HomeMy WebLinkAbout030-410-016 CF Archive.'ire Prevention Bureau
l76 Nelson Avenue
Xoville, CA 95965
Telephone 530-538-7888
yax 530-538-2105
Address: I i U L.14
Address:
Manager:
Owner:
A•..
.lutte County Fire Rescue
California Department of Forestry
and Fire Protection
Facility Inspection Report
~Xhite Copy - Business
Yellow Copy — Occupancy File
Pink Copy — Station File
Occ. Class.
Business Name:
Bus: j 3 i ! `I Hm:
Bus: Hm:
Bus: Hm:
Fax:
AN TNQPF.CTTtnN nF vnITR FACH.ITV REVEALED THE 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 ;Q _
18.
Other
DETAILED EXPLANATION AND CORRECTIONS:
CORRECTED:
Date:
Discussed with:
Signed:
(Print)
.1
Inspecting O.fFicer:
Battalion 1 2 3 4 5 '�6 17
Station: FPB
'.:..
FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH
CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: ,
Fire Prevention Bureau A.. Butte County Fire Rescue ^` White Copy - Business
California Department of Forestry Yellow Copy — Occupancy File
176 Nelson Avenue P
Oroville, CA 95965 and Fire Protection pink Copy - Station_File
Telephone 530-538-7888 Facility Inspection Report Occ. Class.
Fax 530-538-2105
Address: •'-�,(-.5 1 ��r �J� Business Name: „�
Owner/Manager:
Bus: Mw Fax:
Assistant Manager:
Bus: m:
Building Owner.Bus::
ddre
A ss.
OF YOUR FACILITY REVEALED THE FOLLOWING:
1.
AN INSPECTION
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
4t7.
Fire alarm system defective
13.
Exit lighting: Required, defective
Sprinkler system: Service required, defective
14.
Smoke detectors: Required, defective
Kitchen hood extinguishing system service due
15.
Wiring: Exposed, damaged connectors, etc.
Defective appliance, flue combustibles
Fire walls, ceilings, fire doors, draft stops
16.
17.
Heating system:
Address posted and visible from road
Knox Box keys
9. Fire Drill Witnessed Yes ❑ No ❑ 18.
DETAILED EXPLANATION AND CORRIJCTIONS:
Other
CORRECTED:
Date: Discussed with:
2 �L� (Print)i Ke 1
Signed:
4j;
ting Officer:
Battalion 1 2 3 4 5 7 Station: FPB
FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH
CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE:'
Fire Prevention Bureau
176 Nelson Avenue
Oroville, CA 95965
Telephone 530-538-7888
Fax 530-538-2105
�.. Butte County Fire Rescue White Copy - Business
California Department of Forestry Yellow Copy — Occupancy File
and Fire Protection Pink Copy — Station File
Facility Inspection Report Occ. Class.
Address: Business Name:
Owner/Manager: Bus: Hm: Fax:
Assistant Manager: Bus: Hm:
Building Owner: Bus: Hm:
Address:
Adv 7N4Qv1Wr1r1n1V nF VnITR FAt-U.1TV RFVF,AI.FT/ THF. 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 ❑
18.
Other
DETAILED EXPLANATION AND CORRECTIONS: COI Kr:(:1Lra):
Date: /
/� 3
Discussed with:,-;'tiey - 77 t «/
(Print) --i/alf
Signed:
Battalion 1 2
3 4 5 //6) 7
�,>
Station: FPB
Inspecting
Officer:
FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH
CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE:;
5F1
Office ®f the State Fire Marshal -
Fire Safety Correction Notice F
CALIFORNIA STATE FIRE MARSHAL
File No: S1-0- Z� %
-Vn�f/- - -0-0-0-
Name:
Address: 14b5 1-�c-7f L— /
The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected.
I WY Citi 0'. S/ kjC, -
OW 'b/ A1 / A, 1Cs: 1- Vie1- 7~U7111
1
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 Marshall RECEIVED BY DATE
1 _
FN - II R- ; Bb. -. 38151 DK rRa,1 rio.N GREE-fay-dih %%IIHEYELLO W -geld
pagP_____&____
,,ffice of the State Fire Marsha,
INSPECTION REPORT
File No.: o
a (.3. 000 —1 S�—
Name of Facility:
Name of Building:
Address:
Ur LLQ "?SY6 S'
CFICE�,
STATE FIRE MA HAL
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Tc�o lc�O2 s
CE! CX:Z7e &XJ
GO.6 (Rev, 7/
- .m"AMBULATORY
STA E OF CALIFORNIA ... .
BEDRIDDEN
TOTAL CAPACITY
CAF 1ACITY = ' '
PREVIOUS CAPACITY
FIRE SAFETY INSPECTION REa.
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
STD. 850 (REV. 10-94)
.
See instructions on reverse.
MARSHALL
AGE CY CONTACTS NAME
TELEPHONE NUMBER
s
REQUEST DATE
PROGRAM
.
D S/COMMUNITY CARE LICENSING
530 )895-5033
ARF
.26/99
95926
.
EVALUATOR'S NAME
REQUESTING AGENCY FACILITY NUMBER
REQUEST CODE
cI
207/-GURRIERE/mc
0.1302699
OR O i L.L.., C A
2A
4ti•
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. � :'. ,.`.•c ..r. .l'. ••. - .- a.• - ..7. +L ..� _ �.:. �- - -f
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FACILITY CONTACT PERSON'S NAME
'• CFIF6NUMBER - :.
HOURS
RUBY TRUER 533-1319
h
CODES
f•.. .'^H L.^7�'.4 ''p Iw. `� .•O.._y. .1r^• Yf -t tL•. ..r• ..-,nom.\' •., ..w .�y..i..a4.�.:
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; - .. __; -- - - - _,
ORIGINAL. -FIRECLEARANCE
LI ENSING COMMIJNITY CARE.':.jrIJFENSYNex
F. SPECIAL HAZARD
2. RENEWAL B. LIFE SAFETY
AGENCY 520 COHASSET RD, ��
�.
.
N ME AND
CHI C O, CA* 95926
3. CAPACITY CHANGE
ADDRESS'.
4. OWNERSHIP CHANGE
-
5. ADDRESS CHANGE
6. NAME CHANGE
7. OTHER
- .m"AMBULATORY
_ .: = NONAMBUCATORY
BEDRIDDEN
TOTAL CAPACITY
CAF 1ACITY = ' '
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
CODES
.
STATE FIRE
MARSHALL
THORITY
s
FAC ILITY NAME
AMEAND
LICENSE CATEGORY
TRUESGGUEST HOME
-
ARF
STREET ADDRESS (Actual Location)
95926
NUMBER OF BUILDINGS
1465 KELLEY ST.
1
cI
-
..... .
RESTRAINT -
NO
OR O i L.L.., C A
C. FIRE ALARM
s•'.
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..�.A �: w.+,�..:��!r res.fi..�-��ws �..l. .7.'nw'^. :w"ti �.'
FACILITY CONTACT PERSON'S NAME
'• CFIF6NUMBER - :.
HOURS
RUBY TRUER 533-1319
h
'E -CIAL CONDITIONS
EXrLAIN DENIAL OR UST SPECIAL CONDITIONS
CLEARANCEAK464L• CODE
CODES
FIRE
STATE FIRE
MARSHALL
THORITY
4 WILLI EBURG LANE, STE o A
1. IRE CLEARANCE GRANTED
AMEAND
2. FIRE CLEARANCE DENIED
DDRESS
CHICO, CA.
95926
A. EXITS
I
B. CONSTRUCTION
C. FIRE ALARM
D. SPRINKLERS .�
)I
IN PECTOR'S NAME" .or Pr�ntearw :; °` �, •-
fTyped.
-
-TELEPHONt MBER �� - - _
'• CFIF6NUMBER - :.
�-
OCC6PANCY CLASS
E. HOUSEKEEPING
F. SPECIAL HAZARD
IN PECTpN DATE
INSPECT O SIGN RE (Typed or P nfed)
G. OTHER
EXrLAIN DENIAL OR UST SPECIAL CONDITIONS
STATE OF CALiFORNf.-
FIE SAFETY INSPECTION RE '.ST _
STD. 850 (REV. 10-94)
See instructions on reverse.
AGEN(','Y CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM
'5 /COmmuni ty ;are 3cens .:3g 530 895--5033 L;ZSi'g9
EVAL TOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE
02 7/Gurre3re!1t 041 X0269' LA
CODES
f„ X11. ORIGINAL A. FIRE CLEARANCE
LIC NSING2. RENEWAL B. LIFE SAFETY
A ENCY Commune rn Care Licensing
NA E AND
')'0 C O �, a S S e * R . f # 63. CAPACITY CHANGE
AD RESS Chico, C A 95926 4. OWNERSHIP CHANGE
5. ADDRESS CHANGE` -
6. NAME CHANGES -
7. OTHER -
AMBULATORY
NONAMBULATORY -
BEDRIDDEN
TOTAL CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY -
PREVIOUS CAPACITY
CAPACITY
PREVIOUS -CAPACITY
_1
6
FACIU NAME
LICENSE CATEGORY
r G.i v; i ''T u, .r ! r F!
A L i L
STREE T ADDRESS (Actual Location)
NUMBER OF BUILDINGS
CITY
RESTRAINT
.rovii'lex, OA 9 10
LQ
FACIUCONTACT PERSON'S NAME
U vA r
T: ue , 5 33-' J. �' �' �In.
SPECT L CONDITIONS
.....................
CLEARANCE. /DENIA� CODE
CODES
IRE r '.-1. FIRE CLEARANCE GRANTED
NA E AND '� '" ► " _ AU ORITY
2. FIRE CLEARANCE DENIED
ADDRESS A. EXITS
B. CONSTRUCTION
C. FIRE ALARM
D. SPRINKLERS
INSPECTOR'S NAME (Typed or Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS
_ E. HOUSEKEEPING
i f _; �.. .•' :' 1_ ..a - __ - F. SPECIAL HAZARD
'
...-
INSPECTION DATE INSPECTOR'S SIGNATURE (Typed or Printed) r G. OTHER
EXPLAI DENIAL OR UST SPECIAL CONDITIONS
f