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015-380-074 CF Archive
ire Prevention Bureau 76 Nelson Avenue Iroville, CA 95965 'alephone 530-538-7888 ax 530-538-2105 Address: T /I C" Manager: Owner. i:utte County Fire Rescue California Department of Forestry and Fire Protection Facility Inspection Report Business Name Bus: Bus: Bus: White Copy - Business Yellow Copy — Occupancy File Pink Copy — Station File Occ. Class. Fax. Hm: Hm: I AN TNCPFCTTnN nF VnTTR FACH.1'ry RFVF.AT.F.D TAE 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 0 No ❑ 18. Other DETAILED EXPLANATION AND CORRECTIONS: COKKIKULUJI): Iii J Date: Discussed with: Signed: (Print) Inspecting Officer: rsattalion 1 2 3' 4`' 5 6 7 Station: `� FPB - —_ FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION W1' 'H CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: lyltl I ire Prevention Bureau utte County Fire Rescue Vhite Copy - Business 76 Nelson Avenue California Department of Forestry Yellow Copy — Occupancy File roville, CA 95965 and Fire Protection Pink Copy — Station File elephone 530-538-7888 Facility Inspection Report Occ. Class. ax 530-538-2105 Address: Business Name: Fax. .: t: sistant Manager: teEr/Mamger: Bus: Hm: . g Bus: Hm: uilding Owner lAddress: 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 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 0 No El 18. Other II - - ----- DETAILED EXPLANATION AND CORRECTIONS: CORRECTED: lw-4 et -z' / _V 11W11 Date: z Discussed with:/l Signed: Inspecting Officer,?. Battalion 1 2 3 A 5 6 7 Station: FPB FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: to 3 �. r �F . ��. «<_. .F_ pi � � �•r��s' ��� - _- � -=.e ' � ..sem•- �,�•''t � � �.; , ���a� � �,.�"''�,1' �i�,•�-� Imo.,.✓{ __ ti �., •`i_ �.`S'r%. L :,{ w ..$r-•-4-tie'rC.t .zy _ - .• `•f•.�y cam' ji .f.', f �1 � � '�' � "�i.,,. 4 q . 6 _ r Iii 7 �Y'id4 0.w �.•..: 'Rl3 _ L v ,�.��.i.� .. ! � �- h �T^'f: j � . _ �. � ,r t� � + � -. +�, -.r �t � � Gra •� f � ` w. � y F �.�,� �--, x „nor—•� z�'�. � a„ � ti � � - ,. s s e ,� ^[ • �E.A �r�,e� F r(' rt -r, _ '- =+r1sa - sr.•"'y t +Y '• - } t=,• . _ Al w• z� :�'5..�`.y _ �.. -;`-4 s:•F'4., •.r` �_ . .. X3'1'=_c ti,. ..s«Y �-.�.;' WiRlim - �� � T � � ,fix �'P�. Jf`� 4 � �� atm '� r'�''"!�-r`�'y' ,�Yi�' ���T'�' � �•���r��AM r as- gr y r: P�e-a f4`lice of the State Fire' Marshal REINSPECTION REPORT File of Facility: drf1CF� STATE FIRE MA HAL me of Building: dress: �-t"t Citi CA v� e - a ,i) ..y .� t. ._,} •w� s ■i -,4 �.'.t 'i /�•�.- <..•>:ry�' 4.' ��: 5:�y.)�:°: •<' i >. . !w .. 7� V'. < . • � �„� i :l. 1 • 1 i Y _�,{,.��t<( '>4�� _- r..`.�•� at /:� t6 { . -. j. ' I , •?•C `r. "%'. .3 t :s"�•e: 3.• .,e ... "3J' �iC,,im :.�.• .:+;�. ..; ),.. ,,,�: .s.>, ..« ( a' � i;<. \ mar• IM tit. \ ' :. ).' .<F 'r7•. 5;`:` . y. y Discussed with. y . , •.- .s <., -.,. r9 :s �.M ,C � •.,, L. K,y.r:w' �.. I.K4 ><,.,. .< <-nt'a:.:.wt.;',` 't i y't,�•'1.; s•'A •y�i n':'••.. � .;,�, ).' .ti� §i .'i<•\Y �k�n'•' �- �;�y/. w„i S y•.� w'j�'g x•�'�r(� � \,5. t +•� J?.1 r •a. i{.'. � M.w ��< Iy '�j .�9i C Sii.• • :Y _ CS �:• �'�N: t. atM E'♦S+*�-' .L � :A'o �'.I.: S .� `� ��• ,. ,f -,y;, f ,�' y•�'` r'• is •c� 3 ,�,� •'1 .res �' ��r k't.'`3C�:. ''f�. Accornpaffed b Y1• N.y ./. �'!' :.�.` %^jy,. .r .r • •+XhY '.. • t;.• Z �-s��. .v . � �•:.••Y ..�'�< ' +t3'n �� �• y „g ' .(` . • ..`�rr,,,�,,�Y'k• t 'l... . � .. T 'i... • t:. .•►.� r' • +I�'�. -`` •'•±�,fi• '' „' ;< r � •i`X.9 i '. y� • �+�T7j V.T `L11 I,..P' ti.. •:�( <^,• - . r.- w �M ':SS` gal. •��,�1Y: 't� ."n : �-% , • �, � K � .•T*'r..: .. • „ t: • .w• '�.'♦'i`<p.. ,,a •y �':�. :4M : e ovt '�'.. -.: r' J` '... N y� r y..� . •-,G'..hM 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, Fire Clearance Instructions: new deficiencies were identified at the time of this reinspection, and are shown as Items on the attpcFViIeWre Safety Correction Notice. /4-� a f rD M/U (///��.y//���. �/-�•.�{ ■ x' ,�.; - a Y ANA `•E - ✓K �: .•" •7-. > •-' �a;^, .t/ d, ii: !e :.pi�� .• SFV T a���r• /., 'l�! ; .i t Y. t .jy ��c��itw9;,•�{}:•}. �+?'': l' ...0"� :7i( .• \)^'♦��>3 tt♦ i •Y� .: t.. �<' '':<: . �..x;��•-.: t'�: .�� i.<•.f i.�'i•r�•� .T / A-fE•s-.::t ,, '+:.�'. .'('+ r+i � :ly`... .. �.�. ..i y . <i;' .,, i•t-,,'• .�: - l n y 't 1. w l`•. '< :} S. r: ;s♦♦ � ; Y1• N.y ./. �'!' :.�.` %^jy,. .r .r t.lu t .+.j.: �! �f<'•• f f3; • a • ':w�rt » ��. '�?•'?.� f f W i3' ,� �� '4•'I"• :•�. . t. •q• :t: . OGkM STATE Z•� 3.�'' 'C'..-... . f�• < V _<`a ,.6 S x_. Of. . S%a 1 Y„ • •%� ; l `>bt , 11 a .� GO r 5 (Rev. 7/86) Nze—of— Fil �,sfice of the State Fire Marshal INSPECTION REPORT 7 ame of Facility: VK) of Building: is: C c CA -r1 - Discussed with: Title: N -A 1) 11 IVT Accompanied by: -2 - "21, e: FW CUEARM%a (WANM T -DATE STATUS DE M ST I* "Mmm DATE OF GO - 6 (Rev. 7/86) A-., rr Jffice of the State Fire Marshal Fire Safety Correction Notice File No: Name: Address The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety deficiencies be corrected.` The above deficiencies are to be corrected within 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 (' )� ' ISSUED BY (Deputy State Fire Marshal) RECEIVED BY DATE EN -11 (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field .. r-� �* i - -ice �'Y ��.� -X., � � � � s .i• �,.- _.1¢4 � �.. 4� xE-- � ��-"tom s s y. .s"7'�'� � ,'* f lr � e..� � � �• �i3�a�-.��� - WX150 AF - ���`" kba "•"i "�^ } ,J, •r,.--,mac.---i_—^^r - ?tiw .r q77 LIM-* 41. ' � � - - - •� tel- __ �.�^ � , .. . _ y. �.y, _ i - - ' .- rz. � ��t��-. ��_,� � -�.- �'��.: tee. -.-'T ^� 7''� a" _�C'� ^ �'i�-i'• � � fi --�� �`.. � r. _ :k.:'-'.--1 ::g x-`�+-�---- 4:- �•.r.--_..., �+r- :.cam :..s--:.3••-� _ _ `e���a`�, ej- '� �"'�'�..-.�«'s„- e.` �-"'kms "� .,_•r�- --��-+-art- - - 9- � :=_•-''v-..--.�'`'� ,.� �..... � �--•._ ..ate_. � --�> -*�;� �, ^� � r -� .� �•�,.. '��'';�Nrr's� � -vw+-. '� � .,..�L-. _ .a.�i �s.�---._....F.�.�a.�-'�' _ "u'aa�'a..`�'• _ '°z '.,-•„��.",���,�, '-"�-Y# ,.�,}. �f- FT�"*-...5..�.•,�. ' rc �, -"�t ..;.rte,. . � r a � �+e� . Fes'- `%i "_ - '� - � I' .v �'� � ' y';•� _ I +i rte. '�4r� � ',�'r�'- �"i�_' -.'4 _ •-�� - - - - tir _- a - _ "�. tea» t_i _ '� ,:t.,. , --. � -1 fICE ge of ;fice of the State Fire Marshal REINSPECTION REPORT *FIREHAL F le No.: 1Al2— Name of Facility: Name of Building: CL Discussed with: Title: Accompanied by: Title: Fire Safety Deficiencies Numbered ` noted on the Letter ❑ Fire Safety Correction Notice (EN -11) ❑ dated .S 7i 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: \ EKE GRANTED T -DATE STATUS V STATE ADE MARSHA!. DATE OF REINSPECTK>N GO -5 (Rev. 7/86) rags —of— Ci. ,:e of lite Stale Fire Marshal INSPECTION REPORT File o.:. -Q -G -S1 �-�� 0 -Qe<5�* . a v Nal ie of facility: V-1 I(— (f�7L NaOie Of Building: Ad If,e,, t1�z A/ AO -2-,a�,-tea CA 0 STAR r1Rt MA�t IAL • iscussed wit. - • • • • 1 K tid! ccompa i12J - fl. A 1� ""4 L 1' 1 i •.I'. I tiled by % le A. r 5 f% CA kL::;--t\3cA STA'" V MFUTY rpm It DAH OF tMCTM 71 V -L A % PC - 6 ptev. 7/86) File No: Name Address Office of the State Fire Marshal Fire Safety Correction Notice The California 'Health and Safety deficiencies be corrected. Code and the State Fire Marshal's regulations require the following fire safety -i G a r • J 1 i ` `l The above deficiencies are to be corrected within - - 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 ( ) ISSUED BY (Deputy State Fire Marshal) RECEIVED BY DATE EN -11 (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field _.E x'1 � .'r �4 S# - ,� _ 2 _ .. -mac .+r•,�- P>� _ h t .1' M•r2+�F/'- i. e�� � � , i- rq .•rte _ �:-`�rxG 74 .3 - . L � ✓.,�r�4' a.` �- r '� w 1=. � '4 .. 3. � � 'DY'- _ .fix "'c"i . •se-�`f; - � r w `-� ur moo_ h ,'�- ��^ g'-�-�.,.I -s" :; -� % _- x Y h. �i C' _ � ��� �+ '� ' d m _. 'r- za�y 4 ,�- `moi r s ;,.. j r..._h� •w _ as ., -"%''t..��, j!• J ,�r..F�`# -Y�`,a ter, ;rr 1� x .a o} -.YK�•,F �-� �._ .. � "Fe s c f 5 - � •tai G - � •-'''ij ��<c- .,:�,� .�,�.L'� - >:�.�? 1�- C -� �.�� 'M. f �..� ; '^" .T«:. �` - g,- �'- �' _ r _ _ ..,f c y � _`I -3 ,sv�r t � ti ;:� t>-- .. •e'er �;� """t3'--1�•,{+9x ��.1'�'��rx � �=1��`.'_"'rFe�i....}• �` .�... - _- _� _ - y ;zest a , t - - _ � - ti 1-y ^ .SPb' r � y i''1-.,. 'caJ • '`r i`�- -'F' Sr T.". -_ <7^ y r � � �,,,, "ssRr'� .�„_>ri�.`:` ":�'�„�-- _'� �' r•,.� f.. A ,_ K � -,,"-" ,�- ei. --,�� '"� fi' _-.� �' � s •'lam. °�+ .� s _ 7 1 _ _ 4, `��"� .; � � .. .,.ixs. a `�� �e�••-tels n _ F _. - a� Ile— � --^�c � � 3�' ��� ". - "c'�r+•-rte••. y' �i"'cr�..a<�• �-•..- 5=-'.�1•,� - _n-.,-a•fr- ��+rx+ sc t-es� a+-.. .._-. - _ ✓ F, 3' ;s` S � L L"i- �~�� �1 "° e �� 'Z �'rr- �-_ r-�;i �,.� v" E1S-f-ir.c _ ,�-"�.-a*5•t ,feat : _ 4 °4�' -.�„- �,. ,r .c_.<7i3r-af">.n..�'". '� _ :r-�:• '?',�-+i: .�k: d'� File Oiaice of the State Fire Marshal INSPECTION REPORT 10 of Facility: V,-1 "" :2�? f1 1(j�i of Building: r�;� iJ �il� VA � � --7 Go h 6 (Rev. 7/86) rt., '{ f" )scussed Witli`y h77 '1 �Atf.t"Aa AY dY' > g r �P�, H� �OKKW,t�;4�+{4 t,?y I� P(5+''•j STA1115 1�:t R Wil' LLEiL(ZaLf�--- MAJ !e STATE FRE t�} j i� " { =t+ 4J `y 7 r +: r t. t♦! k s yy P � W� ��. DATE OF 4s,: � L 1�+i ��6'S 3(!+ k; 551, K3 {��_ �i`•�j {�� k Q,M � �!��� i H^j y Laq�- � tt Go h 6 (Rev. 7/86) STA1115 1�:t R !e STATE FRE t�} j i� " { =t+ 4J `y 7 r +: r t. t♦! k s yy P � W� ��. DATE OF 4s,: � 1�+i ��6'S 3(!+ k; 551, K3 {��_ �i`•�j {�� k Q,M � �!��� i H^j y k �� � tt Go h 6 (Rev. 7/86) tiff ice of the State Fire Marshal INSPECTION REPORT No.:. — O )CSC_ = c)-5S_i Ime of Facility: V (Dok� 1��,� of Building: ,n \ ;s:, O j 1. Lo � Discussed with:. }- Title: �� n , Accompanied by: `��--� % �r Title "-L-) mac' U�-- '� ��� Cir-. �2� � � (1.�� ►�.�`� �� � � ERE -- T.DATE STATUS STATE FUZE M DATE OF CTION 6 (RS. 786) STATE FIRE MARSHAL COPY DISTRIBUTION: + SEE REVERSE OF COPIES 2 AND 5 FOR r-iriff dMArCTV cion INSTRUCTIONS FOR COMPLETION 2 -FIRE AUTHORITY 1. REQUEST DATE 2. PROGRAM STD 850 (REV. 8/86) 4 -5 -LICENSING AGENCY 3. AGENCY CONTACT 4. TELEPHONE NO. ....... (916) =R 6. S M REGION 7. SFM I.tD.�SNO. 8. REQUESTING AGENCY FACILITY NO. 9. REQUEST CODE p}�]yt Tr 8 [�� NEW AP LICKfI IN ;41372561 CODES 1. ORIGINAL A. FIRE CLEARANCE ��[[��77������{{{� FF 1�(�''�� RESPONSE RMUIR.L'a , .�.- 2. RENEWAL B. LIFE SAFETY 3. CAPACITY CHANGE 4. OWNERSHIP CHANGE 10. 1 GENCY S. ADDRESS CHANGE fl �T c+z+ntf �� aa��.. SOCIAL AME DEPAI;TMEN O SOCI6i..�L SERVICES 6. NAME CHANGE COMMUNITY C.0ti3 LICENSING NO PREVIOUS NAME DDRESS L 520 Cohasset Road, Suite 6 7. OTHER Chico, CA 95926 DATE OF ORIGINAL REO. 11. - MBULATCRY NONAMBULATORY TOTAL CAP. DATE OF LAST FIRE CLEARANCF CAPACITY AGE RANGE (YEARS) PREVIOUS CAPACITY AGE RANGE (YEARS) PREVIOUS TO 18 1 18 TO 65 AND _ 65 OVER CAPACITY TO 18 18 TO �65 AND 65 OVER CAPACITY 19. FACILITY CODE 12. FACILITY NAME 13. NO. SLOGS CODES 1. GACH 7. ICF/OT 1. GACH/R 7. ICF/DD 14. TREET ADDRESS (ACTUAL LOCATION) P.O. BOX 15. RESTRAINT 3. SH 9. ADHC 4. APH 10. CLINIC CITY ZIP CODE 16. HOURS 5. PHF 11. JAIL 6. SNF 12. ICF/DDN 17. JACILITY CONTACT PERSON TELEPHONE NO.. 16A. SPECIAL 13. OTHER TO BE COMPLETED BY INSPECTING AUTHORITY 18. IRE 26. CLEARANCE _ CODE AUTHOR .77AA ii 7 STATE FIRE f�IARcRAL CODES AME _ j �� TJi�{ 1. FIRE CLEAR, GRANTED AND -14 WII,I., AMS M, LI ;�. � 2. FIRE CLEAR, DENIED DDRESS L MOO, CA 15926 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. ID NO. CLASS 1. EXITS 2. CONSTRUCTION 3. FIRE ALARM 24. I SP. DATE INSPECTOR'S SIGNATURE 125. 4. SPRINKLERS 5. HOUSEKEEPING 28. EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS 6. SPECIAL HAZARD 7. OTHER STATE FIRE MARSHAL USE ONLY F 1)EPARTM TT ®F 900TAb S l7VICES 20. REGION. COMMUNITY CARR LICENSING OFFICE 520 Cohasset Road, Suite 6 AND Chico, CA 95926 ADDRESS J INSTAUCTIONS I This form Is designed for use with a window envelope, To use, told at marks Indicated in the left margin. Licensing or Requesting Agencies—Com pt the following. 20 sections. -this form -before submitting it. to the State Fire Marshal . REQUEST. DATE. :inter 'the- date- -request was 12. FACILITY NAME. get : Abe name of the fa6lity a prepared. It will appear on the license. List Identifying sub name e . PROGRAM. Lioensiftgagency O 6,. -.if no n'(i.e., Hacienda Corp] Medina Lodge o a AGENCY .,,,CONTACT, -. TELEPHONE*;O., Now . Insert the total number of buildings to . EVALUATOR... -Enter the name and -telephone be used for lousing of the occupants covered bit the number of agencycontact person. license. . SFM REGION,', Insert one of the following 3 numbers 14. ADDRESS. Insert street address and city on .ye for the SFM regional office in whose area the facility post office box is not acceptable as only location. is located-, 350 Coastal, o Northern, 70 Southern. 5... RESTRAINT. Indicate. J physical restraint (locked , e . _ p ii in a room or the building s to be used n the housing . SFM ID NO. This is -the SFM Identification Number -o the occupants♦ and initially will be assigned by the State Fire M rsb k v ens n , enc user this number on all n for HOURS Indicate' be umber o s the clearan�e re es`s subsequent o bents request. occupants are housed a the facility (less than 0; or . REQUESTING AGENCY FACILITY ou This Is the fil e number. assigned by Abe l cans ng agency. _ a'S E s Use to designate persons who are. determined to be non-ambulatory :dor reasons other . REQUEST CODE.- Use the seven codes shown and than a pbys a .band cap. insert the appropriate number in the box following "Request. Codes. It NAME CHANCE, please list 17. FACILITY CONTACT' o, TELEPHONE previous name. Insert date of original request es6 when i - .1 Indicate the -and nd 1Y ..I. lephMnn rnber of the requestis--otherthan an original. responsible individual at the facility to be con aped 10 . AGENCY E AND ADDRESS. inter the -name by he re authority. and address of the licensing facility requesting the 18. w FIRE AUTHOR, NAME. AND ADDRESS. Insert the inspection. name and address of the fire authority where the . AMBULATORY—NON-A_ BULATORY., facility is located. a t�m >,p»g,�g Capacity: Insert, in the appropriate ppropr�a•te S'a�-�ons A IT CODE. (1 General ,Acute Care Hos; �tal x capacity o licensed ambulatory r non- on. ' ��,} General ct.sre lospal t P.bab ambulatory amb latory occupants covered by this _ G CH/R)s (3) Special Hospital SH), 'r - e - request.' - Psychiatric Hospital PH= () Psychiatric Health Age Indicate the age range of the licensed Facility (PHP), (6) Spilled Nursing Facility '�F ', 7) Intermediate Care Facility/Other (ICF/0T), ange.. occpans Intermediate Care Facility / Developrnentall.y - Previo s If request Is for renewal or capacity Disabled Habilitative ICP / H g ( d It Day Capacit.y.: -change, insert capacity o previous Health Care HC s 10Clinic, 1 Jail,- _ ... clearance:. Intermediate Care Facility/ Developmentally Total S°bo w .� al licensed capacity. It the .cill- Disabled Nursing (ICP , or Other. Capacity: ty is intended to house part ambulatory 20M REGION, OFFICE AND ADDRESS.' Insert the n1lnye ho.w .the total and part non-amb atory, s$Y.r and address of the State Fire Marshal eg�� na. • off he $ wo types f occupants. a ��gy •'W�r a iiy/'v0 i whose area the facility is located. - FIRE AUTHORITY CONDUCTING THE INSPECTION-COMPLETEL I 2 1. INSPECTOR'S NAME. Print the Initial of the In- por';, first - ruin -and full lastname; insert the telephone number where -.the inspector may be con- tacted. - - - 122. . No. Insert the. fire departments. number assigned. by -CPQ: =- . TITLE 19 OCC. CLASS. Use Title 19 occupancy clas iticlations and insert the occupancy determined by the inspector. 24. INSP. DATE. Enter the actual date of the in- spection. 215. INSPECTOR'S ON E. To be signed by inspector conducting the inspection. 26..CLEARAN.CE CODE,_..'Vs0 the. three codes shown an'd insert the, apgreprla +- mbet In -the- box follow_ Ing � "Clearance Code''. OTE: if Code 2 (Denied) Qr Code 3 (Withheld) is used, explain. `. _. DENIA IL CODE- ase only-" the seve codes shown and insert the appropriate number In the box follow- ing "Denial Code". It No, 7 "Other's Is used, explain at Item 28. NOTE! Rre Clearance. cannot �e .:depj d for other than lack of confor- mance with the provis on",%bf Title 19. 28. EXPLAIN DENIAL. If Clearance Code No. 2 or,3Is used,. briefly explain reason. This space is also t.0 be used to eXplain Denial~- Code item noted. - 86 96650 Pae of ,'ice of the State Fire Marshal � O�FKE�, REINSPECTION REPOR"r STATE FIRE MA HAL v z� File No.: Name of Facility: Name of Building: Address: Fire Safety Correction Notice EN -11 El dated -,� have been corrected Y t ) Uncorrected Deficiencies Numbered were re -issued as shown on the Fire Safety Correction. Notice dated I , 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: Y. .e v y -�• 1. :€. y, � 'Ys. ti•- • F f� w` t. e z L y �a s i l• •'e Y S` �' 1' � tJ' ♦^V ♦Y .M'i'l.: j � \- d'^. ♦ r 'l \ ... < .. .- :: -.- e• ,:.,,;F.- ... .� :- .-t M,- ...1. ....: n.,. .......,. S-<... ,.. s-. '..a. 'f' ^�,: z •z.{ :;5 r'.�' •La 2 (• rAn FIRE •ryr, r: � l S. 'k ..G�. S'-;�:. .2. .o s `s' \. •� T-.4 %mac. .z,;.,a' :rf, s �'' N. i.. f x� R..in ':�I'l1C \lf GI[V.7� V�� f� �� �.�" . r, J .s•:.- t-'tY •G, ' 9r �.i. •a >t .. -. -, .. r. t. : �. :.,u. r. -.: .J. , L'. J .. �'",R ... .v� r•i p 1\ . yYs tnp. . �L f x , .: is �-4. E:=" �� _.,,. ,ti-..- ...:. - „- -. .. ,.,.,r;..,a-4.,.,„ $:-.:�R,_>, .....,,4''aT, s,'•"�./J;�.a:+ ..r.;�,,,:,.t. 'b.:: '':1� y I% ,r. r - 5 (Rev. 486) IPA, ice of the State Fire Marshal otEKE r �1 REGIONAL FACILITY FILE CHANGE NOTICE STATE FIRE MA HAL El Name Correction/Change El Change File Number El Issue File Number El Address Correction/Change Fiacility Discontinued ❑ Other OLD -NEW Name: L �=' rte_ `� � % 1 2�� ��t Address..� •C�, 6 City: V t 2 C County: (No. • C l - ) Name: . Address. City: Count : (No.7f3) Y • CC- -- File No.: - � .i •..r. File No.: ...ter+ .r r 6 � Occupancy Class: T•24 M RLE Class: T-24 SFM � ; Comments: rs BV -13 (Rev. 7,86) CWice of the State Fire Marshal REGIONAL � FACILITY FILE CHANGE NOTICE Name Correction/Change El Change File Number Address Correction/Change El Facility Discontinued dfIC'Eot, STATE FIRE MA HAL issue File Number ❑ Other Fite No.:.— Occupancy Class: T-24 SFM FILE File No..._._. .� Occupancy Class: L��.- 2,1p y T-24 SFM FILE sUG-1 _ R SLS Comments: -� �:. ws. '•�. �.i :'Z �sZ!'n•,' :Y".� 7. `�""• '> • '�' y�,,.r • f,.«. � � �e*" :!' . 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L BU b[NC� .... n.... ,,. ,. fin- e ... 03� ,.,n . s... :. ... , t n. .. : :.., , •s... ., :., . - .. . „. .-. ,. ,-. •..- ;:..... ,::-tot :s>� ...i . . ,• .. : of 2 i ^z f. L Y ,... N >.: 3 _. 3cy :;x (��v C_j1. PAge 1 of 2 ofF�ck �.,fice of the State Fire Marshal BUILDING SURVEY REPORT STATE FIRE MA AL File No.. Ci.7 z N 3me of Facility: Name of Building: A dress: l i S Z ��1�U�71�r'�� (li� FJ oc— PZ Owner Telephone No.: ( ) Agent: Telephone No.: ( ) S.. .'X `St �'.. . .v .: n _.. .. .. .\ .. ..'r n.• ...�✓. 1 p ... .,. ..: R!. .yv M.... F .^,i �. Y ,s i ..5�.1 •�^. t Y.: ` `M .. t .r :. � J�- .. ..fa• .. .. . x�� r. Arse c '�• .. ^.l <.. •z} .. .. .. ......: � ♦ Y s .... � - ... '.i Ss .. R < . :.. ,. . , .. • :. � .. . -.._- .. t� 'i...: n.. .,.. ..o, ..�. a Q.+w'.:. .A : r < ...... t<',n :_-.., .:.. ., a .:- .. -.: ...: .. ;' ti. .. .. .. r.. .Y .. .:.- .... ..... .., .., ., �� � i - - f.< :.. ..�G .. ..r. ',�'i .. .. .� ..� ..: ... :,, .Y�'. .cC.. rnY.t >... 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Y. _.. ...:.>: <�. :S-i� .. ^;(. `:.i• ■ n�:....3t ••tr �;^.;� s� ,.- A.L%....\....r+nS..•R.).n.. ��..v...�:...O.. M?•r.... '\.�1. w12.Y. 4rV..M..Y.. ...2 ..,W, w.....\f..•,$..fn...t.:...6..1i!r�G.Y!!�.:Lc:..A•,(vin t:t�wi.:..�`L":r:.,.nv.i`2GNk•4>i�h1 �-.:'. vYw vvO..n,Mr:�:� nlY> ..t. i:.. Jl... wy�'w.M<KNt .,..bY:'Y.-Fi 1. Occupancy TYPE USE r` A CAPACITY, 2. Construction Type �-- � . YEAR BUILT17 (e 0 3. Area (Sq. Ft.) TOTAL LARGEST FLOOR BASEMENT 4. Stories NO. HEIGHT HIGH RISE YES No 5a. Exterior Wall Construction sa Ky i o al Z 2 f b. Opening Protection Is�T �- 6. Interior Wall Construction '�406 Z y -� I AL, Q � ,,t t� �� ►' (�-� jG� 7. Floor Construction e� �„� �„�, i - �• � L,l© v� � -�A-ti G7��' � � � � 8. Roof Construction 9. Attic Draft Stops No. 10a. Occ. Sep. Wall Construction No. b. Opening Protection 1 la. Area Sep. Wall Construction No. b. Opening Protection 12a. Smoke Barrier Wall Construction NO. b. Opening Protection 13a. Corridor Wall Construction b. Opening Protection 14a. Corridor Ceiling Construction b. Opening Protection 15a. Shafts NO. TYPE b. Opening Protection 16a. Stair Enclosure NO. b. Opening Protection CO -4 (Rev. 786) T • • t Fac acne of ility: _ Ft a No.: — — Buildir'O"""Survey Report (GO -4) Page 2of2 _ . ]y :'i... r) b.% T• x.� r kas ,• .., .. • yot n . .,....,. ... �.. .N , � h•3, f:. 1 y+' >f r Mf t7. P ,: ,. - .� � •M. -' • . � rf.' 9t. S: .•: .,,, x ,ct P>•. ✓� v--,r.t' K � � r:• ' ♦e. } t4 �,. '�x�i. v�,��. a: •�, ',.)d�`•'Yl. i 3t•�%. }4 i :>�.. S AA .� ��: . yJ:,�•' L ''7�, d. L -kc ?'. r�J :�tat<- .cY>' � R. ``'` d ns. q� Y fl •{ t•.. ! CY y Y u < z' y. 4. . � a �. Mtt >i .It ✓� �]t < ♦ 17. Stairs .; A. .. �... ..v yw'.a ... ' .' .. , -, :: , , ..:. .i•...... ::: .: ,., .... S♦.; . , < ' Y NO.14096 ' 18. Ramps .s f t ! .. < REV�VVEU BY ... .., n NO.N .,{+,:):.. `^i r i •t' .i'i QRS': .?};. TE r ���: w•C` .:;, .r •Por , 19. Interior Finish Class ry- M UPDATM E �X •C ♦%. i i' .. ... .. 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Other COMMENTS: 1 r., r . >. 9 c ,.....: +, �... .. .� . r ATS c t <. .. ,::..,. . • ::: , :.. .. (.., . :.. > ..., :,try ,k a: r, •2 • >..N .,.. .; A. .. �... ..v yw'.a ... ' .' .. , -, :: , , ..:. .i•...... ::: .: ,., .... S♦.; . , < ' Y .: <,- v.yc .�>"r'Y , >' �i,�c '.), 3. 2%,.,:f - "Y.. , J. '.ti r ;y. .x n.��. < r.: .Z. .a: ..fs� .•3;7 ♦ �d•w .s f t ! .. < REV�VVEU BY ... .., n : .... ,. .c . . w...,. < .. !Y P ....r, b..... -., .. :.. K ., a .. ., ♦ ... t:, .. , :, .. ., ,E, <..:,.., .. ..•., r :. ..v...,..... r. P>4.. x ,..,. .,:'4'.,.n♦ << 3 �•, � :.<. .. _ , _. _,, a .., ... ,r .. � .,.: � .,>,. a . r P 3 �y s ,c. � .: .f , '. ..., .t. n .•. � .. ...... r. ..,£., r... ...:.. �..-.:.. � :':.�. ] >- .. -:>. .... ... .:, P ..�^ a k .. . a, -.a >.. .. ! „t� - ' < .f' -'.ds �:r, � .,{+,:):.. `^i r i •t' .i'i QRS': .?};. TE r ���: w•C` .:;, .r •Por , :w ... ,.. .. ).:, ..,.. .... -. .... .. P• .. .. ., �..: -.r -,.:.. a ..v t ry- M UPDATM E �X •C ♦%. i i' .. ... .. 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T -DATE STATUS bEPIM STATE RSHAL DATE OF INSPECTION CO/ GO - 6 (Rev. 74 ,.-&. 3ffice of the State Fire Marsha, Fire Safety Correction Notice File No: (9'0_ _(7q - _Z�3 Name: Address: Z/l The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety deficiencies be corrected. 77 The above deficiea ncie r� to be ca 'n ected wi `2 days. When ALL deficiencies have been corrected, sign and return -the -cert* ion on th516pposite de of this form. If you have any questions, contact the Office of the State Fire Marshal SSUED BY (Depu tate ' e`arshal) ��j RECEIVED BY DATE EN -11 QW7d6l' v 86 96708 DISTRIBUTIOK/ GREEN—Facility 'WHITE—Region t l YELLOW—Field _zertification of Corrections by Owner I certify that all deficiencies listed on the reverse of this form have been corrected. SIGNATURE I [)ATE (Fold on this line) ...................................................... 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Reinspection Indicates That '�`> New Fire Safety Corrections Should Be Issued. See Reverse Side f&F mni ents and New i re safety Corrections. GO -5 (3/70) REV 5/81 Deputy Comments and New Conditions: New Fire Safety Corrections: OFFICE OF THE STATE FIRE MARSH._ INSPECTION LOG Title gC 14, &jf V I PlFilea MR [n lalgo DUD c Address �.Sj-7- 1014LI B'JdX�e 12J, (2, -a cQ 4 1q9 z 6 Date Ownera i r 6M t .EZ of-,-) Inez- /t,loCL✓Ai Aq 1 t _ • GO -6 (Rev.*, STATE ]FIRE MARSHAL 14"0111 /4"11N I ��QE SAFETY CORRECTION NOTIk..� STATE)FIRE MARSUAL NA E FILE NUMBER RESS, Q F31 9 Fc� Fol Fol 51 � W - I -ol ' a o, 9 adO C44 qS-42-4. ADIC In accordance with the minimum standards of Title 19, California Administrative Code, the following corrections are required: s 1'L4xlib A Ovtce ?�P4 jywodsw4 A Ai0evico- jQ IT�(� ICoge Seg� 2-424&e) The above deficiencies are to be corrected within � ' days. Upon completion, please sign and return the certification on the opposite side of i44s-form 'If you have any questions, contact the State Fire Marshal's Office at 1SS ED BY (D PUTY STATE FIRE MARSHAL) RECEIVED BY DACE 1� 7 r Ell -11 REV. 7/81) YELLOW: REGION WROTE: SAC99.QT. .O.. GREEN: FIELD 88701-355 3-84 12M TRIP OSP CERTIFICATION OF CORRECTIONS BY OWNER I certify that all items listed on -the reverse of this form have been corrected in accordance with the requirements of Title 19, California Administrative Code. SIGNATURE DATE (Fold. or, this line) (Fold on this line) �a - fill"n;6,7�1A�,l�f STATE FIRE MARSHAL 4 Williamsburg Lane, S u ste 3 Chico, Ce 95926 O L D N E W STATE FIRE MARSHAL NAME: ADDRESS: REGIONAL ROUTE T0: (1) COUNTY: (No. ) COUNTY(No* d4 ) FACILITY CHANGE NOTICE (11) SUPERVISOR FILE IDENTIFICATION N0. (2) DATE: RECORDS CONTROL (12) CCUPANCY CLASS: CLERICAL (3) p .NAME CORRECTION/CHANGE q DEPUTY (4) � ADDRESS CORRECTION/CHANGE 'nitials 13) p LOC. FACILITY -LOC.. INSPECTION (5) Q OCCUPANCY CORRECTION/CHANGE (14) p LOC. FACILITY-SFM.*INSPECTION. (i) (6) INSPECTION AUTHORITY CORRECTION/CHANGE (7) � FACILITY DISCONTINUED SFM FACILITY (0) (16) COMMENTS: eAu�. 17) ORIGINATOR LEN- 1 (T) (12/80) (8) ISSU CHANGE IN FILE NUMBER (9) • p OTHER (10) O L D N E W NAME: NAME: ADDRESS: ADDRESS: COUNTY: (No. ) COUNTY(No* d4 ) (11) ILE IDENTIFICATION N0. FILE IDENTIFICATION N0. aaC� aaa0 a 0 El a tj [A H [E.i (12) CCUPANCY CLASS: OCCUPANCY CLASS.: code proc. code proc. INSPECTION AUTHORITY INSPECTION AUTHORITY 13) p LOC. FACILITY -LOC.. INSPECTION (0) Q LOC. FACILITY -LOC. INSPECTION (0) (14) p LOC. FACILITY-SFM.*INSPECTION. (i) Q LOC. FACILITY-SFM INSPECTION (1) 15). p SFM FACILITY (0) SFM FACILITY (0) (16) COMMENTS: eAu�. 17) ORIGINATOR LEN- 1 (T) (12/80) 0F�c'F BUILDING SURVEY REPORT , Date : S -- t - o STATE �E k+lA A.L File No: Name of Facility:. Address: Z 2. vkt t—p er:t5iAi yur-� A14 VA Telephone No. ( ■ NwV of Building: : 1 DESCRIPTION Ccw m& 1. Occupancy.- . Class -- Use LPoAC� �,_w CYC" CA�u,_, Capacity l'Z__- Year Built,- 2, Construction 3. Area (S Ft. } Total Largest Floor Basement 4. Stories No, L High Rise Yes No 5a,,* Exterior Wall Construction p l "t. - h. opening h. Protection V�epLkl tkEp 6. Interior Wall Construction 7. Floor Construction �c 89 Roof Construction WD a C4 -N SQKk_ Slr.7C� o� LAZO • V-k"-ft1dq 9. Attic Dra f t S to s No. (�-� • Oa. Occ. Sep. Wall Construction b. opening Protection No. la. Area Sep. Wall Construction 0 b. opening Protection No. • ..2a, Smoke Barrier Wall Construction • b. Opening Protection �•.� 3a. Corridor Wall . Construction b. Opening • Protection N 4a. Corridor Ceiling . Construction Pik - b. opening Protection N 5a. Shafts Number/TypelN � b. Opening Protection • ' DESCRIPTION Comm* nspected By: (71 tAk No. Attachments: W-'t'�-S w4r<- eviewed By: Date: pdated: 16a. Stair EnclosureN�._ - b. Opening Protection 17* Stairs No.. 0� 18o Lams No. . 1910 i 4te-r i ar Finish Class Room'- Corridor O Exit Encl. N A No. �- Total Width 5 LZ0. 'Exits 21. Exit Hardware TyELe 22a. Exit Signs/ Illumination b. Energency Lightingi....1 • . 23. Auto Sprink, CoverageN 240' Standpipes Class oca t i on . 25: Fire Alarm Covera e 1.26'. Heating �VLCZO Fuel PA f Vent _—.l.�--- --,- 27. Electrical Installation* 28. Stage/ Platform OIA 29. Hazardous Areas �'' • 34. other ' NMNTS : nspected By: (71 tAk No. Attachments: W-'t'�-S w4r<- eviewed By: Date: pdated: ----�-----_ �--'--► -t----•--•-:__--__-�-`-`: - -- ; - -- -- - � ---- --� - -• =-- - -_}- - --?-- -- --... -_ ! _ _ 7 + I _ ' - �_-_-. . -.. --1 ---- , ••--- --j---.__..1 _ . _.... _.T_ -_-_�-•__- ..____ : -1-�- �_-moi----�- -�. ------•r..r« ? i . I i I . 1 I , : I , 1 • • 1 7 I � • , I i � j t 7 1 i ' � i i � 1 j i , I I I . I • ---_� i.-.--_ _�-- -__�._ _._ T( -_- ��__r._-__�-_. �1_._._. J-� ..F__-_-.--1 - _-_ _.----iii-- _i .Y_- - �.- _--._i-. '!---�;_-__.._a- ;-----r.-����1- ♦___ � _ I - .� �. I ' j 1 E �( ' I Nisi -�v ;ScJ�Grc: ; _? _ t f- . ; - . � f , ► I. � t � i IPS , 49, 161 i ma 11ULTIPLE BUILDING FACILITY RECORD `� FACILITY NAME* A/c Q�� �2-�t2xq ADDRESS:qbw moo. 0 G�cm �h-�iS�i� our—up—. FILE NO. J i2tsl:j) El L SERIAL OCCUPANCY FILE BUILDING IDENTIFICATION SUFFIX NO CLASS NUMBER • (See See,, 31- Z, Rev. 3/81 • '7N-11 REV.. 7 /A 1) . YF1 I,rVA1. per -,In t ' ��• '�T r. r;11-11 ITY - ....*, r�---�T.-4—,P1-9n t?_MTRIr�*-, STATE FIRE MARSHAL FIRE SAFETY CORRECTION NOTICE STATE IRE MAR AL FILE NUMBER oo - El 1-11-1 F1 11 El. ET.'D E H F-]�, NAME ADDRESS he-fIn accordance with. the minimum standards of Title 19, California Administrative Code, the- following ollowing corrections are required: I VIA (,I �?A 1 � �� �11J1 1 j �� "� �"""i • « •' �� � f �, l,'� L.�'�� (r A1 �- ( � f �. 1 • The above deficiencies are to be corrected within days. Upon completion, please sign and return the certification on the op osite sid of this form. 1f you have any questions, contact the State Fire Marshals Office at (�-! 1� ) < �., �- • :, 1-�- ISSL EDB (D PUTY-.STATE FIRE MARSHAL) 'RE b IVED• BY DATE - '7N-11 REV.. 7 /A 1) . YF1 I,rVA1. per -,In t ' ��• '�T r. r;11-11 ITY - ....*, r�---�T.-4—,P1-9n t?_MTRIr�*-, W L I- I "C. illi"ZIMIAL INSPECTION LOG T i t I e mpm-z=:51-h. M Fite Address 2 L,',,S Ve_o Cf{-, C0 C,�... � q �� �� Date Owner . Z- f h1S��,n 11�S CA A-1,3 I KAI M., A c L jj 10, C-4,k!'rhl v� uN3 E:)r� E4D KAAl-LIE,,o k N� l - .n accordance with the minimum- standards - o Title 19 California Administrative d .. f � .� Code .the ollowing corrections .are required: Owl A 2A 10 1pz�o e e,Vn0GL4VSV T&e- above deficiencies are to be corrected. within days. 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