HomeMy WebLinkAbout026-181-028 CF ArchiveSTr: ..'rORNIA
NONAMBULATORY
BEDRIDDEN
TOTAL CAPACITY
FIVe. SAFETY INSPECTION REL . -,,EST
,ESQ'
PREVIOUS CAPACITY
CAPACITY
V
STD. s0 (REV. 10 -sad
PREVIOUS CAPACITY
See instructions on reverse.
14
AGEN Y CONTACTS NAME
TELEPHONE NUMBER
0
REQUEST DATE
PROGRAM
C SS COMMUNITY CARE LICENSING
530 895-5033
8/2/00
EVALI IATOR'S NAME
REQUESTING AGENCY FACILITY NUMBER
REQUEST CODE
0`05 - WATTERS
045401885
'
3-A
RESPONSE R Q REQUIRED
�' � � �
CODES
�
�
1
1. ORIGINAL A. FIRE CLEARANCE
LICENSING
AGMENCY
COMMUNITY CARE LICENSING
�
� � r c � ~
2. RENEWAL B. LIFE SAFETY
N MEAND
C. FIRE ALARM
3. CAPACITY CHANGE
ADDRESS 520 C O H A S S E T ROAD9
SUITE 6
HOURS
4. OWNERSHIP CHANGE
{ `E.
DAYS
3S-* _ �J�
}
�' S
CHICO, CA 95926.�,�
HOUSEKEEPING
F. SPECIAL HAZARD
5. ADDRESS CHANGE
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6. NAME CHANGE
7. OTHER
AMBULATORY
NONAMBULATORY
BEDRIDDEN
TOTAL CAPACITY
CAPj 4CITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
1 CODES
14
8
0
0
0
0
14
FACT JTY NAME
LICENSE CATEGORY
D VIS, ANGELA FAMILY
CHILD CARE HOME
FCCH - 810
STR ET ADDRESS (Actual Location)
OROVILLE, CA 95965
NUMBER OF BUILDINGS
7528 MELVINA AVENUE
L
1
CI
B. CONSTRUCTION
RESTRAINT
PALERMO, CA 95968
C. FIRE ALARM
NONE
FACI LITY CONTACT PERSON'S NAME
D. SPRINKLERS
INE PECTOR'S NAME (Typed or Printed)
HOURS
DAVIS, ANGELA D. PHONE#(530) 533-6934
{ `E.
DAYS
CONDITIONS
CLEARANCE /DENIAL CODE
F
7
1 CODES
FIRE
BUTTE COUNTY BUILD . DEPT.
1. FIRE CLEARANCE GRANTED
A THORITY
TAME AND
7 COUNTY CENTER DRIVE
2. FIRE CLEARANCE DENIED
DDRESS
OROVILLE, CA 95965
A. EXITS
L
B. CONSTRUCTION
C. FIRE ALARM
OCCUPANCY CLASS
D. SPRINKLERS
INE PECTOR'S NAME (Typed or Printed)
TELEPHONE NUMBER
CFIRS NUMBER
{ `E.
3S-* _ �J�
}
�' S
. --
HOUSEKEEPING
F. SPECIAL HAZARD
IN PEC ON TE
INSPECTOR'S SIGNATURE (Typed or Printed)
G. OTHER
EX IN ENIAL LIST SPECIAL CONDITIONS
-