HomeMy WebLinkAbout024-010-111 CF Archive (2)c
STA E OF CALIFORNIA
F! E SAFETY INSPECTION REQUEST
STO $50(REV.10-94)
See instructions on reverse.
AGE CY CONTACTS NAME TELEPHONE NUMBER
C SS/COMMUNITY CARE LICENSING 530 895-5033
EVA UATOR'S NAME REQUESTINGAGENCY FACILITY NUMBER
-EWNMOORE 045404443
Lr
ENSING
DEPARTMENT OF SOCIAL SERVICES
G E NCY COMMUNITY CARE LICENSING
N ME AND 520 COHASSET ROAD, SUITE 6
DDRESS CHICO, CA 95926
L
REQUEST DATE PROGRAM
6/27/05 1 CCL
REQUEST CODE
1A
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
FIRE
BEDRIDDEN
TOTAL. CAPACITY
G ACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
3
0
IN PECTION DATE
INSPECTOR'S SIGNA RE(Typed orPrinted)
30
FA LITY NAME
UCEN.SE CATEGORY
ALLEY VIEW PRESCHOOL
850
STF EETADDRESS (Adua1 Location)
NUMBER OF BUILDINGS
1526 HUMBLE AVE.
CI
RESTRAINT
RIDLEY
NO
FA IUTY CONTACT PERSON'S NAME • .YY. -
RRY WITT (530) 846-2358 M -F 7AM-6PM
SPEECIALCONDITIONS
TO BE COMPLETED BY INSPECTING AUTHORITY
F
FIRE
A THORITY BUTTE COUNTY FIRE DEPT.
AME AND 176 NELSON AVE.
DDRESS OROVILLE, CA 95965
L
IN PECTOR'S NAME (Typed orPnnied)
TELEPHONE NUMBER
IN PECTION DATE
INSPECTOR'S SIGNA RE(Typed orPrinted)
LAiNDENIALORUSTSPECIALCON ONS
7
CFIRS NUMBER OCCUPANCY CLASS
CLEARANCE/DENIALCODE //9,�l
CODES
1. FIRE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
D. SPRINKLERS
E. HOUSEKEEPING
F. SPECIAL HAZARD
G. OTHER