HomeMy WebLinkAboutFAI15-0079 Fire Annual Inspection Archive08/16/2007 09:59 FAX 530 695 5934 COMMUNITY CARE LICENSING itoo1/001
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8TATeOF CALIFORNIA
FIRE SAFETY INSPECTION REQUEST
sea Instruction on reverso.
STO.660 (REV. 10.94)
---
AGENCY CONTACT'S NAME
TELEPHONE NUMBeR
ARCUE.ITGATE
PROGRAM
CRSS/COMMUNITY CARE LICENSING
530 895-5033
8/6/07
CCL -
IEVALUATO"NAW RECUMMINGAGENCYPACILITYNUMBER
RECULSTCOOE
0107/MARGIE WHITAKER 045405127
IA
CODES
�,.. ..-.
1, ORIOINA� A. ARE C�EAt�ANCE
LICENSING OEPAR'I1�sENT OF SOCIAL SERVICES
NWA e. UFE SAFETY
Z. REE �
AGENCY COMMUNITY CARE LICENSING
3. CAPACITY CH�wGE
NAME AND 520 CORASSET ROAD, SUITE 6
ADDRESS CHICO. CA 95926
41 OWNERSHIP CHANGE
5. ADDRESS CHANGE
L
S. NAME CHANGE
7. OTHER
AMBULATORY NONAMBULATORY BEOR OEN
TOTAL CAPACITY
CAPAGITY PReVIOUGGAPAGITY CAPACITv PREWUSC-WACRY CAPACITY PREVIOUS CAPACITY
12 0
1
.+1. ♦..TM.AIA.1..1.-..MI....M .•w.-1»Y.�•�.r ry M.—rI .. ...�.•. •• -r.r• •.—•..r•.r »r..........• .r•rr. .•«... .. .. •-...r.�.. w w.... r..r.. r —.....�. . «.. r. »r........ _......... trVr.-..'-M7.I+T•...•...wl�..»•-
FACILITY NAME
. .r,y,r.�.-rN..rwa«.••+w.•.'+.�.►�.►.►-�++h+,+r•w-•�►w1
L�CENBE CATECiOr�`I
OROVMLE CHRISTIAN PRESCHOOL
850
STREEYA00RE86 (ACNNLoos:tWff)
NUMBER OF 8UiL01NG3
3785 OLIVE HWY, ROOM #5
I •I
CIT,
Re3TMMT
OROVILLE
NO
FACILITY CONTACT PE1160 4 NAME
HOURS
TI40MAS HAMMONDS (530) S33-2888
M -F 8:30 -12PM
SPECIAL CONDITIONS
REQUESTING CLEARANCE FOR 12 AMBULATORY CHILDREN AGES 3 - 5 YEARS IN ROOM #5.
TO BE COMPLETED BY INSPECTING AUTHORITY
CLEARMCSIMNIALCODE
H
CODES
xTr'DaM o n
FIRE zw*e.coin Pl�0
1. FIRE C�.EARANCE GRANTED
AUTHORITY
NAME AND �
17 (p
Z. FIRE CLEARANCE DENIED
ADDRESSRe, 2�N�
Oroo
A. EXITS
8. CONSTRUCTION
PAY 5��— Z1.05
C. FIRE ALARM
M-NIF�• 1.W1•W.......1�iM..Y..'M4 .•..M.M..wd« .1 ....• ... �..... . «««..»« ....—r.. .» » .... �...—...« . «.. •r.r «...►.Iw.hNMIM.'..'M,
INBPECTOR'8 NAMEltyID�OaP/tANO) TELEPHONE NUMBER r CFIRG NUMBER OCCUPANCYCLAS9
gD. PRINKLERS
_f/ %
W14 !� -ICx/ 3 �� `��
(s
E. HOUSEKEEPING
F. SPECIAL HAZARD
tlysple9floN YE INSPEC b
r �••• •. M I^ 4• MM W.N• IIN.�
• �•�O�Y•A•NN W.•M
GI OTMER
W'1•M�H.. N�MM+I.M � �
EXPLAIN IAL OR L*T SPECIAL CON91TION5
CC &e4-'0(-4qo&e
FIRE SAFETY INSPECTION REPORT
Butte County Fre Department
Califomia Department of Forestry and Fre Protection
Oroville, Califomia 95965 • (530) 538-7888
BusinessAddress: Cfiy:
Busi gess Name:
Owner/Property Management:
Inspection Date:
Business Phone:
AP#:
NO.
CORRECTIONS REQUIRED
NQ
LOCATION / REMARKS
CLEARED
LOCATION
1 Provide address numbersbuilckU I.D. visible fixe street
EXTTING-
2 Remove obstructions at exits, doors, aisles, stairways, etc.
3
Exit door to open without a key or any spew knowledrlef effort.
4 Repair exit door hardware.
5
Remove obstructions from door required to be closed.
6 Remove locks/latches from doors with panic hardware.
7
Provide sign over main exit door -'This door to remain unlocked during
business hours".
8
Remove storage from under unprotected
/ /
9 Provi Wmaintain exit sKjVemlKfiting.
FIRE E7CI
10
Have fire exti s serviced and taggged.
REaNSPECTION GATES
INSPECTOR
11
Providelmount fire adinguisher as indicated.
1st
12 1 Post a s indicating fire ed usher location.
13
Provide clear access to fire ad usher.
2nd
FIRE PROTECTION EQUWNW
14
Maintain, repair, paint, inspect, and/or test sprinklerlsiandpipe
system/hydrant/FDC/PIV.
Refer to FPB
I 1
15
Maintain 3 feet minimum clearance for access/use of fire
appliances/equipment.
District Attorney
16
Replace damagedrpaintedrmssirg sprinkler hea&/FDC caps.
Feral Clearance
17
1 Provide 5 -year certification test for nkler em.
I OcculpancyCkiss
❑ Check Pre Fire Plan for accuracy.
18
Provide spare sprinkler heads min. ardor cmWfible wrench.
BY ORDER OF THE FIRE CHIEF
You are hereby notified to correct all violations immediately or show cause
why you should not be required to do so. A reinspection will be conducted
on . Willful failure to comply with this notice is amisdemeanor. Violations that are not corrected immediately and/or remain
I after the reinspection may be processed as a criminal offense. Thank you
for your assistance and cooperation in minim¢ing the fire and life loss in
your community.
19 Hood/duct extinguishing tem to be serviced/ tagged every 6 mo.
20 Remove grease from hood, duct, and filters. KEEP CLEAN)
F1REAtARM SYSTEMS
21 Maintain, repair, inspect, and/or test fire charm system.
FIRE SEPARATIONS
Repair holes in required fire resistive cons.
R tn�ction
22Provided
23 it self or automatic cosi fire rated assemblies.
E24
Keep attic access and scuttle openings closed.
ELECTRICAL
Signature of Recipient
25 Discontinue use of adension cords.
26
Install permanent wiring for fixed and stationary appliances.
❑ Owner ❑ Ma r ❑ Employee 0 Other .: i 4/11 i-
27
Provide cover plates for all junction boxes.
Inspecting Officer:-,
28 Remove exposed wiring or protect in approved conduit.
29
Provide a 30 -inch clear space to and in front of electrical panel.
FPB: Engine Com
30
Maintain wiring in good condition and protect from damage.
❑ NO VIOLATIONS NOTED THIS DATE
THANK YOU FOR BEING FIRE SAFEI
RAMMABLE LIQUIDS + COMPRESSED GASES
31
Provide a flammable liquid storage cabinet or reduce storage to 10 gallons or
less.
Adcitronal Comments:
r < ��/ %� ✓fi i
f
Page i of
32 Remove all flammable liquids not used for maintenance purposes.
33 Store flammable liquids; from exits, stairs, or condors.
34 Secure compressed 9w qinders.
35 Arrange storage in an ordefly manner to pro0de access/
36 Remove combustible storage from water heater and electrical room.
37 Remove storage to 24 inches below ceiling or 18 inches below sprinkler heads.
38 Remove IinUdebris from behind washers and
39 Remove waste/rubbish mai-rials from the premises.
40 Keep dumpsters 5 feet away from combustible walls, eaves, or openings.
MMC:EU ANEOUS
41 Other violations an dlor comments.
ire Prevention Bureau
176 Nelson Avenue
roville, CA 95965
Telephone 530-538-7888
Fav- ins
11•.
. 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. 514 fi"Z
Address:y 3-� h�a I, ,,� N�. ; Business Name:
Owner/Manager: � r.,c. ;� �c �C Bus: Hm: Fax.
Assistant Manager: Bus: Hm:
Building Owner. Bus: Hm:
Address:
AN INSPECTION OF YOUR FACILITY 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: CORRECTED:
S1('L Vr Kl..n� V�SY� -JI Y•: Y��C�%� _ iii, v'1L\V�./Y� �Yi,h ,S
T
" � � Jt 2� �.+.� v � r.h¢r I•� ��f � ��! � C e , ,> i'� c+ �^��o .� � 6 a eeaw c (S i'vo�..
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(+'S Cv C 5;� ,j5.Z7 L.(e�.rzY.4. Gv 0
Date:
i C�1
Discussed with:
Tint IJO lfii4j 'jq
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:i- 71. %�
Fire Prevention Bureau
176 Nelson Avenue
Oroville, CA 95965
Telephone 530-538-7888
Fax 530-538-2105
Address:
Owner/Manager:_
Assistant Manager:
Building Owner:
Address:
�13utte 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:
Hm:
Hm:
Fax:
A 1 nvcpFrTrnw nF Vn" FACn.TTV RFVF,AI,F,D THE FOLLOWING:
1.
Fire Extinguishers: Required, service due
10.
Exit(s) obstructed, inadequate
2.
Extension cords: Excess use, defective
11.
Exit signs) 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 CORREC110N s: LuxlcEU 1 _La:
Date
Z
Discussed with:
` inspecting 0f Her:
Battalion 1 2 3 4 5 el 7 Station:FPB tic
FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITII
CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE:
• _..e. f'., T.L'SS••'•r.T ;ST;r �!''.!r '_iv`T�s�'i.��iw`'�f� -.•t .I'cr•^�r !.'A i''. }��—ia- . ,,r �-"'�:`c_.. ,•! _ r .r. . . .^r :n ao� •'
% log
e.-.of._ f
_*.4f1ce of the State Fire Marshal
REPORTINSPE YI NC
STATE FIRE MA AL
53 _ 04 _ 21
e No....
0037 _ 000 _ 555 _ 9
Jame of facility:-- T,)T— - -- SQ L
Jame of Building:
Wdress: - 3785 01ive HighbUy
Orovine CA 5965
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aissed with:
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Y�_ t i► ��.•, . t �• f, !�'•�'„� • i • ( • H•• .•..•, ':M1 1••• •1•�/ •1 .rf rt • �. •/' . 4.•
r Accompanied by: .�. •• r .. ... ,•M .
.! 1 ♦ • � � ••. �; a� , r � • • � i t • '..�y f 'ti • . h ` '•,.t, "�,•`1�t•••!I 0/ t 147 •, • 1 '. , � " • ,
An snmnl on qnd fi dri 11 was i iri-A- at Lbazbom WsbgdAk No ddicienoes wze
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P e or Tice of the State Fire Marshal
REINSPECTION REPORT STATE FIRE MA SHAL
No.: 53 — 04 — 21
00377 000 035 — 1
- -7-
me of Facility: OROVILLE CHRISTIAN SCHOOL
of Building:
1.11111�1 4700MI-rum-.2mm
Oroville.CA 95965
Discussed with:'.e: j .
Accompanied #�y:Dennis Hurt Pr i .% c i ri A 1 • �: . .. *, f� � .Jr
Fire Safety Deficiencies Numbered one through f ive noted on the Letter ❑
Fire Safety Correction Notice (EN -11) E] dated 20 Nov. 90 have been corrected.
Uncorrected Deficiencies Numbered none __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, no 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: •
co - 5 (Re. 7/86)
Of
OFFIx,.: OF THE STATE FIRE MARSHAL
INSPECTION REPORT
Imo.
File N o: 53 - 04 - 21 - 0037 - 000 - 035 - 1
Name of Facility: OROVILLE CHRISTIAN SCHOOL
Facility Address: 3785 OLIVE HWY
.OROVILLE CA 95965-0000
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-An annual inspection was conducted at the above fpcil
were noted on an EN -11.
Note: Fire alarm system includes; Edwards Fire alarm panel, with batter back
Y -u P,
and manual pull stations.
CHECK ONLY IF A DEFICIENCY WAS (VOTED:
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GO -6A (REV. /87) J/
1. CONSTRUCTION
9. CORRIDORS
19. VERTICAL SHAFTS
A. TYPE
A. CONSTRUCTION
20. EXITS, LOCATION & NUMBER
B. AREA
B. OPENINGS
X
21. EXITS, COORS/HARDWARE
C. SEPARATION
10. STAIRS/EXIT ENCLOSURES
22. EXITS SIGNS
2. SIDE YARDS
11. FIRE ALARM SYSTEMS
X
23. EMERGENCY LIGHTING -
3. AREA SEPARATION WALLS
12. FIXED FIRE PROT. SYSTEMS
24. HVAC
4. OCCUPANCY SEPARATION WALLS
13. HAZARDOUS AREA
25. FIRE DAMPERS/SMOKE
5. CONSTRUCTION SEPARATION WALLS
14. DECORATIVE MATERIALS
26. HVAC AUTO. SHUTDOWN
6. SMOKE PARTITION WALLS
15. HOUSEKEEPING
27. INTERIOR FINISH
7. ROOFS
16. ACCESS ROADS
28.
8. CEILING/ROOF,CEIL/FLOOR
17. STRUCTURAL PROTECTION
29.
118.
DRAFT STOPS/FIRE STOPS
30.
.,.
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GO -6A (REV. /87) J/
1_� -Aft.
Jffice of the State Fire Marshal
Fire Safety Correction Notice
File No: - — — - - -
I Name:
Address:
The California Health and Safety Code and the State "Fire Marshal's regulations require the following "fire safety
deficiencies be corrected.
(3/
JIM
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 ( 7'
ISSUED BY (Deputy State Fire Marshal) RECEIVED BY DATE
EN -I I (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE -Region YELLOW—Field
Page -Of_
OF....c OF THE STATE FIRE
INSPECTION I REPORT
-File No: 53 - 04 - 27 - 0037 - 000 - 035 - 1
Name of Facility: OROVILLE CHRISTIAN SCHOOL
Facility Address: 3785 OLIVE HWY
OROVILLE CA 95965-0000
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CHECK ONLY IF A DEFICIENCY
WAS NOTED:
1. CONSTRUCTION
9. CORRIDORS
19. VERTICAL SHAFTS
A. TYPE
B. AREA
A. CONSTRUCTION
20. EXITS, LOCATION & NUMBER
C. SEPARATION
B. OPENINGS
'
21. EXITS, COORS/HARDWAREZ2.
2. SIDE YARDS
10. STAIRS/EXIT ENCLOSURES
EXITS SIGN S
3. AREA SEPARATION WALLS
11. FIRE ALARM SYSTEMS
23. EMERGENCY LIGHTING
4. OCCUPANCY SEPARATION WALLS
12. FIXED FIRE PROT. SYSTEMS
24. HVAC
5. CONSTRUCTION SEPARATION WALLS
13. HAZARDOUS AREA
14. DECORATIVE MATERIALS
25. FIRE DAMPER
DAMPERS/SMOKE
6. SMOKE PARTITION WALLS
15. HOUSEKEEPING
26. HVAC AUTO. SHUTDOWN
7. ROOFS
16. ACCESS ROADS
2.7. INTERIOR FINISH
INISH
8. CEILING/ROOF,CEIL/FLOOR
17. STRUCTURAL PROTECTION
28.
29.
118.
DRAFT STOPS/FIRE STOPS
30.
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Page of Office of the State fire Marsha, OFIREMA
REINSPECTION REPORT' STATEHAL
File No.:
Name of Facility: - /
Name of Building:
Address:
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Fire Safety Deficiencies Numbered rnoted on the Letter ❑
Fire Safety Correction NoticeEN-11
t ) dated 46 e,7 have been corrected.
Uncorrected Deficiencies Numbered were re -issued as shown
on the Fire Safety Correction. Notice dated , which is attached to and made apart of this Report.
P 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:
r
-DATE.
STA116,
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- 5 (Rev. 7/86)
Page --of office of the State Fire Marsha.
�
REINSPECTION REPORT
File No.::��—��'
7— cam%c�2
Name of Facility:
Name of Building:
Address:
.: -: r , ,: ... .. .. ,.,. .. ...c-.,. ... ... .. ,- ... a .... -..-.
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Fire Safety Deficiencies Numbered noted on the Letter ❑
Fire Safety Correction NoticeEN-11 ®'' ���
� ) dated 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: _
P
co - s (Rev. 786)
mftm*N.
Jffice of the State Fire Marshal
Fire Safety Correction Notice
File No:--
Name: tl—) �Z_601 z -/—s
Address: -r%ES tic—
L
The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected.
. 7-
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(---L 77YZA17-
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7
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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 thisJorm. If you have any questions, contact the Office of the State
Fire Marshal at(
ISSUED BY (Deputy State Fire Marshall RECEIVED BY DATE
EN -17 (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
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Page—of— /110�
'office of the State Fire Marsha.
INSPECTION REPORT
File No-:-.5�3- 0_ Z
.r._Name of Facility:
7
Name of Building:
Address: rl
h6 a
rr
1•4
IT
j Aw.
GO - 6 OW. 7/86)
OFFICE OF THE STATE FIRE MARSH-:..
INSPECTION LOG
Title File W] El 01 R
Address Date
Owner
6
GO -6 (Rev. 5/81)
FC
°F Q` BUILDING SURVEY REPORT
Date:'
STATE FIRE MA AL
File No:42�`s'.,6%1-,m?-dl>t- .* 0 -el
Name of Facility:
ss:
Owne =A-. X J• i vr.r Telephone No.
Nance of Building: = .^�,��.ra . 1.... y ! ,ice :7-L t/7-zs- < r..l-x-'."".S'
DESCRIPTION
Comm.
GO -4 (Rev.5/84)
1.
Occupancy
Class
�-
Total , ”!
No. ;, ,�
Use u��j ''"� 4� l�S� ��,„,:.,Capacity
Largest Floor " .4
High Rise Yes
Year BuiltType
Basernent ►
No A--'
2. Construction
3.1 Area (Sq. Ft.)
4. Stories
. Exterior Wall
Construction
A,—
h.
Opening
,
Protection
6
Interior Wall
r
Construction
7
Floor
Construction
8
Roof
Construction
!i -
s - !i
li i`i -•
9
Attic
Draft Stops
No.
10E L . OCC. Sep. Wall
Construction
. Opening
Protection
No. a,
11 . Area Sep. Wall
Construction
. Opening
Protection
No.
l2Smoke Barrier
t.
Wall Construction
. Opening
Protection
1'
l
. Corridor Wall
Construction
. Opening
Protection''
14a.
Corridor Ceiling
-
Construction
'
. Opening
Protection
15a.
Shafts
Number/Type.'
. Opening
Protection
*fes
GO -4 (Rev.5/84)
DESCRIPTION
Cnmm
`�C a. Stair
Enclosure
b. Opening
,
Protection
�
ly
17. Stairs No.
18. Rarrps No.
19. Interior
Finish Class
Room '1, Corridor Exit Encl.
20. Exits
No. Total Width
21. Exit Hardware
Type
22a. Exit Signs/
Illumination
b. Emergency
Li htin
23. Auto Sprink.
Coverage
24. Standpipes
Class/Location
.25. Fire Alarm
Type/Coverage
20'. Heating
, .
Type ,,�✓ Fuel Vent
�----. rs..� f %r "
27. Electrical
, —
Installation
_23. Stage/
Platform
29. Hazardous
Areas
30. Other
CO MNITS s
Inspected BY: _ ►, No. Attachments:
�wiewed By:
Date:
l
Jpdated:
BUILDING SURVEY REPORT
Date:
File No: i,`�-p�-tl-Ga037-tom 3�D-D
Name of Facility:
t.:;^r ss: .a -/J
Owne : �®fi %�rl, �,. yJ i., L L Telephone No.
Name of Building:�llt
DESCRIPTION
Comm.
GO-} (Rev -5/84)
1. Occupancy
Class �_ Use Capacity
2. Construction
'
/yL Year BuiltType
Total Largest Floor j2lm - Basement
No.High Rise Yes No
3. Area (Sq. Ft.)
4. Stories
Exterior Wall
Construction
F-
. Opening
Protection
6. Interior Wall
Construction
GCl 'g,�
7. Floor
Construction
/
8 Roof
Construction
-- GU /`' — Q GLO
9 Attic
Draft Stops
n
No.
—1-0a. Occ. Sep. Wall
Construction
%
.. Opening
Protection
No.
lla. Area Sep. Wall
Construction
. Opening
Protection
No. /jty
l2a. Smoke Barrier
Wall Construction
. Opening
Protection
%
l3a. Corridor Wall
Construction
. Opening
Protection
l4a. Corridor Ceiling
Construction
` . Opening
Protection `
lop*
l5a. Shafts
Number/T
low
. Opening
Protection
GO-} (Rev -5/84)
DESCRIPTION
Crn-n_
�16a. Stair
Enclosure
b. Opening
,
Protection
17. Stairs No.
18. Ramps No.
19. Interior
Finish Class
Room // Corridor Exit Encl.
20. Exits
►
No. Total Width
21. Exit Hardware
Type
22a. Exit Signs/
Illumination,
b. Emergency
Lighting
23. Auto Sprink.
Coverage
24. Standpipes
Class/Locaticn
,
25. Fire Alarm
Type/Coveraqe
26. Heating
Type ,�� Fuel/ Vent_
27. Electrical
Installation
__23. Stage/
i Platform
29. Hazardous
Areas
130. Other
MMSNTS:
Inspected By:
`'viewed By:
Updated:
No. Attachments:
Date:
OFFICE OF THE STATE FIRE MARSHAL-
INSPECTION
ARSHALINSPECTION LOG
It #
T it I e 100 1 'a. ; f'. -1
4 f M 0 R]
Fi le
*dor
Address
Address _4;p�}-5pje'itf— Date
Owner
cz ee'l.
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GO -6 (Rev. 5/81)
4iULTIPLE BTy •
•RECORD
FAC Z LIwTY NAME
'ADDRESS. S 7 F5 6
ter■ •n/••�■�■f�.�
[OIL] lltj� B
FILE -170" dO one
•
•
FLIQ.
CLASS .3_�
SU."c IX ...L,
(See. Sec..Vc.31.
za
•
(a
OFFICE OF THE STATE FIRE MARSHAL
-
INSPECTION LOG
Title Ok(3VJL�-Z rJ1K%S7%vJ 50%ooL � � � Q p Q
Fite
I� l� Q I� l� I� i� 1�] C�1 Imo] C�
Address 375 oLxve OROVILLP, ch. cj-�6
S ') Date
Owner
A PJ AA/A) u kL a f, n e.0
4-� aecToty m-,4 Ore of ria tLL
Vk k A f
G0m6 (Rove 5/81)
r F I CE OF THE STATE F IRE MARSHA►
Title I I _ ,,.r
INSPECTION LOG
l 64 ; 1
00 U 3�0
File❑�Q
❑�1 P�
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Addres cl,Date
Owner
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1.� 1..
AT A V c_le_ I r 0 An AA
GO -6 (Rev. 5/81)
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Exit to Oliva Highway
1
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• b 7. 9
3 SANCTUARY
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a Foyer
p t1.6
WLLJ
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Grass ! ,
........ .r.....
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Sidewalks
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4-2(8/81) v For Off ice Use Only
OFF'' OF STATE FIRE MARSHAL �'L'�L.II� QT
DELET..
*��)
FIRE & PANIC ETY STANDARDS - INSPfGT. �REPORT
Y
if QUAL DATE: 61
FILE:
L k
FA IL ITY NAME;) F' ,-) V t Lt- �_rrr_C H C~ IS " � 1 A A 3
r■ r. iwr■w■��rwr
FAf ILITY ADDRESS: Vez, j}''1 1 L, 1(wt�: , i
.ri r.i...,i...�.�.r�..
(Street)
BU MING NAME:
AL O WAB LE
AC I TY : 4 AMB z N oN-AM3 :
YM BUILT: FLOOR OCCUPIED (P #,A):
A . FIRE EXT. SYS. (YIN) : )
FI ALARM SYSTEM (Y,N) : �J
L7FOLLOW-UP XREV . IN S P. DATE: -- - j_-,+ - c, I� .!
INSPECTED BY:
(Deputy)
PHONE: A
rr■�.r �■ wr��■n.■rr■■..i rrr_I
rr�.r..i .■■r_�.. 1. ` 1•~ r rr.r�r�r.r�wrrr�r■r.�Mrrr i -'-�-i ��..r■ ,r ■r..�+w,+�
(City) (Zip)
NO . aF BLDGS : j OCCUPANCY : 1
TYPE CONST: _._._.+. AREA (sq, f t .) : r ' :: t 0
NO. STORIES: ( HIGH RISE (Y,N): f1
TYPE (W , D , O) : COVERAGE (C, P) :
TYPE (MyA,H,S,C,o) :ti's COV ,'RAGE (C,P) : C,
CHECK LIST
ALTERATIONS/ADDITIONS: HAVE L7 BEEN MADE SINCE SURVEY (GO -4)
HAVE NOT p
ISPOSITIOCLEAR
`" .
CORRECTION NOTICE REINSPECTION DATE:
,�
INSPECTION TIME EXCLUDING TRAVEL (Nearest lath of Hour):
*NA Not Applicable/IC=In Compliance/CN=Correction Needed/CFN=Correction First Noted
RE =Refer Go -4
-�,�. n cessary cQ:r�ents or items of correct?cn to be entered on an Inspection Farr
GO- 6 and
L G� hed to the file copy of this report.
R V ;WED BY:
(supervisor)
DATE:
Original -File' "_ 2nd Copy-KDE 3rd Copy -Field
ITEM
REF* NP. I IC CNI
CFN
I TENT
REF* NA IC CN4 C. -NI
1,
Actual. Capacity
9158
16.
Rousekeepin2
52 "
2.
BaSlzement
22
17.
Pre -Fire Plan
53
3.,
Fire Protection Systems
23 --
180.Suoervision,/Staffing
56
4.
Exposures
24
19.
Portable Fire Ext.
57
5.
At tiCs
28
120.
6.
Interior Construction
2930,3l ;
21.
7.
Fire Assemblies
30p3If 34
22.
8.
Interior Finish
32-
23.
9 .
Hazardous Areas
40 :_-
24 .
0.
Exiting
30j43
25.
1.
Fire Protective Sig. Sys.
44
26.
2.
HVAC
45
270
13.
4ectr ical
46
28.
4o
Decorative Materials
54 f
29.
15,
Stor age
51
30,
ALTERATIONS/ADDITIONS: HAVE L7 BEEN MADE SINCE SURVEY (GO -4)
HAVE NOT p
ISPOSITIOCLEAR
`" .
CORRECTION NOTICE REINSPECTION DATE:
,�
INSPECTION TIME EXCLUDING TRAVEL (Nearest lath of Hour):
*NA Not Applicable/IC=In Compliance/CN=Correction Needed/CFN=Correction First Noted
RE =Refer Go -4
-�,�. n cessary cQ:r�ents or items of correct?cn to be entered on an Inspection Farr
GO- 6 and
L G� hed to the file copy of this report.
R V ;WED BY:
(supervisor)
DATE:
Original -File' "_ 2nd Copy-KDE 3rd Copy -Field