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Home My WebLink About024-220-030xhs Butte County Fire Department KSD cCalifornia Department of Forestry and Fire Protection Fire Prevention Bureau 176 Nelson Avenue, Oroville, CA 95965 530-538-7888/530-538-2105(fax) Fire Safety Inspection Business Address: Business Name:J60—Ir �rj �� cr r/U--�«f®a� Owner/Manager: I000,11 Bus:L�6"— ,g' 5 () Other: Other Contact: Bus: Other: Building Owner: Bus: Other: Address: Occ. Class: AN INSPECTION OF YOUR FACILITY REVEALED THE FOLLOWING: 1. Fire extinguishers: required, service due 10. Exit(s): obstructed, inadequate 2. Extension cords: Excessive use, defective 11. Exit sign(s): required, illumination, photo luminescent 3. Excessive rubbish, trash, debris 12. Exit sign lights: obstructed, defective 4. Fire alarms stem defective 13. Exit lighting: required, defective 5. Sprinkler system: service required, defective 14. Hea ting system: defective appliance, flue combustibles 6. Kitchen hood ext. system: service due 15. Wiring: exposed, damaged connectors, etc. 7. Fire walls, ceilings, fire doors, draft stops 16. Address posted and visible from road 8. Smoke detectors: required, defective 17. Other 9. Fire drill log checked Yes ❑ No ❑ 18. Other type of inspection — State below IDETAILED EXPLANATION AND CORRECTIONS: CORRECTED: Date: L/ lo (((Print) Discussed with: I i l �� rGtl�s Signed: _ �l1 Gt✓ Battalion 1 2 3 4 5 6 Station: ( P Inspecting Officer: -�4 >%� ��'6� By order of the Fire Chief: You are hereby notified to correct all 4e�affions immediately or show cause why you should not be required to do so. A re -inspection 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 re -inspection may be processed as a criminal offense. Thank you for your assistance and cooperation in minimizing the fire and life loss in our community. (H & S sec. 13112) White Copy — Station File Yellow Copy — Re-inspect/business Pink Copy — Business 0 Check when sent to prevention dutte County Fire Department California Department of Forestry and Fire Protection Fire Prevention Bureau 176 Nelson Avenue, Oroville, CA 95965 530-538-7888/530-538-2105(fax) Fire Safety Inspection N. IrFrn�_ Business Address: 6-b -1 1,6 e>0 4 Business Name: OLd .57.9 0' //I," Owner/Manager: e!/ O-'/ Bus: ` G 3 -95") Other: Other Contact: Bus: Other: Building Owner: Bus: Other: ddress: Occ. Class: L _MIIhFAU=100M0go] wielI:4yt1yl4Iva NZLT/=F_14=1011Ion 1:@7@]411141TJll►[ 1. Fire extinguishers: required, service due 10. Exit(s): obstructed, inadequate 2. Extension cords: Excessive use, defective 11. Exit sign(s): required, illumination, photo luminescent 3. Excessive rubbish, trash, debris 12. Exit sign lights: obstructed, defective 4. Fire alarms stem defective 13. Exit lighting: required, defective 5. Sprinkler system: service required, defective 14. Heating system: defective appliance, flue combustibles 6. Kitchen hood ext. system: service due 15. Wiring: exposed, damaged connectors, etc. 7. Fire walls, ceilings, fire doors, draft stops 16. Address posted and visible from road 8. Smoke detectors: required, defective 17. Other 9. Fire drill log checked Yes u No Li 18. Other type of inspection - State below DETAILED EXPLANATION AND CORRECTIONS: CORRECTED: /l 1"7011 (J c�X/ -7 I' /-9 /1G �CgCli ISS//! G CG/C/�/G- i'�ItiGC. 0 op _ S -/l Al � ilrh 1 � � A �F/X 1l'.J' � S 771.✓ G 7v 2Lr Date: Discussed with: Si ed: (Print)C I M or6(ies Inspecting Offi Battalion 1 2 3 4 5 6 Station: ��/v%(J"� By order of the Fire Chief: V You are hereby notified to correc all violations immediately or show cause why you should not be required to do so. A re -inspection will be conducted on . Willful failure to comply with this notice is a misdemeanor. Violations that are not corrected immediatel and/oremain after the re -inspection may be processed as a criminal offense. Thank you for your assistance and cooperation in minimizing the fire and life loss in our community. (H & S sec. 13112) White Copy — Station File Yellow Copy — Re-inspect/business Pink Copy — Business 11 Check when sent to prevention STATE QF CALIFORNIA , FIRE SAFETY INSPECTION ..QUEST STD. 850 (REV. 10-94) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM CDSS/COMMUNITY CARE LICENSING 530 895-5033 5/19/04 EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUESTCOOE 0 10 1 /MARGIE WHITAKER 045403 834 1 A LICENSING DEPARTMENT OF SOCIAL SERVICES AGENCY COMMUNITY CARE LICENSING NAME AND 520 COHASSET ROAD, SUITE 6 ADDRESS CHICO, CA 95926 L AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 50 0 50 FACILITY NAME GRIDLEY MIGRATs CHILDREN'S CENTER - INFANT QTR. LICENSECATEGORY STREETADORESS (AcivalLocation) NUMBER OF BUILDINGS 1567 BOOTH DR., ROOMS 11 2 & 3 CITY GRIDLEY RESTRAINT NO FACILITY CONTACT PERSON'S NAME DIANA BECERRA (530) 846-3204 HOURS DAYS SPECIAL CONDITIONS CAPACITY TO INCLUDE 50 INFANTS (0 - 3 YEARS) IN ROOMS 1, 22 & 3 (FLOOR PLAN ATTACHED TO BE COMPLETED BY INSPECTING AUTHORITY F FIRE STEVE FOWLER AUTHORITY BUTTE COUNTY CDF NAME AND 176 NELSON AVE. ADDRESS OROVILLE, CA 95965-3425 L INSPECTOR'S NAME (Typed orPrinted) TELEPHONE NUMBER X30 )53�-355� INSPECTIONDATE INSPECTOR'S SIGNATUR TypedorPrinted X20 -� I/ 1oa EXPLAIN DENIAL OR LIST SPECIAL CONDI NS CFIRS NUMBER OCCUPANCYCLASS 0 q 01 ll> I -/ CLEARANCE/DENIAL CODE CODES 2,,,,FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER 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 BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 50 0 50 FACILITY NAME GRIDLEY MIGRATs CHILDREN'S CENTER - INFANT QTR. LICENSECATEGORY STREETADORESS (AcivalLocation) NUMBER OF BUILDINGS 1567 BOOTH DR., ROOMS 11 2 & 3 CITY GRIDLEY RESTRAINT NO FACILITY CONTACT PERSON'S NAME DIANA BECERRA (530) 846-3204 HOURS DAYS SPECIAL CONDITIONS CAPACITY TO INCLUDE 50 INFANTS (0 - 3 YEARS) IN ROOMS 1, 22 & 3 (FLOOR PLAN ATTACHED TO BE COMPLETED BY INSPECTING AUTHORITY F FIRE STEVE FOWLER AUTHORITY BUTTE COUNTY CDF NAME AND 176 NELSON AVE. ADDRESS OROVILLE, CA 95965-3425 L INSPECTOR'S NAME (Typed orPrinted) TELEPHONE NUMBER X30 )53�-355� INSPECTIONDATE INSPECTOR'S SIGNATUR TypedorPrinted X20 -� I/ 1oa EXPLAIN DENIAL OR LIST SPECIAL CONDI NS CFIRS NUMBER OCCUPANCYCLASS 0 q 01 ll> I -/ CLEARANCE/DENIAL CODE CODES 2,,,,FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER 1 STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 10-94) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM CDSS/COMMUNITY CARE LICENSING 530 895-5033 5/19/04 CCL EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0101 /MARGIE WHITAKER 045403835 1A TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE/DENIAL CODE FIRE STEVE FOWLER AUTHORITY BUTTE COUNTY CDF NAME AND 176 NELSON AVE. ADDRESS OROVILLE, CA 95965-3425 INSPECTOR'S NAME (Typed orPrinted) T 10 257..t INSPECTION DATE INSPECTOR'S SIGNATU EXPLAIN DENIAL OR LIS SPECIALCONDITIONS TELEPHONENUMBER CFIRS NUMBER OCCUPANCYCLASS Printed) CODES C)FIRE-CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING DEPARTMENT OF SOCIAL SERVICES AGENCY COMMUNITY CARE LICENSING 2. RENEWAL B. LIFE SAFETY NAME AND 520 COHASSET ROAD, SUITE 6 3. CAPACITY CHANGE ADDRESS CHICO, CA 95926 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE I L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 24 0 24 FACILITY NAME LICENSE CATEGORY GRIDLEY STATE PRESCHOOL CCC STREET ADDRESS (Actual Location) NUMBER OF BUILDINGS 1567 BOOTH DR. - ROOM #7 CITY RESTRAINT GRIDLEY NO FACILITY CONTACT PERSON'S NAME HOURS DIANNA BECERRA (530) 846-3204 DAYS SPECIAL CONDITIONS PRESCHOOL CHLDREN AGES 2 - 5 YEARS IN MODULAR ROOM #7. FLOOR PLAN ATTACHED. TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE/DENIAL CODE FIRE STEVE FOWLER AUTHORITY BUTTE COUNTY CDF NAME AND 176 NELSON AVE. ADDRESS OROVILLE, CA 95965-3425 INSPECTOR'S NAME (Typed orPrinted) T 10 257..t INSPECTION DATE INSPECTOR'S SIGNATU EXPLAIN DENIAL OR LIS SPECIALCONDITIONS TELEPHONENUMBER CFIRS NUMBER OCCUPANCYCLASS Printed) CODES C)FIRE-CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER STATE ?F CALIFORNIA FIRE SAFETY INSPECTION ..:QUEST - STD. 850 (REV. 10-94) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM CDSS/COMMUNITY CARE LICENSING 530 895-5033 5/19/04 CCL EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0101 /MARGIE WHITAKER 045403 833 IA LICENSING DEPARTMENT OF SOCIAL SERVICES AGENCY COMMUNITY CARE LICENSING NAME AND 520 COHASSET ROAD, SUITE 6 ADDRESS CHICO, CA 95926 .L * AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 75 1 0 0 75 FACILITY NAME CC GRIDLEY MIGRANT CHILDREN'S CENTER & LA ESCUELITA LICENSE CATEGORY �� , o �, C STREETADDRESS (Actual Location) 1567 BOOTH (ROOMS 4 & 5) NUMBER OF BUILDINGS CITY GRIDLEY RESTRAINT FACILITY CONTACT PERSON'S NAME NO DIANNA BECERRA (530) 846-3204 HOURS SPECIAL CONDITIONS DAYS REPLACES PRIOR REQUEST (8/7/03) FOR LA ESCUELITA (045403832) & GRIDLEY MIGRANT04540 { 3833). THIS REQUEST IS SUBMITTED BECAUSE THESE PROGRAMS WERE COMBINED &WILL USE ROOMS 4 & 5 (FLOOR PLAN ATTACHED) TO SERVE AGES 2 - 5 YEARS. TO BE COMPLETED BY INSPECTING AUTHORITY FARE STEVE FOWLER AUTHORITY BUTTE COUNTY CDF NAME AND 176 NELSON AVE. ADDRESS OROVILLE, CA 95965-3425 INSPECTOR'S NAME (Typed orPrinted) 45 T ro w C-tE;e INSPECTION DATE ' INSPECTOR'S SIGNATURE(Typ EXPLAIN DENIALORLTSPECIALCONDITIONS 7 J TELEPHONE NUMBER CFIRS NUMBER OCCUPANCYCLASS (J�o)53k,--3 WV9 eydlr 46 - CLEARANCE/DENIAL CODE CODES 6) FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY 3. CAPACITY CHANGE 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE 6. NAME �J CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 75 1 0 0 75 FACILITY NAME CC GRIDLEY MIGRANT CHILDREN'S CENTER & LA ESCUELITA LICENSE CATEGORY �� , o �, C STREETADDRESS (Actual Location) 1567 BOOTH (ROOMS 4 & 5) NUMBER OF BUILDINGS CITY GRIDLEY RESTRAINT FACILITY CONTACT PERSON'S NAME NO DIANNA BECERRA (530) 846-3204 HOURS SPECIAL CONDITIONS DAYS REPLACES PRIOR REQUEST (8/7/03) FOR LA ESCUELITA (045403832) & GRIDLEY MIGRANT04540 { 3833). THIS REQUEST IS SUBMITTED BECAUSE THESE PROGRAMS WERE COMBINED &WILL USE ROOMS 4 & 5 (FLOOR PLAN ATTACHED) TO SERVE AGES 2 - 5 YEARS. TO BE COMPLETED BY INSPECTING AUTHORITY FARE STEVE FOWLER AUTHORITY BUTTE COUNTY CDF NAME AND 176 NELSON AVE. ADDRESS OROVILLE, CA 95965-3425 INSPECTOR'S NAME (Typed orPrinted) 45 T ro w C-tE;e INSPECTION DATE ' INSPECTOR'S SIGNATURE(Typ EXPLAIN DENIALORLTSPECIALCONDITIONS 7 J TELEPHONE NUMBER CFIRS NUMBER OCCUPANCYCLASS (J�o)53k,--3 WV9 eydlr 46 - CLEARANCE/DENIAL CODE CODES 6) FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHER i STATE OF CALIFORNIA • HEALTH AND WELFARE AGENCY DEPARYWENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING FACILITY SKETCH (Yard) The Yard Sketch should show all buildings in the yard including the home (with no detail), garage and storage building. Include walks, driveways, play area, fences, gates. Show any potential hazardous area such as pools, garbage storage, animal pens, etc. Show the overall yard size. 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Class. Fax 530-538-2105 Address: 7 Business Name: Owner/Manager: p. Bus: Hm: Fax. Assistant Manager: �^) �''_ ; , More, Bus: Hm: Building Owner: Bus: Hm: Address: • wT YXTensrlr7nlT nr Vn7Tu F A !'TT .TTV RFV -FAT .F.n TAF. Fi OI .I ,nwYNC-- 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 0 No ❑ 18. Other DETAILED EXPLANATION AND CORRLCTIOINJ: UVKKEU-1 L: Date: Discussed with: Signed: (Print) Inspecting Officer: Battalion 1 2 3 4 5 6 7 Station: FPB FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE:_' ` rL,'t�-'• q� � - � SGT �y -.- �1, 1 - �, •s`-Y^��£.. 'moi.. J1 •�5G � Q¢{ f -1 �ri,jx c ff �_,r� � �- - ,• _= "`.-`' P 2` '� - .•paw iF�C t {_ moi. S .• l .4y' _- �� i � ,...-..-T-._ -ems -��... s.�.T.i: - _ b' `_ Y '�' � ms'µ• _ ~ ��-`x_� .f' -`�--� �"` �`3 ;.•- is r.. � � �� 4 d .,•.�..a +`.ate � .-+e+, SVS `mac. � '�- � •.' • - - ` , a _ , - _ Fire Prevention Bureau 176 Nelson Avenue Oroville, CA 95965 Telephone 530-538-7888 Fax 530-538-2105 Address: I I ':::� Manager: Owner: 3utte County Fire Rescue California Department of Forestry and Fire Protection Facility Inspection Report air — Business Name: Bus: Bus: Bus: ... White Copy - Business Yellow Copy — Occupancy File Pink Copy — Station File Occ. Class. raa f , 14 (aVC Cev .' Hm: Fax. Hm: Hm: I AN MR.PF.f TION OF YnITR FACTLITY REVEALED THE FOLLOWING: 5V r! 1. Fire Extinguishers: Required, service due �f .10. Exit(s) obstructed, inadequate 2. Extension cords: Excess use, defective 11. Exit sign(s) required, illumination 3. Excessive rubbish, trash, debris f ' 12: Exit sign lights need replacing 4. Fire alarm system defective X/ 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 r/ 17. Address posted and visible from road 9. Fire Drill Witnessed Yes 11 No ❑ 18. Other DETAILED EXPLANATION AND CORRECTIONS: COKKLUTEV: Date: Discussed with: Signed: >.� rint 6a nedk.L Inspecting Officer: Battalion 1 2 3 4 5 6 7 Station: € FPB FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION Wl'IM CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: GRIDLEY FIRE DEPARTMENT INSPECTION REPORT DATE BUSINESS NAME ADDRESS 14- -7 ge,,Ttf PHONE � — OCCUPANCY Lo NO. OF BLDGS. NO. OF STORIES MANAGER/OWNER ADDRESS 4&1L 1A 111012-1 -40 PHONE EXITING APPROVED YEX NO NA 1. EXIT ❑ ❑ EXIT SIGNS C, ❑ 3. EXIT CORRIDORS ❑ ❑ 4. AISLE/SEATING ❑ ❑ 5. OCCUPANT LOAD SIGN ❑ ❑ 6. OCCUPANT LOAD ❑ ❑ FIRE PROTECTION 7. FIRE EXTINGUESHERS 8. AUTO SPRK. SYSTEM 9. HOOD EXTING. SYSTEM 10. STANDPIPES 11. ALARM SYSTEMS 12. FIRE ASSEMB/WALLS APPROVED YES NO NA ,Jr El2. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ BUILDING 13. ELECTRICAL 14. HEATING EQUIP 15. COOKING EQUIP 16. DECORATIONS 17. OPENINGS VERTICAL HORIZONTAL 18. HOUSEKEEPING 19. ADDRESS POSTED APPROVED YES NO NA ❑ ❑ 1 ❑ ❑ E ❑ ❑ E ❑ ❑ E ❑ ❑ ❑ ❑ ❑ ❑ 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 INSR ❑ ❑ 27. OTHER ❑ ❑ REMARKS ALL EXCEPTIONS NOTED ABOVE MUST BE CORRECTED BEFORE CLEARANCE IS GRANTED FIRST INSPECTION d GRANTED ❑ YEARLY FEE $20.00 SECOND INSPECTION ❑ CONDITIONAL ❑ FINAL INSPECTION ID7 DENIED TIME �yJN� EXT INSPECTION :��i INSPECTOR `J REPRESENTATIVE �� GRIDLEY FIRE DEPARTMENT INSPECTION REPORT DATE)o2— d BUSINESS NAME iL1 Ilk- PHONE 14 (0' 3-2,4 ADDRESS ill -C6-7 jQ12,, u OCCUPANCY z il I L p NO. OF BLDGS. NO. OF STORIES MANAGER/OWNER PHONE ADDRESS EXITING 1. EXIT 2. EXIT SIGNS 3. EXIT CORRIDORS 4. AISLE/SEATING 5. OCCUPANT LOAD SIGN 6. OCCUPANT LOAD BUILDING 13. ELECTRICAL 14. HEATING EQUIP 15. COOKING EQUIP 16. DECORATIONS 17. OPENINGS APPROVED YES' NO NA 25. SIGNS ❑ ❑ L� v,p4z NO NA 7. FIRE EXTINGUESHERS ❑ ❑ O , ❑ o ❑ ❑ APPROVED YES NO NA 25. SIGNS ❑ ❑ L� v,p4z NO NA 7. FIRE EXTINGUESHERS ❑ ❑ O , FIRE PROTECTION APPROVED NO NA 25. SIGNS ❑ ❑ L� v,p4z NO NA 7. FIRE EXTINGUESHERS ❑ ❑ O , 8. AUTO SPRK. SYSTEM ❑ ❑ ❑ 9. HOOD EXTING. SYSTEM ❑ ❑ � 10. STANDPIPES ❑ O -H 11. ALARM SYSTEMS � ❑ D 12. FIRE ASSEMB/WALLS ❑ ❑ B� SPECIAL CONDITIONS 20. EMERGENCY LIGHTING 21. GREASE HOODS & DUCTS 22. L.P.G. 23. COMPRESSED GAS 24. CHEMICALS APPROVED YES NO NA 25. SIGNS ❑ ❑ L� HORIZONTAL ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VERTICAL ❑ ❑ Q] 25. SIGNS ❑ ❑ L� HORIZONTAL ❑ ❑ 26. HAZ MAT INSP. ❑ ❑ L� 18. HOUSEKEEPING C'f ❑ ❑ 27. OTHER p ❑ 19. ADDRESS POSTED Ja' ❑ ❑ /*100) REMARKS� Ai��0, (2.G � poel /<OFenovca. 2,Q-GA-rzm 54Aw 5%�/n /vf L� 3 0': ,A, /l/f S: 0 /0-./ 4-1 d ALL EXCEPTIONS NOTED ABOVE MUST BE COAECTED BEFORE CLEARANCE IS GRANTED FIRST INSPECTION ❑ GRANTED ❑ SECOND INSPECTION ❑. CONDITIONAL O FINAL INSPECTION V DENIED ❑ TIMENE TINS CTION INSPECTOR 77-1,oVY �� REPRESENTATIVE /IL 'C YEARLY�FEE $20.00 � at BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE TITLE 19/24 FACILITY INSPECTION INSPECTION NO. �� 2 3 REINSPECT: _� YES E] NO Facility J�7 UT ;t: y A/ 7) V_ Occupancy Address L�G��. t�r�-r-�1 �.e r V Inspector�1� Phone LS!/ - 6L24F-_/ Station - Contact iF''s dLi'/?,�'�l Station Phone P Compliance: Yes No = 0 Not applicable = N/A i ACCESS -- All inspections Address correct/posted and visible from road (Butte Co. Code 32-9) Access to public street or 20 ft. wide lane (r19-3.05) Gates wide enough to admit fire apparatus (r19-3.16) f�Fire protection equipment visible/accessible (T19-3.14) PORTABLE FIRE EXTINGUISHERS --All Inspections Extinguishers have current annual service tag (r19 -575.1A) —.,,,—Maximum travel 75 ft. (r19 -567) V " Provide clear access to fire extinguisher (r19-563.2) _,/. Extinguishers mounted on wall/or in cabinet, visible and signed (r19-563 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 /V�Exit illumination and signs in place (CBC 1003.2.8.2) Maximum occupancy sign in place (r19-3.30) A�� ! Two exit doors/panic hardware swing in direction of travel (CFC 2501.8.2) HOUSEKEEPING --All Inspections ,i No waste or rubbish accumulation inside or outside T19-3.14) Reduce storage to at least _" below ceiling/ sprinkle4s, (r19-3.14) Remove combus. storage from heater, mech., elect. room (r193.1sf) /t! if Provide approved metal container for oily rag storage (T-19-3.19.) Flammable liquids stored properly (r-19-3.15) ELECTRICAL --All inspections _Extension cords do not replace p anent wiring (CEC-400-8(1)) Extension cords do not pass through doors/walls (CEC-400-8 (2,31) �30 inch clearance around all electrical panels (CEC-110-16A) 1--' All panels and breakers are marked (CEC-110-17 C) J,, Repair holes in fire -resistive construction CEC (300-21,22) L,-, Multi -plug power strips have circuit breaker (CEC 400-13) FIRE PROTECTION EQUIPMENT -- All Inspections A,�:41lood system serviced/tagged every 6 mo. by cert. tech. (r19 -9o4) _Clean filters, hood, and duct area over cooking appliances (CFC 1006.2.8) r Maintain extinguishing systems (r19 -3.24j Provide spare sprinkler heads (6 min.) and/or sprinkler wrench (T19-904.5) Replace damaged, corroded, or painted sprinkler heads (r19-904.5) Identify sprinkler valves and secure in open position (r19-904.5) _,_Replace missing caps on fire department connection (r19-904.3) '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 (r19-749, 754) SCHOOLS, JAILS AND HOSPITALS Decorations and curtains fire retardant (T19-3.08) G tanks fenced with locked gates (r19-3.22) FIRE DRILLS -- School and Day Care (Title 19-3.13) 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 Teachers take roll books 'zG Owner/Manager AP #. .2 max= SUPPLEMEISR,ARY INVESTIGATION-REPOfP� 4 � oRiGiNaroR'3 CASE NUMBER STATE OF CALIFOR Q F DEPARTMENT OF FORESTRY AND FIRE PROTECTION INCIDENT DATE ORDER NUMBER CASE TITLE MONTH DATE YEAR COUNTY REG RU INCIDENT # /.l1G i5w, = �G L /G/�TG=� /SGS Nb '• L- G.- �Gri2iG� �if.+iEG S . L /➢LGA �X iT S/G�f/ /z- f9"�Ge 5S Gr/z 46�7—.4 Ale000e 72 /� BSc GSL Tt?, 4� 647 6�7AJ Tit � fi-T��U P2L�!°i2ce� �u (4 OP1ES TO INVESTIGATION STATUS R ❑ REG ❑ HQ ❑ DA ❑ AG ❑ - OTHER CLOSED CONTINUING PRI TED NAME OR REPORTING OFFICER SIGNATURE F EPORT NGOFF .< Tz�7 V&7x j �c per / i. LE 1 (REV. 2/88) CDF #7540- . 130-0070 OTHER FFICER'S TITLE DATE OF EPL RT Office of the State Fire Marshal Fire Safety Correction Notice � ; i.) _� File No: '911-Ci'911-Ci- �/ _ - 2 �)0ET--0-00- 5-I Name: Address: SF I I CALIFORNIA STATE FIRE MARSHAL The California Health and deficiencies be corrected. Safety Code and the State fire Marshal's regulations require the following fire safety PJ i A)[1 _z / I r i �1 /� ; 1LL I �cikLi-+ -i ' A Ker -- -r _ I C- S I �v ILE&VIII �' �. J _1) 1JG's rQ L4 C: T "1 fi rS The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State 4. J r' Fire Marshal at ISSUED BY (Deputy State Fire Marshal) RECEIVED BY DATE EN - II (Rev. 7/86) 89 88751 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field I..... .. -.. _..•.r...-- .��- r-� �� _�� _ _ - a.�d�-fir_ ti ATE' OF CALIFORNIA - � tl O:NSixfETYANS '1JEST . See tstri tons on reverse.. V. fasa) _ A ENCY CONTACT .$,NAME ' - " -= TE ONE NUMBER REQUEST DATE P RAM �3I`YA-&- SING 530 895-5033 11/23/98 'qR`S NAME = REQUESTING AGENCY (FACILITY NUMBER REQUEST CODE -��' - z 045401922 _ 3A 5A CODE_ S RESPV SE REQU S .. i 1. ORIGINAL : A. FIRE.CLEARANCE 4: ICENSII G B. SAFETY - VARDTM O ` SOCA S-FRVICES.,, . :. • AGENCY � - 2:: RENEWAL LIFE - - _ IME AND _ : •. - ITY CARE LIC G . = .. 3. CAPACITY CHANGE _A_ • DDRESS -:" `-5 C 3 A3 � AD 9 SUI 6- 4. OWNERSHIP CHANGE MCS CA 9592 _ 5. ADDRESS CHANGE - 6. NAME CHANGE " 7. 'OTHER AMBULATORY - NONAMBULATORY BEDRIDDEN F :_ TOTAL CAPACITY . C ACITY ' -PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS ' CAPACITY 24 13'. 0 0 0 24 PACIUTY'NAME UCE1: NS CATEGORY GRIDLE .''R�� CSC - Z50 _ ET-ADCAESS (AchtatL;ocatFon) NUMBER OF BUILDINGS 6-B00TF,-:DRIVE. -Cl RESTRAINT ' '40 w ITY-CONTACT PERSON'S NAME HOURS . 194A B CERRA ,(530)-846-4054 or 3204 DAYS ..SP CiAL CONDITIONS \ u-( yJ.�•.+• ham.\\ } �:f�?y{� Y . �R ? {:{.{, .... ^tiYiC `�J�,• ••\�\"\J; i\ } 1 Yom. - s?} .{.r } \.h \ •A \ •�, _ 4 f J�_ S f�•. '.{• -• ' • 3�Yyh :{'•:' ••} xv,�f}��y�.\ • ••\,}r 4�{••,' �; y \ A••�\ J:'{ \ J}{�'y%\ A \ • J .••M \ �:a• : •i A ?.V • :\x.,:• i M. {!\}:ti• W,•:titi�. •��'•"i:: ♦ �\Yi•}:•.��•({{y� }.\:•:{J��i} .? \• �• Y h{`• • •� •y J }�.l,�i•{:.: ti•{�i r 1 :•.i•••{'•'.•tiJ....}:{y\.I! • :K } }, f tiY •N • .. \,• h �\•• y \ rJ. " •.•\ h '.�,}•, A:N]' •x i'•i•J•}JJ{ �y ,.h}• y/ J.1 •, y(11'G t,: f� �•, J. r.f •h vy�yiJ J \ • rt-•{: {'\�:>i.\` i\\\ \'., • •• :CLEARAMCE'IDENIAL CODE CODES FARE STATE FIRE MARSHAL `A rtiJORITY A�N e JACK �'IRISKY � �. FIRE CLEARANCE GRANTED - N, _-_E=I4ND WILLIA ISBURG LANE 9 SMITE A 2. FIRE CLEARANCE DENIED Claw o CA 95926 A. EXITS B. CONSTRUCTION C. FIRE ALARM ^T'Z�•" - -^,ICY ��. r �.r•+vs•pwA �.. � ti.�-ae.�.�••S•3.i.'1n/.T. � � L - ..��.+.� __'_+�•.V/+i-�-...rte- .�•Yr7 7 � x• -•�+•, Y��n.•� � -4s ��J"s� .......-��.IJ. i•+,�..-.._r-.R�..J: r. .. ._ n - _. - _. _ _ _ D:. SPRINKLERS 4SP ECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS Ao 't,P C ON DATE- INSPECTOR'S SIGNA RE (Typ d 'nted) 41 IN "IAL OR LIST'SPECIAL CON IONS F. rtvuStKttrmca 3 F. SPECIAL HAZARD G. OTHER- STAIE OF CALIFORNIA -RESOURCES AGENCY CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTIOty OF ICE OF THE STATE FIRE MARSHAL CHI O BRANCH OFFICE 4ILLIAMSBURG LANE, SUITE A CHI O, CALIFORNIA 95926 PETE WILSON, Governor (530) 895-4312 CALNET 8-459-4312 PLAN REVIEW TRANSMITTAL TO: f IV LNS FACILITY NAME: FACILITY ADDRESS: DATE:. (-Zr k --`� CSFM# PROJECT DESCRIPTION: i As requested, we have reviewed [] Plans [] Other: for the project listed above to determine conformance with the fire and life safety standards of Title 19 and 24, California Code Of Regulations. By copy of this transmittal we are: ,.-..J�Advising you that the project listed above was found to be in accordance with the • applicable provisions of Titles 19 an 24. (] Returning the items listed above to you for review. Consideration shall be given to all comments noted in red marks on the documents. [] Requesting that you contact our office at the telephone number listed above for an appointment for our stamp of approval and/or back -check. Nothing inour r 'ew sVall b construed as encompassing structural integrity. Approval of this plan does not aurize or pro any omission or deviation from applicable regulations. Final approval is su�ec to field in pectj n. Deputy St4tf Fire mal cc: FAT (530) 895-4349 !Ch ers Network - SFMCA ST TE OF CALIFORNIA - RESOURCES AGENCY PETE WILSON, Governor CALIFORS14 EN of C LIFORNIA DEPARTMENT OF '" F RESTRY AND FIRE PROTECTION CALNET 8-459-4312 C 0 FICE OF THE STATE FIRE MARSHAL INSPECTION REPORT z (530) 895-4312 RE PRQTFCT� �9Y roR'T, D F File No. 00-04-23-0024-000-555-9 Name of Facility: Butte Child Development Name of Building: Address: 1567 Booth Drive Gridley, California 95948 Discussed with: Title: Accompanied by: Tony Asblod Title: Sub Contractor An reinspection was conducted at the above location. The purpose of the inspection was approve the interconnection of the fire alarm system between the new relocatable installation and the existing buildings. The fire alarm system was tested and installed as per approved plans. Fire clearance is granted for the use of the new building. Fire Clearance Granted Yes X No Deputy State Fire Marshal Jack Pirisky FA(530) 895-4349 IC fiefs Network - SFMCA T -Date 1999 Date of Inspection 12114198 (530)895-4474 ATSS 459-4474 FAX 895-4459 (800)564-2999 TDD 895-4474 Administrative Officer: Gary E. Sannar Board of Commissioners: Jack Carmichael Larry Hamman Gene McFarren Gladys Waidley Lena White Sean Worthington 112t EQUAL HOUSING OPPORTUNITY r.. HOUSING AUTHORITY of the COUNTY OF BUTTE 580 Vallombrosa Avenue Chico, California 95926 November 18, 1998 Jack Pirisky T SFM III 'Specialls+ State of California Office of the State Fire Marshal 4 Williamsburg Lane Suite A Chico, Ca 95926 RE: Fire Alarm System at Butte Child Development/Gridley Dear Mr. Pinsky: This letter is being written to protest your decision not to approve the fire alarm system at Butte Child Development in Gridley. The Housing Authority's protest is based upon the letter to Michael Viera dated September 4, 1998, from Kelly Mingle, the architect for the Butte Child Development building, a copy of which is enclosed. I respect iuiiy request that your decision be reversed. Since ly, ary Eannar Administrative Officer GES:shg Enclosure -Q- - _g.. _ A - - - - _ _-�,._s� �'�'.-_�-' � F#��'�-' - -_ g=as- - =�� = =-• - 11/17/1998 14:25 5388793034 Image Builders Construction 7 Three Sevens Lane Chico,, CA 95973 Phone: 530-879-3030 Fax: 530-879-3034 id PAGE 81 November 17,1998 Roy Peters } Housing Authority of the County of Butte 580 Vallombrosa Ave. Chico, Ca 95926 } RE. Fire Alarm Systema at -Butte CWId Development Roy We are pleased to submit a quote to you for the amount of $840.00, (eight hundred forty dollars and zero cents). Includes: 1. FPL Tray Cable 2. Weather heads for overhead feed 3 Two cootactors to incorporate the different voltage of eacb fire alarm system. If you have any questions, please feel free to call. RespecffuUY, Foul E. Gray Project M�B� t icem # 739039 -a%, .QA, Office of the State Fire Marshal Fire Safety Correction Notice File No: ------ Name: Address: SF I I CALIFORNIA STATE FIRE MARSHAL The California Health and Safety Code and the State deficiencies be corrected. Fire Marshal's regulations require the following fire safety LAO L- o t -V S u, T-74 c , _ IL. Lt iT r�1 1A+ The abovedeficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State Fire Marshal at ( ) ISSUED BY (Deputy State Fire Marshal) RECEIVED BY DATE EN -11 (Rev. 7/86) 89 88751 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field A ka XellyMingle .. - _ �a1•.,^no- �.�: �. ..�fpi-.. :y'.i= �S �• 1 i.,v-'t �'1� w:�:b'j4� ..> a.`Y ,`:� •1-y+i' a �r �y �.`L" w' Q wL +.. , w�'��,a�...�t:f'.L''�`w''r't :fti.:-�".C•Ji-f�'`w•,�v :.: �l��L.'.+. �a ` s:. r. =Y Architecture and Planning September 4, 1998 Mr. Michael Viera Butte County Building Division Department of Development Services 7 County Center Drive Orovitle, CA 95965-3397 Re: APN 024-220-030 Portable Child Care Building Relocation Dear Mr. Viera, As stated in our phone conversation last week, we have encountered a problem with existing conditions at the site of the above referenced project. The 20' separation notation on the drawings, that was originally requested during plain review by Joe Cambell of the State Fire Marshal's office in Chico, is infeasible. During construction it was discovered that an existing fence and row of trees created a situation which made this separation difficult to achieve. Roy Peters of the Housing Authority of the County of Butte talked with Joe Cambell regarding this issue and Mr. Cambell stated that he had no problem with reducing that clearance to 15-9" but that we should contact your office with this request as well. After our conversation on Wednesday and your subsequent conversation with the Housing Authority it was understood that reducing the separation to 15-9" would be acceptable by all parties. 0f you have any question or comments, please feel free to contact me at (916) 797-2860. Sincerely, V Kelly Min le, A.i.A. Owner/Architect cc: Mr. Roy V. Peters, Housing Authority of the County of Butte Mr. Earl E. Gray, Image Builders Construction STAT OF CALIFORNIA FI E SAFETY INSPECTION REQ .ST See instructions on reverse. STD. 1,50 (REV. 10-94) ADEN Y CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM D S COMMUNITY CARE LICENSING 916 895-5033 8/12/97 EVA L ATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0 01/SEXTON 045401389 SA CODES # RESPONSE REQUIRED LI ENSING DEPARTMENT OF SOCIAL SERVICES GENCY COMMUNITY CARE LICENSING N ME AND A DRESS 520 COHASSET ROAD, SUITE 6 CHICO, CA 95926 L J AMBULATORY NONAMBULATORY BEDRIDDEN i CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY + p p 0 16 18 p FACILITY NAME A ESCUELITA ' STI 1EET ADDRESS (Actual Location) I 567 BOOTH DRIVE CITY I RIDL-'EY FACILITY CONTACT PERSON'S NAME IANA BECERRA 916 846-3204 i S CIAL CONDITIONS w FIRE STATE FIRE MARSHAL UTHORITY ATTN : JACK PIRISKY NAME AND 4 WILLIAMSBURG LANE, SUITE A ADDRESS CHICO, CA 95926 J 'OR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS nON DATE INSP CT0jT IGNA URE (Typed or Pr to t -.-d� -I On L I DENIAL OR UST SPECIAL CONDITIONS c��►� i �AL 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY 3. CAPACITY CHANGE 4. OWNERSHIP CHANGE S. ADDRESS CHANGE 6. NAME CHANGE 7. OTHER TOTAL CAPACITY 16 LICENSE CATEGORY DCC - 850 NUMBER OF BUILDINGS 1 RESTRAINT NO HOURS DAYS CLEARANCE /DENIAL CODE 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 Office of the State Fire Marshal � REGIONAL � FACILITY FILE CHANGE NOTICE • OfEKE0 STATE FIRE MA SHAL -' Name Collection/Change El Change File Number D Issue file Number ❑ Address Correction/Change ❑facility Discontinued ❑Other i � � n � t, V~ �ScN s t � a ; ) t a � ��' � X 7 i. � � '�i . •. C. Y K . a � . t , O� ii '�f f .. i• i:` Y. `' V .f .�•�{ '. , �• •� .is .1 i!l•' �� , �_ ' :x•1; d!-' ?. �`i IZ ma�yy«• fY� f',,j��p, M•H�y>t sal �q�.��e,ui �Ni ,■i A?`�� .tp� i� » s'^ s! %: °� �sf� ;+�,!' Ki > Jf�iIv, cif. Tx,� _ l.`R-iS�� 1 ��'��_•� .��5 � Z < .'F. _C%� � r�I K�' .- A- x, Name: - [-►, Address: L' '" `�` City: • County: �(No. Name: Address: City: County: L�-- �- Com.-•--- _r r (No. r File No.:.i�'_--� -� File No.:._.._ .� ._.._ Mow �. 1 Occupancy Class: '% T-24 SWM FILE .Occupancy Class: T-24 SFM FQE Comments: L ter+ L- �� L w�r_w■ wf_■rn w f wrrrrr_ EN •13 (Rev. 7/66) Office of the State Fire Marshal � REGIONAL FACILITY FILE CHANGE NOTICE �FICEpy. STATE FIRE MA AL' Name Collection/Change El Change file Number ❑Issue file Number Address Correction/Change El Facility Discontinued ❑Other ��. 1 %t [x�•y�..: �"1�j."'.�x'f11t 5. .1 Q a � � j:" �� _P"T ,;. t /t ! . �' j�'J�'7�� •i !�'`7� .,��M: �yr'��c91� ')fi �1i• � �'%fly`, o�• Qtt y"�j` i� ��3�ri�,`�{�: c xi J��` [ ;tt �r c >• !�, ...�i �.�.f..�i { "�.. i• I , e;" 1 �- .s �I'f • 9. :�i:.•aCY l . 'i' .. r. .I✓�1f 1F y� ..,r: � g`•r.�''.: Q : �:t�'.':.t � v � t ; • y � Name: Name. �► - w..____ Address: `�-�' �"� `-' • — . _: � � Address. t r � w City: t 7)L-- City: r County::ELI(No. '2County• (No. File N o.: Lc, t .tt_:. r- File No.: Occupancy Class: �' �� • p y . �ccupanty Class. T•24 SFM FILE T-24 SFM FILE Comments: EN •13 (Rev. 7,86) oma•. a► Office of the State Fire Marshal Fire Safety Correction Notice The California Health and Safety Code and the 'State Fire Marshal's regulations require the following fire safety deficiencies be corrected. J - The above deficiencies are to be corrected withindays. When ALL deficiencies have been corrected, sign and return the certification on the opposite side of this form. If you have any; questions; contact the Office of the State Fire Marshal at ( ) ISSUED BY (Deputy State Fire Marshall RECEIVED BY - DATE EN -11 (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field No...�.t_—�� 1 of Facility: of Building: G.Jce of the State Fire Marshal INSPECTION REPORT I 6 (Rev. 7/86) Discussed with: Accompanied by: d.�.�( l �.1.G`:s:�.!ti i'Zj Title: Title: STATUS DEPUTY STATE - E DATE OF MPECTION r _ j 7 I 6 (Rev. 7/86) c ,_ C' FIRE CLEARANCE GRANTED T DATE STATUS DEPUTY STATE - E DATE OF MPECTION r _ j 7 I 6 (Rev. 7/86) . .. .. ; 17-1 •ver • vim• �, rye r t ;t��' ¢Li}ca-e++..tx •rr.•�r•p�iii�r' pr�•rs.t•�.._..._ �. 1. t 1 t• w Y, _r STAT FIRE MARSHAL COPY DISTRIBUTION: SEE REVERSE OF COPIES 2 AND 5 FOR FIR SAFETY INSPECTION REQUEST 1-3-STATE FIRE MARSHAL INSTRUCTIONS FOR COMPLETION 2-FIRE AUTHORITY STD 8 0 (REV. 8/86) 1. REQUEST DATE 2. PROGRAM 4-5-LICENSING AGENCY 9/28/93:: 3. AG CY CONTACT 4. TELEPHONE NO. S. EVALUATOR DSS / COMMUNITY CARE LICENSING (916) 895-5033 0104/M. BROMLEY S. SFM REGION 7. SFM I.D. NO. S. REQUESTING AGENCY FACILITY NO. 9. REQUEST CODE 041371708/041370396 3/A THIRD AND FINAL REQUEST - RESPONSE ''.REQUIRED . CODES 1. ORIGINAL A. FIRE CLEARANCE j� PA"Oco� 2. RENEWAL B. LIFE SAFETY 3. CAPACITY CHANGE I DEPARTMENT OF SOCIAL StR'VICE "� 4. OWNERSHIP CHANGE 10. AGr=NCY COM1 11.1 N I TY CAR }lam L I CJ:il'IS I NG a t S. ADDRESS CHANGE NA VE 5210 Cob s.se t Road, Suite' B S. NAME CHANGE AN Cil i Co,' CA 95926 •` PREVIOUS NAME AD RESS L 7. OTHER 50 CHILDREN, AGES 0-2 YRS. - (INFANT CENTER) 85 CHILDREN, AGES 2-5 YRS. - (PRESCHOOL) DATE OF ORIGINAL REQ. 11. AN BULATORY NONAMBULATORYTOTAL CAP. DATE OF LAST FIRE CLEARANCE • CAPAZ ITY AGE RANGE (YEARS) PREVIOUS CAPACITY AGE RANGE (YEARS) PREVIOUS TO 18 19 TO 65 AND CAPACITY CAPACITY TO 18 18 TO 65 AND 65 OVER 65 OVER 135 X 0 19. FACILITY CODE 135 850 840 -CCC 12. FACILITY NAME 13. NO. BLDGS CODES GR DLEY MIGRANT CHILDREN'S CENTER 1 1. GACH 7. ICF / OT 2. GACH/R 8. ICF/DD 14. STREET ADDRESS (ACTUAL LOCATION) P.O. BOX IS. RESTRAINT 1567 BOOTH DRIVE 1966 NO 3. SH 9. ADHC 4. APH 10. CLINIC CITY ZIP CODE 16. HOURS GR DLEY CA 95948 DAYS 5. PHF 11. JAIL 6. SNF 12. ICF/DDN 17. FA ILITY CONTACT PERSON TELEPHONE NO. 16A. SPECIAL AN13ELITA CASTANEDA 846-3204 -(916) 13. OTHER TO BE COMPLETED BY INSPECTING AUTHORITY 18. FIFE �CODE JACK PIRISKY 26. CLEARANCE A U H O R STATE FIRE MARSHALL NA E 4 WILLIAMSBURG LANE, SUITE A CODES AN 1. FIRE CLEAR, GRANTED CHICO, CA 95926 ADDRESS L2. FIRE CLEAR, DENIED -I 3. FIRE CLEAR, WITHHELD 27. DENIAL CODE CODES TO BE COMPLETED BY INSPECTING AUTHORITY 21. INSPECTOR'S NAME TELEPHONE NO. 22. CFIRS 23. T-19 OCC. �-` ID NO. CLASS (lic!_7 ` It _Z0.15 j r 1. EXITS 2. CONSTRUCTION 24. IP DATE 25. INSPE6 R'S Sf N TORE J 3. FIRE ALARM ! f (. A/t 26. X IIAIN DENIAL OR LIST SPECT L CONDITI S 4. SPRINKLERS A 12�� - "'� .�, 1 J�. HOUSEKEEPING PING 6. SPECIAL HAZARD � 7. OTHER STATE FIRE MARSHAL USE ONLY 20. RE 310N. DE'l ARTMENT OF SOCIAL SERVICES OF FICE C0111'liNlITY CARE LICENSING ; AN 5f.)0 Cehasset Read, Suite 6 '••.. of ;ice of the State Fire Marshal REINSPECTION REPORT of Facility: �-1,\ CCS-�� of Building: Discussed with: Accompanied by: �'�1�Et k��1% P Title,� .;: Title.(U�-� Fire Safety Deficiencies Numbered �- Z noted on the Letter ❑ Fire Safety Correction Notice (EN -11) ❑ dated— �� -'I ' —have been corrected. Uncorrected Deficiencies Numbered were re -issued as shown on the Fire Safety Correction. Notice dated which is attached to and made a part of this Report. In addition, new deficiencies were identified at the time of this reinspection, and are shown as Items on the attached Fire Safety Correction Notice. Fire Clearance Instructions: DEPOTSTA�RSHAL DATE OF REINSPECTION FIRE CLEARANCE GRANTED T -DATE STATUS DEPOTSTA�RSHAL DATE OF REINSPECTION G - 5 (Rev. 7/86) . r __.. .. � .. .. ."•�w7•._. _ .. Y r .. .r r - r. . i ... ..A. .. '4.w•.• ... r.rY ...y.-. ..T':a•j...na ..:.i.i. •.tiv..._ _ ... STATE F IRE MARSHAL COPY DISTRIBUTION: E REVERSE OF COPIES 2 AND 5 FOR FIRE AFETY INSPECTION REQUEST 1-3 - STATE FIRE MARSHAL 2 - FIRE AUTHORITY ;STRUCTIONS FOR COMPLETION STD 85 (REV. 8/86) (Continuous) 4-5 - LICENSING AGENCY 1. REQUEST DATE 2. PROGRAM 7/13/93 ` 3. AGENCY CONTACT 4. TELEPHONE NO. 5. EVALUATOR dss community care licensing (916 ) 895-5033 0104/M, BROMLEY 6. SFM REGION 7. SFM ID. NO. S. REQUESTING AGENCY FACILITY NO. 9. REQUEST CODE 041376152/041376154 1/A CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY 3. CAPACITY CHANGE 10. A ENCY I�EPARi'MENT QF fiOCIA � � �� N ME C OMMU N t TY UY E LICENSING A D 520 'Cohas�et noadd t Suite G A DRESS Chico, CA 95926 J 4. OWNERSHIP CHANGE S. ADDRESS CHANGE S. NAME CHANGE PREVIOUS NAME 7. OTHER 6 INFANT - (0-2 YR.) DATE OF ORIGINAL REQ. 13 PRESCHOOL - (2-5 YRS.) 11. AMBULATORY NONAMBULATORY TOTAL CAP. DATE OF LAST FIRE CLEARANCE CAPAC TY 19 AGE RANGE (YEARS) TO 18 18 TO 85 AND 8 5 OVER X PREVIOUS CAPACITY CAPACITY 0 AGE RANGE (YEARS) TO 18 18 TO 65 AND 85 OVER PREVIOUS CAPACITY 19 19. FACILITY CODE 850/830/CCC 12. FACT LITY NAME 13. NO. BLDGS. CODES LA ESCUELITA 1 1. GACH 7. ICF/OT 2. GACH/R S. ICF/DD 4. APH 1. SH 0. CL N c 5. PHF 11. JAIL s. SNF 13. OTHER ICF/DDN 12. 14. STRI ET ADDRESS 830 EAST GRIDLEY ROAD P.O. BOX 966 15. RESTRAINT NONE CITN G IDLEY CA ZIP CODE 95948 16. HOURS 95948 17. FACILITY CONTACT PERSON TELEPHONE NO. 16A. SPECIAL - .A GELITA CASTANEDA (916) 846-3204 TO BE COMPLETED BY INSPECTING AUTHORITY 18. F RE UTHOR. STATE FIRE MARSHALL 26. CLEARANCE CODE AME JACK PIRISKY CODES ND 4 WILLIAMSBURG LANE, SUITE A 1. FIRE CLEAR, GRANTED DDRESS CHICO, CA 95926 0 2. FIRE CLEAR, DENIED 1- 3. FIRE CLEAR, WITHHELD 3. 27. DENIAL CODE TO BE COMPLETED BY INSPECTING AUTHORITY CODES 21. INS ECTOR'S NAME TELEPHONE NO. 22. CFIRS ID. NO. 23. T-19 OCC. CLASS 1. EXITS 2. CONSTRUCTION 3. FIRE ALARM 4. - SPRINKLERS 24. INSFI. DATE 25. IN PE IGNATU S. HOUSEKEEPING S. SPECIAL HAZARD 7. OTHER 28. EXPLAIN DENIAL OR LIST SPECIAL CON O �.� C•' A,./ Lk f-2LI 2'ez STATE FIRE MARSHAL USE ONLY 20. F EGION, F-DEPARTMgNT OF SOCIAL SERVICES FFICE COMNSUNITY CARE LICETISING %ND 520 Cohasset Road, Suite 6 ADDRESS Chico* CA 95926 L_..�.I Pagof. File No.:.2.- /O"N r�110�1 - Office of the State Fire Marshal INSPECTION REPORT .1 Name of Facility: Name of Building: Address: 4 C1P, 1 Q 4 t �i ' •\:. . t 2' �• .�_-'r.c�•'�. k,; r!bi ° x. A1. Ek' i'Y--' fF'• `.3 v S .y,� i f. r' .♦ . 1 ••` itt`: �•: r M ,'�.s�.. ,t.. �;.•'1 p %"q�� ti .'+('� e ,.•'z�> �� .y6 �i�,„.. >..�.c Ai•yf R' r� • � .•; �1 ,"'�Ye 3-?� � t.l>::t - iL, S':i : i,+.. . _..:,' ;�... �, .fir• .: crv;' F Vt; �j�4•pp++�� ' r%ii. ^ti�i�¢'"Y'r ij,�' �' ':1�.i'.ri !'�, i, "i'. e., S t" 'i :'.»!i .�, .(�� S 7« •Y _.+'i,..:Fw '."t .X �t �;.�-}�i•.. .1 � s. � •""'6: .t.., .r.-.'f4`t;"�lR�' o iii• .y �! a�eF • 1 � j . f i`'.'�dlP,i,; ��i: i'.a . �•,}. '3 ..,r �a�•, t. , i:. i Vi 3 '>� iTl.i�. ;'? �i;7 t,'�T'`'•\Y.' •:e < +•, S ,�.f. Y i �' N] :T . /' . �r.: i\�i. Discussed W �. .:>,. •�� _ a . �„.��ryf 1 �'t�� "Ykf. 5. `L:•'�5. 2, ,�y>Y 5L-,•+,, .`si? 3 :.i- s. a r. R:, t, •-'titf.. '�•- • ^+ .. ..3. .o R.Ar. YA• .FI....�.✓. v: � 1 yr '..i .. .t a {[ 1, �1• - • :' ', 1 � Y �•. '� a ' •' 3' .aha 3, •. 1 /• v2.. .4; � .(•. t1�3-. l.. • . .r . s•.' .... .r X c�"�ikC.. :tC �'e'h/�. .k. -•[ � .i.` f.•. , 4 •.C. "a e ''1 .v .i"S:• � -<y-' •:3 f..�Z IS: j. `3i..:.�t .. R.. !. � Y •:1,1 0tv. >e a• • F',j •*L' ��t,.•' •.e: E: Rf -:�a> : l ,� b+ . -I; :.\ "�, f .>% "N�['� q >t.. y,,,ab4,Av , rdt+,� • � '^9 ., .S \ ,i•. r .S9 YS .r: .t{,�,.,�'}.rat. ',n �'�' r”"'ak �.i� a- >< '"' Yk{2S k. { j�� `.i -).Y`!4 .zL' ' -4.- .t• :�. t�. c '_ • "'' A • �,•• r',�.F!'�w+a, , L+ y.� �. �.• � �' ; •.Fi�• �', 4`. 'i �: •ati� • ^»'6 , f . rS �;• i; •`� :M"j, •" ��1a. r.,fH� Q r i� '�;, .r :�. wf �J1 � riY.• r:y�:�< )' �••e Kt '�. y7��ts• J `r1 ��• ''Y"•e• Vit.. t•� '>�' '.aYTt: ..•yrt 17r+At A! �,.� .yv i ��S,la; "n �'�;�i��V,�sY.i'� 77• !_v1. s4.R'::?:.' �' �;�}♦ �1 •�q r -,.., ------ •• _\ _- �. �.. •• � tzy,'yP a ?".. <•t..�%'• �' ��a.,s l.. .�i, : • p��"S "1(.tiq 'i.f >e�-'+'�-s.., t' �• Accompanied Ln .rt fi;-'iSv ' S .:• r 5� y s a i $i 9 ._ • Y,"S;nr t: / 1 �•, •1 _� . .i: ;t l i �t. p♦ y'ay". 7. L- v�,' .•"la."- '�S'� :,.r: '^' \` - ♦ n / ��rr.� • �� y ,t' ...� ,y. t' -•: �+•<�' ,�:7• Jj� q.s ..��^-�.,�r•a�"• ,� \' :+i i. .�... 1" h`+ '�. . { S �i-f �•i> � •`� :v ii<Y.t't+'.!d: S;... q� .w4;�5!, ..t.>ii�p ('Yik i�• d"- �'a� a'� ��- ;� Yi'k.;f•..$t � t e "a- <: �. k i/� fir {It 1. i• -y.. � � y =•; `l'"T !', `t: - • .A ;i.1,+; .'�.• :Sf, k +y:�r Yr•.4'Y�•�3•� � �'i... .i'+�' !A:� ��, t �� r �j�,�a., £-„L"�I-. •F t'' ♦ `a. c� � t -, - r-; �' ,��Y`+� -• ?i•, Y- t'�s. ptls.,� s.?• y?,t.;¢' .{ gin: i�.i..�:�+ ,z��-.:^, t, :* s'. r 1 r z 20 k��,,,,_ i, T �,.trt-�- �,� •-s- � FW CUEARANa c 1: [:f i)}..R it •�'-S '•�;. 14',• -i'c S1 i •��•' ,=cv• ` <.� �� K _ � 'It- ( -y; ,r't� ��• vi �••iv .p.�i� ..3jwl� o •u '-s<e[•,: x` ;r '� 7.. �� Y£'• 1•. a •i. 'j`. - �. s f• �. � --r '�, •�� p�q"y:��Q y'%:; j� ,'1�� < +!`j ¢ ��>,t2.r' Mi�• '• 1F• .S:'.��.''.// `�, .. < - � � '.\ t �. M1 r �'�. vli 1"!°.�,�•}y.. �'''� �Wr .{ L .}' •�,..> r •�-?+- s. 7A,+�.1.~yC4:t,' �. r,� •r.:,�v'�T '�,�� r�':1'{/ 1� ��-"`114 ' i t. •�, `{�•. r'�7 .1• �• � `ter : � r r • , ' � • Yt .i1�"1' •` i (t •.U., ` .V Y r:<. 1,;, n : .•'+:t.. D �+.. STATE ME MNtSft j' • , �• .1 � � ' . • �' v '>M{` (.�t'�.: .a „� ��• ,,,;, .a'41"pr 7 R .;•r7{ {),.•y � ..;�M Y�.T�{ ..+.,. �,T � +f._.Ji?�. >. 'F• X, • ,� j _i- Y. i gip;,: Tit r� :� s}a� �>, 'i. r ATE OF c�](♦ r. 7 • ! ""� � t •• i v . i�(T Set_ �•: • d ` •1 j ' • `•�+ \ ', • ' �;. � (fib '.Y ��•• IY�.Y ^! '7 .�.->�: �a�l. 'r �'t. •1'�L{ r.,d,' Y _ Y 1•',Q�]. <, ?�)Y�SL.. .I: 4. .�l��y. _ �� T { �.�•.• Y T C"Yi.'� � ♦ 1'r^ .{I�4 ' ,}"F j'ti (+ • �.{, � i�+ �'�', �t�j� ♦�,...1 \�,1. r V GO - 6 (Rev. 786) Office of the State Fire Marsha Fire Safety Correction Notice File No: — — - — Name: _ Address: The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety deficiencies be corrected: The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State Fire Marshal at C ISSUED BY (Deputy State Fire Marshal RECEIVED BY,, DATE EN -I I (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field File No: _------- Name: Address -Office of the State Fire Marshak Fire Safety Correction Notice The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety deficiencies be corrected. -r, 1 �^ i 77-, Rte r+� _ i^ , �i1- � _ �._,. n T" � \ _ r. n w.� _ . - � . /� n ._ 7 l _ r-.�'7C , l 1 •-• /1 A n n (' 1 (il . C OA V _ Y.. 11 The above deficiencies are to be corrected within _- days. WhAt ALL deficiencies have been corrected, sign and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State Fire Marshal at ( ) -Zza - __:��c v ISSUED B IDeputy State Fire Marshall DATE (Rev. 7/86) 8ti 9b/UB UISIKIBUIIUN: UKLLN—Lauhty VVHII t—Kegion 7tLLUVV terfification of Corrections by Owner I certify that all deficiencies listed on the reverse of this form live been corrected. SIGNATURE D.9 TL (Fold on this line) ........................................... . ..... ......................................................................................... ......... ........................ ................. ....................... ............ ............. .......... (Fold on this line) ........................................................................... ...................................... ........ 4 .......... 3 f:4 JUL j ,..-Office of the State Fire Marshal REGIONAL FACILITY FILE CHANGE NOTICE ❑ Name Correction/Change ❑ Change File Number Issue File Number ❑ Address Correction/Change ❑ Facility Discontinued : ❑ Other °UlD ikazWEW? :, x. Name: C Address: - City: C� `1 S' 9 q g County: o (No. 6 ) Name: Address: City: County: (No. ) File No.: _ — _ — — File No.: Occupancy Class: T-24 SFM FU Occupancy Class: T-24 SFM Fid Comments: ORIQdATi� fS 4 t� xw rox Rd e rd at 4 xf�w f IN -13 (Rev. 7/86) PPLICATION FOR A CHI DAY BARE CENTER LICENro`` ! ... {. se lnstiuctians on Back) FOR DEP/�FiTE�I£IVT USE ONLY �'� REPLY TO: COM: FACILITY NUMBER: � w DA ACTION TYPE: w R EWED BY- FACILITY TYPE: 1. I APPLICANTS) NAME n _ _ L /%, 3. 1 APPLICANT MAILING ADDRESS 4APPLICATION A. INDIVIDUAL. FILED BY: D. PROFIT CORP S. FACILITY (OR AGENCY) NAME LA ESCUELITA 6. FACILITY LOCATION 830 East Gridle Rd. 7. MAILING ADDRESS P.O. Box 966 8. PERSON IN CHARGE OF FACILITY An eli to Cas taneda 8. TYPE OF AGENCY OR FACILITY ® A. INFANT CARE CENTER B. DAY BARE CENTER (PRE-SCHOOL) ❑ C. SCHOOL-AGE CENTER C0o6 %?.* , 1 Y CARE LICENSING 2. REQUESTED ACTION (CHECK ONE): ❑ D. CHANGE OF FACILITY TYPE C3 A. INITIAL APPLICATION 0 E. CHANGE OF OWNERSHIP ❑ B. CHANGE OF CAPACITY L] F. CHANGE WITHIN CORPORATION ❑ C. CHANGE OF LOCATION ❑ G. OTHER CITY STATE ZIP CODE TELEPHONElAREA CODE Q59 846-1204 B. PARTNE SHIP x C. NON PROFIT CORP. E. COUNTY F. OTHER PUBLIC AGENCY CITY • vvv. Gni-dlev CITY Gridley TITLE Pro ram Director n ae ❑ it�ANT D. SICK CHILD CENTER PRE8CHOO°,. FLI E COMBINATION ' SCS{OOL,,AQE (CHECKAPPROPWATE BOXES FOR C011f8IN4Tl0 N CEN1EM SICK ❑ O. OTHER (SPECIFY) TOTAL NUMBER ZIP CODE 61, TELEPHONEIAREA CODE 9-994R l(ql 46-32-04 STATE ZIP CODE CA 95948 if. Ir ► rvvvlLANU {IAM% IV NU14- AMBULATORY CHLDREK CKZK HERE: 1Z DAYS AND HOURS OF OPERATION: OF A COMBINATION CENTER IS CHECKED. ENTER DAYS AND HOURS FOR EACH COMPONENT). 15 Both age groups are from 5 a.m. to 5000 p.m. 13. PROPERTY OWNERSHIP:: ❑ OWN Lx RENT ❑ OTHER (SPECIFY) - • • - _ 13A. NAME AND ADDRESS OF FACILITY OWNER. IF RENTING OR LEASING: Butte County Housin Authority 850 Vallo mbrosa Chico_, CA 95407 14. WAS FACILITY PREVIOUSLY UCENSED� IF YES. FACILITY NAME AND NUMBER: LICENSING AGENCY NAME: 11 YES X) NO 1S. IS MAJOR CONSTRUCTION REOUIRED? GATE CONSTRUCTION BEGIN: I& SOURCE OF WATER FOR HUMAN CONSUMPTION ❑ YES ® NO DATE TO BE COMPLETED: PUBLIC ❑ PRIVATE 17. NAME AND FACILITY NUMBER OF OTHER COMMUNITY CARE. CHILD DAY CARE, RESIDENTIAL CARE FACIU71ES FOR THE ELDERLY. OR HEALTH FACILITIES LICENSED TO OR OWNED BY APPLICANT WITHIN THE LAST FIVE YEARS; (g) A. G ev Migrant CC 041371708 58 X75760 6. ri _P� _ 13709 C• - D. E. F. 18. APDLICANDLICENSEE RESPOIVSIBILITE:S. A. IN LIGATION TO COMPLYING WITH THE NEIL TN AND WVE UN SAFETY CODES AND REGULATKINS APPLICABLE TO LICENSING AND FIRE SAFE l Y. DERSTAjVD THAT THERE IS ALSO AN OBLIGATION TO MEET OTHER STATE. FEDERAL ANQIOR LOCAL CODES AND REGULATIONS SUCHAS. MNNa BUd DRa SANITAT#X LABOR AND JUS N DjSCRjW#"101V REOUIREMENT3T B. YVVE HAVE READ AND UNDERSTAND THE STATUTES AND REGULATIONS WHICH PERTAIN TO MY10UR LICENSING CATEGORYPRIOR TO THE ISSUANCE OR RENEWAL OF THE LICENSE. C. WVE SHALL ENSURE THAT AT THE TAME OF EMPLOYMENT OR FIRST DAY IN THE FACILITY ALL PERSONS SUBJECT TO FpI K3EITPRAVT REQUIREMENTS S/�i1Ll 8E F�VICTERpRBVTED AND COMPLETE AN AFFIDAVIT ON PRIOR CRIMINAL RECORD HISTORY. D. IF "VE OPERATE A FACILITY WHICH PROVIDES CARE O AND SUPERVISION TO CHILDREN. WYE SHALL ENSURE TNAT�D ABUSE MWX CHECK SRM y� PERSONS SUIMECT TO FINGERPRINT REQUIREMENTS IS SUBMITTED TO THE LICENSINGS AGENCYAS REOUIRED. E. WVE SHALL NOTIFY THE LICENSING AGENCY IMMEDIATELY IFA PERSON, SUBJECT TO F#JWRPRW Mp REOUIREMENTS, IS CONVICTED OFA CRIMEAFTER EMPLOYMENT. F. kW SHALL SHALL OB TAIN APPROVAL FROM THE LICENSING AGENCY PRIOR TO MAKING ANY CHANGE(S) THAT AFFECT THE TERMS OF THE. LICENSE 19. THE SIGNATURES) BELOW AUTHORIZES THE LICENSING AGENCY TO RENEW MY/OUR LICENSE FALL LICENSfMO ST.AA124ROtS ARE METAT THE TWE OF RENEWAL UNLESS WVE NOTxFY THF LICENSING AGENCY THAT t%S WISH To TERMINATE THE LICENSE. WVE SHALL NOTIFY THE LK:ENSIVGAGENCY WHEN &W WISH TTI TFRM#VATE THE LICENSE. 20. /(WE) UNDERSTAND THAT I (WE) HAVE THE RIGHT TTI APPEAL ANY DECISION REGAROINCS THE DISPOSITION OF THIS APPLICATaOM 21. • I(INE) DX CLARE UNDER PENALTY OR PERJURY THAT THE STATEMENTS ON THIS APPLICATX NAAD ON THEACCONFANYpMO ATTACHMENTS ARE CORRECT TO THE BESTOF MY (+OUR N EDGE. ) SIGNE CAAA�C B TITLE COUNTY WHERE SIGNED a DATE -4*3 SIGNEP TITLE COUNTY WHERE SIGNED DATE IC 204A (5/01) e of Facility: Q Y e of Building: 'ess: Office of the State Fire Marshal INSPECTION REPORT IN GO 6 (Rev. 7/66) � ' � .z• •. • { t. .� �Y�t +,( Y t•• '•Z.YwN, ' ' Y .( •�•: • ri <. j`A 'S.��"'( .it •:.� y' +`v:'• •• { �'^' Y �� :. .f e•' : • ry>. �• �. ♦t :^ t Ji •w, .7.' :� - .. ,�I y . '• .A. Y„'S,c �i o;. d:l-tR �:'.!. ti{' ,• ' 'scussed with: ... , . ,tle: ccompanied by: -DATE •1 r �il1 • ,�. -• 4 DEPM sTATE ME MARS" :, S j { R l DATE �� V i�- �nk �• < 1. � V ie S •t v . GO 6 (Rev. 7/66) • -1K CXEARANa GRANrHD -DATE •1 r �il1 • ,�. STAIIS DEPM sTATE ME MARS" :, S j { R l DATE �� nk �• < 1. ••� <f �'•r''.• �, ! , GO 6 (Rev. 7/66) i Pale of Office of the State fire Marshal INSPECTION REPORT ile No.:. 00 _-_04 - 23 ame of Facility: GRIDLEY MIGRANT CHTI,DRENS CENTER of Building: ess: 1567 BOOTH DR T VE GRIDLEY, CA 95948 Discussed with: Title: Accompanied by: Angelita C;atan. da Title: Admi.ni st-rator A follow-up inspection was attempted at the above facility. The Program STATE Administy ator told me the facility will soon be closed for the season, and that all corrections will be made prior to openingnext season. 'rhe EN -11 issued 9-16-92 was not reissued. L FRE CLEARANCE GRANTED T -DATE STATUS F-9308 Of KM STATE FRF MAPS" DATE OF M1lSPECTM SLAUGHTER 7 Dec 92 GO - 6 (Rev. 7/86) Iice of the State Fire Marshal REINSPECTION REPORT No.: ne of Facility: of Building: <21-1L. Discussed with: Title: Accompanied by: Title: Fire Safety Deficiencies Numbered noted on the Letter ❑ Fire Safety Correction Notice (EN -11) ❑ dated / have been corrected. Uncorrected Deficiencies Numbered �2 �� . `� were re -issued as shown on the Fire Safety Correction. Notice dated Z? �� C �— , which is attached to and made a part of this Report. In addition, new deficiencies were identified at the time of this reinspection, and are shown as Items on the attached Fire Safety Correction Notice. Fire Clearance Instructions: -CIA C' LL-TL9 (AAG' 1A1�1- � (L- �.� FRE CLEARAWCE GRANTED T -DATE STATUS G� Ot . t DEPUTY STAT FRE AL DATE OF REINSPECTION v - - 5 (Rev. 7,86) -All Jffice of the State Fire Marshal Fire Safety Correction Notice File No: — — — — Name: Address: *FIRE HAL The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety deficiencies be corrected. The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign and return the certification on the opposite side of this forma If you have any questions, contact the Office of the State Fire Marshal at ( ) ISSUED BY (Deputy State Fire Marshall RECEIVED BY DATE EN -11 (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field office of the State Fire Marshal Fire Safety Correction Notice *FIRE HAL The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety deficiencies be corrected. J The above deficiencies are to be corrected within "' days. When ALL deficiencies have been corrected, sign and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State Fire Marshal at ( ) ISSUED BY (Deputy State Fire Marshal) RECEIVED BY DATE EN -I t (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field 'age of . .lice of the Stale Fire Marshal Oo. f le No.:.C� qarmeof racility: 0 ame of Building: INSPECTION REPORT STATE IAL ddl ess:Ce& 4P6 Z --� '>• Yf►' •I !�• ! I+ � kt •`' •�� •�i• dx �S� fl; i,1.. Atf■ ``■■•1�V�SCUSSeC� �NIii1s • .t ,��. .:'• ,J ,��•• i}� 7771 �, `..:j •!�•.� -r;.{• .t, }S,►•.� ��:� #• •' ,�!_ ;�/�• +-:; f + t.1 ., _ • ' • 1 i •t i t,:►' i 'i .1 u �• '•pj ` '( i j 1.• 'S r { •s c.r s, f• i JJ�' 4.') 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' � +. �, ��., ;,� � � _ , i �.-°� Y ! 3 ':i J•, _ �`. Office of the State Fire Marshal °�F��' INSPECTION REPORT STATE FIRE MA AL No.:. -00 ---OA--:- �.3_ 0014 _ 000 _ 555 9 me of Facility: -CR __T_Di.F.Y _R -FA iI START ('FNTFR of Building: 850 E. Gridley Road Gridley, CA 95948 • � '.' � •' � i .'.. *5l. ; - i` ` � !.: a .�r�•,Y � •�. � . Title: lied by: S t a f f Tide: An annual inspection was conducted at the above facility, - y. No deficiencies were noted at this time. The facility maintain s a reasonable degree of fire and life safety* -Fire clearance is ranted for 24 ambulatory children. STATE FRE MARSHAL Go - 6 (qev. 7/86) y T -DATE - r -- ST/1715 9-ZQ 51 •s ! .. DATE M w �A ry � O 7 GHT E R ; . I el IT