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Home My WebLink AboutFAI15-0061 Fire Annual Inspection ArchiveST TEOFCALIFORNIA FIRE SAFETY INSPECTION REQUEST -qTk RSntPFV See instructions on reverse. AC ENCY CONTACT'S NAME TELEPHONENUMBER REQUESTDATE PROGRAM DSS/COMMUNITY CARE LICENSING 530 895-5033 7/22/04 EV 6,LUATOR'SNAME REQUESTING AGENCY FACILITY NUMBER REQUESTCODE 101/MARGIE WHITAKER 045404167 5A CODES 1. ORIGINAL A. FIRE CLEARANCE DEPARTMENT OF SOCIAL ST LICENSING 2. RENEWAL B. LIFE SAFETY AGENCY COMMUNITY CARE LICEI%T' AME AND 520 COHASSET ROAD 1r, e 3. CAPACITY CHANGE DDRESS CHICO, CA 95926 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY C PACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAP CITY PREVIOUS CAPACITY Z F ILITYNAME LICENSECATEGORY BUTTE COUNTY HEAD START - POPLAR 850 ST REETADDRESS(AclualLocation) NUMBER OF BUILDINGS 075 POPLAR ST. C11 Y RESTRAINT ROVILLE NONE FACILITY CONTACT PERSON'S NAME HOURS ILDA RAMIREZ (530) 533-5673 M -F 8AM - 5PM SF ECIAL CONDITIONS LOCATING FROM ROOM 1 TO ROOM 27 AT EXISTING SITE TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE/DENIAL CODE CODES 1. FIRE CLEARANCE GRANTED FIRE CDF / STEVE FOWLER AUTHORITY 176 NELSON AVE. NAME AND 2. FIRE CLEARANCE DENIED OROVILLE, CA 95965 DDRESS A. EXITS LB. J CONSTRUCTION C. FIRE ALARM -----TTT��--��--��- D. SPRINKLERS IN PECTOR'S NAME (Typed orPrinted) TELEPHONENUMBER - CFIRS NUMBER OCCUPANCYCLASs E. HOUSEKEEPING. ( ) F. SPECIAL HAZARD G. OTHER PECTIOE PECTOR'SSIG TURE TypedcrPri IN INS NDAT _i v � _ EX PLAINDEN IAL ORLIST SPECIAL CON D 10 �� 7 60 ass a CALIFORNIA FIRE SAFETY INSPECTION REQUEST �l.r � STO.e501REV1,o-jH) Ser ins tructlorns In reverse. AGENCY CON7aCTIS NAME 1''EIEPMONE NUMaEI� RE4UE8T pr►TE PROGRAM CDSS/COMMUNITY CARE LICENSING 530 895.5033 21510 C . I .•_`r �•.. • .. 1i/14.•... �. NIM.••. ._ CL EvALUATOR`S NAME .. . ..... . 1« /M • . ._ .__ . .i_.. -- ._ .. . . ... -. ... _.._ REQUESTING AGENCY FACILITY NUMQER REQUEST CODE ..1. MARGIE 'V�rHITAICEIt 045405112 3A 1. F" LICENSING DEPARTMENT OF SOCIAL SERVICES ' AGENCY COMMUNITY CARE LICENSING NAME AND 520 COHASSET ROAD, SUITE 170 ADDRESS CHICO, CA 95926 I IFA7(M (530) 895-5934 CODES 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL S. LIFE SAFETY 3. CAPACITY CHANGE a. OWNERSHIP CHANGE 5. ADDRESS CHANGE 5. NAME CHANGE 7. OTHER aMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CApACJTy PREVIOUSCAPAC!TY CAPACITY PREVIOUSCAPACiYY 56 24 0 0 56 FAGLMYNAME TLC POPLAR PRESACHOOL LICENSECATEGORY 850 8TR6ETA0DRES3 AaumlL _ _' _ ."• I •_ — •• — -- ...__ .._ .. t ocedorl) 2075 POPLAR AVE. ##23 (ADDING ROOMS i#26 & #f27) NVMBER OF OUILOINGS CIT1 " .--- - • . 1 __ �.... •• _ -- — iiil... OROVILLE 95965 RESTRAINT - - .1 NO FACILITY CONTACTPERSONIS NAME ~ — • - • - RACHEL S EIDENGLANZ (530) 538,2950 HOURS M -F 7:30AM • 5PM SPECIAL, CONOtTIONS 1 INCREASING CAPACITY - ADDING ROOMS #26 & #27. TO BE COMPLETED BY INSPpCTING AUTHORITY F FIRE BUTTE COUNTY FIRE DEPT. AUTHORITY 176 NELSON AVE. NAME AND OROVILLE, CA 95965-3425 ADDRESS 1 R � fig }/oS Z;6w It'i !. tN9PECTGIilNAME (TjpederPKiltsd) TELCAHONEI�iVMBER CFIA9 NUMBER a� tNSPCC7ROATE INSPECTOR'S SIGNATUREt , 0 j EXPLAIN DENIAL 00 UST SPECIAL C0NDIr1pN OCCUPANCY CLAS6 G�� C LCZARANCf_ IDCNIAL COO E CODES E CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRLICTION C. FIRE ALARM 0. SPRINKLERS E. HOUSEKEEPING F. SPECIAL HAZARD G. OTHRIQ l00/100o lVN0I838 03IH3 133 EE099680E9 XVI 80:60 6042/ll/ZO r ^'�_ . :�•'. --ti �. r--�.... - . STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST see instructions on reverse. STD. 850 (REV. 10-94) AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM CDSS/COMMUNITY CARE LICENSING Ir 530 895-5033 9/19/07 CCL EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0107/MARGIE WHITAKER 045405112 3A CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING I DEPARTMENT OF SOCIAL SERVICES � 2. RENEWAL B. LIFE SAFETY AGENCY COMMUNITY CARE LICENSING 3. CAPACITY CHANGE NAME AND 520 COHASSET ROAD, SUITE 6 ADDRESS CHICO, CA 95926 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 c 24 15 0 0 24 r LICENSE CATEGORY FACILITY NAME TLC POPLAR PRESCHOOL 850 STREETADDRESS (Actual Location) NUMBER OF BUILDINGS 2075 POPLAR AVE., #23 CITY RESTRAINT OROVILLE 95965 NO FACILITY CONTACT PERSON'S NAME HOURS RACHEL SEIDENGLANZ (530) 538-2950 M -F 7:30AM - 5PM SPECIAL CONDITIONS REQUESTING CAPACITY INCREASE FROM 15 TO 24 PRESCHOOL AGE CHILDREN IN ROOM #23 TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE/DENIAL CODE CODES FIRE BUTTE COUNTY FIRE DEPT. 1. FIRE CLEARANCE GRANTED AUTHORITY 176 NELSON AVE. 2. FIRE CLEARANCE DENIED NAME AND OROVILLE, CA 95965 ADDRESS A. EXITS ATTN: MATT DAMON B. CONSTRUCTION I_._ _......' C. FIRE ALARM _ _ __ __�----------„ ^ - D. SPRINKLERS NSPECTOR'S NAME (Typed orPrinted) ____ ~�� TELEPHONE NUMBER __ -�� CFIRS NUMBER OCCr CLASS OCCUPANCY E. HOUSEKEEPING F. SPECIAL HAZARD NS TION DAT ECTO edor inted) G. OTHER LAIN DENT LOR LIST SPECIAL NDITIONS 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 1/18/07 CCL EVALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0107/MARGIE WHITAKER 045404938 4A CODES �ATTN: STEVE FOWLER 1. ORIGINAL A. FIRE CLEARANCE LICENSING DEPARTMENT OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY AGENCY COMMUNITY CARE LICENSING ACILITY NAME NAME AND 520 COHASSET ROAD, SUITE 6 3. CAPACITY CHANGE ADDRESS CHICO, CA 95926 4. OWNERSHIP CHANGE 850 5. ADDRESS CHANGE FAX # (530) 895-5934 6. NAME CHANGE 2075 POPLAR STREET #26 & #27 7. OTHER AMBULATORY NONAMBULATORY -1 BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY OROVILLE, CA 95965-3425 PREVIOUS CAPACITY ADDRESS 23 �ATTN: STEVE FOWLER IN SPECTOR'S NAME (Typed orPrinted) TELEPHONE NUMBER 23 ACILITY NAME LICENSE CATEGORY E CENTER HEAD START PROGRAMS - POPLAR CENTER 850 TREETADDRESS (ActualLocation) NUMBER OF BUILDINGS 2075 POPLAR STREET #26 & #27 ITY RESTRAINT OROVILLE NO ACILITY CONTACT PERSON'S NAME ryVUK%li JOANNE AIELLO (530) 321-4209 OR (530) 741-2995 EXT. 135 M -F 7AM - 6PM PECIAL CONDITIONS HANGE OF OWNERSHIP (THIS LOCATION IS CURRENTLY LICENSED FOR THE SAME CAPACITY) TO BE COMPLETED BY INSPECTING AUTHORITY EAPLAIN DENIAL OR LIST SPECIAL CONDITIONS CFIRS NUMBER I OCCUPANCYCLASS 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 r- -1 FIRE BUTTE COUNTY FIRE DEPT. UTHORITY 176 NELSON AVE. AME AND OROVILLE, CA 95965-3425 ADDRESS �ATTN: STEVE FOWLER IN SPECTOR'S NAME (Typed orPrinted) TELEPHONE NUMBER IN 31PECTION DATE INSPECTOR'S SIGNATURE(TypedorPrinted) EAPLAIN DENIAL OR LIST SPECIAL CONDITIONS CFIRS NUMBER I OCCUPANCYCLASS 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 STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 10-94) coe See instructions on reverse. uENCY CONTACTS NAME TELEPHONE NUMBER CDSS/COMMUNITY CARE LICENSING 530 895-5033 VALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER MARGIE WHITAKER 045402234 ,--- LICENSING DEPARTMENT OF SOCIAL SERVICES AGENCY COMMUNITY CARE LICENSING NAME AND 520 COHASSET ROAD, SUITE 6 ADDRESS CHICO, CA 95926 REQUESTDATE PROGRAM 2/22/05 CCL REQUEST CODE 3A 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 APACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 20 13 0 0 r I5 --- __.--- - ---- -- - _--�- ___�..__ _ .....--- LICENSECATEGORY ACILITY NAME 850 BUTTE COUNTY HEAD START - POPLAR TREETADDRESS (ActualLoca6on) NUMBER OF BUILDINGS 2075 POPLAR ST. ITY RESTRAINT OROVILLE NO CILITY CONTACT PERSON'S NAME HOURS DAYS HILDA RAMIREZ (530) 693-2294 PECIAL CONDITIONS TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE/DENIAL CODE ~� CODES 1. ARE CLEARANCE GRANTED FIRE CDF/STEVE FOWLER AUTHORITY 176 NELSON AVE. 2. FIRE CLEARANCE DENIED AME AND OROVILLE, CA 95965 A. EXITS ADDRESS B. CONSTRUCTION �- C. FIRE ALARM n SPRINKLERS I SPECTOR'S NAME (Typed orPrinted) TELEPHONE NUMBER i ' CFIRS NUMBER ' OCCUPANCY CLASS E. HOUSEKEEPING �' �� 05 r F. SPECIAL HAZARD G. 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White Copy - Business 176 Nelson Avenue California Department of Forestry Yellow Copy — Occupancy File Oroville, CA 95965 and Fire Protection Pink Copy — Station File Telephone 530-538-7888 Facility Inspection Report Occ. Class, E Fax 530-538-2105 Address: Business Name: I& .,-,,.'. _k 4e_ak Owner/Manager —h. Bus: ; 3 h• Z g 1 a Hm: Fax: Assistant Manager: Bus: Hm: Building Owner: Bus: Hm: Address: AN iNCPVrTInN OF 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 ❑ 18. Other (DETAILED EXPLANATION AND CORRECTIONS: CUKREC'I'EI): C 1\ S.ee_ x.1(4 C cx C ate: "Z Discussed with: Signed: r j /ZL-I/ cX(Print) �Ve Inspecting Officer: �attali'on 1 2 3 4 5 6 �7 Station: >' FPB FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH ORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: 04ft— STATE OFCAUFORNIA FIRE SAFETY INSPECTION REQUEST STD. 850 (REV. 10-94) AGENCY CONTACTS NAME CDSS/COMMUNITY CARE LICENSING EVALUATOR'S NAME 0101/CINDI BETHELL See instructions on reverse. TELEPHONENUMBER 530 ) 895-5033 REQUESTING AGENCY FACILITY NUMBER 045403636 LICENSINGDEPARTMENT OF SOCIAL SERVICES AGENCY COMMUNITY CARE LICENSING NAME AND 520 COHASSET ROAD, SUITE 6 ADDRESS CHICO, CA 95926 L REQUEST DATE PROGRAM 1/16/03 REQUESTCODE 3A CODES EN VFs� 1.ORIGINAL A. FIRE CLEARANCE Q, 2. RENEWAL B. LIFE SAFELY O3. CAPACITY CHANGE O Q 4. OWNERSHIP CHANGE Or � 5. ADDRESS CHANGE 6. NAME CHANGE 10"'IsITO* 7• OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY APACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CILITYNAME LICENSECATEGORY + POPLAR CHILDREN'S CENTER CCC EETADDRESS (Actual Locadon) NUMBER OF BUILDINGS 2075 20th STREET 1 C TY RESTRAINT ROVILLE, CA 95965 NO Fj CILITYCONTACT PERSON'S NAME HOURS DIANA DROBNEY (530) 538-2910 M -F 8-119 12-3 S ECIALCONDITIONS TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE/DENIAL CODE CCt- CODES FIRE A THORITY "ttv �Uwte--(e 1. RE CLEARANCE GRANTED AME AND 1� 4" N �i `Jl'��1� Lie. 2. FIRE CLEARANCE DENIED ADDRESS r; v IN Ir J A. EXITS L B. CONSTRUCTION C. FIRE ALARM ECTOR'S NAME (Typed or Printed,' TELEPHONE NUMSER rFIR.Q NUMBER OCCUPANCYCL4SS D. SPRINKLERS �, _ r % �" ` E. HOUSEKEEPING ,3D) S . F. SPECIAL HAZARD :CTIOND E INSPECTOR'S SIGNATURE(TypedorPrinted) G. OTHER 2 D `� kliq 5PIALOR UST SPECIAL CONDITION -S Olt dr Lr��t l