NO 6 0 ❑ YES ❑ NO 12 19 CODE 16 16 12. FACILITY NAME 13. NO. BLDGS. CODES JESSEN. SUZANNE FAMILY DAY CARE 1 1. GACH 9. ADHC 2. GACH/R 10. CLINIC 14. STREET ADDRESS (ACTUAL LOCATION) P.O. BOX 15. RESTRAINT 1662 BLASER LADE NONE 3. SH 11. JAIL 4. APH 12. ICF/DDN CITY ZIP CODE 16. HOURS DURHAM, CA 95938 DAYS 5. PHF 13. RCF G. SNF 14. CCF 17: FACILITY CONTACT PERSON TELEPHONE NO.. . 16A. SPECIAL JESSEA SUZANNE ('916) 8g1-682 7 '7. ICF/OT 15. DAF , 8. ICF/DD 16. OTHER ' _ - , • - TO BE COMPLETED BY _ INSPECTING AUTHORITY 26. CLEARANCE 18. FIRE . CODE AUTHOR CODES NAME BUTTE COUNTY BLDG. DEPT. 1. FIRE CLEAR, GRANTED AND 7 COUNTY CENTER DRIVE ADDRESS OROVILLE, CA 95.965 2. FIRE CLEAR, DENIED 3. FIRE CLEAR WITHHELD 27. DENIAL CODE --•• -%=--TO-BE-COMPL-E--ED•BY=INSPECTING AUTHORITY �^� • .-- - �- «..- •� �- � -�_,� ;,.: _..---------CODES --•-.-•- __, 21. INSPECTOR'S NAME TELEPHONE NO. 22. CFIRS 23. T-19 OCC. 1. EXITS ID NO. CLASS 2. CONSTRUCTION 3. FIRE ALARM 4. SPRINKLERS 24. INSP. DATE 25. INSPECTOR'S SIGNATURE S. HOUSEKEEPING 8. SPECIAL HAZARD 28. EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS 7. OTHER s STATE FIRE MARSHAL USE ONLY DEPART OF SOCYAL SEF{YtC88 20. REGION, COpRMMITY CARE TTAL+1lt INC OFFICE 520 Com sset Road, 4 -fti•S d AND Chloe, CA .9.598 ADDRESS L STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD 850 (REV. 3.93) (Reverse) INSTRUCTIONS This form is designed for use with a window envelope. Licensing or Requesting Agencies -Complete the following 20 sections on this form before submitting it to the State Fire Marshal (SFM) 1. REQUEST DATE. Enter the date request was prepared 2. PROGRAM. Licensing agency use. 3. AGENCY CONTACT, 4. TELEPHONE NO., 5. EVALUATOR. Enter the name and telephone number of agency contact person. 6. SFM REGION. Insert one of the following 3 numbers for the SFM Regional Office in whose area the facility is located: 350 Coastal, 330 Northern, 370 Southern. 7. SFM ID NO. This is the SFM Identification Number and initially will be assigned by the State Fire Marshal. Licensing Agency—Insert this number on all clearance requests subsequent to the initial request. 12. FACILITY NAME. Insert the name of the facility as it will appear on the license. List identifying sub name if known (i.e., Hacienda Corp/Medina Lodge). 13. NO. BLDGS. Insert the total number of buildings to be used for housing of the occupants covered by the license. 14. ADDRESS. -Insert street -address and city only. A post officebi isnot acceptable as only location. 15. RESTRAINT;;.'x Indicate, if "physical restraint (locked in a room or the building is to be used in the housing of the occupants. 16. HOURS. Indicate the number -of hours the occupants are housed'at the facility (less than 24 or 24+). 16a. SPECIAL. Use to designate persons who . are 8. REQUESTING AGENCY FACILITY NO. This is the file determined to be non-ambulatory for reasons other than number assigned by the licensing agency. a physical handicap. 9. REQUEST CODE. Use the seven codes shown and insert the appropriate number in the box following "Request Code". If NAME CHANGE, please list previous name. Insert date of original request when request is other than an original. 10. AGENCY NAME AND ADDRESS. Enter the name and .address of the licensing facility requesting the inspection. {. 11. AMBULATORY—NON-AMBULATORY. Capacity: Insert, in the appropriate section, the capacity of licensed ambulatory or non-ambulatory occupants covered by this request. Medical Indicate if medical care will be provided to Care: client. Previous If request is for renewal or capacity change, Capacity: insert capacity of previous clearance. Total Show total licensed capacity. If the facility is Capacity: intended to house part ambulatory and part non-ambulatory, show the total of the two types of occupants. 17. FACILITY, CONTACT PERSON—TELEPHONE NO. Indicate the name and -telephone number of the responsible individual at the facility to be contacted by the fire authority. 18. FIRE AUTHORITY, NAME AND ADDRESS. Insert the name and address of the fire authority where the facility is located. 19. FACILITY CODE. (1) General Acute Care Hospital (GACH), (2) General Acute Care Hospital/Rehab (GACH'/R), (3) Special Hospital (SH), (4) Acute Psychiatric Hospital (APH), (5) Psychiatric Health Facility (PHF), (6) Skilled Nursing Facility (SNF), (7) Intermediate Care Facility/Other (ICF/OT), (8) Intermediate Care Facility/Developmentally Disabled Habilitative (ICF/DDH), (9) Adult Day. Health Care (ADHC), (10) Clinic, (11) Jail, (12) Intermediate Care Facility/ Developmentally Disabled Nursing (ICF/DDN), or (13) Residential Care Facility (RCF), (14) Community Corrections Facility, (15) Drug and Alcohol Facility, (16) Other. 2.0. REGION, OFFICE AND ADDRESS. Insert the name and address of the State Fire Marshal Regional Office in whose area the facility is located. FIRE AUTHORITY CONDUCTING THE INSPECTION -COMPLETE THE FOLLOWING: 21. INSPECTOR'S NAME. Print the initial of the in- spector's first name and full last name; insert the telephone number where the inspector may be contacted. 22. CFIRS ID. NO. Insert the We department's number assigned by CFIRS. 23. OCCUPANCY. Use California Building Code occupancy classifications and insert the occupancy determined by the inspector. 24. INSPECTION DATE. Enter the actual date of the inspection. 25. INSPECTOR'S SIGNATURE. To be signed by in- spector conducting the inspection. 26. CLEARANCE CODE. Use the three codes shown and insert the appropriate number in the box following "Clearance Code". NOTE: If Code 2 (Denied) is used, explain. 27. DENIAL CODE. Use only the seven codes shown and insert the appropriate number in the box follow- ing "Denial Code". If No. 7 "Other" is used, explain at Item 28. RTe-:-Are cannot be denie, for other than lack of conformance.with Ir rt he`prpvlaions of.Title f$ CCF17Lbalifornia Building Code; California Fire bode.. 28. EXPLAIN bENIAL: "If .Clearance Code No. 2 or 3 is used, briefly explain reason. This space is also to be used to explain Denial Code item noted. 93 95589 I Suzanne Jessen Family Day Care 1662 Blaser Lane Durham, CA 95938 Attn: Suzanne Jessen Eutte coitnt BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397 TELEPHONE: (916) 538-7541 FAX: (916) 538-2140 March 25, 1996 RE: Day Care Fire Inspection A.P. #040-15-0-026 The Department of Social Services Community Care Licensing in Chico has made a request to this office for a fire safety inspection of your proposed day care facility (maximum capacity, 12) at 1662 Blaser Lane, Durham, Your property is located within an A-10 zone which requires a use permit from the Butte County Planning Department prior to business operation. Please contact them at (916)538-7601 between 8:00a.m. and 4:00p.m. for information on how to proceed. When you have made the application for the use permit and paid the appropriate fees, you may apply to this office for a Special Inspection for the fire inspection. For the Special Inspection we will require a plot plan showing the building location on the property, a floor plan showing room uses, windows, doors, mechanical equipment etc., and the appropriate fee and the application signed' by the property owner. After we make the Special Inspection, we will write a letter advising you of any improvements and building permits that may be required. We will not notify the Department of Social Services of any clearances until you have been issued a use permit and complied with both the Planning and Building Department requirements. Should you have any questions concerning this matter, please contact this office. MCV:dms cc: Department of Social Services Planning Department Yours very truly, "C.ieira,.B.O: Man ger, Building Inspection COUNTY OF BUTTE BUILDING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE OROVILLE, CALIFORNIA 95965-3397 RETURN SERVICE REQUESTED z- 0 V I L.( 4;�� a AP& 161 8 02PLETER � ac & 7151708 U.S. POsraoe `7 SUZANN JESSEN AMILY DAY CARE 1662,B DURHAM CA 95938 JE55662 959361031 IC97 16 04/17/96 RETURN TO SENDER JE55EN PO SOX 1179 DURHAM CA 95938-11.79 .,a c" on O!a 1 C:D UO Cj 14 7, H a-- "A rP .,a r cn surnnhp-, Je-ssen ku o AIcLAP-y- I cLne- D u r h cx FP PP JAN' *2 0, 21535010 3, u, f E Alii NG b.. � I F VTS I O'i\,* .PQ Ex I it. • v44 C( (2 Bern 5.22 AC. ItoAli - Lane pvt MYvT 4u 1020 y. APPROVED Development Plan DATE USE PERMIT —VARIANCE MINOR U.P..k:��—ADMYERMIT DIRECTOR OF DEVELOPMENT SERVICES cn surnnhp-, Je-ssen ku o AIcLAP-y- I cLne- D u r h cx FP PP JAN' *2 0, 21535010 3, u, f E Alii NG b.. � I F VTS I O'i\,*