HomeMy WebLinkAbout015-380-011_12_19_85-11_3_04Fire Prevention Bureau
176 Nelson Avenue
Oroville, CA 95965
Telephone 530-538-7888
41x 530-538-2105
Address: 0
Owner/Manager: (�
Assistant Manager: _ ----
Building Owner:
Address:
�hite
Iutte County Fire Rescue Copy - Business
California Department of Forestry / Yellow Copy — Occupancy File
and Fire Protection V Pink Copy — Station File
Facility Inspection Report Occ. Class.
Business Name: HD)4,C
-1- Bus: a -..� Hm: Fax:- ,!;7/ f.,
Bus: -T Hm:
Bus: `a, � ; Hm:
I AN TNCPVCT1nN [1F V(IITR FA( H.ITV REVEALED THE FOLLOWING:
1.
Fire Extinguishers: Required, service due
10.
Exit(s) obstructed, inadequate
2.
Extension cords: Excess use, defective
11.
Exit sign(s) required, illumination
3.
Excessive rubbish, trash, debris
12.
Exit sign lights need replacing
4.
Fire alarm system defective
13.
Exit lighting: Required, defective
5.
Sprinkler system: Service required, defective
14.
Smoke detectors: Required, defective
6.
Kitchen hood extinguishing system service due
15. Wiring: Exposed, damaged connectors, etc.
7.
Fire walls, ceilings, fire doors, draft stops
16.
Heating system: Defective appliance, flue combustibles
8.
Knox Box keys
17.
Address posted and visible from road
9.
Fire Drill Witnessed Yes ❑ No ❑
18.
Other
DETAILED EXPLANATION AND CORRECTIONS: UUMC U t ra:
ate:
Discussed
i fed:
Awith:
3
rinty
--5—
Inspecting` . fficer:
�attalion 1 2 3 4 5 6 7
Station: FPB
PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION 1'M
ORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: ��
Fire Prevention Bureau
176 Nelson Avenue
Oroville, CA 95965
-lephone 530-538-7888
,Butte County Fire Rescue
California Department of Forestry
and Fire Protection
Facility Inspection Report
White Copy - Business
Yellow Copy — Occupancy File
Pink Copy — Station File
Occ. Class.
ran ✓✓v-✓✓v-t,.iv✓
Address: n
Business Name:
ar H j y '2_
Owner/Manager: ya tht,��r ,
Bus: �_9 Hm: Fax:-$
Assistant Manager:
Bus: Hm:
M
Building Owner. �! ` U� �j1 �' •
,Bus: -
Station: FPB
Address:
AN INSPECTION OF YOUR FACILITY REVEALED THE FOLLOWING:
1. Fire Extinguishers: Required, service due
10. Exit(s) obstructed, inadequate
2. Extension cords: Excess use, defective
11. Exit sign(s) required, illumination
3. Excessive rubbish, trash, debris
12. Exit sign lights need replacing
4. Fire alarm system defective
13. Exit lighting: Required, defective
5. Sprinkler system: Service required, defective
14. Smoke detectors: Required, defective
Kitchen hood extinguishing system service due
15. Wiring: Exposed, damaged connectors, etc.
Fire walls, ceilings, fire doors, draft stops
16. Heating system: Defective appliance, flue combustibles
r8.7Knox Box keys
17. Address posted and visible from road
Fire Drill Witnessed Yes ❑ No ❑
18. Other
DETAILED EXPLANATION AND CORRECTIONS: CORRECTED:
ate
Discussed with:
Signed:
(Print) v
t-attalion
M
Inspecting Office
1 2 3 4 5 6 7
Station: FPB
ORE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH
ORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE:
BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE
TITLE 19/24
FACILITY INSPECTION
INSPECTION NO. ,'1 2 3
REINSPECT: r YES R NO
Facility
���%S4CL .� `-f �.
Occupancy
✓`' �-f
Address
Inspector
t-?�iiL`
Phone
`' -
Station
Contact
Station Phone
Compliance: Yes =11�f
ACCESS --All inspections
Address correct/posted and visible from road (Butte co. Code 32-9)
r " Access to public street or 20 ft. wide lane (T19-3.05)
vr' =dates wide enough to admit fire apparatus (T19-3.16)
`Fire protection equipment visible/accessible (r19-3.14)
PORTABLE FIRE EXTINGUISHERS -- All Inspections
No = 0 Not applicable = NIA
E Extinguishers have current annual service tag (r19-575 1A)
Maximum travel 75 ft. (T19-567)
Provide clear access to fire extinguisher Cr19-563.2)
Extinguishers mounted on wall/or in cabinet, visible and signed (T19-563.8)
EXITS -- All Inspections
J Exits not obstructed Cr19-3.11)
i Exit signs in place (CBC 1003.2.9.1)
Doors operate without key or special knowledge (CFC 1207.3)
Rooms with Occupant Load of 50 Persons or More
Exit illumination and signs.iri place (CBC 1003.2.8.2)
Maximum occupancy.sign in place (T19-3.30)
Two exit doors/pafiic hardware swing in direction of travel (CFC 2501.6.2)
HOUSEKEEPING -- All Inspections
!_%` No waste or rubbish accumulation inside or outside T19-3.14)
yReduce storage to at least "below ceiling/ sprinklers (T19-3.14)
,L Remove combus. storage from heater, meth., elect. room (r19 -3.19f)
J 'Provide approved metal container for oily rag storage (r-19-3.190)
Flammable liquids stored properly (r-19-3.15)
J
Corrections and Comments��/%��
ELECTRICAL --All inspections
Extension cords do not replace permanent wiring (CEC-400-8(1))
Extension cords do not pass through doors/walls (CEC-400-8 9,3))
"30 inch clearance around all electrical panels (CEC-110-16A)
All panels and breakers are marked (CEC-110-17 C)
epair holes in fire -resistive construction CEC (300-21,22)
MUM -plug power strips have circuit breaker (CEC 400-13)
FIRE PROTECTION EQUIPMENT --All Inspections
Hood system serviced/tagged every 6 mo. by cert. tech. (r19-904)
Clean filters, hood, and duct area over cooking appliances (CFC 1006.2.8)
Maintain extinguishing systems Cr19-3.24)
Provide spare, sprinkler heads (6 min.) and/or sprinkler wrench (T19-904.5)
Replace damaged, corroded, or painted sprinkler heads (T19-904.5)
Identify sprinkler valves and secure in open position (T19-904.5)
Replace missing caps on fire department connection (r19-904.3)
Provide 5 -yr. certification test for sprinkler/standpipe Cr19-904)
r
MECHANICAL EQUIPMENT --All Inspections
_Vents and chimneys -- No obvious hazards (CMC -Ch. 8)
SMOKE DETECTORS -- Day Care Sr. Res., Hospitals, Apts.
-=Properly installed and tested (r19-749, 754)
SCHOOLS, JAILS AND HOSPITALS
Decorations and curtains fire retardant (T19-3.08)
LPG tanks fenced with locked gates (r19-3.22)
FIRE DRILLS -- School and Day Care (Title 19-3.13)
All systems operable/hooked to office
Held monthly (elementary schools)
Held semi-annually (high schools)
Evacuation plans posted in all rooms
Emergqhcy procedures posted in office
Teachers take roll books
The above deficiencies must be corrected within days.
Owner/Manager
Inspection Date:
AP #
S TEOFCALIFOR�IA
RE SAFETY INSPECTION REQUEST
S .850 (REV. 10-94)
See instructions on reverse.
A ENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
SS/COMMUNITY CARE LICENSING 530 895-5033 12-2-02 RCFE
EV LUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUESTCODE
207/DONNA GURRIERE 041373048 2A
CENSINGERVICES
DEPARTMENT OF SOCIAL S
AGENCY COMMUNITY CARE LICENSING
WE AND 520 COHASSET RD., STE. 6
,DDRESS CHICO, CA 95926
L
J
CODES
1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY
3. CAPACITY CHANGE
4. OWNERSHIP CHANGE
5. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER
AMBULATORY
NONAMBULATORY
BEDRIDDEN
TOTAL CAPACITY
CAF ACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
B. CONSTRUCTION
0
0
6
6
0
0
6
FAC LITY NAME
LICENSECATEGORY
G SELLE'S CARE HOME #2
RCFE
STR ETADDRESS (Actual Location)
NUMBER OF BUILDINGS
2140 CERES AVENUE
1
CITY
RESTRAINT
CIIICO,, CA 95926
NONE
FACILITY CONTACT PERSON'S NAME
HOURS
EI,IZABETH & EFREN MEMORACION (530) 893-8078
24
CONDITIONS
[CDF BUTTE
'FIRE 176 NELSON
AU HORITY OROVII.,LE, CA 95965
NA E AND ATTN: STEVE FOWLER
A DRESS
L
INSP
/02
EXPL
TO BE COMPLETED BY INSPECTING -AUTHORITY
TOR'SNAME (Typed orPrinted) TELEPHONENUMBER CFIRS NUMBER OCCUPANCYCLASS
E. HOUSEKEEPING
I �F-V JL) �,j�- �a L� / U 3 S �, �, F. SPECIAL HAZARD
TION DATE INSPECTOR'S SIGNATURE(TypedorPrinted) G. OTHER
JDENIAL ORLIST SPECIAL CONDITIONS2 /66- 4D
63
.I
C9jof�-
CLEARANCE/DENIALCODE
CODES
1. FIRE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
D. SPRINKLERS
TOR'SNAME (Typed orPrinted) TELEPHONENUMBER CFIRS NUMBER OCCUPANCYCLASS
E. HOUSEKEEPING
I �F-V JL) �,j�- �a L� / U 3 S �, �, F. SPECIAL HAZARD
TION DATE INSPECTOR'S SIGNATURE(TypedorPrinted) G. OTHER
JDENIAL ORLIST SPECIAL CONDITIONS2 /66- 4D
63
.I
C9jof�-
B
A
CHICO FIRE DEPARTMENT
INSP�..C_TION REPORT
r �
Date: !
SINESS: Q-"" 1 SF,1 I -e -,V La r L Ln Ow—k- Z PHONE::
DRESS:
CUPANCY TYPE: R -z (l NO. BLDGS: 1 NO. STORIES:
,NAGER/OWNER:PHONE::
DRESS:
,ILING ADDRESS:
RE ARKS: 1 D `sa r v it 1 a
k ak�- Q v�� r lv b— oV9 in
('1J 1� D P �? �A 1 l l✓ A vl ft,A o lJ1A17,7. CQ-
8—c- n Sl
` r w�cw
L L(j6 bR,,,.,.&--k, Lc moi(
OCCc\
All arInspection
noted above must be clearance is granted. �A
Repection 0 Granted O INSPECTOR:
Re O Conditional
0tO Denied O AGENT:TIMl NEXT INSPECTION:S wo %-4
APPROVED
APPROVED
EXITING
Yes
No
N/A
FIRE PROTECTION
Yes
No
N/A
1. Exit
❑
0
❑
7.
Fire Extinguishers
❑
❑
2. Exit Signs
❑
❑
0
8.
Automatic Sprinkler System
❑
❑
r�
3. Exit Corridors
,�
❑
❑
9.
Hood Extinguishing System
❑
❑
Aisle / Seating
L
❑
❑
10.
Standpipes
❑
❑
Occupant Load Sign
❑
❑
c�
11.
Alarm Systems
❑
❑
/
6. Occupant Load
❑
❑
12.
Fire assembly / Wall
®
❑
❑
APPROVED
APPROVED
BUILDING
Yes
No
N/A
SPECIAL CONDITIONS
Yes
No
N/A
1
L. Electrical
❑
❑
21.
Emergency Lighting
❑
❑
1
Heating Equipment
22.
Grease Hoods and Ducts
❑
❑
1
Cooking Equipment
❑
❑
23.
Liquefied Petroleum Gas
❑
❑
.®
1
Decorations, etc.
®
❑
❑
24.
Compressed Gas
❑
❑
1
Openings: A. Walls
®
❑
❑
25.
Chemicals
❑
❑
B. Ceiling
Q
❑
❑
26.
Signage
❑
❑
1
Knox Box / Keys
❑
❑
27.
Flammable, Combustible Liquids
❑
Q
❑
1
Housekeeping
❑
❑
28.
Permits Current
❑
❑
f
2
Address Posted
❑
❑
29.
Other:
❑
❑
RE ARKS: 1 D `sa r v it 1 a
k ak�- Q v�� r lv b— oV9 in
('1J 1� D P �? �A 1 l l✓ A vl ft,A o lJ1A17,7. CQ-
8—c- n Sl
` r w�cw
L L(j6 bR,,,.,.&--k, Lc moi(
OCCc\
All arInspection
noted above must be clearance is granted. �A
Repection 0 Granted O INSPECTOR:
Re O Conditional
0tO Denied O AGENT:TIMl NEXT INSPECTION:S wo %-4
v.
1, C
......... ....
, 016i."j
t.
.1. '4LZ
Al.
0.
j
"16
;4-0'
10
-21
4 1
kv
tJ► e u( file Stale 11111-e Mal-shalINSPECTION RL1,01tr
srn1E rirt� e n1n%�nni
p 4,5 k — ....
11.�r1� cif E ��c.ility:(tn Gi iA-oV\AG;
I I.�rr1 . of 11110ding.
A(Ifhr«' 2t 40 ,
• f.= �'�;•.�'•`r f'�th ! ; ; t t i : 7 �,�' •��'.: i'/:i=•.. �'' �: f}'1. • �c�'. ... � .f, •• , 11 �; � ,� •; '; .�' �• :,' �• ,� i:' .�I��+ ••�• ,�, .•
f stuSSrc1
yrs
4
22Nd
N
1 f. C.1�Af!1V 1►„E C t/If �It,
MAN
J 1 �• V% • f t ,, /
.•.mss M •
MR
Y I,
sAA
(Prv. 7/M•)
!' {
Willi:
: • '
' ' �
Ai
• •.':• �! .�•t' ��•,'�
cc. mpai ded by:
+ .� •:I�j,'�tii'•� �' i�.� St,•.4'IIi', ��
,• r• ,1, � 1 1.•. �.�. r�.f �i �..�. •
J�4�-
yrs
4
22Nd
N
1 f. C.1�Af!1V 1►„E C t/If �It,
MAN
J 1 �• V% • f t ,, /
.•.mss M •
MR
Y I,
sAA
(Prv. 7/M•)
No.:
ffice of the State Fire Marshal '—
REINSPECTION REPORT
of Facility: I . � I V I(' 1� - - (-�tu
of Building:
Discussed with:
Accompanied by:
Title:
Title:,
Fire Safety Deficiencies Numbered y noted on the Letter EJ
Fire Safety Correction Notice (EN -11) 0 dated eave been corrected.
Uncorrected Deficiencies Numbered were re -issued as shown
on the Fire Safety Correction. Notice dated which is attached to and made a part of this Report.
In addition, new deficiencies were identified at the time of this reinspection, and are shown as Items
on the attached Fire Safety Correction Notice.
Fire Clearance Instructions:
STA
DEPUTY 51 TE FIRE
DATE OF REINSPECTION
I t7
FIRE CLEARANCE GRANTED
T -DATE
STA
DEPUTY 51 TE FIRE
DATE OF REINSPECTION
I t7
0-5 (Rev. 7/86)
.ft. ..•,
Jffice of the State Fire Marshal
Fire Safety Correction Notice
File No:
I Name:
I Address:
*FIRE
HAL
The California Health and `SafetyCode and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected.
T e above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign
a' return the certification on the opposite side of this form. If you have any questions, contact the Office of the State
Fi Marshal at
ISSU D BY (Deputy State Fire Marshall RECEIVED BY DATE.
EN -17 (�Rev.7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
*e -of -
(dice of the State Fire Marshal
INSPECTION REPORT
le No.:. f— —
lam
e of Facility. __ .�-- ••
ne of Building:
rens.
CA
Ntc5-
�FICEq,,
STATE FIRE MA AL
FRE CLEARANCE GRANTED
T -DATE
STATUS
SPATE "M
DATE OF
trON
[C)
I
GO - 6 ev. 7/86)
Office of the State Fire Marshal
Fire Safety Correction Notice
*FIRE
PIAL
The California Health and Safety
deficiencies be corrected:
Codeand the State Fire Marshal's
regulations require the following fire safety
(
jFi
e above deficiencies are to be corrected within days. When ALL' deficiencies have been corrected, sign
d return the certification on the opposite side of this form. If you have any questions, contact the Office of the State
e Marshal at ('
ISS ED BY (Deputy State Fire Marshall RECEIVED BY DATE j
EN -11 (Rev. 7/861 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
Page -of -
Office of the State Fire Marshal
INSPECTION REPORT
He No.:.
1
Jame of Facility:
lame of Building:
ddress: WO
� , r
CIEI►RANCE
� 'S ry :jy.� vyt• -.�:; y .ti\'i` ice• s r
i b
i rt �'I .��`p� •;y e. ''i
MY STATE FRE > L • . .r
„.
.;. - - .. -' �•. «✓i►:. Y; -.< �, .�' * S �y r .K.. ej'.' .Rj' i
�. �,.<
1...
� �y'�
� F
-�". Yn' t
���� �k.
•� �• ?A 1. y':!'. .t'• g `'-
�.� '�
Discussed with:
- : t ;� _ � �. •
,s
Title:
1
p:. y�.- iti: ✓'�Y. ? � : i., `a S 1 x'- `-yt: �
t•. .. '4 r� . %°• • ♦f yt�t... ' ;,�. �: d"• ,x,, � .'�^e.
'�s. a+�,4 i ' S.<.4; a -. �_ f �
i y'�`fi K`4
- ��" S�' � . T..`.4'
i � f :Z t' + ., '.i
T- T
Accompanied by:
µ : ; ,. • .
T&: .
� , r
CIEI►RANCE
STATUS
7 0
MY STATE FRE > L • . .r
DATE Df SPECIIQN '
t7t'. M _ ` - i.- -
titer rr'••
V
GO.6 ev. 7/86)
Page -o/ P�
Office of the State Fire Marshal
INSPECTION REPORT
File No.:
r
of Facility:
me of Building:
- - Rh •w �y ".�
j •�' r L7
f,. `� .�'" 3.. �'� � \.- 'x: •r ,t. •fie- .tj ?t dY". iii }__ ;c "�:� � -
.: t • -:i'f. •'� . '�5. ( 1 p r '. w;i�, � .F 1' .V r. y l•,. 'a. .
• �. � �;�
-
Discussed with:
7,��. i �. •i I
•S .. . 1, + Y i �/ ' i
t
a+N..! < }
_?.. w
TWe
\i f• ,l '3i�:S••fr• 1'•\v .,i. �-
♦^i �♦ •A-.Dt�:i.'7 Z - .• .. . .
41,;
•�
.,,
' I'.• t ,•
Accompanied y:
... a. ,t �• f3S3 �
-
`fy. +" r )
Title: -
a � f 1 ♦L..f
- 4 "
dGia�r
T7, ---t Ll
(]FARAtVC.EC RANTED :< T.Mu >. STARS
STATE FRE DATE , OF 0491E :TM
3 .(..'�� •�. ° ,� 3�` •�� <,in •6'i '.t''' d r• *.i+.(, ,�,it ic' i. t.ii. tii 2'�: - ••
10Z
GO . q (Rev. 786)
Office of the State Fire Marshal
INSPECTION REPORT
No.:. 00 _ 04 __ 47
0051 _ __ 000 = 035 _
ne of Facility: GUILCEL REST HOME
of Building:
2140 Ceres Ave.
Chico. CA 95926
i
Qiscussed with:
accompanied by:
i
Staff
Title:
Title:
A annual inspection was conducted at the above
facility no deficiencies were noted
a this time.
The facility maintains a reasoanble degree of fire and life safety.
F re clearance
is granted for six nonambulatory
clients, one of which maybe bedridden
i client room
with 44" exit.
EIRE GRANTED
T -DATE
STATUS
YE
1-9206
STATE EEE MARSHAL
DATE Of INSPECTION
S TIGHTER
15 July 91
GO - 6 (Rev 7/86)
Bice of the State Fire Marshal �
REGIONAL
FACILITY FILE CHANGE NOTICE
Name CoRectionlChange
El Address Correction/Change
El Change File Number
❑ Facility Discontinued
❑ Issue Fife Number
❑ Other
ts:
:•Y w.....� si. .� .y<: �,. ..�,.i,« ..1. •2 .t: »_b �.. r, w.>->>7" - '• >•:, > .u•.r .; ��,r. n i-.. - _, '.A► >i
s T •„S::Y}}�� .!i" ^-:>^<-.�' a.. r:�g••.,�:- 7 ,.. ?'i'.i. a.r. ,1 ��. ►•.-' .-`Z. Sis -<- 4. E •, > C�.. ,•�.��•.��y. ...'..<
♦♦tt • l.V•.'7' .*. •S> .a s' �:. k ,.Z .. i4f,,� Ax w. �T �t [ �'y .`p6 .R•5��1w.
.7 7 �, � �<� ` ;J... !� "t• J. '.LD 1'A+:.'.• .Z�'. .mss��, �'xT ! "F i. <;v3�.�+•�
;�4°.•-'�`�^�'„ • f..,a.. �� f, f " t �'R'. . r .7e ,!. .L ;�.r. <
t r tt Y�< w
s' '•t '�►�-, et �,� wa .:M•7 F� ,n,.f%, 3. J. ^'•.�., .ry. -. .....#•'' :.s. r 1 :.t �-iiP�''4.s':T .L. •: "i .. '.•.'°1<� r>7'a. s��: •fit :�., �- 1 .
t.. t�% "tri•. r?S. �" ,� �:���.,^.r„f< ,,r^•.> yF ,i': �,i ':Y...� A«.�tF., k3 'l r' s ,� c, •� .f ,•dt
..,.e• t. r1; ;, •..a. by :i :4. �s.>:j�.;lt.,e .:7"� .f .: >�+.or A �T.. 3'i ^ti' !?�.•�} .; `.. ?..� g•:"<f �'A3'M. �� 9+,'<t3 ?.� '���',<A�S.. fi. �i � ;�•,t«.«. �• i�
� �. 1 >•g:" £J. `%:Mr.r r+•i.i.F. �. ,�i•[�..' •b: ;,�:�<yu3, .� !% 4•.s-. ,� �y--. .v�.:y s. •�y-an: ��,{ 4.�^��' .... x ! jj
..f <�•• .••'••a'.� - �>I w' �.s..� <-_+slk r :.�; >5.�. q.� rv��.�`. ��• -•y' }��,,�>str - r -!."4� :�•:o•. .►T: •"r>+!� aei. „�•�i. is �:• C ,.��`• ,gT t r
� t'�;.�q�stPr sfl - :i:.� .+. R;i, ::C�,.-.'-.t,. ...,:';r`"'Y fx'r,• .«�1xi3 �.`•;�W -�!. «..D. yh.s; �, ,' �c' ,..,. yi�:: : -rr �.Fr�S�.�y'^-» S •. 31 ..,. .-s t, moi';' { ..r�����y��+"t>�
�tk� .c.> ,.i'.:'>. :�: a' >., Sr :>,. : �k•+. .ssr- � �: '�:;; -3.•. ;,t, kt ,t w`�'S� .'A►'�6. "'i ^>." •rc.rr, ,4ar•�a �� .i.• v. »'.•. %� • :��
v<:s `�`S.:t i:i' . ►.�1't.. vJ! •�. _ d' . a r ��',����.3»» •w .i L �w.+�c a. >, .�s .. ae; .r J ;,,•, ��� r ..L'^ Jt
:fes +v, ritsr. , '.r`i;'. .n 'K�.r�"'�.,$•>� ?T q�' t,� :.i.+�, �=' � �. v7;' ',,a -t, 'tci�• �3t n t. .5ct _ O
•. �. W. !T. :t, .) ... � .� .:\ •i•,.Y. <'. i. .iL, .�M,. .�... i '�'.:.' 4 f � 4e a +.
w
�. > 'i ....� �'.Z:,• .�^ .'i!'!.. . Sr s'.:1. . F.. +.. s • '�.t> l • .is ,: "L* .� � e. .S• i'..4i .t �
i•. . �•: ?•.. y. `.b A'D.>.�• ��: •„�Y`� 7 .1!.^,:.i l<h s: .. `�','�:.: 'P. 1,. K;f.i Q,C at:r�,('•t: w.•.a. .• ��{{..x v�q'�
,
..s' .. .. .. ,tv. :. •i.�• s:' •l'.. .7. :. �y ,.s >. .(. >. .7. i.<.. :I' 'fY •� ..lig• •;j.. •.✓T ♦•;.
'�- ':i-, •Lfi: 'v Y`- moi.-. ./., .... :� ..•�:. e3• -♦-w's .s... .!• ..
EN -13 (Rev. 7/86)
0 L D
NEW.
,..
Name:Name•
QU
-00
m
ddress.
Address. �..�
•
City: ' "" C.-
City:
Y
ounty: r� '' (No.
County:
No.
le No.:= — —
I� —
Fi a No..
9ccupancyClass:
•'' T-24
M FILEOccupancy
•
Class. T-24
SFM FILE
ts:
:•Y w.....� si. .� .y<: �,. ..�,.i,« ..1. •2 .t: »_b �.. r, w.>->>7" - '• >•:, > .u•.r .; ��,r. n i-.. - _, '.A► >i
s T •„S::Y}}�� .!i" ^-:>^<-.�' a.. r:�g••.,�:- 7 ,.. ?'i'.i. a.r. ,1 ��. ►•.-' .-`Z. Sis -<- 4. E •, > C�.. ,•�.��•.��y. ...'..<
♦♦tt • l.V•.'7' .*. •S> .a s' �:. k ,.Z .. i4f,,� Ax w. �T �t [ �'y .`p6 .R•5��1w.
.7 7 �, � �<� ` ;J... !� "t• J. '.LD 1'A+:.'.• .Z�'. .mss��, �'xT ! "F i. <;v3�.�+•�
;�4°.•-'�`�^�'„ • f..,a.. �� f, f " t �'R'. . r .7e ,!. .L ;�.r. <
t r tt Y�< w
s' '•t '�►�-, et �,� wa .:M•7 F� ,n,.f%, 3. J. ^'•.�., .ry. -. .....#•'' :.s. r 1 :.t �-iiP�''4.s':T .L. •: "i .. '.•.'°1<� r>7'a. s��: •fit :�., �- 1 .
t.. t�% "tri•. r?S. �" ,� �:���.,^.r„f< ,,r^•.> yF ,i': �,i ':Y...� A«.�tF., k3 'l r' s ,� c, •� .f ,•dt
..,.e• t. r1; ;, •..a. by :i :4. �s.>:j�.;lt.,e .:7"� .f .: >�+.or A �T.. 3'i ^ti' !?�.•�} .; `.. ?..� g•:"<f �'A3'M. �� 9+,'<t3 ?.� '���',<A�S.. fi. �i � ;�•,t«.«. �• i�
� �. 1 >•g:" £J. `%:Mr.r r+•i.i.F. �. ,�i•[�..' •b: ;,�:�<yu3, .� !% 4•.s-. ,� �y--. .v�.:y s. •�y-an: ��,{ 4.�^��' .... x ! jj
..f <�•• .••'••a'.� - �>I w' �.s..� <-_+slk r :.�; >5.�. q.� rv��.�`. ��• -•y' }��,,�>str - r -!."4� :�•:o•. .►T: •"r>+!� aei. „�•�i. is �:• C ,.��`• ,gT t r
� t'�;.�q�stPr sfl - :i:.� .+. R;i, ::C�,.-.'-.t,. ...,:';r`"'Y fx'r,• .«�1xi3 �.`•;�W -�!. «..D. yh.s; �, ,' �c' ,..,. yi�:: : -rr �.Fr�S�.�y'^-» S •. 31 ..,. .-s t, moi';' { ..r�����y��+"t>�
�tk� .c.> ,.i'.:'>. :�: a' >., Sr :>,. : �k•+. .ssr- � �: '�:;; -3.•. ;,t, kt ,t w`�'S� .'A►'�6. "'i ^>." •rc.rr, ,4ar•�a �� .i.• v. »'.•. %� • :��
v<:s `�`S.:t i:i' . ►.�1't.. vJ! •�. _ d' . a r ��',����.3»» •w .i L �w.+�c a. >, .�s .. ae; .r J ;,,•, ��� r ..L'^ Jt
:fes +v, ritsr. , '.r`i;'. .n 'K�.r�"'�.,$•>� ?T q�' t,� :.i.+�, �=' � �. v7;' ',,a -t, 'tci�• �3t n t. .5ct _ O
•. �. W. !T. :t, .) ... � .� .:\ •i•,.Y. <'. i. .iL, .�M,. .�... i '�'.:.' 4 f � 4e a +.
w
�. > 'i ....� �'.Z:,• .�^ .'i!'!.. . Sr s'.:1. . F.. +.. s • '�.t> l • .is ,: "L* .� � e. .S• i'..4i .t �
i•. . �•: ?•.. y. `.b A'D.>.�• ��: •„�Y`� 7 .1!.^,:.i l<h s: .. `�','�:.: 'P. 1,. K;f.i Q,C at:r�,('•t: w.•.a. .• ��{{..x v�q'�
,
..s' .. .. .. ,tv. :. •i.�• s:' •l'.. .7. :. �y ,.s >. .(. >. .7. i.<.. :I' 'fY •� ..lig• •;j.. •.✓T ♦•;.
'�- ':i-, •Lfi: 'v Y`- moi.-. ./., .... :� ..•�:. e3• -♦-w's .s... .!• ..
EN -13 (Rev. 7/86)
of Facility:
Utf ice of the State Fire Marshal
INSPECTION REPORT
_�-=, l.V ill. i�—�-� i (-+ �? t:l,f.[:� . Z✓
of Building: f r
Ss: (L C /1/ l �{ '
0 , I,['\ f,JG: [`5.
EARAN GTED
Discussed with:
Accompanied by:Title:
Title:
4 y,
f /
STATE RE MARSHALL
DATE OT INSPEION
6
rJCA
ti
u
'CLQ 6o�v_
CV (1� tel%
�1�� L.�
- c L�V
Lj
0 , I,['\ f,JG: [`5.
EARAN GTED
T•6AiE/}
v
STATUS
f /
STATE RE MARSHALL
DATE OT INSPEION
6
I
GO- 6 (Rev. 7/86
P e :bf1
office of the State Fire Marshal a�fKEC".
INSPECTION REPORT STATE FIRE MA 1HAL
File No.: .LL �) t%
L 'A
C) 0,C)
Name of Facility: M
Name of Building:
Ad rens: °_li
r��eo C,AJ� as�2 LO
Y..: ,....:. .
V •dt,
> G-
l T.
h Y
„
? 5
f r
'k
s
ar 3
S
t•
t. ✓ -
Y
`'7 a
c --
s
> s"
s.
�L. 1
•
IS Cl,i5Sift
_�_�r_ .-_�` : :. J ,..x. ..,-. ,. .. f. :>.,:: t , 1�:. ii... } ...,., •Y.3: .,. : ..C"'f :.:`a /''Y`. s:-:. ♦ k •. S• %.i
[
-
:,
s
i 4 ?
Ij
5.
n•
c... T
9,.
, 9
- T. J .f ,., •F
C
R.
s
t {
� r
tY
.v'r• : Y C Y..
K ''v
..... . ..: , . - .... .<r.... > o?.� .., 3".C, .1, -:.._. c<..,i'. o-. r , ' :. �,.�✓: ... .. .a... 4i :..(,<..,f.. . 3. .r v.. !!Ek .\r.:.. 3 r,:
ccom aniec� b
,.n
Z.
.. 'f! •^.0 1
X
yy -< 3 3 -
h
�. 3
s.
.x'. .: Y.•1 a , is
,r s,
: .-. .,. .. .4 . r.,, a-<. .:,,,..'.� -...,. !....k<,,, F. :r,..,, ..�, ., \:v.. <.., v ,`: ... ... :,:-m•:. '.`>..:•'>`'3. .J. ;!; ,i.\-... w \ s J.. i Y
G,-21
�.
LA)
L�L
.J3 'iF
:.z
tP
>� y
R
.d
T �
i R-
\
x � s
Y 2
ti
ft •
s` f
$ k
a 7 a
C:
4 <
3
3 6
A t.:
S
t:
:Y
t,
t
.a s
GO - 6 Qtev. 7/86)
:.>✓ 5 2. �.
'-±.,,Hl >� :fk z•! . Ry. ae.•aCia \,
r
L s
p
rr
R )
R• G>'t.:, -1 ,� a Vis.
r t i
r'
h
'S
x. YY?e���--,kk�'3'C r • Y.
<.'��:Y3):®.
>K
•hRr E t
ie ':a\-'.�w•^;
�,)3i•
" .: s. ::':�C>.`-�i`,i�,,\� ... ,.,> r i iXa��,r'.,.a ,.
.1
<
'F"•' f. 'TF > G to yJ ,q � <, YYt. � .\ C
�} ^'.},. <...: :: v4 -.�., +tA. ./7 ,.f'r .K -'fa t C.(
,/ yx .,r !..: 1` . .� G Y:;
4 K . .f�� '.'2'3C& ♦ >r (..
y Y'n r„ Y � ST
ff � S
� � �
fA•.
:-: VI,� Y�': V�O
. V. .
K
�,ffnn i a 4 S
>• V Pt Y
>:'tai 3 A < Cv t^'. F Y J• ..!? t .t , t,- !!' y�:"'w,
a •Y'r � •1 �(s.
>
> � rte. .t7 • .t., aj
h ST •' i.
2 T. r a
-'9
q',`�-�.i�C z-.� {jY art � �l r \ L \ 4 ' t � � t''
- � � ��yl��j t t t '•ri t £ Jl> - ,',;I,Y<.(� 1< 'f
CE E MARSHAL
IRF -IqOFFTY INQaI=r_Tinkl Q=i :QT
COPY DISTRIBUTION: SEE REVERSE OF COPIES 2 AND 5 FOR
i -A -STATE FIRE MARRHAI INSTRUCTIONS FOR COMPLETION
._
- _ 2 -FIRE AUTHORITY - 1. REQUEST DATE 2. PROGRAM
D 850 (REV. 8 / 86) 4 -5 -LICENSING AGENCY 10-17-89
3 AGENCY CONTACT 4. TELEPHONE NO. 5. EVALUATOR
DOSS/COMMUNITY CARE LICENSING (916) 895-5033 0113/BETHELL
S. SFM REGION
7. SFM I.D. NO.
S. REQUESTING AGENCY FACILITY NO.
9. REQUEST CODE
7A
041371870
PLEASE CLEAR FOR 1 BEDRIDDEN CLIENT IN BEDROOM WITH
CODES
1. ORIGINAL A. FIRE CLEARANCE
44" DOOR (OFFICE HAS BEEN MOVED)
•
2. RENEWAL B. LIFE SAFETY
3. CAPACITY CHANGE
4. OWNERSHIP CHANGE
DEPARTMENT OF SOCIAL SERVICES
IC.AGENCY COM �IUNITY CARE LICENSING
S. ADDRESS CHANGE
NAME 520 COHASSET ROAD SUITE 6
S. NAME CHANGE
AND
CHICO, CALIF. 95926
PREVIOUS NAME
ADDRESS
L �
7. OTHER
.
RESPONSE REQUIRED
DATE OF ORIGINAL REO.
it AMBULATORY
NONAMBULATORY
TOTAL CAP.
DATE OF LAST FIRE CLEARANCE
CA PACITY
AGE RANGE (YEARS)
PREVIOUS
CAPACITY
AGE RANGE (YEARS)
PREVIOUS
TO 18 18 TO 65 AND
CAPACITY
TO 18 18 TO 65 AND
CAPACITY
19. FACILITY
65 OVER
6
65 OVER
160+
6
CODE 740
12. FACILITY NAME
13. NO. SLOGS
CODES
MARINO RESIDENTIAL CARE #3
1
1. GACH 7. ICF/OT
2. GACH/R 8. ICF/DD
14. STREET ADDRESS (ACTUAL LOCATION)
P.O. BOX
1S. RESTRAINT
2140 CERES AVENUE
NO
3. SH 9. ADHC
4. APH 10. CLINIC
CIT v
ZIP CODE
16. HOURS
CHICO, CALIF •
195926
24
5. PHF 11. JAIL
B. SNF 12. ICF/DDN
17. FACILITY CONTACT PERSON
TELEPHONE NO.
16A. SPECIAL
PEG MARINO
(916) 894-8263
13. OTHER
TO BE COMPLETED BY
INSPECTING AUTHORITY
26. CLEARANCE
CODE
18. FIRE
JACK PIRISKY
#4 WILLIAMSBERG LANE, SUITE 3
CODES
A ME
AME
CHICO, CALIF • 95926
1. FIRE CLEAR, GRANTED
NO
2. FIRE CLEAR, DENIED
DDRESSII I
l.__
3. FIRE CLEAR, WITHHELD
27. DENIAL
CODE
TO BE COMPLETED BY INSPECTING AUTHORITY
CODES
NS CT 'S NAME
TELEPHONE- NO.
22. CF1RS
23. T-19 OCC.
ID NO.
CLASS
1
1. EXITS
li ..,
V.
2. CONSTRUCTION
3. FIRE ALARM
24. P. E
25. INSPE T R'S (GNAT E
4. SPRINKLERS
5. HOUSEKEEPING
28. X LAIN DENIAL OR LIST SPECIAL CONDITIONS
gA�:SPECIALHAZARD
7. OTHER
I k
STATE FIRE MARSHAL USE ONLY
IVB
20. EGION. DEPARTMENT OF SOCIAL SERVICES
FFICE
COMMUNITY CARE LICENSING
AND
520 COHASSET ROAD, SUITE 6
DDRESS
CHICO, CALIF, 95926
0 ffice of the State fire Marshal
REINSPECTION REPORT STATE FIRE MA HAL
No.: 6e)6)— 4�Z7
of Facility:
of Building:
is.
..R ..A , ... .. >:., :....... ... .... .. r ,.. .. .... ... F. .. ./.. Y ,<Y. ...r. .. �",.: .2.� .. a�'.r s r,8- •'>. ; s(: 'Mf :. •;L'%/`
. -. ., ..... .. n .... . --.+, .: i ..... ..,E .... , ... .. .-.,. :' ..> ..... ....,, p... ... .,... „ J>.. ,.. .fi.. M'': ,:!�✓'' /
.. ., o:.., ... -. ... .,.. .., <..... .... .. ?. r . .. > .['mac, .
- :. a , i. , 'n .. <,' ...- -.. .. �� . :.. ><. :. a ...,-. :... .. .cn.. •< < .. .-:Np T� :..'�. y
.. .. %:> -�;� ••
�-' I J 1.. .,•:..: ... .,, ..... ...:., >.> .> ..,.....,:nG.>....,02....Q. ;..).:,::...T y.G.;.:l,>,.. w.w ',;£...4frry,.3y;.z :ffY:.:.P, . 2.. .k"raw '- :R:t. t.• .�Y,.<: .•>. .J2,R: i..:.: ..>, :>.,
.... aw <.. ...... :. .. n r. >` f. ,. v. -, :..V.r: .. N ,. ,., A .. t F r . : .✓... n Y> -.i .. SL.. � � :: .: ....
... ... ,. .... .. ,.., :.... Y ... .r , s,. ... .. .., [. .. k X.... s ..,... ,... 3r ✓9 .?.. :t b { „f'. V. h -
.:..
>...,A'. ..s .a'Y a�'. "7� .... ... w... .. .-. .- ,.s>, r -. _ ,: r. ,. .. ... .,.: J Xt.3'v <. >.F{X ..' ♦ , .. v ,��, ..'o, -s2. A... -.. r. - �:.< -.+n., p -a' {
.. -. ... ... -.. .« ..9 >. ,. x <. ..• ,. .,,: ,-, rr. I}%.r, :, k cr b r.t K, -,:_l-, < <. h�'
n) 'A
>. .. -.. ., ... t .... ... ... -. ., '.0 ,. P.,nf�.;. .. .... .. .: .Y' .. .. v h.. ... >°f' >, .,;q,<--;:.: ♦ :592.
'CCOi
i.
mrx
'q
• v <>,x $ )
.: ,. _. l.. r!... ..., . ... .Y.�,v). i >,v. ...,: .. F, ..., .<.1., >:: h.. ,.:.. .>:,.: /..M E 'x .. .... p .ZR•'
Fire Safety Deficiencies Numbered
l
noted on the Letter El
Fire Safety Correction Notice (EN -11) ❑ dated have been corrected.
Uncorrected Deficiencies Numbered were re -issued as shown
on the Fire Safety Correction. Notice dated , which is attached to and made a part of this Report.
n addition, new deficiencies were identified at the time of this reinspection, and are shown as Items
on the attached Fire Safety Correction Notice.
ire Clearance Instructions.
6e-
e. <
: �. a.,, 2, .:n ..> .+ ..- ,��s�, «,<� >,. < r.:'k. .r .< s•>,: .,t' �{..
� <- .. � <t . � .. .,• ,�,s.,..., .n; s ..<, <J '�,,. .L.. ,:a"Y+�., ,n> � EG :,.c:. .:''sf'4`t£ ,.. ( t.. ..� .�. .�rfi .;'
�k., I 'F„1� i>:na. 8. \ ,.R °S, .. �'i's, <,j A�,,,,j `5s F � - � .N •
"�-Q' s <T ..n'. <,a• .. .. ')-<. �u:- ;:'^,.. >' F. . . .. t . tt':'• 'v r t�v ':'�Cb” .,>.sd: ..�. .ar '. 1;' '4:F 4. S .f,}
y .. 4. .:. , r ,. .. i ./ .. ), .. ''L 7: :: <. `44C :,:"' •' .. nA�' ,r`.. F� ♦.:y, ,< k .:,,., a .i.
�Y���f./7f�71r�� d � `ni :\• '�o [[¢¢ �+ Wit.
L • L ,
fk ,, l t•n
,�:` "`::§,'' «•t.x .r <a: `. � rA
i :� �� ,'(^< `� `ra
•;:. L ?vf � S.i 'i i
�'o�. r.\' ?? Y ,
� •GL' . :>- 't) . !">
:<.:. _� ,.y
At'
y �..
f
�a,, �iY
;S�1 s. jam, g
.t
) f
,
;t. •�;, L ., ',' .. :: ..,; :.:, ,:,: .,.. :, -•'YY. t: .w._ .�r' :i A. �� !, .ti ?r ., .,�,: 'y.k� .�:.
Y: 4, 0k
-:,,. � < � �.�1� �.. � k �
.,.. Y STATE FSE .._...:• L ,>. �.. ...a. ;. :., �. �> ���.��� >>. ><> ..� :�-. .�,;� t �,« ,,;>;
}� ,
,. .> e .. '. ... .,.. ^, .. < .. ...k.;t ..... <:e.b-.:ir .Efi• .i- ..,,, b. :> r r ..� kP..
..n ..y , ,. , .. .. a.... .,. , {. ,.! .. .. .n ..<s)... �-.: > .,: .. : � )"f �''35<' a ': i`'.. �. ;ri.SJ
>�., [ �• ¢ r,K._.:
'v�C >,+ k`t yt s .��• ' F: '`•?i.•f "'>r
: ELATE
{L;
\ t
r: �s4a ,;-. �,•. .a.
C 'K °t. •y �S
,+:a' .n
�E 22,�rr
r
><!r.•'. i •rte. [3
X r
.t •
Go - 5 (Rev. 7/86)
Office of the State Fire Marshall
REINSPECTION REPORT
��� 7
No.:
- —----
c� SZ_ L Z _ G� _ /
of Facility:
of Building:
is:—
�,�� 411-,- 7
{ Discussed with: tom% ' Title:
Accompanied by: Title:
Fire Safety Deficiencies Numbered noted on the Letter ❑
Fire Safety Correction Notice (EN -11) ❑ dated have been corrected.
Uncorrected Deficiencies Numbered were re -issued as shown
on the Fire Safety Correction. Notice dated which is attached to and made a part of this Report.
In addition, new deficiencies were identified at the time of this reinspection, and are shown as Items
on the attached Fire Safety Correction Notice.
Fire Clearance Instructions:
im CLEARANCE CRVQM
T -DATE
STATUS
-
IOCKM STATE ME VAR%M Z.-
DATE OF REf*I KCT10N
/ • L f
0.015 (Re 7/86)
Office of the State Fire Mars.
Fire Safety Correction Notice
File No:'�� - �!
Name: `��— — — —S //�
Address:
The California Health and Safety Code and
deficiencies be corrected.
the State Fire Marshal's regulations require
the following fire safety'
he above deficiencies are to be corrected within _ '� C� days. When ALL deficiencies have been corrected, sign
nd return the certification on the opposite side of this form. If you have any, questions, contact the Office of the State "
ire Marshal at'/( i= )
f
IS LED BY (Deputy Stite Fire Marshall ; RECEIVED BY DATE `
r
EN -11 (Rev. 7186) 86 96708 DISTRIBUTION: GREEN -,facility WHITE—Region YELLOW—Field
�••• ,,.,
office of the State Fire Marshal
Fire Safety Correction Notice
File No:
ame: 1)0 k�4 A� U
dress: —21
6(
LlD
11 C-) -�
1UL
�z
The California Health - and Safety Code
deficiencies be corrected.
and the State Fire Marshal's 'regulations require the following fire safety
41
n1 i �� ��
= /J
1/
V
- _;7 �` f� Z_
Th above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign
an return the ccertificatiorl the opposite side of4his form. If you have any questions, contact the Office of the State
Fir Marshal at�
ISSUE BY (Deputy State Fire Marshall RECEIVED BY DATE
i
EN -11 ( ev. 7186) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
Page of
Office of the State Fire Marsh,
INSPECTION REPORT
File No.:.
Name of Facility: — 44
Name of Building:
Address: -Z—
1.
S - " f/, Z
,�4 — S
FIRE CLEARANCE GRANTED T -DATE
.i
i
DE ATE F
4.
-6 (Rev. 7/86) .
STATUS
DATE OF
SATE FIRE MARSHAL
C10C C A CCTV ihi0nc^-rinwi ncni nrc%r
COPY DISTRIBUTION:
4-7-CYATC C10C KAA042UAI
Go
'h.or
SEE REVERSE OF COPIES 2 AND 5 FOR
INSTRUCTIONS FOR COMPLETION
2 -FIRE AUTHORITY
ST 850 (REV. 8/86) 4 -5 -LICENSING AGENCY
1. REQUEST DATE
2/14/89
2. PROGRAM
3. jkGENCY CONTACT
4. TELEPHONE NO. 5. EVALUATOR
bsslco '
-5Q33 0103/Bob aldwell
S. 9 FM REGION
7. S15M I.D. NO.
S. REQUESTING AGENCY FACILITY NO.
9. REQUEST CODE
41
30
041371870
7A
CODES
1. ORIGINAL A. FIRE CLEARANCE
EQUESTING FIRE CLEARANCE FOR ONE BEDRIDDEN CLIENT
2. RENEWAL B. LIFE SAFETY
F Dept. of Social Services
3. CAPACITY CHANGE
4. OWNERSHIP CHANGE
10. GENCY Community Care Licensing
.5. ADDRESS CHANGE
AME 520 C o h a s s e t R d. 6
S. NAME CHANGE
,#
ND Chico, CA 95926
PREVIOUS NAME
ADDRESS
7. OTHER
DATE OF ORIGINAL REQ.
11. 0 MBULATORY
NONAMBULATORY
TOTAL CAP.
DATE OF LAST FIRE CLEARANCE
CAPJ CITY
0
AGE RANGE (YEARS)
TO 18 18 TO 65 AND
65 OVER
PREVIOUS
CAPACITY
CAPACITY
6
AGE RANGE (YEARS)
TO 18 19 TO 65 AND
65 OVER
60+
PREVIOUS
CAPACITY
6
Ill. FA
CODE '�Zb /RCF E
12. F CILITY NAME
13. NO. BLDGS
CODES
M RINO RESIDENTIAL CARE #3
1
1. GACH 7. ICF/OT
2. GACH/R 8. ICF/DD
14.S REET ADDRESS (ACTUAL LOCATION)
P.O. BOX
1S. RESTRAINT
2 40 Ceres Ave.
no
3. SH 9. ADHC
4. APH 10. CLINIC
CITY
ZIP CODE
16. HOURS
Chico, CA
95926
24
5. PHF 11. JAIL
6. SNF 12. ICFIDDN
17. F CILITY CONTACT PERSON
TELEPHONE NO.
16A. SPECIAL
P g Marino
(916)725-4740 or 893-8078
13. OTHER
TO BE COMPLETED BY
INSPECTING AUTHORITY
18. FIRE
26. CLEARANCE
CODE
At ITHOR Jack Piriski
N ME #4 Williamsberg Ln . ,Suite 3
A D Chico C A 95926
A DRESS
CODES
1. FIRE CLEAR, GRANTED
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. CFIRS
ID NO.
23. T-19 OCC.
CLASS
00
-2
1. EXITS
2. CONSTRUCTION
3. FIRE ALARM
4. SPRINKLERS
5. HOUSEKEEPING
6. SPECIAL HAZARD
7. OTHER
24. J6 OTE
25 PECTOR'S
2 . E LAIN DENIAL OR LIST CIAL CONDITIONS
a-4!!!�I& >VI�00
20. REGION.
OFFICE
AN
ADDRESS
FJ�T-ick
Dept. of Social Services
Community Care Licensing
520 Cohasset Rd., #6
Chico, CA 95926
J
P�gP ai .►.
Office of the State Fire Mars,
INSPECTION REPORT
File No.: - .i 9 5�— "-�2
Name of Facility: //�fe%
Name of Building:
Address:
C)iscu5$ed With: ___ __—:_ � _ Title:
Accompanied by:
Title:
rea c1f.aW WC t FaN'fill T -DATE -
1
DATE: Of INSPECTION
GO 6 (Rev. 7;86)
pot
, 1
,v f_Aw1
COPY DISTRIBUTION:
,.CT/ONS
SEE REVERSE OF COPIES Z AND ,
ll'1�+ FOR CO#IP�i,ETI�ON
_
j "�' 1-3--STATE FIRE MARSHAL
` SPECTION2--FIRE AUTHORITY
t, RquES't' PAS �R i
4-5--LICENSING AGENCY-9116/'
'
-
' a. RVALUATOR
4. TELEPHONE NO. '
` unit Care Licensin (916) 895-5033
�►� /Co y
0103*mRobert Caldwell.
ff+ ' f ?Ivl..l.p. -NC11• - - .. ... S. R19GUESTING AGENCY F�91lCIL�TY
041371870
;
l
CODES
F a
CAPACITY C"ANG9 ;
4. OWNERS"1P CYAN
ttt=ililil.. Department of Social Services.
At�Ii�RF..&h'i C.NA►IWIaiG
Community Care Licensing
NAME CHANICAr;
520 Cohasset Rd.,
,
co,A 9'6
s '
° l,;
O,AT QF p #• _
TOTAL. CAP.
VA 'T Cr ;
a t
V ; NONAMBULATORY
"flu "
•
'.. ► aE (YEARS) PREVIOUS CAPACITY AGE RANGE {YEARS) PREVIOUS
CAPACITY C/I,PA,�ITY
ANI? TO 1 S 18 TO 6S AND
161. PACRI»IT"!f
'
TQ; 10; 10 TO 65
' �: :, �JVIi3R 85 OVER
6
_COUFf. f
REEN-m"w"wr
t1.0
71
1 S. NO. P1..13�v�.S
C4�Qes _
1. 7. i�i�JQ1 i
1
,? 'if AL j.00,,�►TIOl1p P.O. BOX AR- Rip. JCARE 1-3RT D-ENTTAL:
t W ,Y.
S• RESTIIMTQAC/,�
. 8. ICiF I ISD
3•no 9. App 4
40 ZIP ca �p�
Yf
1. H4U�
4 AP '
4
iI 25926
•
i.
�• F . 'Li�• IF,1R
13. 0
- TELEPHONE NO.
5-47
1.6q. SP��11
:,Marino
TO BE COMPLE"1't�D By
c !
INSPECTING AUT CMT'IC
CLEAt3ANOG
X��4X%=it Jack Pirisk1
COAGS
#4 Williamsberg Ln.
,• T,
i QRAKW
' x G h 1 c o, CA 95926
. FIRE C., D� '
3. FIRE CLEAR
7. ENI
TO BE COMPLETED BY INSPECTING AUTHORITY
ZZ. CFIRS
T$LEPHONE NO. ID NO.
4r9• T-18 OCC.
Y=
CLASS
l!
EXITS
CONSTRUCTION . ,•
& FIRE ALARM
tN s A RE
'
+�. SPRINKLERS `
u T . PI L ONDITIONS910
'
�. µtill El t
C SPECIAL, .A� � '
7. OTIC
STATE FIRE UM *NLY '
f r
,MARS"A1-
j Dept. of Socia. Services
c maunity •Gere Licensing
TIM
+ +520 Cohas•set Rd
.chico,, CA 959,4o;
Office of the State Fire Marshal
REGIONAL *FIRIEMA
FACILITY FILE CHANGE NOTICE STATE 1A
Name Correction Change
El Change File Number
❑ Address Correction/Change ❑ Facility Discontinued
0 L D
Name: le -,)7=
Address:
City: —� 6Jiel
County: (No. -(7
File No.: ___. _ -- _7—
—
Occupancy Class:
T-24 SFM FI E
Comments:
EN }13 (Rev. 7,86)
❑ Issue File Number
❑ Other
Name: /'%C1f/c�/11�7 tc 5�v - ✓Tiri'L_ 4
Address:
City: 62
County:' 1%%- (No. �_ )
File
Occupancy Class: �-'� �f'� --Z
T-24 SFM FIE
DATE
Page —01—
Jffice of the State Fire Marsh&,
INSPECTION REPORT
No
'Name of Facility: 77—
ame of Building:
ress:
T- CC
DiSCUSSed with: Title.
Accompanied by: Title:
X7 -
U WARAWCE a_4�,'JJED
FY:TT$7T7T—fFk4 MARSH1d
GO -4 (tey. 7186)
DATE
STATUS
DAZE
Office of the State Fire Marsha,
Fire Safety Correction Notice
File No
Name:
ddress: - -
L
The; California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected.
"t o e T /'J�-'.°3 •.
c_
Freturnhe -certification on the opposite'side of this form. If you have`any questions, contact the Office of the State
attate
Fire Marshall
RECEIVED BY
DATE
1117
EN 11 (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
eficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign
Freturnhe -certification on the opposite'side of this form. If you have`any questions, contact the Office of the State
attate
Fire Marshall
RECEIVED BY
DATE
EN 11 (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
Pte_—of Office of the State Fire Mar I
REINSPECTION REPORT
File No.. G C_-
C� V / %
Name of Facility: �L1- / C1 -r7—
Name
7
Name of Building:
Address: " �zo
Discussed with: with:___Y_ '. � __ .: 1 '' ' -__ __ -__ 1 itle:
Accompanied by: Title:
Fire Safety Deficiencies Numbered / noted on the Letter ❑
Fire Safety Correction Notice (EN -11)— ' dated c E�` = have been corrected.
Uncorrected Deficiencies Numbered were re -issued as shown
on the Fire Safety Correction. Notice dated
In addition,
Fire Clearance Instructions:
, which is attached to and made a part of this Report.
new deficiencies were identified at the time of this reinspection, and are shown as Items
on the attached Fire Safety Correction Notice.
RMA CE T gaTR / STATUS,
E F1R€ sHgl T-
DATE OF REINSPECTION a�
5 (Rev. 7/86)
OFFICE OF
Office of the State Fire Marsha
Fire Safety Correction Notice STATE FIRE MARSHAL
File No:
Name: L- —4/ Cl T-7— C Z
ddress:
The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected:
A 7�7_
he above defici cies are to be corrected within days. when ALL deficiencies have been corrected, sign
nd return the ertifi ion on the opposit�ide of this form. If you have any questions, contact the Office of the State
ire Marshal t
I SUED BY (Depot to ' e fGiarshaq /
RECEIVED BY
DATE
EN I (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
Certification of Corrections by Owner
I certify that all deficiencies listed on the reverse of this form have been corrected
SIGNATURE DATE
4
(Fold on this line)
(Fold on this line)
'- —
�/� Vr'.
Is te%
Domestic USA
r
OFFICE OF THE STATE FIRE MARSHAL .
INSPECTION LOG
T i fi I e _ �" oz 1J
File
ly [j]
E 9 1E a U.
Address , �,.
jr 0
444� Date
Owner
07 gCV; LA
GO -6 (Rev.- 5/81) .
OFFICE OF THE STATE FIRE MARSHAL
INSPECTION LOG
I� [� DID C] E
File
ODEE E�29
Address E � : � 'S ��f ' 6,�4dc &-q gf-,q z 6 Date 46
Owner PR. EVA L (.,i -
Alt4 ii-► 44 G.fbe.t 'rl`�f,::
rte' 60-4 dAt-N&O ia-30-45'
c
kYo u
(NTrE co &cirzc oi-vor OcF)
GO -6 (Rev. 5/81)
-+►, ./r
Office of the State Fire Marsha,
Fire Safety Correction Notice
ile No: rCZ- - 0 `d - = f
L i <? 1 ff f dD,zF
dress: 4 -fit: C E+L€t's AVE
The California Health and
deficiencies be corrected:
Safety Code and
the State Fire Marshal's regulations require the following fire safety
SSUED BY (Deputy State Fire Marshal)
RECEIVED BY
DATE
i �'( ..' ;,i•
:i.`. V.(-i€:.-€rf�c.':.7r;cpr
-i i_�
T:—
jP_ x'702
The above deficiencies are to be corrected within X°<"" days. When ALL deficiencies have been corrected, sign
and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State
Fire Marshal at (2%.,,,.
SSUED BY (Deputy State Fire Marshal)
RECEIVED BY
DATE
E -11 (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
OFFICE OF THE STATE F i RE MARS... ,L
INSPECTION LOG
Title
fft,c a
ho",r 0-
y
File
Address
Date 12
Owner
tQu e r re a �► l oz.s s AC C r10 wJ 060C 7-141 s
IQ OC L
tL dea04 �rA C L t �.
S et V v+� �4 �J 16L Q `f
#Ci91L C /OTF
icf
t f co vxior c . O, r
,,,.,.GO- b (Rev.. 5/813
.r'
of
1"iULTIRLE BUILDING
RECORD .
FACILITY NAME,
ADDRESS
• •- ..CMfeo gs-426
FILE SIG. Eol, :61) 3 0 .oEol B
_ U
BE:
. . . . . . . ... .
ipp
0
F I L E.
OCCUPANCY
BUILDING
•
-SUFFIX Na. - CLASS NU! t
(See. Jec..Vc_ 3)
OFFICE OF THE STATE FIRE MARSHh_
INSPECTION LOG
T i t I e
Address
Owner
�: �C.r� -f-rLAetc
yo CF. 4ell' z C,w Q ro T
F&r .4 ol -
File
12 6
El El Q El
Date
A
L t oc o..o) 1r oJ-w ! ,2 . l w I i
a3 -I -a, U c 14tmoa L&A2& ,r.r 4 TV 4 T aJo1 wov4
Tl r <,Ac I
r
iat
'T,4 1- re 4 µA L
( Rev • . 5/81) - - _ -
� �
--v
of "g
w
BUILDING SUR REPORT
Date: ! 0- low
STATE HIRE1b+lA AL
File No: 00 -0q -Y7 000 3 30- 0
Nof Facility: CL L tot M K �tOMC. .�
Ad ress : ,a LL, Q. e urn w e+a `?T- 6
er:'�,�� c r Telephone No. (Qt6 -rL)-7,7
Narre of Building:Awd6 A gldovC
DESCRIPTION
Cain o
E.
an
Class J-14 Use .
Ad'ss.0�.: , ,A L
,A w.,x
Capacity
construction
"O -j-- IrI T
Total 260 Largest Floor
No,, Nigh Rise
2 61"
?des
Year BulIt
Basewnt
No
/7f -400P.?,
�
Y
3. Area -(. Ft.)
4. Stories
Exterior Wall
Construction
Ar
C, ,� 7,iA
a CT16�
D.
Opening
Protection
r T I S tc*4 cro ez
IS eor r
0110 A 4L s
6v
Interior Wall
_
Construction
?
Floor
Construction
t. 0OC402 444K
8
Roof
Construction
.� �,
�, n
S wQQ
04A IF
90
Attic
Draft St22s
Noe mat 6"14
-
-v, -,J9 13
L
i
o s (2r r
l0a. Occ. Sep. Wall
ConstructionAida-
r .
1).
Opening
Protection
No..
11 a. Area Sep. Wall
Construction
.
opening
Protection
No.
12at-0 Smoke Barrier
Wall Construction
.
Opening
Protection
-
AA -
13a.
13 .
Corridor Wall
Construction
.
Opening
Protection
AdMr
` 14a.
Corridor Ceiling
Construction
,
.
Opening
Protection -
15a .
Shafts
NuThe r/Ir
b.
Opening
Protection
AAA
r_rt_ A C /4 A %
Conor.
16a.'
Stair
Enclosure
b,
opening -
Protection
17 ,
Stairs No.
18.
R s No.
19.E
Interior
Finish Class
20*
Exits
1 21*
Exit Hardware
?2a.
Exit -.Signs,/
I llumi nat ion
b.
Emrgency
Lihtim.....�
r-
Auto Sprink,,
Covera
4 .
- Staridp ipes
C1assAocation
.'6
Fire Alarm
Tvne/Coveraoe
DESCRIPTION
WAX
ifle—r A t
Room Corridor "4 Exi t Encl.
No., Total Width IV
krz AA sw Kra Y��`
Heatipg Type�rogcrto 4j& Fuel 1.,14 rw 44 L 6,a s Vent y1`t
` E lect r i ca l
Installation � tLlTALt#r 6t, lc its
r
,. Stage/ -.
Platform
` Hazardous
Areas
Other
ITS
Inspected By:f � No. Attachn�nts:
CT/
ewed By: Date:
J
Updated:
&--Ir 7--)
CLOC77- (u42C I-i^,-�,C7
a1�ro Cf yrs a�r�CN�cc� �� r26
0 0 0 4 1-i `1
m
U o 0 3 3 C) O
T- 1.4 I-y�