HomeMy WebLinkAbout047-300-066 CF Archive4,
See Instructlarl8 00 reverse,
StA,rcofCALIFORI"Ilk INSPECTION REQUEST
nFOUESTOATE
FIRE SAFETY IN PROGRAM
FNUMSER 6 CCL
895-5033 'FausafcooE
AGtm—cico,ATACT*r mAME ING S 1 AC'.lLITYmVm;lFA
SICOMMUNITY CARE Lic
ENS
CDS AaENCII F 5A CODES....
045404728
eVAL TATO $NAME A. FIRE CLEARANCE
0104/LISA MCKAY .............. .... .... 1. ORIGINAL
2. RENEWAL a LIFE SAFETY
DEPARTMENT OF SOCIAL SERVICES 3, CAPACITY CHANGE
COMMUNITy CARE LICENSING4. OWNERSHIP CHANGE
AGENCY 520 COHASSIET ROAD, SUITE 6 5, ADDRESS CHANGE
NAME AND HIC0. CA 95926 15 NAGE CHANGE
ADDRESS C 7. 0'THZIt
N NAMBUL y
pIq
RY 0 PAC17Y CAP&07Y
PREVIOUS CAPACITY CAPACITY
('APAVI-ly
......
14
rACid-tYNAVE
RU131O, KERRI FAMILY CHILD CARE HO.N4E
$ T R P, F Ir,(>(lRF.6S fActwil L0106'0
4316 KEITH LANE
...... ....
CITY
CHICO ........ .
9AGILITY 'C'ON'FA'C'tpfR5oN'SNAME. ......
KERRI Rul3IO (530) 343-6835
-;R—E�tOUSCAPACIVY
8
UCENBECATEGORY
10
,,jmggpt 0; su1l-10INGS
Rr=5tpAINT
NO. .. . ......
...... ....
NOVIRS
M -F 7-.30AM-1:30PM
to BE coMPLETIED By INSPECTING AUTHORITY
_"1KE-Aft'ANCE'16SN'AL CODE
... . ............... . ... .... ... ..
FIRE C141(;0 FIRE DEPT,
AUTHORITY 842 SALEM ST,
NAME AND C.tAIC0, CA 95929
ADDRESS
cc"
INSPECTION DA
—2,r y
print"
r
I&
CODES
1,/FIRE CLEARANCE GRANTED
2. FIRE CLEAMANrE DENIED
A. EXITS
a. CaNtTRWION
C. FIRE k A"
0, Mr'.ItR5
"I"k,