HomeMy WebLinkAbout006-043-003 CF ArchiveS ATE OF CALIFORNIA
IRE SAFETY INSPECTION REQUEST
S D. 850 (REV. 10-94)
3ENCY CONTACTS NAME TELEPHONE NUMBER
CDSS/COMMUNITY CARE LICENSING 530 895-5033
/ALUATOR'S NAME REQUESTING AGENCY FACILITY NL
D 104/LISA MCKAY 045404503
-ICENSING DEPARTMENT OF SOCIAL SERVICES
AGENCY COMMUNITY CARE LICENSING
VAME AND 520 COHASSET ROAD, SUITE 6
ADDRESS CHICO, CA 95926
AMBULATORY
NONAMBULATORY
APACITY PREVIOUS CAPACITY
44
CAPACITY
0
PREVIOUS CAPACITY
CAPACIT',
'ACILITY NAME
THE ENCHANTED KINGDOM #1
TREETADDRESS (ActualLocaUon)
291 E. LASSEN AVE.
CITY
CHICO
FACILITY CONTACT PERSON'S NAME
CHRIS & LEAH CARLSON (530) 345-5036 OR (530) 370-1352
SPECIAL CONDITIONS
TO BE COMPLETED BY INSPECT],
F
FIRE STEVE FOWLER
AUTHORITY BUTTE COUNTY FIRE DEPT.
NAME AND 176 NELSON AVE.
ADDRESS OROVILLE, CA 95965
L___.
INSPECTOR'S NAME (Typed orPrinted) TELEPHONE NUMBER CFIRS
i
i
INSPECTION DATE INSPECTOR'S SIGNATURE(TypedorPrinted)
EXPLAIN DENIALOR LISTSPECIAL CONDITIONS
l.J v
t
CODE
CODES
)RIGINAL A. FIRE CLEARANCE
RENEWAL B. LIFE SAFETY
aPACITY CHANGE
; WNERSHIP CHANGE
DRESS CHANGE
,ME CHANGE
1HER
TOTAL CAPACITY
CATEGORY
OF BUILDINGS
;INT
"S
NICE/DENIAL CODE
CODES
RE CLEARANCE GRANTED
RE CLEARANCE DENIED
EXITS
CONSTRUCTION
FIRE ALARM
SPRINKLERS
HOUSEKEEPING
SPECIAL HAZARD
OTHER