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HomeMy WebLinkAboutFAI15-0074 Fire Annual Inspection ArchiveFire Prevention Bureau 176 Nelson Avenue Oroville, CA 95965 Telephone 530-538-7888 Fax 530-538-2105 Address: Assistant Manager: Building Owner. Address: lutte County Fire Rescue California Department of Forestry and Fire Protection Facility Inspection Report White Copy - Business Yellow Copy – Occupancy File Pink Copy – Station File Occ. Class. Business Name: Bus: Hm: Bus: Hm: Bus: Hm: Fax: 1kT TVQD'VrmTnV nr VnITu Ti Ad-n.ITV Ul .VFAI.FD TAF Fnu nWING: 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 CORKEU1101VJ: l.VxicEU it .L: Date:` 1 % Discussed with: r- Signed: Tint L � Inspecting Officer: B alion 1 2 3 4 5 11116`' 7 Station: - FPB (FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION W.�'I'H CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE:` r Y Fire Prevention Bureau 176 Nelson Avenue Oroville, CA 95965 Telephone 530-538-7888 Fax 530-538-2105 Address: Owner/Manager: Assistant Manager: Building Owner: ^Zutte County Fire Rescue California Department of Forestry and Fire Protection Facility Inspection Report Business Name: Bus: Bus: Bus: White Copy - Business Yellow Copy — Occupancy File Pink Copy — Station File Occ. Class. Hm: Fax. Hm: Hm: A iv nveu-VrrrrnM n1V VnTTu I ACC ITV RFVFA_t FII TAF Foi.i.nwiNc.! 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 CORREC'T'IONS: UUMCLUTEV1. Date: Discussed; with:. _ Signed: rint / � \� � - Inspecting Officer B alion 1 2 3 4 5 6 7 Station: FPB - PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: ' r V Amb" BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE TITLE 19/24 FACILITY INSPECTION yet"' Zaor INSPECTION NO. ® 2 3 REINSPECT: U YES [—]NO Facility f u I ler- C u e6;4 e-_ Occupancy 'R � , � , 1 Address ZGo?� —1 el,o w. �� Aup Inspector O'lof k N.9.}-.clyAt1 ,�7W �n Ear 6h Phone S 9-'3. - ©9�Z o,-- V, Ile Station /113 Contact Fu I1N r Station Phone -;`T :� -72 e7 Compliance: Yes =.4f ACCESS --All inspections Address correct/posted and visible from road (Bufte co. Code 32-9) Access to public street or 20 ft. wide lane (T19-3.05) 7!`Gates wide enough to admit fire apparatus (T1s -3.16) ^� Fire protection equipment visible/accessible (r19-3.14) PORTABLE FIRE EXTINGUISHERS — All Inspections No = 0 Not applicable = N/A ✓ Extinguishers have current annual service tag (r19 -575.1A) / Maximum travel 75 ft. (r19-567) Ls Provide clear access to fire extinguisher (T19-563.2) Extinguishers mounted on wall/or in cabinet, visible and signed (r19-563.8) EXITS --All Inspections V Exits not obstructed (r19-3.11) Exit signs in place (CBC 10032.9.1) ✓ 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) ± 1 - Maximum occupancy sign in place (T19-3.30) 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 T19-3.14) Reduce storage to at least "below ceiling/ sprinklers (T19-3.14) %%' Remove combus. storage from heater, mech., elect. room (r19 -3.19x) ' t Provide approved metal container for oily rag storage (r -19-3.19c) 1y Flammable liquids stored properly (r-19-3.15) ELECTRICAL --All inspections / 14Extension cords do not replace permanent wiring (CEC-400-8(1)) t.- Extension cords do not pass through doors/walls (CEC-400-8 (2,3)) �r 30 inch clearance around all electrical panels (CEC-110-16A) All panels and breakers are marked (CEC-110-17 C) L' Repair holes in fire -resistive construction CEC (300-21,22) v' o,'1'� 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. (T19-904) Clean filters, hood, and duct area over cooking appliances (CFC 1006.2.8) Maintain extinguishing systems (T19-3.24) Provide spare sprinkler heads (6 min.) and/or sprinkler wrench (r19-904.5) Replace damaged, corroded, or painted sprinkler heads (r19-904.5) Identify sprinkler valves and secure in open position (T19-904.5) Replace missing caps on fire department connection (r19-904.3) Provide 5 -yr. certification test for sprinkler/standpipe (r19-904) MECHANICAL EQUIPMENT -- All Inspections V Vents and chimneys -- No obvious hazards (CMC -Ch. 8) SMOKE DETECTORS -- Day Care Sr. Res., Hospitals, Apts. V' Properly installed and tested (r19-749, 754) SCHOOLS, JAILS AND HOSPITALS Decorations and curtains fire retardant (r19-3.08) LPG tanks fenced with locked gates (r19-3.22) FIRE DRILLS -- School and Day Care (Title 19-3.13) NAII 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 Corrections and Comments Kib d'/V I W `> )1u 7 r y-rk% The above deficiencies must be corrected within days. Inspection Date: Owner/Manager AP # BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE TITLE 19/24 FACILITY INSPECTION `:ice. °_ ALO L) INSPECTION NO. ; '1 2 3 REINSPECT: YES [—] NO Facility Occupancy Address 10,-)3 2�_ Inspector–7_%57.0 , ` ?-"IP7_60. N" �1;_r Phone 4 2� �-3 46 0 l '= Station Contact 61 [ Fk L Station Phone Compliance: Yes =✓ ACCESS --All inspections -V Address correct/posted and visible from road (Butte co. Code 32-9) V, Access to public street or 20 ft. wide lane (T19-3.05) !Gates wide enough to admit fire apparatus (r19-3.16) Fire protection equipment visible/accessible (T19-3.14) No = 0 Not applicable = N/A PORTABLE FIRE EXTINGUISHERS -- All Inspections Y Extinguishers have current annual service tag (T19-575.1 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 CT19-563 8) EXITS --All Inspections Exits not obstructed (r19-3.11) //�Exit signs in place (CBC 1003.2.9.1) jj T / Doors operate without key or special knowledge (CFC 1207.3) Rooms with Occupant Load of 50 Persons or More °r Exit illumination and signs in place (CBC 1003.2.8.2) Maximum occupancy sign in place (T19-3.30) 7 f 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 T19-3.14) Reduce storage to at least "below ceiling/ sprinklers (r19-3.14) Remove combus. storage from heater, mech., elect. room (r19-3.190 '�.LProvide approved metal container for oily rag storage (T -19-3.19c) ;i Flammable liquids stored properly (r-19-3.15) Corrections and Comments 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) V 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 NL�'', Hood system serviced/tagged every 6 mo. by cert. tech. (r19 -9o4) Clean filters, hood, and duct area over cooking appliances (CFC 1006.2.8) Maintain extinguishing systems (T19-3.24) I , Provide spare sprinkler heads (6 min.) and/or sprinkler wrench (T19-904.5) , Replace damaged, corroded, or painted sprinkler heads (T19-904.5) Identify sprinkler valves and secure in open position (r19-904.5) f -Replace missing caps on fire department connection (r19-904.3) nJ Provide 5 -yr. certification test for sprinkler/standpipe (r19-904) MECHANICAL EQUIPMENT -- All Inspections f, Vents and chimneys -- No obvious hazards (CMC -Ch. 8) SMOKE DETECTORS -- Day Care Sr. Res., Hospitals, Apts. r' ;" Properly installed and tested (T19-749,754) SCHOOLS, JAILS AND HOSPITALS %Decorations and curtains fire retardant (T19-3.08) (f.; LPG tanks fenced with locked gates (T19-3.22) FIRE DRILLS -- School and Day Care (Title 19-3.13) N �/- All systems operable/hooked to office N4- Held monthly (elementary schools) /d�Held semi-annually (high schools) 4LEvacuation plans posted in all rooms Emergency procedures posted in office /711E =1 Teachers take roll books The above deficiencies must be corrected within s : days. Owner/Manager f -- Inspection Date: `7' -5--QD AP # File No Name: _ Address: SF Office of the State Fire Marshal - Fire Safety Correction Notice ID I I CALIFORNIA STATE FIRE MARSHAL The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety deficiencies be corrected. ASO--� AAA l= sit y (AJ 5 r• i �`fTx` r ; ,C tiJ 4A ! L Wt,/ bxt K11J(, 110 1'6z v, , A, %t. y r-fg 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 O ISSUED BY (Deputy ,State Fire Marshall RECEIVED BY DATE 4 t EN -11 (Rev. 7/86) 89 88751 61 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field �. .. Office of the State Fire Marshal Fire Safety Correction Notice File No: — — - — Name: Address: SF Wa I 1 CALIFORNIA STATE FIRE MARSHAL 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 ( ) ISSUED BY (Deputy State Fire Marshal) RECEIVED BY DATE EN -11 (Rev. 7/86) 89 88751 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field I �A tTY INSPECTION REQS _. ST See instructions on reverse. - - AG TAC NAME BEDRIDDEN - TELEPHONE NUMBER REQUEST DATE PROGRAM WI 0PRNIT r-OARE LIOMSIN(,; CAPACITY 530- 895-5033 02/11100 0 EVAL UATOR'S NAME REQUESTING AGENCY FACILITY44UMBER REQUEST_ CODE 0207/DONNA LICENSE CATEGORY GURRIE 041374479 STRE EET ADDRESS (Actual Location) 7A = 2003 TFA4M AVEC - - CITY - - CODES -'RESTRAINT 0R `MLLE, CA 95965 �1�R�'��� -�� 50����.i SERVICES—' N0 1 OF�IGINAL A. FIRE:CL,EARANCE LI. ENSING_. _ . } WI CARE` LICENSING'. - 2. RENEWAL :13. LIFE:SAFETY"' , - N ENCY ME=A►ND 520 CO SSET' ROA:s . SUIT 6 3.CAPACITY CHANGE = _ ADDRESS CHICO, CA 95926 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE 6. NAME CHANGE - 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN - TOTAL CAPACITY CAP CITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY _ 0 66 FACI ITY' NAME ' _ _ _ LICENSE CATEGORY FULLER'S GUEST HOME .740--_ STRE EET ADDRESS (Actual Location) NUMBER OF BUILDINGS 2003 TFA4M AVEC CITY -'RESTRAINT 0R `MLLE, CA 95965 t. N0 FACI CONDITIONS ESTING NEW - INSPECTION LAST ONE WAS COMPLETED IN 1993 _HUUH5 t''�tit'•''fi%;�k •�. �'' ' �."S<''�: s3'�kr•?Xr'��'••n {� "�� v i+�q?n`Y> • {' 3' �yx��� ��,v��i'".�yr�r �r' +�av+. �r•\f+� • �4�•.'•}:{ r�.+' •{:. {v-''�'{�r.i;. fi { ''vfr'• �ti''Y'v' • ?•: r.:;^C•k; . ;Q:?y�;; .\\`�?:: ':{k}: �%•v:'` •. �} :4:.?:s:�:•>:f•S :r,.;:e�i ; STATE E OF CAL rt"ORNIA FIRE SAFETY INSPECTION REG EST W SM 850, (REV. 10-94) (REVERSE) -INSTRUCTIONS This form is designed for use With aw'indo-w envelope Llcensl.ng or Requesting Agencies --Complete the following 19 sections on this form before submitting It to the fire authority having jurisdiction.. 1. AGENCY CONTACT, 2. TELEPHONE NUMBER, 2-E LU TOR, Enter the name and telephone number of agency contact person. 3. PROG9AM. Licensing agency use. 4. REQUEST DATE, Enter date request was prepared. 6. REOUESTING AGENCY FACILITY NUMBER. This is the file number assigned by the licensing agency. 7. REQUEST CODE,. Use the seven codes shown and insert -the appropriate number in the box following "Re- quest Code If NAME CHANGE, please list previous name. Insert date of original request is other than an original. 8. AGENCY NAME AND ADDRESS. Enter the name and address of the -licensing facility requesting the inspection. Capacity: Insert in the appropriate section, the capacity of licensed ambulatory or nonambulatory oc- cupants covered by this request. Previous If request is for renewal or capacity change, Capacity: insert capacity of previous clearance. Total Show total licensed capacity. If the facility .is Capacity: intended to house part ambulatory, nonambu-. latory, and part bedridden, show the total of the three types of occupants. 0 10. FACILITY NAME. Insert the name of the facility as it will appear on the license. List identifying sub name if known (i.e., Hacienda Corp/Medina Lodge). 11, LICENSE CATEGORY, Insert the category of licen se being sought as it will appear on the license certificate. 12.ADDRESS. Insert street address and city only. A post office box is not acceptable as only location. 13. NUMBER OF BUILDINGS. Insert the total number of buildings to be used for housing of the occupants covered by the license. 14, RESTRAINT, Indicate if physical restraint (locked in a %. . room orthebuilding) I is - to be used in the housing of the - occupants. 15. FACILITY CONTACT PERSON—TELEPHot -E NIJM- BER. Indicate the name and telephone number of the responsible individual at the facility to be contacted by the fire authority. 16.Hous. Indicate the number of hours the occupants are housed at the facility (less than 24 or 24+). 17, SPECIAL CONDITIONS. Indicate any conditions unique to this request. As an example, if the inspection - request is for one building in a multi -building facility. FIRE AUTHORITY CONDUCTING THE INSPECTION—COMPLETE THE FOLLOWING: 18. FIRE AUTHORITY, NAME AND ADDRESS. Insert the name and address of the fire authority where th.e facility is located. 19. CLEARANCE/DENIAL CODE. Use the two codes: 1 for dearance granted, and 2 for clearance denlied. If denied, also include the appropriate letter code. As an exkample, Denial based upon exiting would be coded 2A. 20. INSPECTOR'S NAME. Piw*int the initial of the inspector's I- Tirst name and full last naffie; 'Insert the telephone number where the inspector may be contacted. 21. CFIRS I.D. NUMBER. linsert the fire clepartments num- 4 4 beras,c,-,'IgnedbyCa,,,Iforii.ia,F-.re Incident Reporting System. 22. OCCUPANCY CLASSIFICATION. Use California Building Code occupancy classifications and insert. the occupancy determined by the inspector. 23. INSPECTION DATE, Enter the actual date of the Inspection. 24. INSPECTOR'S SIGNATURE. To be signed by the IIP inspector conducting the "inspection. 25, -.EXPLAIN DENIAL OR SPECIAL CONDITION& If clearance code #2 is used, briefly explain reason. '`his 01 space is also to be used to specify any additional limitations placed by the fire authority, such as the use 0It , certain floors or sleeping rooms approved for nonarnbullatory clients. @aoNuea OSP 98 14587 Office of the State Fire Marshai 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. `E_--! 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 -11 (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field Fi age of- � VF ice of the State Fire Marshal °�� INSPECTION REPORT STATE FIRE MA HAL e No.:..sY" me of Facility: :ZL(, A k;�3S me of Building: dress: CA A n w 'Ascom aniLd b fr"0�'y��'.,..^•p�l !: t, Rr.� �'i <ir�• `. �H 'q"'i# f ti f.4.n` �a1 NMa " yi Y �S'f+�.kSi°.. .�$< �, 1 k � ya�uYy a ! €y �n •rai m 'f x s %P3 e" I e': a .. 1. ,:'�'t, a•.�,rr'. ,rrS.: r'�''i�,�a:iGi �,a%i,�+t 2:i'�. ��'19�v '.�Y:w� 1 •a ,� . o a ?£A ��p) 44.� r .�; •''31 t�...,�••}5��,,7C�Z'.Iof�'�iv .:•� i', a„ s. t,Y� ,t,., k �. �'�y #>?c � Y. : kf `' .��,i }K �K � ri .. +as Tf � �.s = 'x lr it r e . •' �.� . �� ,,�i;��ti'�'+^s<'d'jtq}.. �' . i .;'f•. sZ ; t �c '1"!•.f,�;?, ,S•f�!r >iy- .� i �'! 3y�'� r 3', -- . 12`��� • t- _.4 / ?>� k �` A3x� vj y,�'QiK%; ��y'i, �a•.3.d° �-� � l,Yp�tir 'p•• 2 � .^ f•:L'k A..s%!:r�'.> �. .. n )�fAi,Cy: :�SP'*kr�;, �,^-s�,>Jv;A,y `..`ii if/: .�'. � w a � )R.:..� �. t� ... '. ' rr �RVYM )EPLITY .D . � SES,. c+`�.� �� '";�• � ,,, � � • .�. a,.,r ... i-�ti TE WMA. GO- 6 (Rev. 7/86) •^! 4UX •r • a na •> is r'} ! k`:' r ,y , d q ,_S� ►f �' Vy � C v�w.. <k j'. Yiy' .• -t).,... ':u('. " �., i.r :e ^%�J.. i., . i t•.�.. :'n'•� �1 _ r.'a . 1. ..Y t _ �C - •L- t . rATE �v g'f pj,�,•a: i• _.fir. �� ;s�3 �.;r, ��: s. P e OFpRFKF� `'mice of the State Fire Marshal REINSPECTION REPORT STATE FIRE MA SHAL No: off_— — Name of Facility: N me of Building: A dress: Olt M GLEN 4a �aAVY��Qi • :l +�'• c• 't f:- � `"- •.Z' 4 ':r »..t moi. :e..1�.. ,"�`; .. (�U�scu5sed +� /�a:.. .^K ,� ! 4. N..A �'� w^./... • •m'6µ'.. 'y' fi `f..:4..r :\ .�rrh > •� - w ...ir .. �Y ��4. •(N ) ter-• $,w �. 't• .� .t • with: -- . ' } ot '1'� Z:"t. '4i' ..�y�� r-' '9' ia:.•&i•a»• •a:. 73 'k:� k, - ';L9. .�°!;w. Y� •K�y, :� ^k > Y \.►�`"a•-.t- ."4i>"^• tr. - r; �=w. �• $o►= tai'. :t 5:..'A'. >t :lY) A -., •-,E.� e ^�.�.' 1a•'• E .Sal 'sYY a .:fix '\ L• '+.: fA !;: A. Se•' •,r•. 4 4- .S( 1 :(... � f'•'r .1 � 9. -'YF iii.. 4,111 ..;tet A y ♦'lf h '�M, M , : r• i i 9" > ✓4 AcconnP anied a ka w, Y ky w.:a .3 rt it. .iii �'y� )!.' <% r� :.]. ••F :E-: •+f ;� .,.,yy `(!: e :. ,.r.•• .W {•::r ..•r'. !�'` y,$ kS;:an' ,. k`�. r• A.': a h': 'a,. :�., .' •. :..,. .. r: 3. - r, �.�. 1 '�, ." _: :'•• w�a 'r� "X. w 1'+ '�.,. .. ., . M: . Ir,. '...>. . .. .. .,..,,,.. ., .. S.,M .., ...':' . :'{+> t...»r .�,° s•:,, . a• .•3�t• ' E - `a . ! . .3 'w >•,• .r1. t:: ..!'� .. t 1 L �CS^ ' a�p� �`>..r r.cr. n,.. - 1P. ;i'i .. .", t' �"' :`�f:. �. a•w1.. <¢ k`rt�a: :.r3 a'F°� • a>.• ;:pt�i,.`i iw-"`:aN iR A <3:vd:�.>.. ^t is"<..1. .b }}1 '�11 A�j�,,•a-{. 'i{tib �.ylj R ••. 4 t' DEPUTY STAHRf J!� Fire Safety Deficiencies Numbered noted on the Letter ❑ '•t Fire Safety Correction Nonce (EN -11) El dated ave been corrected. DAZE OF .RE�Pf(:1lE i Uncorrected Deficiencies Numbered were re -issued as shown yy.. / rt<k K �,��..,I!�'r>Oe., > \ :�;• ,!-: w '`' t�V' 1A' ./ �IF't' � ... ra•::. .f..�$ N.• � `� >`• • ��a„ . �;. Lf.. �p on the Fire Safety Correction. Notice dated , which is attached to and made a part of this Report. -�i 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: M GLEN 4a �aAVY��Qi T -i7 C'E' ..f<� <} ,�.�� �►``:: R'1� "!'Yy1 r�!'" .. :) - `�I'i'. Y•''ia, - r• .. V-1 •!� a, l -4�� 4.a`', 'y:'» a. �... t' DEPUTY STAHRf J!� " :' p' r 71 ✓ »�/yA, 'P =:'. J A `I 1v••9 .^l. 4�.. V .'t. V' }Sy- '•t DAZE OF .RE�Pf(:1lE i ' - .. yy.. / rt<k K �,��..,I!�'r>Oe., > \ :�;• ,!-: w '`' t�V' 1A' ./ �IF't' � ... ra•::. .f..�$ N.• � `� >`• • ��a„ . �;. Lf.. �p rviK�. (, � >�,•.`.•t-. -�i 'y� .1� �., '�)� �j/�� $: v GC - 5 (Rev. 7/86) ' K ' - ;/ }` fir•.. � � � r c It•E UENRMU C AIIIUJ z : { ♦ 3 II - - txl�ulr STMT IIPJE MOMAL .. t ��� SIAIUS y ) 1 DATE C* FMCTM - Mew PIV4 �j;yt/f?} _ !'-•i'f�d�'•5.�f '���•��ilist'•�" •*r,. 'lf.�°'��b.i•�igiZ�'f:.a'�'�:,125f5�Gt�'i{fl�il4ftffiy]L'.+9?�...��i'7�Zrc���'a.•'a_t".�}I�L•4"i�'.:.>a frif�'+'I/ifi:'•!.'_•s��ttiiJGiJ3t3ai�i�J�a.-...--t. :. _. .'tai A�.� '� ;a --w .� .. ., , � .. ,. - . "• . " ;i�!f� 8.{*�.: � r^?:_..i "�i f rt �"�' �.�i'i 'k i`• � 'iii`' v x i - •r. id' • � i"� "" r•: t i i"f �. '�, �'iY• _13e�S �a �i+ •� '.:' ::,•� e- � a: j .•... ie Of [lie ,slale I'll a U-111-Shal ' INSITC110N.RL110 �� srAtE In KIA IfAt I Of I t hm._ j + ..�.�._ w..._ ��. •••ter •.� '' . . 11• iter cit t .,c ilicy: FULLER GUEST HOME t 1. i t �e t�1 Iji �ilc lit ��;: • . �.� .. •" A III Pcc: 2003 Tehama Ave, Oroville CA 95965 • :. f 1, � (A/� 1, •r• ; �•• f ., i r: •; • i i�� 1 • j••� . � '. •• •• •. ', � +• ' �. • t; ' ,' •1 i Mi . ` . ' •• 'ISi' .• I.i •. • . • • 1 '!' 1 �" 1[���'• � � S'�•' r �' r ! �•''•��,� r•�1�.•�1 r •� i �I:i.•!• _ t .'l,rf•.?, •` •�1,• r = !� 1 •� j ..,�, ••+�3• •r• ••' �•t 1. • 111: ' � • • %' ! ♦ • i '' ,�, • ' , 1 • ,: •• t r j t � 1 • AI '•+•i1OA • h• , ( h'•1 • t•�•'ii11•i ,-•r ,f}� ; �;,i _;•• •I ,; '••• '•rl �.•! •`..•�j' ��te'�.�;i • •• �• •;'/.. Atcu�t�pimiied by: F 'r Owne 0 gyrator s • icle: • ' f • • .•�' ii J •r.l�...,.,1/` =•4i•.J•,. .�r5'•I.•.; • .1 1' t• f• i'`, A ' 1.1 i } ! � .. • •, At the request of Community Care Licensing, an inspection was conducted at the above :- facilit . The license re uest i -s'; for '6' nonambulatorY age ed clients, the home has been extensive!remodled to accomodate `these clients* the buildingplans e approved by the Butte CountL Building Department before the changes in the code. As'such,'-•the g building has two smoke detectors in the corridor serving the Slee in wins which are interconnected to one another. An EN-11.was issued to have each sleeping room equip- ped ui - P ped with additional battery operated smoke detectors. The separation between et een the arae and main -house was perforated with a number'of penetrations, these too were id of ' don the EN -11, trt 6tNtAF,K,E CRNNItli ; ,. ,MAR .. • w•r .. •+w w •w+f.rw �' 3 IXrvtY St�1tt I ri Nth"LV. • SIAIUS i bAlf OF SLAUGHTER' 4 Jan 93 ' lice of the State Fire Marshal pf F SCF FACILITY BUILDING RECORD STATE FIRE MA HAL IIeNo.:----_-- acility Name: FULLER GUEST HOME �ddress: 2003 Tehama Ave Oroville. CA 95965 SFM BUILDING FILE NO. FACILITY BUILDING NO. BUILDING NAME T-24 OCCUPANCY CLASSIFICATION FILE 000 Main building R -2.2A IN -19 (Rev. 7/86) l age 1 of 2 ^ i OEIICE C' G. rice of the State Fire Marshal BUILDING SURVEY REPORT AL STATE FIRE MA FleNo.:—=—_-- ame of Facility: FULLER GUEST HOME ame of Building: Address: 2003 Tehama Ave. Oroville. CA 95965 caner: Marie'! Fuller Telephone No.: (91E2) 533-f)942 gent: Telephone No.: ( ) _ �Z rA Fk f.QRpik r s' ��% tWFtk t� '� v ti . aeiiti' k ; 1. Occupancy rrvE R -2.2A —T --""Gro Grou Home CAPACITY 6 Nonam' s 2. Construction Type - TvDe V nonrated YEAR BUILT 1992 3. Area (Sq' Ft.) TOTAL LARGEST FLOOR BASEMENT 4. StoriesHEIGHT Sin le MGFI R5E YES NO 5a. Exterior Wall Construction i t► nr r MR b. Opening Protection 6. Interior Wall Construction I" nr n GWRI wand frame 7. Floor construction wood frame and concrete slab 8. Roof Construction 9. Attic Draft Stops No. 10a. Occ. Sep. Wall Construction No. b. Opening Protection 11a. 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 ` TvrE b. Opening Protection 16a. Stair Enclosure NO. b. Opening Protection 4 #Rev. 7/66) 80 60878 • ,• .. le:-'i:K F IVY.I,7' ^-*-,Y'a';r--'�;.-•NV-,-. yrit• '�'Q14'*%R.I,pK[ Tr,B tln�r!r �: 1 . , , l � �', y r'++ ' '9'.,+"' . aT '. . . •� `- - Name of Facility: FULLER GUEST --Uva : t. .!' - - - ,II•, r S" tl r `R . � �' ' a ,.. ,. 1'• . • . ,• ' -i," .- - t"' .._ t-. ' .- 1 • • , Buildin Report G0.- 4,_ -. .i. _ , - -r id - , s•. '" ". , < , i - \} fe. . ,• � -.:- )urv. f'.e I . 1.. I.. . l; t' ' 3r • fur �: > a'. t rx. le No.. _ _._. _ �. 1_..► � ' 7 , � � . .11-4 �, I r r,, `;""'f�•-{i,•.1 t i t. -t '` ;.. .. ��' .1:;1 -. . r� �y s`.�.�. ,�f'. t ,� , .� , .X� f " + :; / ,1 f �4 t i • � , , . , , K Page 2 of 2 1 I I '"t, '. t rtt at 7 ,•• • r „ , r .4- !j. iu, • y f.A q.:' ..S:r� - . No.. - r���...,,, ' 7-� �' - . _ 1 _ :� , :.. r• A, ', r 19. 1 '� •�,T•. 'ice ser �` ,�.} , •' '• ,'` - 'e. f i:jy,. i. ti., .. ~� •S'' ''•'r at ✓ t „ i` ' it;:� • y' - , e'1,'.�at 1' %•�'F• ,'ay,' a<+y' i' 1', 'r -� �} "r' - -1 - ? 'r9", •? .. -i. -" ••• 'a' . - 11EXIT EPICt.OSURE , . _ • • - nja 1. - . � Exits • r: .i4% - - •E- K - `•,Y :�, >•. r. ] . 1• ,'1 ii Item t:;?-.- ✓' onvi}. '���. �ai..t� ">w !. {' :i i." -y` '.0 % ., x% +• •.>' .1.` ee - ,.5.♦• •t, - �` .e' •' '► _ i.q idipX1^ ���� �" a��F. '••� •. •''f. J, \'' .Zj V 1. `i' 'lrt;',' t rr.: it > :t Ey r� x, _y . a,:. ,Y'. .p.: .:s'c ;#j�.. .< t is .! .�+1�• ..i- r ••�` •!!: •. n.. : N - .: _ _ ; ; -;: _ • 3..s t,. . 1. 17. Stairs �,_ �� 6,2111 le ' �. 18. Ramps ,.: . ti} : t .. , �: t'.., ,.:' .,: ,! 1 No.. - r���...,,, ' 7-� �' - . _ 1 _ :� , :.. r• A, ', r 19. Interior Finish Class • • - t. H ,'ii' 'rk: ; f• .,• -r .Ij 'i. r. ,Y Y:� 't ROOM t III I , CORRIDOR . , :- 1_ :. i nZa 11EXIT EPICt.OSURE , . _ • • - nja 20. - . � Exits F ::i - NO .' `'" • . • , • '° t4 - - - TOTAL WITH � t _' W.Mft=&� - - >� .. ' .� N - - 1 . • 34 • . j 1. 21. Exit Hardware Type r . • .. . L 22a. Exit Signs/lNumination .' �;: �r, :. -% .. �,>�,t t - . - :,, ,. ;.,, " . A �* .1,;'' , . . , : � i � ; , : ,.,-4,.;��.�, - " A" 1�'. . I V .� 1. 1. - L�> 23. Auto Sprinkler Coverage ; ,, ,, L ` 't- ' . '. . ' . . tit t'• .�• �_ .. . :1 I 24. Standpipes Class/Location �, 1'1, 1� I., � 7:��,- t M 5�; � - I � .1 � � 1. i � . 25. Fire Alarm Type/Coverage - ` �' , ., :, N : ,�.: .19 .. y rs 26. Heating, Ventilation and • '.. 11, .' i i or rre . F .. '1.►. KI.,: 1.. t .� ,, . • . -" L; _, , ,% • i 1.i .'t n +. �i 1 1 >` '� F Air• Conditioning •ray L�iL ..� t 1.s0. • r �t I 27. Electrical Installation =v >t; `rd..4 � --V �-,- :. • _ �.� •. . ' , , s - • •.. I 28. t Stage/Platform �,� . ti . Ilk.- ; ,. .• ,, ..;� t. Ott " • ► 1e :ii s 1 �.. ^ �� r. s 1 t 29. �4 Hazardous Areas - . ". I f -. fl.` 1' 1 , .' .t "'.) f! � w ��- --- -•1. • - i. �L j .S,"t ,z r r'".i. 1 I. > Ir' , .•" r�i;�. ��,A�t; :u. t:,> ; , :� •; ;1, • _ , . ,. if:� t:. . ' j r. :. _ . M. Cather h • F; �: * r , � : '. ; - -' `' i -�° ... 4 �.., I . ,. • r , . • - `+'j 1., - �..>. 11• ': •1 'h. 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'T, *. - r r_i .!%'- 6 f - lj. �x- Office of the State Fire Marshal *FIREMA REGIONALFACILITY- FILE CHANGE NOTICE STATEAL ❑ Name Correction/Change El Change File Number ® Issue File Number ❑ Address Correction/Change ❑ Facility Discontinued ❑ Other J - r 0 L i'D, N E W 6i rc n ;'r Name: Address: City: County: (No. ) Name: FULLER GUEST HOME Address: 2003 Tehama Ave. City: Oroville, CA 95965 County: Butte (No 04 ) File No.: — _ _ _ _ File No.: Occupancy Class: T-24 SFM FU Occupancy Class: R2.2A T-24 SFM FIE Comments: New facility please issue file number and send labels. m 1. �§z Office of the State Fire Marshal Fire Safety Correction Notice File No: Name: Address: — SF I 1 CALIFORNIA STATE FIRE MARSHAL The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety deficiencies be corrected. s t 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 Slate Fire Marshal) RECEIVED BY DATE EN -11 (Rev. 7/86) 89 88751 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field II r. '1 Y t . t v;+r t a • j\ t`: ;l 3. t ,ti l'•b 3v' dais •'tJ�t4:-: a• `?` i, - _ r rtr -'•tt l }i '•'�`A •�.{'. ♦r ei.i�I�i.' j 1 � •'1fi �•-•�, �(ry'{�►l-+r�+.ti :i'.;1r]�'il•\ r- �"�f¢[�'':jxiA �,'� .1,�j. t_�rr !�•'yt�.it ^� 'd• ��: 1a� I tr,.�. )/ • 't••x+ t•;'';r��T j• '• ';a4 r�9 _ •.n �!!r, , rvl��ti .�. n}:ii�j�''V , '.•�;(.�'Yr'ji. T,�r,Y,. i�. � C•T't'..+� .;r•1 •;; r,,. �t�1;�Y'7• '�r!'T.�` - .{ j a: '' nL''•I�dz�..t_ s. .�;•,t' 1;. i y LI w r -h _�ice of the 'ae Matsha +. 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MV4 =i�-Z•�'.: et t:i; is rr "y��?y'�' ST E LFift MARSHAL ~'' COPY DISTRIBUTION: • REVERSE OF COPIES 2 AND 5 ► „W I FETY INSPECTION REQUEST. , 1-3 •STATE FIRE MARSHAL,.; INSTRUCTIONS FOR COMPLETION 2 • FIRE AUTHORITY ' '; .rY STD 50 (REV. 8/86) (Continuous). 4'^5 •LICENSING AGENCY ,. _ w 1. REQUEST DATE 2• PROGRAM 12/23/92 3. A ENCY CONTACT 4. TELEPHONE NO. 5. EVALUATOR -^ SS/Community Care Licensing`:-'' (916,-) 895'5033.�`.' 0207/Robert Caldwell `. S. S M REGION 7. SFM ID. NO. S. REQUESTING AGENCY FACILITY NO. 9. REQUEST CODE '-' 30 i' `' 041374479 ,r - la HIS REPLACES REQUEST DATED .12/22/92 • a •.1 CODES 1. ORIGINAL A. FIRE CLEARANCE a-•1 r z, M1 . ,• �. 2. RENEWAL B. LIFE SAFETY 3. CAPACITY CHANGE _. •. 4. OWNERSHIP CHANGE 10. AGENCY Dept. of Socia 1 � :Services - .. "...,t,,.. a , '•'A • •�' S. ADDRESS CHANGE NAME - • ' Community Care Licensing :: :, ~' ' �~. s. NAME CHANGE : AND 520 C o h a s s e t R d,,# 6 PREVIOUS NAME ADDRESSI - w. ,� Chico,- CA 95926 _ l� 7. OTHER . DATE OF ORIGINAL REQ. 11. AMBULATORY NONAMBULATORY TOTAL CAP. DATE OF LAST FIRE CLEARANCE CAP CITY AGE RANGE (YEARS) PREVIOUS CAPACITY AGE RANGE (YEARS) PREVIOUS TO 18 18 TO 86 AND 65 OVER CAPACITY TO 16 18 TO 65 AND CAPACITY 19. FACILITY . X 6 86 OVER X-. .... 6 CODE 740/RCFE 12. F CtLITY NAME . • � �r 13. NO. SLOGS. CODES I ~ . t ULLER' S GUEST HOME ... •J • _ � ,.� - 1 . ' �''-`- 1. GACH 7. ICF/OT 2. GACH/R 8. ICF/DD 14. S EET ADDRESS P.O. BOX 15. RESTRAINT 003 Tehama ' 'Ave � � � -. � ;+ •, -•. �' } � ,� , �� • • . 3. SH s. ADHC � ,- no 4. APH 10. CLINIC 5. PHF ''11. JAIL C ZIP CODE ,... 18. HOURS R O V I L L E .. `... ,_ J <` ' ` 95965. 24 6. SNF 12. ICF /DON '. ?'� ., ':; 13. OTHER 17. FACILITY CONTACT PERSON TELEPHONE NO. L. IBA. SPECIAL ariel Fuller f - - ;.. (916) 533-0942 I 4,. TO BE COMPLETED BY - INSPECTING AUTHORITY 4 18. FIRE 26. CLEARANCE AUTHOR. Jack Pirisky', State Fire Marsha CODE NAME #4 Williamsburg Ln, Suite Awe :� CODES AND - Chico, C A . 9 5 9 2 6 1. FIRE CLEAR, GRANTED ADDRESSI ►:� . • . - ' �� .. .. Z. FIRE CLEAR, DENIED ., .. _. ',,: 3. FIRE CLEAR, WITHHELD P _ ...._'--... ,,........ ..., 27. DENIAL _.., ... CODE TO BE COMPLETED BY INSPECTING AUTHORITY . w CODES 21. INSPECTOR'S NAME TELEPHONE NO. 22. CFIRS 23. T• 18 OCC. "• _,.... •. ID. NO. CLASS 1. EXITS SLAUGHTER - _ • " C 916 •) 895-4312 ,,.. ,. ..�.. t 555 R-2 2A 2. CONSTRUCTION 0 3. FIRE ALARM 4. SPRINKLERS 24. IN P. DATE 26. INSPEC S IGNA ' eb ...: 5. HOUSEKEEPING 28. EXPLAIN DENIAL OR LIST' SPECIAL CONZAsNTED 6. SPECIAL HAZARD ' � •� 7. OTHER FIRE CLEARANCE IS FOR SIX 0 AMB LA RY ELDER X CLIENTS BEDROOMS WITH DIRECT EXITS r STATE FIRE MARSHAL USE ONLY ETURN TO: 20. EGION, OFFICE L • . i ., '. .. ;: .. ;. 1 •.. , . its.. .a .. .J-•�1!•LR :.°::'1. .. ,, • Dept of Social: Services Community Care.•Licensing 520 Cohasset Rd ." , #6 Chico, CA .95926 ate. ,h, «. •, t • Fir •` .. iu.A`-_�i'�''• :i+ "a172 •�1'~ {. 4,404•1�I�.. �•�„r t . t• y}�, ...�_, . _ ' '���, :.�J�:ii2iaiil�L'�`��i'`��:11a►-I ;�:..T •:71 .. living deck room j"V)JOv- s c(� garage , \ Y XIo' bath 12 PCZ o \ 1�,0p6�F EC EIVED family XY / ate" s NOV 2 12005 room � quanrters attic crawl K closet ` Conimun ty Care Licensing space RE IVEO -- 1 2005 - COMMU11Y Licensing DIAGRAM 2eth Street walkway • x/3 r guest guestroom visitor roo"/_ .vo.- about 60 closet k.iath� closet ® garage iG YX guest room � =� guest room(Z \ / k-A/ow ":� gas shutof-for / visitor cottage 3 furnace �, F 3: closet L;"Q guest roomer guest room(l) X lr /VVV rWcs Qcloset v \ / E water ! IC bath bath shutoff officefete I— kitcen living deck room j"V)JOv- s c(� garage , \ Y XIo' bath 12 PCZ o \ 1�,0p6�F EC EIVED family XY / ate" s NOV 2 12005 room � quanrters attic crawl K closet ` Conimun ty Care Licensing space RE IVEO -- 1 2005 - COMMU11Y Licensing STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT 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. Try to keep the sizes close to scale. Use the space below. FAru Y NAM£ I ADDRESS �� (yt k i -y *OKE' CAP -t--2 a a �I � t}s�{vlJ►- rte 0lt c► v 1 t, t � j c�S 1 q505 - RECEIVED 5 5 - RECEIVED SEP 13 2005 Community Care Licensing IRS I ldriveway niAGRAH loth Street walkway A&4 guest guest rooms r F visitor ro o about: 60 cottage Get \L7—T L!, ti closet a 1:1 th cluftt closet garage f? quest guestfoam rooma A gas shutoff for AA4J AVAJo L L visitor cottage L&3ET _H OL i. u.5 t;"artr closet Lot W 4 *t �., � guest room6c) guest roomw closet Lj 0 Fyn waftr ba ath shut4ff A&' office 1.4 kitcen living room rM garage *nVJT5 ,x20 family room attic crawl space deck .7 --IGO bath a xz 4 �x I/ Q WE FXfo quarters F7 dosekt RV; WED 1 ?ODS VED g�j y�g � --NOV 2 1- 2005 deck .7 --IGO bath a xz �x I/ Q WE FXfo quarters dosekt RV; WED 1 ?ODS VED g�j y�g � --NOV 2 1- 2005 Community Care Licaming Z 0 <4 ;4f u low - 1 v ( a i l ' 1 1• r ! I !A 0 r ♦ 'e a a n �C► r o totu bb 1p ' T Z in v Cl { '.• e I ' Wr vb 714 I >0 (A �:. ' � ' sem.`• � ! t+ — -• — � "r1�: �pu► t � _l'4+ti� s • f 1 y 'T% O dh d ' 1 W_ tJ r � Y_1.. O o 'R 1 0 ' O. i.• r _.��' Q l 1 � • f P • �{�_ 4 '1 RECEIVEDRECEIVED • NOV -2 1 .200 - E P 13 2005 r, All.`, Community Care Licensing CommunkyCm o M .41 1' STATE', OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD. &50 (REV. ,o -s,) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DSS/COMMUNITY CARE LICENSING 530 895-5033 1/30/06 RCFE EVALIy' TOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 02 7/DONNA GURRIERE 045001764 1A CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING DEPARTMENT OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY A ENCY NAME AND COMMUNITY CARE LICENSING 3. CAPACITY CHANGE ADDRESS 520 COHASSET ROAD, SUITE 6 4. OWNERSHIP CHANGE CHICO, CA 95926 5. ADDRESSCHANGE S 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPA ITY 5 r PREVIOUS CAPACITY CAPACITY Sj�- PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 0 0 0 6 FAG NAME LICENSE CATEGORY FAMILY HOME CARE RCFE S ADDRESS (Actual Lc;at(on) NUMBER OF BUILDINGS 20103 TEHAMA AVE. 1 CITY RESTRAINT O OVILLE, CA 95965 NO FAGCONTACT PERSONS NAME " NILLY RAMIL (415) 468-6797 24 SPECIkL CONDITIONS IRm, BUTTE COUNTY FIRE DEPARTMENT AND 176 NELSON AVENUE Ess OROVILLE, CA 95965-3425 S I OR'S NAME (T)W or Prinhd) TELEPHONE NUMBER ION DATE INSPECTORS SIGNATURE crypey orP~ i DEMAI OKI IST SPECIAL CONDITIONS i CRRS NUMBER OCCUPANCY CLASS 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPECIALHAZARD G. OTHER rlKt: SAl t 1 Y INb1JLt:l IUN STD.; (REV. 10-84) See wst►„et/ons on reverse. AGEr CY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM D§S/COMMUNITY CARE LICENSING 530 895-5033 1/30/06 RCFE EV/L ATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0207/DONNA GURRIERE 045001764 1A OROVILLE, CA 95965-3425 CODES 1, ORIGINAL A. FIRECLEARANCE A. EXITS LICENSING DEPARTMENT OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY AGENCY NAMEAND COMMUNITY CARE LICENSING 3. CAPACITY CHANGE A'DRESS 520 COHASSET ROAD, SUITE 6 4. OWNERSHIP CHANGE CHICO, CA 95926 5. ADDRESSCHANGE S 6. NAME CHANGE OCCUPANCY CLASS 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY F. SPECIALHAZARD G. OTHER 0 0 6 0 0 0 6 FACILITY NAME LICENSE CATEGORY FAMILY HOME CARE RCFE STREIET ADDRESS (Actual Location) NUMBER OF BUILDINGS 2003 TEHAMA AVE. 1 CITY RESTRAINT OROVILLE, CA 95965 NO FAG TY CONTACT PERSONS NAME HOURS N LLY RAM I L 415 468-6797 24 CONDITIONS CLEARANCE /DENIAL CDDE F CODES 1. FIRE CLEARANCE GRANTED FIRE BUTTE COUNTY FIRE DEPARTMENT AUTHORITY NA E AND 176 NELSON AVENUE 2. FIRE CLEARANCE DENIED A DRESS OROVILLE, CA 95965-3425 A. EXITS S B. CONSTRUCTK)N C. FIRE ALARM D. SPRINKLERS OSPEICTOR'S NAME (Typed or Primed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS E. HOUSEKEEPING F. SPECIALHAZARD G. OTHER iSPETION DATE INSPECTOR'S SIGNATURE (Typed orPr»ted) OD XPLAIN DENIAL OR UST SPECIAL CONDITKNJS ire Prevention Bureau 76 Nelson Avenue lroville, CA 95965 'elephone 530-538-7888 ax 530-538-2105 Address: Z� O iwner/Mana er: Manager: Owner. Butte County Fire Rescue California Department of Forestry and Fire Protection Facility Inspection Report .•. White Copy - Business Yellow Copy – Occupancy File Pink Copy – Station File Occ. Class. Business Name: Bus: Hm: Fax: Bus: Hm: Bus: Hm: AN MQDTi d-'r1nN (1F V(IITR Ti At-n.1TV RF,VFA1.F11 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:.., 18. Other 41FTAH XD EXPLANATION AND CUR.NEC 'HU1N N: UvlutLu I r' L: Date: Discussed with:_ Signed: X� (Print)eA�vCEs hut( K f rLCzj�' Battalion 1 2 3 4 56.-'7 � Station: — FPB 6 Inspecting Officer: FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR CUUPEKA-HU-N W1111 CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: ire Prevention Bureau 76 Nelson Avenue lroville, CA 95965 �.lephone 530-538-7888 ax 530-538-2105 AM*, Butte County Fire Rescue AEftWhite Copy - Business California Department of Forestry Yellow Copy — Occupancy File and Fire Protection Pink Copy — Station File Facility Inspection Report Occ. Class. Address: MjzBusiness Name: 4 -. Z —. C- er/Manager: Bus: Hm: Fax. sistant Manager: Bus: Hm: uilding Owner. Bus: Hm: . ,.r n Q-D1V 9 -T7nAT nu vniTD F A f n .TTv i2vv- . A T .F.n TNF. 1rni .i ,nw1N(T_ 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 ■ 1SAUwlo/V Y[II►I_1011ZKIlNk*,4X" I� !LVLiL1A"5Lqrj= Date: Discussed with: Signed: Tint AW Inspecting Officer: Battalion 1 2 3 4 5 6 7-,*' Station: 3 FPB � � -T u&% FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUK UOOYl MA'1IUn W1111 CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE TITLE 19/24 INSPECTION NO.�� 2 3 FACILITY INSPECTION REINSPECT: YES NO Facility Occupancy X-1 Address Z/ /30.;:;r/ic�- Lam/.'d/%r_r_ Inspectorc:— Phone u " — !G;F- 5-- Station /=✓ Contact, �:,Ws. � F`"4 Station Phone Compliance: Yes =r 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 (T19-3.16) /L! " Fire protection equipment visible/accessible (r19-3.14) No = 0 Not applicable = N/A PORTABLE FIRE EXTINGUISHERS -- All Inspections Extinguishers have current annual service tag (T19 -575.1A) Maximum travel 75 ft. (T19-567) %Provide clear access to fire extinguisher (T19-563.2) tExtinguishers mounted on wall/or in cabinet, visible and signed (T19-563.8) EXITS --All Inspections L; Exits not obstructed (T19-3.11) A4LExit signs in place (CBC 1003.2.9.1) u - Doors operate without key or special knowledge (CFC 1207;3) Rooms with OFcuant Load of 50 Persons or More Exit illumination and signs in place (CBC 1003.2.8.2) Maxinium-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 T19-3.14) Reduce storage to at,least ".below ceiling/ sprinklers (T19-3.14) Remove combus.'storage from heater, mech., elect. room (r19 -3.19x) Provide approved metal container for oily rag st. age (r -19-3.19c) Flammable liquids stored properly (r -19-3.T5 c” Corrections and Comments i l 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 9,3)) 30 inch around 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. (T19-904) Clean filters, hood, and duct area over appliances (CFC 1006.2.8) Maintain extinguishing systems (T19-3.24) Provide spare sprinkler heads (6 min.) and/or sprinkler wrench (r19-904.5) Replace'daTaged„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 (T19-749,754) SCHOOLS, JAILS AND HOSPITALS Decorations ald:clirtains fire retardant (r19-3.08) LPG tank`s'fO ced 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 The above deficiencies must be corrected within days. Inspection Date:Y—' Owner/Manager AP #. BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE TITLE 19/24 FACILITY INSPECTION INSPECTION NO [a ; 1 /'Z 3 REINSPECT: � YES ' NO Facility r ! r •, ..� f%l�i�G -' r.ribt/_ Occupancy Address %_2 _20 Inspector Phone �' `% /e r' aM Station Contact ,,. F/7(16 Station Phone �2 _�J X 5c_� Compliance: Yes = If ACCESS --All inspections Address correct/posted and visible from road (Bufte Co. Code 32-9) Access to public street or 20 ft. wide lane (r19-3.05) Gates wide enough to admit fire apparatus (T19-3.16) -Fire protection equipment visible/accessible (T19-3.14) i No = 0 Not applicable = N/A PORTABLE FIRE EXTINGUISHERS -- All Inspections Extinguishers have current annual service iag (r19 -575.1A) 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) A_. 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 (T19-3.30) 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 T19-3.14) Reduce storage to at least "below ceiling/ sprinklers Cr19-3.14) Remove combus. storage from heater, mech., elect. room (T19 -3.19n Provide approved metal container for oily rag storage (T -19-3.19c) Flammable liquids stored properly CT -19-3.15) Corrections and C ELECTRICAL --All inspections Extension corns Ifo not replace permanent wiring (CEC-400-8(1)) Extension co,fds 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. (T19-904) Clean filters, hood, and duct area over cooking appliances (CFC 1006.2.6) Maintain extinguishing systems (r19-3.24) Provide spare sprinkler heads (6 min.) and/or sprinkler wrench CT19-904.5) Replace damaged,_corroded, or painted sprinkler heads Cri9-904.5) 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 1 .Vents and chimneys -- No obvious hazards (CMC -Ch. 8) SMOKE DETECTORS -- Day Care Sr. Res., Hospitals, Apts. ,, roperly installed and tested (T19-749,754) SCHOOLS, JAILS AND HOSPITALS Decorations and curtains fire retardant (r19 -am) LPG tanks fenced with locked gates (T19-3.22) FIRE DRILLS -- School and D;ty Care (Title 193.13) 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 The above deficiencies must be corrected within days. Inspection Date:' iOwner/Manager AP #