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024-080-090 CF Archive
To email this form do the following: 1. Click on "File" 2. Click "Save" 3. Click on "File" again 4. Click on "Send To" 5. Click on "Mail Recipient" 6. Address to Cyndi Wilson 7. Click "Send this Sheet' Business Name Larkin Guest Home Date of Inspection 5/22/2003 Number of Violations 0 Inspector Name Sean Norman Reinspection Date 5/20/2004 White Co Business Fire Prevention Bureau Autte County Fire Rescue Copy - 1/6 Nelson Avenue California Department of Forestry Yellow Copy — Occupancy File Oroville, CA 95965 and Fire Protection Pink Copy — Station File elephone 530-538-7888 Facility Inspection Report Occ. Class. ax 530-538-2105 Address: (6 Business Name: Owner/Manager: Bus: % Hm: Fax: r Assistant Manager: Bus: Hm: Building Owner: Bus: Hm: Address: -A -.T n.To7fT.-r-Fd-%-&T nV XUATTD IVA!`7T.ITV RF.VFAIND TAF. 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 ❑ No U 18. Other CORRECTED: Date: Discussed with: Signed: rint Inspecting Officer: Battalion 1 2 3 4 5 6 7 Station: FPB FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. Yuum uvurLKAiiVI4 wiiil CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: w � r. 44 w /o*" BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE TITLE 19/24 FACILITY INSPECTION Facility < Occupancy Address "T!"qj Inspector i Phone t .,- i ;r ` f Station Contact Station Phone Compliance: Yes =_f ACCESS --All inspections Address correct/posted and visible from road (Butte Co. Code 32-9) Access to public street or 20 ft. wide lane (T19-3.05) Gates wide enough to admit fire apparatus (T19-3.16) Fire protection equipment visible/accessible (T19-3.14) PORTABLE FIRE EXTINGUISHERS --All Inspections _Extinguishers have current annual service tag (T19 -575.1A) somok, q� INSPECTION NO. 1 2 3 REINSPECT: F] YESL,y'NO No = 0 Not applicable = N/A Maximum travel 75 ft. (T19-567) Provide clear access to fire extinguisher (T19-563.2) Extinguishers mounted on wall/or in cabinet, visible and signed (T19-563.8) EXITS -- All Inspections Exits not obstructed (r19-3.11) Exit signs in place (CBC 1003.2.9.1) Doors operate without key or special knowledge (CFC 1207.3) Rooms with Occupant Load of 50 Persons or More Exit illumination and signs in place (CBC 1003.2.8.2) Maximum occupancy sign in place (r19-3.30) Two exit doors/panic hardware swing in direction of travel (CFC 2501.8.2) HOUSEKEEPING --All Inspections No waste or rubbish accumulation inside or outside T19-3.1 Reduce storage to at least _" below ceiling/ sprinklers (r19-3.14) Remove combus. storage from heater, mech., elect. room (r19 -3.19f) Provide approved metal container for oily rag storage (r -19-3.19c) ELECTRICAL --All inspections Extension cords do not replace permanent wiring (CEC-400-8(1)) Extension cords do not pass through doors/walls (CEC-400-8 (2,3)) 30 inch clearance around all electrical panels (CEC-110-16A) All panels and breakers are marked (CEC-110-17 C) Repair holes in fire -resistive construction CEC (300-21,22) Multi -plug power strips have circuit breaker (CEC 400-13) FIRE PROTECTION EQUIPMENT —All Inspections Hood system serviced/tagged every 6 mo. by cert. tech. (T1s -904) Clean filters, hood, and duct area over cooking appliances (CFC 1006.2.8) Maintain extinguishing systems (r19-3.24) Provide spare sprinkler heads (6 min.) and/or sprinkler wrench Cris -904.5) Replace damaged, corroded, or painted sprinkler heads Cr19-904.5) Identify sprinkler valves and secure in open position (T19-904.5) Replace missing caps on fire department connection (T19-904.3) Provide 5 -yr. certification test for sprinkler/standpipe (T19-904) MECHANICAL EQUIPMENT --All Inspections _Vents and chimneys — No obvious hazards (CMC -Ch. 8) SMOKE DETECTORS -- Day Care Sr. Res., Hospitals, Apts. Properly installed and tested (T19-749,754) SCHOOLS, JAILS AND HOSPITALS Decorations and curtains fire retardant (r19-3.08) LPG tanks fenced with locked gates (T19-3.22) FIRE DRILLS -- School and Day Care (Title 19-3.13) Flammable liquids stored properly (r-19-3.15) ____All systems operable/hooked to office Held monthly (elementary schools) Held semi-annually (high schools) Evacuation plans posted in all rooms Emergency procedures posted in office i Teachers take roll books Corrections and Comments b The above deficiencies must be corrected within days. Inspection Date: Owner/Manager AP # STiE OF CALIFORNIA FIRE SAFETY INSPECTION r`Q ST See inbiructions on reverse. ST .850 (REV. 10-94) REQUEST DATE PROGRAM NCY CONTACT'S NAME TELEPHONE NUMBER bix CARE LICENShii , " ,LUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 4IA GURRIERE CODES 1. ORIGINAL A. FIRE CLEARANCE ICENSING �DEPARTpMT OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY AGENCY AM AND COI.2 UNITY CARE LICENSING 3. CAPACITY CHANGE ADDRESS 520 COHASSET ROAD, SUITE 6 CHICO, CA 95926 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY 1ACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY ;ILITY NAME LICENSE CATEGORY 1EET ADDRESS (Actual Location) NUMBER OF BUILDINGS Y RESTRAINT ;ILITY CONTACT PERSON'S N/4 E \ HOURS 46-484/, _CIAL CONDITIONS ill -i5 REQUESi. I 'OR AN UPDATE. Till: LAST IRE SA ETT :i=�� EC`i ION 3 19:+ �. TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE /DENIAL CODE FTED CODES CRAWFORD FIRE 3UTTE COUNTY FiRE 1. FIRE CLEARANCE GRANTED AUTHAME RITYANDD NAMEAND ,; SON AVEPrTUE 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS l D CA -T' „J113�/ B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS �d G }�1L i'JE �itli/N� E. HOUSEKEEPING f / / l F. SPECIAL HAZARD IN PECTION DATE INSPECTOR'S SIGNATURE (Typed or Printed) ] ` G. OTHER EXPLAIN DENIAL OR LIST SPECIAL CONDITIONS r BUSINESS NAME ADDRESS OCCUPANCY GRIDLEY FIRE DEPARTMENT INSPECTION REPORT NO. OF BLDGS. DATE PHONE NO. OF STORIES MANarFuinwrvEu .�PHONE ADTIRFCC EXITING 1. EXIT 2. EXIT SIGNS 3. EXIT CORRIDORS 4. AISLE/SEATING 5. OCCUPANT LOAD SIGN 6. OCCUPANT LOAD APPROVED YES NO NA YES NO NA ❑ D ❑ 14. HEATING EQUIP ❑ ❑ 15. COOKING EQUIP ❑ D ❑ BUILDING APPROVED NO NA YES NO NA 13. ELECTRICAL ❑ ❑ 14. HEATING EQUIP ❑ ❑ 15. COOKING EQUIP ❑ ❑ 16. DECORATIONS ❑ ❑ 17. OPENINGS ❑ ❑ VERTICAL ❑ ❑ HORIZONTAL ❑ ❑ 18. HOUSEKEEPING ❑ ❑ 19. ADDRESS POSTED 9 ❑ O FIRE PROTECTION 7. FIRE EXTINGUESHERS 8. AUTO SPRK. SYSTEM 9. HQOD EXTING. SYSTEM 10. STANDPIPES 11. ALARM SYSTEMS 12. FIRE AS S EMB/WALLS APPROVED APPROVED NO NA YES El El 20. EMERGENCY LIGHTING ❑ O ❑ ❑ ❑ 22. L.P.G. ❑ ❑ ❑ Q SPECIAL CONDITIONS APPROVED YES NO NA 20. EMERGENCY LIGHTING ❑ ❑ 21. GREASE HOODS & DUCTS ❑ ❑ 22. L.P.G. ❑ ❑ 23. COMPRESSED GAS ❑ ❑ 24. CHEMICALS ❑ ❑ 25. SIGNS ❑ ❑ 26. HAZ MAT INSP. ❑ ❑ 27. OTHER ❑ ❑ REMARKS 04) Amma&t COW' IF AW AT "ThW 9600E avF* 65 A?461rfo 91 ;:;k� 642 44 od � t � ALL EXCEPTIONS NOTED ABOVE MUST BE CORRECTED BEFORE CLEARANCE IS GRANTED FIRST INSPECTION GRANTED ❑ YEARLY FEE $20.00 SECOND INSPECTION ❑. CONDITIONAL ❑ FINAL INSPECTION DENIED .�. TIME ::::,,NEXT INSPECTION INSPECTOR �" REPRESENTATIVE AoAo—�Igo a,c�r ice of the State Fire Marshal REGIONAL FACILITY FILE CHANGE NOTICE El Name CoRedion/Change El Change File Number DAddress Correction/Change El Facility Discontinued � Issue File Number ❑ Other OLD NEW Nam Address: • City:, County: No . v ( ) Name: 4-tAxii Address: City: 6AtAC-114CAv ty_ - County. (No. ) File No.: .' -_ — _ �.. File No.: Occup cy Class: T•24 SSM FILE Occupancy Class: T-24 SFM FlLE Comments: " rz. / ;�.�., 1-•� 15-- ' (z'ni -mak h e1L.._. EN -13 (Rev. 7/86) ce of the State Fire Marshal INSPECTION REPORT e No.:. ame of Facility: 4-4 ame of Building: G,-,Lk,�J r,_— _ 2 z%/,w• GSI TH 019^,t5. O n" -� ..j / G s /,Z -- h G GO - i (Rev. 7,86) DATE OF • GO - i (Rev. 7,86) Ifice of the State Fire Marshal FACILITY BUILDING RECORD File No.:.Q Facility Name: .2-4/Qt 5j Address: I25; ? L47L/GSJ .rlw.m 'z CI a r r SUPING { tUl1.Or[N x -t c L k . ��. NO. y .�Y4 s:xtA- .ct.� z; 3— f7b > �0A EN -19 (Rev. 7/86) d" T } S .t i•: ii' ff�l f f i X 2 u f� ! WC —C PAN� T� : � rc, wlcATiOIy *01- Page 1 of 2 '"O"`'fice of the State Fire Marshak?0 BUILDING SURVEY REPORT File No.: Q -6q -_�j Z Name of Facility: �'-Iasje.-, Name of Building: pfflCf0, STATE FIRE MA AL Address: .4n..1k<0 �.gn�� �R.�e(�i L'A 915,Wf,51v Owner: Telephone No.: ( ) Agent: 0+14) 1<4 v Telephone No.: @�'SC r. 1 ✓- .'f . �. 1. max.. t, ..'4 YY. l:. _ ¢. - �'� x Y6' t 6r.,, .-1��{Y':R• �,,..�y "'� A� r S: ����: ..+Cis�.i.: .�' .t 7ij�V a ,s,x�'• r P:. :ri^ r� ;w 3: .y • v�.: R •:Ni r >. s ri G as y z. .�, .:c•. .z ..�- ..lir i' t.. S•''.? -"-- :: L'.6c tw } � .G♦. S F.L ,.'fi F ':T. (. i "y� L. YZ y3i✓'-Z(k 47°.r'(!k� :�Y`'. ♦%.. :� .{ .?...b^. 'F r�: P .' --. 'VAi':�tM.ti^�I��Y�Mi����'��J.�,A.���4���C��S^.i1��f��A w'y�, '� 9�. �� :: �> .1tZ� W .•�L 7 /� � md.�>f�.tSl.+7Si..i'uw.}scd.'�i.i��ir:•A#ew..yp.:li��aY •. USE cAPAWY -YYEAR BUILT % 1. Occupancy 2. Construction Type---rKp 3. Area (Sq. Ft.) TOTAL aoe LARGEST FLOOR BST A) 4. Stories NO. ..� --- HEtGHT HIGH RISE CN YES 5a. Exterior Wall Construction ZAp % V00'a b. Opening ProtectionA-r l S I.A=rH Ile 6. Interior Wall Construction 7. Floor Floor Construction 8. Roof Construction NO. NO. 9. Attic Draft Stops 10a. Occ. Sep. Wall Construction b. Opening Protection 1la. 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 b. Opening Protection NO. TYPE NO. 16a. Stair Enclosure b. Opening Protection - 4(Rev. 7/86 __ AZI Name of Facility: ,t�4iL<c"j &cg!�5 ra&tlolu A-5 File No.: L9- 42--A2 � � Y'r Y- sl C—) -a-5--- — ) BuildirowSurvey Report (GO -4) Page 2of2 , ,. ... .,.., y � r v 6X r > ). , ., ... <^. 3J . >.. ...: , s .. �. , ♦r <, s'" :3. >:': $"M -. .>. Iy 6 �O ♦Yv .� d -Y ffJ-.a/+'.- a.'«,�>,y, �.r'3 :' .,:.,rt^,. ter• ;,dj t:-:. ••... 9f . it H � yj� '�" � ',<' •r. :f <'a:. -.F b , , :. - r, :-< .. '.-..��i����ri�� -, . , -..:t r. r .-T ..'•� -. x �^ .,ti Ex �c {r r�' .f. ,_.<;;. n ,.. ..f-. �.., }t .. fir' ,.,1 �' •sz.: -wc; z°°s: < .:i k- 7 :r. .. ' - .. .v >. ... - - . ,ru P Y ..- ... .: •..��,'� <. .. r.: � '�.. ;�`; . .'` ..1E .. .•3Y.'. '^'�.. n-�! , 3' " ff>,,... t: ! d. {ft� r. • �f ..r ,s�+u .s fN. ���•r-ry. .@'� Y !4 ,.f"> :> >r f: ,,t f ", �vs.:. i <- ., ,; ...< Jt <. , ..S , ... . ...:% h + :�r�, f,A Y �:3: }, y a: � < . 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COIIASSET RD. #6 AD RESS CHI Cts, CA 95926 ,ATE FIRE MARSHAL COPY DISTRIBUTION: • tRE SAFETY INSPECTION RE T 1 -3 -STATE FIRE MAR SHAL SEE REVERSE OF COPIES 2 AND 5 FOR INSTRUCTIONS FOR COMPLETION ._-•. __. �� .�--_�. TD 850 (REV. 8/86) 2 -FIRE AUTHORITY 1. REQUEST DATE 2. PROGRAM _ _ - 4 -5 -LICENSING AGENCY 5-1-90 . AGENCY CONTACT DSS/COMUNITY CART LTCENSTNG 4. TELEPHONE NO. (916) 895-5033 5. EVALUATOR 0104-/SiqlTfl G. SFM REGION 7. SFM I.D. NO. S. REQUESTING AGENCY FACILITY NO. 041372940" 9. REQUEST CODE . 1A I CODES I. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY F3. CAPACITY CHANGE 14). DEPT,4. AGENCY U�� • �� S�Cj�, �'E',R�T��i'•�' •• OWNERS HIP CHANGE ��[(�� pp NAME COM-JUNI TY CARE ItTE'NS 1 NG 5: ADDRESS CHANGE AND 520 COHASSE t Rte #6 6. NAME CHANGE ADDRESSLef"co,CA 95926 PREVIOUS NAME , 7. OTHER r 1. r DATE OF ORIGINAL, REQ.------ 11 AMBULATORY NONAMBULATORY DATE OF LAST FIRE CLEARANCE TOTAL CAP. CA PACITY AGE RANGE (YEARS) PREVIOUS CAPACITY CAPACITY AGE RANGE (YEARS) PREVIOUS TO 18 18 TO 65 65 AND OVER TO 18 18 TO 65 AND CAPACITY � • 2 x 65 OVER 19. FACILITY CODE 12. FACILITY NAME 2 ` 7 3 5 i�ARKTN GUEST tl�BF � 11. NO. BLDGS CODES 14. STREET ADDRESS (ACTUAL LOCATION) 1 . GACH 7. ICF / OT 1297 .LARKIN RD P.O. BOX 15. RESTRAINT 2. GACH/R 8. ICF/DD CITV NO 3. SH 9. ADHC GRIDLEY CA ZIP CODE 16. HOURS 4. APH 10. CLINIC 17. FACILITY CONTACT PERSON 95948 2 4 5. PHF 11. JAIL , � ANN AAI, •• • TELEPHONE NO. 16A. SPECIAL 6, SNF 12. ICF/DDN (916) 846-4844 13. OTHER TO BE COMPLETED BY INSPECTING AUTHORITY S. IRE 26. CLEARANCE CODE JACK PTR ISKY UTHOR f, T 4 WI+-��+�-�r AMBURG LANE AME CH I C0 CA 95926 CODES AND ! 1. FIRE CLEAR GRANTED DDRESS 2. FIRE CLEAR, DENIED 3. FIRE CLEAR WITHHELD 27. DENIAL p- CODE TO BE COMPLETED BY INSPECTING AUTHORITY 21. INSPECTOR'S NAME TELEPHONE NO. 22. CFIRS CODES 23. T-19 OCC. ID NO. CLASS 1. EXITS 2. CONSTRUCTION 24. INSP. DATE 25. 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