HomeMy WebLinkAbout066-310-024 CF ArchiveIN
Business Address: L/ h 6
Busies Name: ` ? Z
owner/Property Management:
"cIRE SAFETY INSPECTION REPO'
Butte County Fre Department
Califomia Department of Forestry and Fre Protection
Oromlle, Califomia 95965 • (530) 538-7888
�G . city:
lr/ �:
Inspection Date:
Business Phone:
APM
33
NO.
CORRECTIONS REQUIRED
NQ
LOCATION I REMARKS
CLEARED
LOCATION
/ !
1 Provide address nurnbersbjk4 I.D. visible from street
EXMNG
2 Remove obstructions at exits, doors, aisles, sbhvays, etc.
3
Ed door to open without a key or arry sped knowledge) effort.
! /
4 Repair exit door hardware.
5
Remove obstructions from door required to be closed.
6 Remove locksUches from doors with panic hardware.
7
Provide sign over main e(it door - "This door to remain unlocked during
business hours.
8
Remove storage from undo unproteded staff
I /
9 Providdmaintain exit *Vemergency lighting.
FIRE EKTINGLISHERS
10
Have fire s serviced and tagged.
REMSPECTION DATES
INSPECTOR
11
Providehount fire extinguisher as indicated.
1st
/ /
12 Post a sign indicating fire exit usher location.
13
Provide clear access to fire ad usher.
2nd
/ /
FIRE PROTECTION EM MENT
14
Maintain, repair, paint, inspect, and'or test sprinkler/sbrid pe
system/hydrantIMC/PIV.
Refer to FPB
/ /
15
Maintain 3 feet minimum clearance for access/use of fire
appliances/equipment.
District Attorney
/ /
16
Replace damage#ainteNmssing sprinkler heads/FDC caps.
Final Clearance
/ /
17
Provide 5 -year certification test for sprinklerkbridppe system.
Ocamawclass
❑ Check Pre -Fire Plan for accuracy.
18
Provide spare sprinkler treads min. q ardor compatible wrench.
BY ORDER OF THE FIRE CHIEF
You are hereby notified to correct all violations immediately or show cause
why you should not be required to do so. A reinspection will be conducted
on . Willful failure to comply with this notice is a
misdemeanor. Violations that are not corrected immediately and/or remain
after the re4nspection may be processed as a criminal offense. Thank you
for your assistance and cooperation in minimizing the fire and life loss in
your community.
19 Hoodrduct edinguishing system to be serviced/ lagged every 6 mo.
20 Remove grease from hood, dud, and filters. KEEP CLEAN
FIREALARM SYSTEMS
21 Maintain, repair, i ardor test fire alarm system.
FIRE SEPARATIONS
22 Repair holes in required fire resistive construction.
23 Provideirepair self or automatic closing fire rated assemblies.
24 Keep attic access and scuttle openings closed.
ELECTRICAL
Signature of Recipient:
25 Discontinue use of edersion cords.
26
Install permanent wiring for fixed and stationary apoiances.
❑ Owner ❑ Manager ❑ Employee ❑ Other
27
Provide cover plates for all 'unction boxes.
Inspecting Officer
28 Remove exposed wiring or protect in approved conduit.
29
Provide a 3Nnch clear space to and in front of electrical panel.
FPB: Engine Com
30
Maintain wiring in good condition and protect from damage.
O NO VIOLATIONS NOTED THIS DATE
THANK YOU FOR BEING ARE SAFE]
FLAMMABLE L K UTDS GASES
31
Provide a flammable liquid storage cabinet or reduce storage to 10 gallons or
less.
Additional Comments:
Page of
32 Remove all flammable liquids not used for maintenance purposes.
33 Store flammable liquids mray from exits, stairs, or condors.
34 Secure compressed gas cylinders.
STORAGE + HOUSE KEEPM
35 Arrange sbage in an orderty manner to piuMe access)
36 Remove combustible storage from water heater and electrical room.
37 Remove storage to 24 inches below ceiling or 18 inches below sprinkler beads.
38 Remove linVdebrs from behind washers and dryers.
39 Remove waste/rubbish me'-naIs from the premises.
40 Keep dumpsters 5 feet away from combustible walls, eaves, or openings.
MISCELLANEOUS
41 Other violations ardor comments.
�opahn��nt �r �
Na ales yC �+ICde
SANDRA SHEWRY
Director
State of California—Health and Human Services Agency
Department of Health Services
LICENSING AND CERTIFICATION
CHICO DISTRICT OFFICE
1367 East Lassen Avenue, Suite B-1
Chico, CA 95973
(530)895-6711 FAX (530)895-6723
FacsimileTransmission
Date: 5,
a S' ,
ARNOLD SCMWARZENEGGER
Governor
PFrom:*LQ&Number of Pages `l + Cover
14
vv......%-Wl . r 9 —",*\ _ /
licensing and Certification 1367 East Las -son Avenue Suite
{530} 895-6711 13-1 Chico, CA 95973
Internet Address: www.dhs.ca. ov
Z0/T0 3Jdd OG OOIHO 0 (INV -1 EZL9968069 50:ZT L00Z/5Z/50
FAX TRANSMITTAL
FIRE PREVENTION BUREAU
BUTTE COUNTY FIRE RESCUE
CALIFORNIA DEPARTMENT OF FORESTRY
AND FIRE PROTECTION
Also serving Gridley and Biggs
176 Nelson Avenue
Oroville, CA 95965
Office (530) 538-7888
Fax (530)538-2105
❑ Confidential <NionmConfidential
W o: '11041rC14 P6-;O�llcll
epartment:
Faxu: 5C('5--6 �� 3
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'From: 'V4 ��-�%�G'r� Phone#:534'5-3P- ;ryr-r
Subject:_ � T,f� �� � �1�(r..¢�i,q - P74,00"tx �.�I-dl/CY ��l-9C 7lGt//LI�I�J'
D Urgent 00) or your review ❑ Reply ASAP 0 Please Comment
MESSAGE:
"'he document being faxed is intended onlyfor the use of the individual or entity to which it is
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addressed, and contain(s) information that is privileged, confidential, and exempt from disclosure
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nder state and federal law. If the reader of this message is not the intended recipient, or the
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,mployee or recipient, you are hereby notified that any dissemination, distribution, or copying of the
ommunication is strictly prohibited. If you have received this communication in error, please notify
s immediately by telephone and return the original message to us at the address above via the
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n ted States Postal Service.
PAGE 10 C�a7
STATE OF CAUIPORN1A - FORESTRY ANO Flkt PROTECTION
FIRE SAFETY INSPECTION REQUEST
STD. tlSa (Re V. 4-2000) See instructions on reverse.
AGENCY CONTACI''b NAME TELEPHONE NUMBER KEEBT 11A)E PROGRAM
• .�d ter' �r I
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EVALUA'f'QFi'b Ma • __
R GUESTING ASSNCY FACILITY NUMBEk REQUEST CODE •
CODES
LICENStORIGINAL A. FIRE CLEARANCE
b f �
�
2. RENEWAL EwAL B. LIFE SAFETY
NAME AND �' ` L• �1.1''l ` '� "e•0..�'�'w.., 3• CAPACITY CHANGE
ADDRESS
4. OWNERSHIP CHANGE
,.� L k Ll
• S c1 0 5. ADDRESS CHANGE
i
0. NAME CHANGE
T OTHER
AMBULATORY NONAMBUI-ATORY BEDRIDDEN TOTAL. CAPACITY
CAPACITY MCwIPVG CAPACITY CAPACITY WREVICY0 CAPACITY CAPACITY PREVIOUS CAPACITY
FACIUTY NAME
LICENSE CKrtiGORY
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NUMBER QF BUILDINGS
GI'Pr
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RESTRAINT
PACiI.lTY CONTACT Pl±ASO $NAM
4iry CONTACT PERtiON's TELEPHONE NUMBER
HOURS
'3 .13 r)q 9--m 9,.q . �� 7'
SPECIAL CONOITIONS
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TO BE COMPLETED BY INSPECTING AUTHORITY
CLEARANCE WENIAL CODE
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G P e
COO ES
AUTHORITY / �� L c�vGr
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I • FIRE CLEARANCE GRANTED •
AME AND
ADDRESS 1 �d IC C Lf C iq
2. FIRE CLEARANCE DENIED
A. EXITS
r
8. CONSTRUCTION
C. FIRE ALARM
,N$PECTpR'S NAME (Typod ormintool
7r��
TELEPHONE NUM6EA
Sad
CFIRS NUMbiN
OCCUPANCY CLA66
0. SPRINKLERS
E. HOUSEKEEPING
1144
INSPEC ION 17A v
INSPECTOR`S$IG AT (T
_
F • SPEC IAL HAZARD
G. OTHER
X N DENIAL OR LIS"r SPECIAL Co&ffiot4S
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Also
of:
4and C
STATE FIRE MARSHAL
;FIRE SAFETY INSPECTION REQUEST
Cm .ncn' inry n,n�♦
COPY DISTRIBUTION SEE REVERSE OF COPIES 2 -ANO 5 FOF
1 -3 -STATE FIRE MARSHAL INSTRUCTIONS FOR COMPLETION
,�• �,��. c•rInr nuinvrui/
I. REQUEST DATE
2. PROGRAM
4.3 -LICENSING AGENCY
01/28/2003
3:,.AGENCY CONTACT
4. TELEPHONE NO.
5. EVALUATOR
..Pam Valencia, RN HFES
(530) 895.6711
'6. SFM'.REGION
7. SFM I.D. NO.
B. REQUESTING AGENCY FACILITY 140.
9. REQUEST CODE
NORTHERN
Al
CODES
1. ORIGINAL A. FIRE CLEARANCE
Department of Health Services
10. AGENCY Licensing and Certification
2. RENEWAL B. LIFE SAFETY
NAME DHS, LAC, Ch1 = 01strict Office
3. CAPACITY CHANGE
AND 1367 East Lassen Avenue, Suite B•1
4. OWNERSHIP CHANGE
ADDRESS Chico, CA 95973
S. ADDRESS CHANGE
6. OTHER
xr: AMBULATORY
NON AMBULATORY
TOTAL CAP.
DATE OF LAST FIRE CLEARANCE
CAPACITY
AGE
)
PREVIOUS
CAPACITY
AGE RANGE (Y
S)
PREVIOUS
TO' 18
65 AND
CAPACITY
TO 18 18 TO
65 AND
CAPACITY.
19. FACILITY
78GETO(y
65
OVER
65
OVER
CODE
0
0
a
0
0
o
a o
0
0
0
17
12. FACILITY NAME
13. NO. BLDGS
CODES
MAGALIA•PINES FAMILY PRACTICE MEDICAL CLINIC
1
1. SNF 10. HHA
2. GACH 11. ADHC
14.'..'STREET ADDRESS (ACTUAL LOCATION)
15. RESTRAINT
14130 SKYWAY
3. CORH 12. ICFDDN
4. SPHOSP 13. CLINICS
5. APH 14. REFRLAG
CITY:
ZIP CODE
16. HOURS
MAGALIA, CA
95954
6. PHF 15. UNLICEN
7. ICF 16. JAIL
8. ICFDD 17. OTHER
17. -FACILITY CONTACT PERSON
TELEPHONE NO.
16A. SPECIAL
JONALD SAKAL
(530) 873.1676
9. ICFODH
Steven J. Fowler its Rural Health Clinic.
TO BE COMPLETED BY
INSPECTING AUTHORITY
Fire Captain
Fire Marshal
26. CLEARANCE CODE
Office (530) 538-3859
Pgr. (530) 871-8381
CODES
Cell (530) 521-8768
CLEAR. GRANTED
;the 4ff>IRE
Butte County Fire DepanmenUCDF Fire
2. FIRE CLEAR. DENIED
3. FIRE CLEAR. WITHHELD
ridley 176 Nelson Ave., oroville, CA 95965
27. DENIAL CODE
1U oC UUMLCI CU 01 wSPECTING AUTHORITY
CODES
21. INSPECTOR'S NAME TELEPHONE NO- 22, CFIRS 23. T-19 OCC_
S 3 IO NO. CLASS
1. EXITS
5�- 7Vt:5 �u� � 5 3� '3o Sy 'fJ S5
2. CONSTRUCTION
FIRE
24. I P, TE' 25.. INSPECTOR'S SIGNATURE
3. ALARM
4. SPRINKLERS
.�/ ,' 3
5. HOUSEKEEPING
L
6. SPECIAL HAZARD
2.8-'-EXPLAIN-DENIAL OR LIST SPECIAL CONDITIONS
STATE FIRE MARSHAL USE ONLY
20',REGION State Fire Marshal
OFFICE 4433 Florin Rd, $400
AND' Sacramento- CA 95823
ADDRESS
ZO"d 92:SI SOOZ 8Z u2f 2Zz9-S68-02S:xP3 00IH0 •12130 B -OIC
Fire Prevention Bureau
7E- Nelson Avenue
Oroville, CA 95965
Telephone 530-538-7888
Fax 530-538-2105
Address:
9wner/Manager:
Assistant Manager:
Building Owner:
Al AA..9%c.es*
Butte County Fire Rescue White Copy - Business
alifornia Department of Forestry , Yellow Copy — Occupancy File
and Fire Protection Pink Copy — Station File
Facilitv Inspection Report .AP No.
60
(Business Name:OF
Bus: �'73 1 Hm: Fax:
Bus: Hm:
Bus: Hm: I
A N TNIRPECTTON nF VOT TR Ii A CYT .TTV u IWVr A T 1'n Tsv vnir i n«rrvr .
I.
Fire Extinguishers: Required for service, due
9.
Exit(s) obstructed, inadequate
2.
Extension cords: Excess use, defective
z 10.
Exit sign(s) required, illumination
3.
Excessive rubbish, trash, debris
11.
Exit sign lights need replacing
4.
Fire alarm system defective -
12.
Exit lighting: Required, defective
5.
Sprinkler system: Service rdefective
13.
Smoke detectors: Re uired, defective
Required,
6.
Kitchen hood extinguishing system service due
14.
wiring: Exposed, damaged connectors, etc.
7.
Fire walls, ceilings, fire doors, draft stops
15.
Heating system: Defective appliance, flue combustibles
J1 8.
Knox Box keys
16.
Other:
j ,,rte i tj►1jUz" zz#..CLAlr A t tV1r An D U UMI L UTIUiN N: CORRECTED:
�I -e��
111a jJCA. L L.MA i .
ttalion l 3 4 5 6 7 IStation: FPB
RE PREVENTION SAVES LIVES, PROPERTY, AND B 1SS. YOUR COOPERATION WITH
)RRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE:
JIM
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