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FAI15-0062 Fire Annual Inspection Archive
09/25/2008 15:20 FAX 530 895 5934 COMMUNITY CARE LICENSING li� 001/001 �3 ATt OF CAJPORNIA IRE SAFETY INSPECTION REQUEST . mo iAEv. to-wl See Instructions on reverse. Al NCY CONTACT'S NAME TELEPHONE NUMBER ATE PF4xw MSS/COMMUNITY CARE LICENSING 530 895-5033 :itGUEBT / 8 RCFE ALUATOn NAME REOUESTING AGENCY FACILITY NUMBER REOUE$T CODE 6191PAT COFFMAN 045000959 3A FAX #: (530) 895-5934 CODE& F—DEPARTMENT t. ORIGINAL A. FIAECLEAAANCE EN OF SOCIAL SERVICES 2. RENEWAL 8. LIFE SAFETY AGENCY YE AND COMMUNITY CARE LICENSING , 3CAPACITY CHANGE ADDRESS 520 COHASSET ROAD, SUITE 6 ., OwNERBHIPCHANGE CHICO, CA 95926 S. ADDRESSCHANGE L_ S. NAME CHANGE r, OTHE R AMBULATORY NONAMBULAYOAY BEDRIDDEN TOTAL CAPACITY CAPACITY Fwvw6 CaAcIty CAPACITY PREVIOU6 CNAC(TY CAPACITY PREVKYI6 T1iPACtTT 0 63 39 0 0 63 FACILITY NAMI7 LICENSE CATEGORY LARKSPUR LODGE RCFE AWREW (At7WI L=fi l) NUMBER OF BUILDINGS 900 20TH STREET RESTRAINT ROVILLE, CA 95965 NO AQUTY COWACT PERSONS NAME t10URs � A"`RRIE LIEGMANN 530) 538-8200 24 SPEaAL CCwyncNs CLEARANCE MENIAL CODE F— 7 0009• RRE BUTTE COUNTY FIRE DEPARTMENT �RECI.EARANCEORANTED AurNORfTr NAME AND 176 NELSON AVENUE 2. FIRE CLEARANCE DENIED AD0pee9 OROVILLE, CA 95965-3425 A. EXITS S. CONSTRUCTION L C. FIRE ALARM NAME O)Md or CU Pr•+r� TELEPHONE NUMMA CFIRS NUMBER OCPANCY C1A88 D. BPRINItl ER8 E. ,p '7 HOU6t]GEEPING V �—� I`� — f y0 P. 6PECIAL HAZARD DATE INSPECTOR'S SIGNATURE (T)VW G, OTHER -2 -0,�-3 Oz - M,. BURAN OMA6OR 11117T SPECIAL CONDITION® 09/23/2008 15:20 FAX 530 895 5934 COMMUNITY CARE LICENSING 12001/001 ir ATE OF C;%UFONNIA IRE SAFETY INSPECTION REQUEST aw(MV.,o-w► S" Instructions on romwe. A(IfiNCY CONTACTS NAME TELEPHONE NUMBER RCOUEET ATE PROGRAM -- SS/COMMUNITY CARE LICENSING 530 895-5033 7/ s RCFE ENFALUATO" NAME REOUEBTINO AOENOY FACILITY NUMBER RE vw MOE J6191PAT COFFMAN 045000959 3A FAX #.* (530) 895-5934 CODES ' .JC��w DEPARTMENT OF SOCIAL SERVICES t. ORIGINAL A. FIRE CLEARANCE AGENCY 2. RENEWAL B. LIFE SAFETY YE AND COMMUNITY CARE LICENSING 3. CAPACITY CHANGE ADDRESS 520 COHASSET ROAD, SUITE 6 4, OWNERSHIPCHAN©E CHICO, CA 95926 S. ADDRESSCHANGE L 8. NAME C:ANGE r. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY r. ACrff PREVOUS UPACITY CAPACITY PREVIOUS WACM CAPACITY PREYICUS CAPACM 0 63 39 0 0 63 FA CAM NAME UOENSE CAnGORY LARKSPUR LODGE RC -FE V TEXT ADDREW (AMW I= ftn) NUMBER OF BUWNGS 1900 20TH STREET 1 CI ry ROVILLE, CA 95965 RE9TAMNT NO TY CONTACT PERSONS NAME UT aouRa ARRIE LIEGMANN 530 538-8200 24 CONWONG 7 7 FIRE BUTTE COUNTY FIRE DEPARTMENT rmOFm ME AND 176 NELSON AVENUE wiles® OROVILLE, CA 95965-3425 L WCTpWONAA& (f)pdaPP694 TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLA O r- Jam, w L -78 y�3� NECIM DATE INSPlL70" BPONATURE (iyp0 a 2 - Jell JUN OR" LV4 UQT SPECIAL CONOITKN/ CLEAP AWA VENIAL CODE 1,_YlRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS S. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. HOUSEKEEPING F. SPEOIALHAZARD G. OTHER FIRE PREVENTION BUREAU BUTTE COUNTY FIRE RESCUE CALIFORNIA DEPARTMENT OF FORESTRY AND FIRE PROTECTION Also serving Gridley and Biggs FAX TRANSMITTAL 176 Nelson Avenue Oroville, CA 95965 Office (530) 538-7888 Fax (530) 538-2105 Confidential ❑ Non -Confidential To: &12! P- Department: From: Subject: V FAX#: 63 ---3 -- S5�� Phone#: 5� g — ;;>Oc14 ❑ Urgent [For your review ❑ Reply ASAP ❑ Please Comment MESSAGE: The document being faxed is intended only for the use of the individual or entity to which it is addressed, and contain(s) information that is privileged, confidential, and exempt from disclosure under state and federal law. If the reader of this message is not the intended recipient, or the employee or recipient, you are hereby notified that any dissemination, distribution, or copying of the communication is strictly prohibited. If you have received this communication in error, please notify us immediately by telephone and return the original message to us at the address above via the United States Postal Service. PAGE OF "`SIRE SAFETY INSPECTION REPO"' Butte County Fre Department California Department of Forestry and Fre Protection i �% d 7 Oroville, California 95965 • (530) 538-7888 Business Address: City.- Business Name: Owner/Property Management: 63 Inspection Date: -7/3P /e Business Phone: , _-5 i - NO. CORRECTIONS RMRED NQ LOCATION I REMARKS CLEAR® LOCATION 1 Provide address numbersbAcIT I.D. visile from street EXIT NG 2 Remove obstructions at exits, doors, aisles, sWways, etc. 3 Bdt door to open without a key or any special knowledgel effort. / ! 4 Repair edit door hardware. 5 Remove obstructions from door required to be closed. 6 Remove locI&Wches from doors with panic hardware. 7 Provide sign over main exit door -'This door to remain unlocked during business hours". 8j j Remove storage from under unprotected stairway. 9 Provide/maintain exit sigrilerneigency fighting. FIRE EXTINGUISHERS 10 Have fire s serviced and bgged. RE-INSPECfIONDATES INSPECTOR 11 Provide/mount fire extinguisher as indcated. 1st 12 Post a sign inclicafing fire edi usher location. 13 Provide clear access to fire actinguisher. 2nd FIRE PROTECTION EQUIPMENT 14 Maintain, repair, paint, inspect, and/or test sprinkler/sox1pipe systemA ydrant/FDC/PIV. Refer to FPB 15 .. Maintain 3 feet minimum clearance for access/use of fire appliances/equipment. District Attorney 16 Replace damage#aintedhnssing sprinkler hea&s FDC caps. Final Clearance ! / 17 1 Provide 5 -year certification test for sprinkler/standpipa system. I Ocapamychm ❑ Check Pre -Fire Plan for accuracy. 18 Provide 'nkler heads min. arxYor cam wrench. BY ORDER OF THE FIRE CHI EF You are hereby notified to correct all violations immediately or show cause why you should not be required to do so. A re4rispection will be conducted on . Willful failure to comply with this notice is a misdemeanor. Violations that are not corrected immediately and/or remain I after the reminspection may be processed as a criminal offense. Thank you for your assistance and cooperation in minimizing the fire and life loss in your community. 19 l food/dict exti UIShI tem to be serviced/ to eve 6 mo. 20 Remove reese from hood, duct, and filters.(KEEP CLEAN) FIREALARM SYSTEMS _ 21 Maintain, repair, inspect, and/or test fire alarm system. FIRE SEPARATIONS 22 Repair holes in required fire resistive construction. 23 PrmWrepair self or automatic closing fire rated assemblies. 24 Keep attic access and scuttle openings closed. ELECTRICAL Signature of Recipient: 25 Discontinue use of edension cads. 26 Install permanentwiri for fixed a stationaryappllances. ❑Owner OManager OEmplcyee ❑Other 27 Provide cover plates for all junction boxes. Inspecting Officer: 28 Remove exposed wiring or protect in approved conduit. 29 Provide a 304nch clear space to and in front of electrical panel. FPB: Engine a Com 30 Maintain wring in good condition and protect from dam age. El NO VIOLATIONS NOTED THIS DATE THANK YOU FOR BEING FIRE SAFE! 1. FLAMMABLE LLCM • CON GASES 31 Provide a flammable liquid storage cabinet or reduce storage to 10 gallons or less. Additional Comments: ,Q / f C/ L %-4 % d�o o Page_ of 32 Remove all flammable liquids riot used for maintenance purposes. 33 Store flammable liquids amay from exits, stairs, or corridors. 34 Secure compressed gas qindefs. STORAGE •HOUSED 35 Awange s in an manner to provide a -z /egm. 36 Remove combustible storage from water heater and electrical room. 37 Remove storage to 24 inches below ceiling or 18 inches below sp6nkler heeds. 38 Remove IinWebris from behind washers and dryers. 39 Remove waste/n#lbsh ma+wrals from the premises. 40 Kee{ dumpsters 5 feet away from combustble walls, eaves, or openings. MISCELLANEOUS, 41 Other violation sardoraxmmenis. E OF CALIFORNIA E SAFETY INSPECTION REQUEST Ri RM raFv10-941See Instructions on reverse. _ AGOCYCONTACMNAMEE: TELEPHONE NUMBER REQUEST DATE PROGRAM SS/COMMUNITY CARE LICENSING 530 895-5033 6/8/06 RCFE EV ATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 207/DONNA GURRIERE 045000959 3A CODES 1. ORIGINAL A. FIRECLEARANCE CENSING DEPARTMENT OF SOCIAL SERVICES 2. RENEWAL B. LIFESAFETY GENCY AMEAND COMMUNITY CARE LICENSING a CAPACITYCHANGE DDRESS 520 COHASSET ROAD, SUITE 6 4. OWNERSHIP CHA [Cf- CHICO, CA 95926 s. ADDRESSCHANGE L_ 6. NAME CHANGE 7. OTHER FAX #: (530) 895-5934 AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACfIY CAPACITY PREVIOOS CAPACITY CAPACITY PREAM CAPACRY 7PREVIOUS 0 41 35 0 0 41 Lm NAME LICENSE CATEGORY RKSPUR LODGE RCFE SfREET AWRESS (AMW Locetb.) NUMBER OF BUILDINGS 900 20TH STREET 1 ROVILLE, CA 95965 RESTRAINT NO U Y CONTACT PERSONS NAME IARRIE HOURS LIEGMANN 530 538-8200 1 24 m BUTTE COUNTY FIRE DEPARTMENT kUTNAME AND 176 NELSON AVENUE ADDRESS OROVILLE, CA 95965-3425 L_ NAME (IV""' TELEPHONE NIAM BER CRRS NUMBER OCCUPANCY CLASS i�i1 Ulam- � ( 1�o ) S 38 - &Z'40 3:-§ - I "'�" /. DATE INSPECTOR'S SIGNATURE - d %v I A& X IVAL OR LIST SPECIAL CONDITIONS CLEARANCE ADENIAL CODE CODES !9 RE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS S. CONSTRUCTION C. FIRE ALARM D. SPRRGQB s E. HOUSEKEEPING F. SPECIALHAZARD G. OTHER u.� _ L x-0 �..— _. _ —� era --- — --,(- • • -- -- - � I I 11 I i r butsueall eRIO M.unwwoO Booz Z o Nnr GHfINeiANG %b pol.113Z e: DCG�lP9/vG,y .Larkspur Lodge Fire Pireventivn Bureau 176 Nelson Avenue Oroville, CA 95965 Telephone 530-538-7888 Fax 530-538-2105 Address: Assistant Manager: Building Owner: Address: 46%4 Butte 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 He Occ. Class. �J\ 2 Hm: Fax. Hm: Hm: AN YNQ.PFC T1nN nF VnITR FAC H.1(TV RFVFALED TFT, 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 CORRECTIUIN S: Cuxlcr:c: r�:I�: Date: _ Discussed with: Signed: (Print) NA0 (A I UTCv--- f Inspecting Officer: Battalion 1 2 3 4 5 '6 7 Station: FPB FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH c CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: �% ire Rrevent bn Bureau 3utte County Fire Rescue White Copy - Business 76 Nelson Avenue California Department of Forestry Yellow Copy — Occupancy File roville, CA 95965 and Fire Protection Pink Copy — Station File elephone 530-538-7888 Facility Inspection Report Occ. Class. Fax 530-538-2105 Address: Business Name: Owner/Manager: Bus: Hm: Fax. sistant Manager: Bus: Hm: uildine Owner: Bus: Hm: I AN INCPFCTION OF VOIiR FAC H.1TV REVEALED THE FOLLOWMG: 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: CORKECTEL: Date: Discussed with: Signed: G% ((Print) Inspecting Officer: Battalion 1 2 3 4 5 6 7 Station: FPB FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: A STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Chico Residential, 620 Cohasset Road COMPLAINT INVESTIGATION REPORT Site 6 Chico, CA 96926 This is an official report of an unannounced visit/investigation of a complaint received in our office on 08/05/2003 and conducted by Evaluator Donna Gurriere PUBLIC COMPLAINT CONTROL NUMBER: 253755 FACILITY LARKSPUR LODGE FACILITY 45000959 NAME: NUMBER: DIRECTOR: LIEGMANN, CARRIE FACILITY TYPE: 740 ADDRESS: 1900 20TH STREET TELEPHONE: (530) 538-8200 CITY: OROVILLE STATE: CA ZIP CODE: 95965 CAPACITY: 35 CENSUS:� DATE: 08/13/2003 TIME BEGAN: lov MET WITH: CARRIE OR KURT LIEGMANN TIME COMPLETED: ALLEGATION(S): 1 During the month of August, 2003, the fire alarm system was not in full operation as required. 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 During the investigation, the licensee advised that she was unaware that the fire alarm system was defective, 2 when the fire marshal conducted his testing. The alarm system company arrived within 24 hours to repair the 3 alarm system. 4 5 The preponderance of evidence standard has been met. Allegation is substantiated. 6 7 8 9 10 11 12 13 Substantiated Estimated Bays of Completion: SUPERVISOR'S NAME: Norma Soto-Nannery TELEPHONE: 530.895.5033 LICENSING EVALUATOR NAME: Donna Gurriere - TELEPHONE: 530.895.5805 LICENSING EVALUATOR SIGNATURE: : 08/13/2003 acknowledge receipt of this form and and stand my ap hal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: jrDATE: 08/13/2003 LIC9099 (FAS) - (6/00) Page:1 of 2 -1/ �J STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Chico Residential, 620 Cohasset Road COMPLAINT INVESTIGATION REPORT (Cont) Suite 6 Chico, CA 96926 FACILITY NAME: LARKSPUR LODGE DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 45000959 VISIT DATE: 08/13/2003 Deficiency Type POC Due Date / Section Number DEFICIENCIES PLAN OF CORRECTIONS(POCs) Type A 1 FIRE SAFETY - The fire alarm system was not in full operation 1 The licensee has advised in writing that 2 as required. All facilities shall be maintained in conformity with 2 the alarm system company has repaired Section Cited 3 the regulations adopted by the state fire marshal for the 3 the alarm system. No further plan is 87669 4 protection of life and property against fire and panic. 4 required at this time. 5 5 6 6 7 7 1 1 Section Cited 2 2 3 3 4 4 5 5 6 6 7 7 1 1 2 2 3 3 4 4 5 5 6 6 7 7 1 1 2 2 3 3 4 4 5 5 6 6 7 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Norma Soto-Nannery TELEPHONE: 530.895.5033 LICENSING EVALUATOR NAME: Donna Gurriere TELEPHONE: 530.895.5805 LICENSING EVALUATOR SIGNATURE- DATE: 08/13/2003 I acknowledge receipt of this form and andstand my appeal rights as explained and received. ==. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2003 LIC9099 (FAS) - (4196) Page: 2 of 2 STATE OF CALIFORNIA - HEALTH AND -HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Chico Residential, 620 Cohasset Road Suite 6 Chico, CA 96926 This is an official report of an unannounced visit/investigation of a complaint received in our office on 08/05/2003 and conducted by Evaluator Donna Gurriere PUBLIC COMPLAINT CONTROL NUMBER: 253755 FACILITY LARKSPUR. LODGE NAME: DIRECTOR: LIEGMANN, CARRIE ADDRESS: 1900 20TH STREET CITY: OROVILLE CAPACITY: 35 MET WITH: CARRIE OR KURT LIEGMANN FACILITY NUMBER: FACILITY TYPE: TELEPHONE: STATE: CA ZIP CODE: CENSUS: DATE:. TIME BEGAN: TIME COMPLETED: 45000959 740 (530) 538-8200 95965 08/13/2003 ALLEGATION(S): 1 Fire safety drills have not been conducted at least once every three months as required. 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 During the investigation, the licensee advised that when the fire marshal was reviewing records of fire safety 2 drills, it was determined that the facility staff have not been conducting the drills every three months as 3 required. 4 5 The preponderance of evidence standard has been met. Allegation is substantiated. 6 7 8 9 10 11 12 13 Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Norma Soto-Nannery TELEPHONE: 530.895.5033 LICENSING EVALUATOR NAME: Donna Gurriere TELEPHONE: 530.895.5805 LICENSING EVALUATOR SIGNATUR - ATE: 08/13/2003 I acknowledge receipt of this form and understand my appeal rights as explained and received, FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2003 LIC9099 (FAS) - (6100) Page:1 of 2 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont) FACILITY NAME: LARKSPUR LODGE DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number DEFICIENCIES CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION Chico Residen", 620 Cohasset Road Suite 6 Chico, CA 96926 FACILITY NUMBER: 45000959 VISIT DATE: 08/13/2003 PLAN OF CORRECTIONS(POCs) Type A 1 CARE FOR PERSONS WITH DEMENTIA - Licensee did not 1 Licensee agrees to develop and submit a 08/21/2003 2 ensure that fire safety drills were conducted. Fire and 2 plan of correction to the licensing agency. Section Cited 3 earthquake drills shall be conducted at least once every three 3 Licensee shall submit a roster of all staff 87724(f)(9) 4 months on each shift and shall include, at a minimum, all facility 4 persons advising that they have . 5 staff who provide or supervise resident care and supervision. 5 participated in the recent fire drills. 6 6 7 7 1 1 Licensee shall submit the plan within one Section Cited 2 2 week. 3 3 4 4 Appeal rights provided. 5 5 6 6 7 7 1 1 2 2 . 3 3 4 4 5 5 6 6 7 7 1 1 2 2 3 3 4 4 5 5 6 6 7 7 Failure to correct the cited Oeficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Norma Soto-Nannery TELEPHONE: 530.895.5033 LICENSING EVALUATOR NAME: Donna Gurriere f TELEPHONE: 530.895.5805 LICENSING EVALUATOR SIGNATURE: toATE: 08/13/2003 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 0DATE: 08/13/2003 LIC9099 (FAS) - (4196) Page: 2 0€2 .. Fire Prevention Bureau 3utte County Fire Rescue 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. = Fax 530-538-2105 Address: Business Name: Owner/Manager: Z12Z Bus: Hm: s�,o Fax. Assistant Manager: Bus: Hm: Building Owner: Bus: Hm: Address: .ter n►TQ1DU9"m7nV n1V Vn1T12 TRACH ITV RFVFAIRD TAF, F01.I.nWING! 1. Fire Extinguishers: Required, service due F10. 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 Knox Box keys 17. Address posted and visible from road +9. Fire Drill Witnessed Yes ❑ No El18. Other DETAILED EXPLANATION AND UORREU11UNno: �zZ L� C'J 72 UUMPL Ulr.L: Date: -2 Discussed with: 1 rin lQ�6 1.-iC or ° igned: �1✓ Battalion 1 2 3 4 5 E 7 Station: 'FPB 'nspect' Officer FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERA11U N W1111 CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: FRUM FAX Nd. :532+1E89 Fiu9- 07 2W3 01:lEPM p1 ,�= ��-�1CCULApM ��C�itIT1f �Y�iT� 1-�C-7ACCu�M orOWNID 30 Neon Avenue (530) 53285 OroviU4, CA 9690 • . daoa 011rglgr a Fire A18H113 (M) DO&08M �*aremad (6�Oj 87�•53i 1 .'LAIrkM**tu' LndBv 1900 St- OroviUa, Ca •Plaa�ee be �vdvi�ad that eer+k`aa w"p�� and tie problem with the sernbee has been fixed as of 816103. pnY , Ions, do est hesitate to cd1 me at 532.0886, sincerely, s �Ord Qpemions M%aW Ed WdOG : Z O FOOZ LO ' 6 rvd t7t7ss OES : *ON Xdd a6 p°-1 -Ands M a e -j : WOdj EVACUATION PLAN In case of fire fin the lodge all residents will be evacuated to the cottage. Should there be a fire in tbtc cottage all residents will be evacuated to the main building. In case of an explosion then all residents will be evacuated to the back parking lot until the danger is over and help arrives. Protocol for E vacr�tion: Each staff will be assigned a task and a certnln area to evacuate. 1. Cook: Responsible for turning off the gait valve and the electrical breaker and checking dining room and dining room bathroom for residents. Also responsible for checking the grounds for any stragglers. 2. Kitchen Helper: Responsible for assisting the Activity llinctor with evacuating residents in the Activity area including bathroom, hair salon and office. 3. AID # l.; Responsible for getting hospice residents into their wheel chin and to a safe place. Will an that that ruldents on oxygen are escorted to a safe place with their portable canisters. 4. Aid # 2; (Med Tech) • Responsible for getting the mod setup to a #do place and assisting co-worken with the evaeuatiou. 5. Aid # 3: Respouib►ic for checking the Grand wing including bathrooms ,....` and elosets for residents. �. Aid # 4: Responsible for checking the Nelson vying including bathrooms and cbsets for residents. 7. Administrator or peen en in charge will collect emergency information and see that it gets to a safe place. Ile or she will oversee evacuation and Delp wborever necessary. In casu of nn explosion, residents will be evacuated through the back gate to the Employee parking Lot •ot. The aide nerensible for checking the Nelson and Grand Vftgs will also cogect blankets if needed. Ed WdOS :t 0 E:0OZ LO '6nkj 1717GS S OF -S: 60N XV -1 a6Pol indsMi el : LQdj '1 . .- '- :t '.i "Syt J _ .!'' t ,i��.} •�<-. :0. I i �'. •. ,, ;t `. . ,� . .. I � a.•'• - I` 1• I:'•�� 1. •` •• I, ` .� . • 1' , •�� , t_• 1• �,. � •. ti l' - - •I t' :.... .• 1's• 1 - ••t. '•1� 1: �-Zi�l,+.` ..1•�j �S V Y •�' - • � •• _. /. t -• .. 1 � ,i/ I•.♦. .. — ,:t. `h.l'i .Is: 1 fir•;�i• r 1 _ ' tZ _.�_ . ,' I _ s:,� 1 1 ...'7;. •L _- 3'1 .r r ; 1 �Il 1 1 - - 1t. 1 '• is 1 1 •• �1. - • :� - - • t ••• 1 l 1 . .tel, •-, -- II •. ,�.: '�- ♦1: ly• � ... _ _ r. _< .- � � CJI '/ .-. . _.. - Vc':•-. , - •. - Vit• • • ♦ � . . - � � _ •. ,,• � : < � i- 1• � • •� S I A I EOFCALIFOHNIA FIRE SAFETY INSPECTION REwUEST STD. 850(REV.10-94) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DEPARTMENT OF SOCIAL SERVICES 530 ) 895-5805 ? 05/05/03 RCFE LVALUAfOR'SNAME j REQUESTING AGENCYFACILln'NUMBER 1 REQUES-)CODE 0207/DONNA GURRIERE t 045000959 3A CODES �I LICENSING ' DEPARTMENT OF SOCIAL SERVICES AGENCY COMMUN1TY CARE LICENSIIWO NAME AND 520 COHASSET ROAD, SUITE 6 ADDRESS CIRCO, CA 95926 FAX #: 530 895-5934 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY 3. CAPACITY CHANGE 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE 5. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACI TY 0 0 CApACD-{ PREVIOUS CAPACITY 35 f 30 CAPACITY PREVIOUS CAPACITY 0 1 0 35 FACILITY NAME LICENSECATEGORY LARKSPUR LODGE ! RCFE STREETADDRESS (ActualLocation) NUMBER OF BUILDINGS 1900 20TH STREET 2 CITY j RESTRAINT OROVILLE, CA 95965 NO FACILITY CONTACT PERSON'S NAME HOURS y CARRIE OR KURT LIEGMANN 538-8200 24 SPECIAL CONDITIONS 176 NELSON AVE. FACILITY HAS TWO BUILDINGS. BUILDING #1 IS LICENSED FOR 30 NONAMBULATORY RESIDENTS. LICENSEE IS REQUESTING THAT BUILDING #2 BE LICENSED FOR 5 NONAMBULATORY DEMENTIA RESIDENTS, TOTAL CAPACITY OF 35. FACILITY HAS A LOCKED PERIMETER. OROVILLE, CA 95965 :: : . ..... ::.:..:.: TO BE:.a�APETEO:=:BY:`INSPEOI'1NC..4DT#-tDiTY >. ' <.. ,..... .... ; CLEARANCE /DENIAL CODE STEVE FOWLER CODES FIRE FIRE MARSHAL '!. IRE CLEARANCE GRANTED AUTHORITY 176 NELSON AVE. NAME AND OROVILLE, CA 95965 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS i B. CONSTRUCTION + C. FIRE ALARM SPRINKLERS INSPECTOR'S NAME (Typed orPrinted) TELEPHONENUMBER ( CFIRS NUMBER OCCUPANCY CLASS E. HOUSEKEEPING Ita _ �� �- v % �� "",j 0 -�j' G� . b �,� l ► / F. SPECIAL HAZARD INSPECTION DA TE INSPECTOR'S SIGNATURE(Ty{sed P - {' G. OTH ER EX PLAIN DENIAL OR LIST SPECIAL CONDITIONS STATE OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD. 850(REV. 10-94) AGENCY CONTACTS NAME DEPARTMENT OF SOCIAL SERVICES EVALUATOR'SNAME 0207/DONNA GURRIERE TFA-, '-- 3 See instructions on reverse TELEPHONENUMBLH REQUEST DATE PROGRAM 530 895-5805 — 09/17/02 RCFE REQUESTING AGENCY FACILITY NUMBER 1 REQUESTCODE 045000959 ; 3A LICENSING DEPARTMENT OF SOCIAL SERVICES AGENCY COMMUNITY CARE LICENSING NAME AND 520 COHASSET ROAD, SUITE 6 ADDRESS CHICO, CA 95926 FAX #: 895-5934 CODES _ —i 1. ORIGINAL A. FIRE CLEARANCE 2. RENEWAL B. LIFE SAFETY 3. CAPACITY CHANGE 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE F. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY TO BE COMPLETED BY INSPECTING AUTHORITY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUSCAPACITY CAPACITY PREVIOUS CAPACITY STEVE FOWLER 0 0 30 20 0 0 30 FACILITY NAME AUTHORITY 176 NELSON AVE. LICENSECATEGORY LARKSPUR LODGE NAME AND RCFE ST REETADDRESS (ActoelLoratlon) OROVILLE, CA 95965 _ NUMBER OF BUILDINGS 1900 20TH STREET ADDRESS 1 CITY RESTRAINT OROVILLE, CA 95965 NO FACILITY CONTACT PERSON'S NAME HOURS CARRIE OR KURT LIEGMANN, TELEPHONE #: 530 538-8200 INSPECTOR'S NAME rrypeda Panted) 1 24 SPECIALCONDMONS FACILITY HAS REQUESTED AN INCREASE IN CAPACITY FROM 20 NONAMBULATORY TO 30 NONAMBULATORY RESIDENTS. DEMENTIA AND LOCKED PERIMETER FENCE GATE WAIVERS APPROVED ON 02/07/02. INSPECTIONDATE INSPECTOR'S SIGNATURE(TypedorPnntefY' G. OTHER EXPLAIN DENIAL OR LIST SPECIAL CSNDITIONS TO BE COMPLETED BY INSPECTING AUTHORITY CLEARANCE/DENIAL CODE STEVE FOWLER ____ CODES FIRE FIRE MARSHAL 1. FIRE CLEARANCE GRANTED AUTHORITY 176 NELSON AVE. NAME AND 2. FIRE CLEARANCE DENIED OROVILLE, CA 95965 ADDRESS A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS INSPECTOR'S NAME rrypeda Panted) TELEPHONENUMBEH ! CFIRS NUMBER OCCUPANCYCLASS E. HOUSEKEEPING F. SPECIAL HAZARD INSPECTIONDATE INSPECTOR'S SIGNATURE(TypedorPnntefY' G. OTHER EXPLAIN DENIAL OR LIST SPECIAL CSNDITIONS Sim 9-11-02 Butte County Fire Department ISPUR 176 Nelson Avenue Oroville, CA 95965 - Captain Ted Crawford Dear Mr. Crawford, According to Title 22 Section 87702, we are required to inform you that we have accepted a resident who requires the use of oxygen. She will be in room # 2 and is physically capable of operating the equipment, able to determine her need for oxygen and can administer it herself. Furthermore, " No Smoking -Oxygen in Use" signs will be posted in the appropriate areas before this resident moves in and all electrical equipment in her room will be checked for defects. Please let us know if you need any further information . Sincerely; Carrie Liegmann: administrator 1 1900 TWENTIETH STREET O1RO`YILH, CA 959,65 530.538.8200 FAX 530.533.5544 EMAIL: 1.A.„r1oJae8oneMdin.00m BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE TITLE 19/24 FACILITY INSPECTION INSPECTION NO. 0 2 3 REINSPECT: I YES NO Facility/�N�i2$Gt/L �G�- Occupancy _ �' _ Address 1%9D Inspector Phone Station Contact Station Phone Compliance: Yes =r ACCESS --All inspections Address correct/posted and visible from road (supe Co Code 32-9) Access to public street or 20 ft. wide lane (T19 -3.o5) Gates wide enough to admit fire apparatus (T19-3.16) 1?7Fire protection equipment visible/accessible (T19-3.14) PORTABLE FIRE EXTINGUISHERS -- All Inspections No = 0 Not applicable = N/A Extinguishers have current annual service tag (T19 -575.1A) Maximum travel 75 ft. (r19-567) Provide clear access to fire extinguisher (r19-563.2) 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) 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 (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 storage (r-19-3.190) Flammable liquids stored properly (T-19-3.15) Corrections and Com .rte^ 1 c i 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 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 1006.2.8) Maintain extinguishing systems (r19-3.24) Provide spare sprinkler heads (6 min.) and/or sprinkler wrench (r19 -9o4.5) Replace damaged, corroded, or painted sprinkler heads (T19-904.5) 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 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 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) 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: /e Z %' D Z-- Owner/Manager Owner/Manager AP #. STATE= OF CALIFORNIA FIRE SAFETY INSPECTION REQUEST STD. 850(REV.10-94) See instructions on reverse. AGENCY CONTACTS NAME I TELEPHONENUMBER ` REQUESTDATE PROGRAM DSS/COMMUNITY CARE LICENSING 530 895-5805 01/24/02 1 RCFE EVALUATOR'S NAME ( REQUESTING AGENCY FACILITY NUMBER REQUESTCODE 0207/DONNA GURRIERE ! 045000959 lA AND 7* CODES r-- 1. ORIGINAL A. FIRE CLEARANCE LICENSING I DEPARTMENT OF SOCIAL SERVICES AGENCY COMMUNITY CARE LICENSING 2. RENEWAL. B. LIFE SAFETY NAME AND 520 COHASSET ROAD, SUITE 6 3. CAPACITY CHANGE ADDRESS CHICO, CA 95926 4. OWNERSHIP CHANGE 5. ADDRESS CHANGE FAX ,#(530)895-5934 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 0 0 20 0 0 j 0 20 FACILITY NAME LICENSE CATEGORY LARKSPUR LODGE 2. FIRE CLEARANCE DENIED RCFE STREETADDRESS (ActualLocation) A. EXITS NUMBER OF BUILDINGS 1900 20TH STREET B. CONSTRUCTION 1 CITY I RESTRAINT OROVILLE, CA 95965 C. FIRE ALARM NO FACILITY CONTACT PERSON'S NAME D. SPRINKLERS HOURS CARRIE OR KURT LIEGMANN (530) 538-8200 OCCUPANCYCLASS 24 SPECIAL CONDITIONS 7* APPROVAL IS NEEDED FOR LOCKED PERIMETER AND KEY PAD EXITS. -17 TO BE COMPLETED BY. INSPECTING AUTHORITY CLEAR IDENIALCODE STEVE FOWLER ---i CODES FIRE FIRE MARSHAL 1. FIRE CLEARANCE GRANTED AUTHORITY 176 NELSON AVE. NAME AND OROVILLE, CA 95965 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS B. CONSTRUCTION � C. FIRE ALARM D. SPRINKLERS INSPECTOR'SNAME (TypedorPrinted) TELEPHQNENUMBER CFIRS NUMBER OCCUPANCYCLASS I i E. HOUSEKEEPING F. SPECIAL HAZARD INSP CT ATE INSPECTOR'SS! AT E(Ty orprinted) G. OTHER 90001 EXP IN DEhIAL OR LIST SPECIAL CONDITIONS -17 s TEST FOR PRE-ENGINEERED WET CHEMICAL FIRE SUPPRESSION SYSTEM Date of Test: ' - *-0 o oq....� Purchase Order# This was a: Functional Test � f Cartridge Test Dump Test Installation Name:._ Zo. Lode, � Address: ��(�0 gLc City, State, Zip: 20v <<.(,�P, C Local Authority: ser -ol " e Address: -7b AJLACS,,,,1 City, State: Colt �-�� Com' Name of Inspector: "v"'s' ' "V cru I I DEPARTMENT OF DEVELOPMENT SERVICES - BUILDING 7 County Center Dave * Orovllle, California DIVISION a 95965 Tel�ne (534) 538-7541 +Rev 2/96j APPLICA PE'RWIT No TION AND PERMI ASS ssoA P�1ACQ NU1�Ot BUILDING PERMIT Ow A -Ovo �' _ T ro � TlLE�iON! C' Irl _ so. FT. occ. BUILoI ow 's ww AoOM219, NG VALUATIOillillillillillllllllIIIIIIIIIIIIIIIIIIIIIIiiiiiiI N coKr �w� 1f COW WTORl wuuNo AoOAss f3so/i k,, cams rAUCTiON LENDER LENDs ywc#jo AD0AEsv ARCHITECT OA ENiQNEEA PWC ECT OR EN(WEER j MoUUNO ADORE- eu o AaoREss �. LOT NO1 I SUBMISION-11 WME TlLfAgN! UCEME No. lam. Moo, (If PARCEL Mow USEOFSTRUCTURE SF Duplex O Mobilehome O Other OPWVY TYPE OF WORK New O Addition O Remodel O Utilities O Instagation O Other O Desc ibo Work: 0 'PERMIT FEE PAU> SRA SHERIFF OTHER 0 0 AMOUNT NCEZ"b n 00rr � 1101C C�GI� LT�J s sg, w 'fir Num 3 3 `7 4 S*6� TO BE SVT IWNWOM001=0 NTip MPUM Fireplace PERMIT FEE S Total Valuation a Filing Fee 20.00 Main Service Ficin Fee b 20.00 Permit Fee $ NEW CONST. OR ADONs. Plan Checking Fee $ NON-AEs+O. Energy Plan Checking Fee = POWER APPAAATUS S PERMIT FEE _ C$d PLUMBING PERMIT 200 1.00 Filing Fee 20.00 Each Trap SAL .30 7.00 Solar or heat pump water heater 5.00 23.00 Water piping Mobile Home Facilities 15.00 Each gas water heater or vent 15.00 Gas PIPLng astm t - 5 outlets 15.00 Building sewer __7 15.00 Mobile Home G W (020.00 PERMIT FEE S MECHANICAL PERMIT Filing Foe 20.00 [Hood eetin onlin 8.50 ntilation PERMIT FEP. S Mobile Home Installation Fee i Energy Inspection Fee t occ CONST. TYPE TOTAL FEES OCI . o. no +NP a.000 CD PAAM, I Po I NO I ssuE This permit is hereby Issued under the applicable provisions of the Butte County Code and/or Resolutions to do work Indicated above for which fees have been paid. By Data PERMIT EXPIRES ON 1 PERMIT FEE S ELECTRICAL PERMIT Filing Fee 20.00 Main Service NOV OR LESS 200A OR LESS 23.00 Main Service 200A To f oo*A 48.00 NEW CONST. OR ADONs. t DWE L M OCCUP. s ACC. etas. 3.50sFr°: NON-AEs+O. MUITNOvn.ET 47.50 POWER APPAAATUS + ssxu OUMPT CIR. Ex. Occup. ouTLET OA F=mEs 200 1.00 Ex. Occu APPL48. OR SAL .30 .FaEo I OUTLETS ME310.) EA 5.00 Temporary Service 23.00 Mobile Home Facilities 20.00 Misc. Wiring 23.00 PERMIT FEE S MECHANICAL PERMIT Filing Foe 20.00 [Hood eetin onlin 8.50 ntilation PERMIT FEP. S Mobile Home Installation Fee i Energy Inspection Fee t occ CONST. TYPE TOTAL FEES OCI . o. no +NP a.000 CD PAAM, I Po I NO I ssuE This permit is hereby Issued under the applicable provisions of the Butte County Code and/or Resolutions to do work Indicated above for which fees have been paid. By Data PERMIT EXPIRES ON 1 QROTECT/pN y��Q �01Ec1c�yf� a V AQP � Q * Lic. C5555875 G16 SAN66��5 �Q '9TF p� CAUFO��► 40' AFF In the path of egress — e NOZZLE EXTENDS 6 INCHES EELOW HOOD 35,74o, IF IF IF Griddle {1 F0 IRange-Sn 36.00' L x29.00 D 36.DD' L x28.00' D High Proxlmlty Hlgh Proximity AP1 AlMMW — 4D'-48• 1 t lllin JOB Larkspur Lodpe LO ATION I]rovlUe, Cry DATE JOB ,4 DWd DRAWN BY REV 1.00 ALE B.5' x 11' DRAWING NUMBER: C:\ACRD\FS PROCi\TXTFILES\608LAR1M.FSD Job #: 0 Job Name: Larkspur Lodge Drawn by: . System Size ANSUL-3.0 Total FP required: 8 Hood # 1 9' 0" Long x 45" Wide x 24' High Riser # 1 Size: 12" x 14' NOTES - FIELD PIPE DROPS AS SHOWN SLEEVING, ELBOWS, TEES, AND NOZZLES SUPPLIED BY CAS - RELOCATE NOZZLES IF FLOW PATTERN IS BLOCKED BY SHELVING, SALAMANDERS, ETC. - MAXIMUM 9 ELB❑WS IN SUPPLY LINE. -- MINIMUM 72 INCHES ❑F AGENT LINE FROM TANK TO FIRST NOZZLE. - IF APPLICABLE, PRE -PIPED CHARBR❑ILER DROPS ARE SHIPPED LOOSE. - FACTORY PIPING EXTENDS A MAXIMUM OF 6" ABOVE THE TOP OF THE HOOD. - APPLIANCE DIMENSI❑NS LISTED REPRESENT THE C❑❑KING SURFACE SIZE, NOT THE OVERALL APPLIANCE SIZE. - THIS FIRE SYSTEM COMPLIES WITH U,L. 300 REQUIREMENTS FACTORY PIPING ------ FIELD PIPING ♦% n ce ZOt N STff-0- JOB Larkspur Lodge LON TION Uroville, CA RATE IJOB DWG g REV. 1.00 BY 8.5' x Il` EIRE SYSTEM NOTES Irl 1SER6L CUSTOMER RESPO?ISIBLE FOR ADDITIE►PAL LABOR A1I) PARTS CHAWks AS A RESULT 13F CUUK14G EOUIPHENT LAYOUT CHANGES OR 14ISINFOR111110 AFTER RELEASE OF ORDER CUSTOMER RESPIOASIBLE FEIR ADDI71144AL TRIPS BY FIRE SYSTEM DISTRIDUTDR DUE TO .JOB SITE DELAYS. UNION LABOR CHARGES, If REQUIRED, ARE EXTRA. GfiSLYALY-r MECHANICAL OR ELECTRICAL GAS VALVE IS TO BE INSTALLED BY PLURBING C041RACTOR. PLI-WRING PE54MIT REQUIRED FUR GAS VALVE I1IS7ALLATION. 2-UjRIf sduI IAF ELECTRICAL cnoxr}tG EQUIPMENT MUST BE SHUT OFF WK*j EIRE SYSTEM IS ACTIVATED. ELECTRICAL CONTRACTOR IS TO nCIVIDE SHUT OFF CONTACTS UR SHL$4T TRIP BREAKERS, THE DESIGI{ OF THE FIRE SYSTEM SHALL CCIWPLY WITH S.}Ik".A_ GUIDELINES FOR SEISMIC RESTAIN(TS OF HECHOOCAL SYSTEMS. APPROVED ANICHMAGE, R-0010 SUPPORTS AND BRACING OF PIPE i CUkDUIT. 1F APFLICAT E T -A EXISTING FIRES SYS MUST BE 14TERCON[NECTED TO THE ANSUL SYSTEM - THE TEST WILL BE C%nUCTED IN FRONT OF A SYSTEM INSPECTOR WITH A NITPUGE4 CARTRIDGE VITH BALLOONS COVER�``NG THE SYSTEM NUZZLES. THE TEST WILL BE CONDUCTED SI}k1LATINIG THE REMOTE AND AUTOMATIC ACTVAT101{_ I-0 BOX WITH 1/2' KIPS POSITIOI(ED AS SHOWN WITH TA13S IN THE UPPER RIGHT AD LOWER LEFT IF BUXK TO BE 60' ABOVE FINISHED FLOOR 1/2' ENT. TO BL 12' ABOVE FINISHED DROP CEILI?(G LINE WITHQIT BENDS OR OFFSETS. ONE 4-0 BOX TO BE PRIVIDED FOR EACH REMOTE PULL STATION WHEN TWO REMOTE PULLS ARE 140104TED SIDE BY SIDE. THE DISTAIMCE BETWEEN CE.NTER'S SHALL BE NO LESS THAT; 7% REGULATED RELEASE ASSEMBLY, REGULATED ACTUATOR ASSEWBLY, AND TANK EW DrSURE MUST BE LOC-AIED IN AREAS WHERE AIR TEhhPERA7URE PILL NST FALL BELOV 32 DEGREES F OR EXCEED 13D DEGREES F. 1. VnuNT THF. REGULATED RELEASE ASSEMBLE AND EACH REGULATED ACTUATOR ASSEi48LY REQUIRED BY COMPLET045 THE FOLLUVIH6 STEPS: A. SELECT A RIGID SURFACE FOR NOUNrING TFE ENCLOSURE. THE MUUNTINU LOCATIONS MUST ALLOY! THE REGULATED RELEASE ASSEti(BLY AND THE REGULATED ACTUAIM ASSEMBLY TO BE VITH04 TIE LIFDTATION W THE ACTUATION{ AND EXPELLANT GAS LINE LENGTHS AND MUST BE ABLE TO SUPPiIRT THE WEIGHT OF THE ASSEMBLY. i(OTE= WALL MOUNTED SYSTEMS WILT. B. DETACH THE COKER FROM THE ENCLOSURE. REWOVL AGENT TANK FROM ENCLQSURE AND THE EXPELLANT GAS LINE HDSL FRIM THE TA30uADAPTOR ASSEMBLY_ C. SECURE ENCLOSURE BOK TO SELECTED R(MNTING LOCATION USttiG THE FOUR WUNTD'(G HOLES_ USE APPRDPRIATE TYPE OF FASTED{ERS DEPENDING ON THE MOUNO(G SURFACE. VAI -1. 1413UNTED SYSTEMS. SLEEVt4G, ELBOWS, TEES, AND NOZZLES SUPPLIED DY C -1.S. OR FIRE DISTRIBUTOR. ALL PIPE FOR 1.5/2,4 GALLON SYSTEM IS 1/4'. ALL PIPE FOIR 3-0/35 GALLON SYSTEM IS 3/8'. ALL PIPE SHALL BE BLACK IRON SCHEDULE -I0. ALL EXPOSED PIPE SHALL DE CHROME SLEEVED. t917ZLES SHALL BE A HAXIRUW OF SW ABOVE SURFACE OF COOKING EQUIPMENT. LEGJEND — FIRE dABJNET ANI UL VOTE 1 3 GALLON TANK ASSEMBLY � 2 1.5 GALLON TANK ASSEMBLY 3 OEM AUT❑MAN BRACKET a- 4 OEM REGULATED ACTUATOR 5 ANSULEX LIQUID AGENT (3 GAL.) 6 ANSULEX LIQUID AGENT (1.5 GAL.) 7 CARTRIDGE (101--20) 8 CARTRIDGE (101-10) 9 CARTRIDGE (101-30) 9A CARTRIDGE (LT -A-101-30> 9B DOUBLE TANK CARTRIDGE 14 TEST LINK 11 DOUBLE MICR❑SWITCH �?ROTECTI 12 HOSE ASSEMBLY 'eco 2W aF��' ���CT,ay` � DUCT NOZZLE (419337) -�,, 1W NOZZLE ASSEMBLY (419336)' 1F NUZZLE ASSEMBLY (419333) 1N NOZZLE ASSEMBLY (419335) 1J2N NOZZLE ASSEMBLY (419334) 3N NOZZLE ASSEMBLY (419338) 245 NOZZLE ASSEMBLY (419340) OF CAUVQ 230 NOZZLE ASSEMBLY (419339) w 2120 NOZZLE ASSEMBLY (419343) 290 NOZZLE ASSEMBLY (419342) 260 NOZZLE ASSEMBLY (419341) 28 DETECTOR BRACKET J 29 LOW TEMP FUSIBLE LINK H 30 HIGH TEMP FUSIBLE LINKLi MGV MECHANICAL GAS VALVE EGV ELECTRICAL GAS VALVE CL 34 REMOTE MANUAL PULL STATI❑N S SWIVEL ADAPTOR Zp+� 5TYeoT JOB Larks or Lodge w __ ,� LO ATION Oroville, CA DA 27E JOB f s rf Ti �m — _ = s DWd DRARN BY w ?, RF'V, 1.00 i ALF' 0.5' x 11' F n) W um rswnsa' ro C! ni xoq a ql ui ftS V a OIf Q N f'000� w. •www w _ told w a www wwai 0 M www L •4 r r • wawaa�a�waw/aaaw�aw wiwwlrr► rr ro � • r i r lk 11� 111 r r r ■ ■ ■ w=In nEms L A *Pa. c===Cn t mew sp �♦ f , r �J& low -_ CL_ 'a Olivas GBOJOAaE] %t 0 z � _ �p�us��p�l� pe�r�l��i��e�1 •� weGis-10 aBuisu lod )IoolS .9 D - �., JO t4V^ `U;aAO U01 AU03 'ir Q H nbw 1aw"a UGlJOQAUGC) ' m r, eatl;a Appsdea peJinbaM 'Lr I_11 m ' edimJd speaw ojV1.• 01010 ueUO mOH V u:3ede* eiftiols p►ojlnbalj • I, a OIf Q N f'000� w. •www w _ told w a www wwai 0 M www L •4 r r • wawaa�a�waw/aaaw�aw wiwwlrr► rr ro � • r i r lk 11� 111 r r r ■ ■ ■ w=In nEms L A *Pa. c===Cn t mew sp �♦ f , r �J& low -_ CL_ Inter -Departmental Memorandum To: Building Department Planning Department From: Ted Crawford, Fire Department Subject: Community Care Licensing Request, STD 850 for Larkspur Lodge, 1900 20th Street, Oroville Date: August 30, 2000 The attached Std 850 form from Community Care Licensing has been received for our approval. Prior to the Butte County dire Department making a fire clearance inspection itis requested that your department check for compliance with Butte County ordinances (use permit and zoning) and building requirements and occupancy based on the requested category. Please forward your requirements to this office and we will forward them to the applicant. Planning requirements: Building Department Occupancy classification Building Requirements: Other: CC: G. Morris Chrono File Copy .:................ � r Inter -Departmental Memorandum To: Building Department Planning Department From: Ted Crawford, Fire Department Ea Subject: Community Care Licensing Request, STD 850 for Larkspur Lodge, 1900 20th Street, Oroville Date: August 30, 2000 The attached Std 850 form from Community Care Licensing has been received for our approval. Prior to the Butte County Fire Department making a fire clearance inspection it is requested that your department check for compliance with Butte County ordinances (use permit and zoning) and building requirements and occupancy based on the requested category. Please forward your requirements to this office and we will forward them to the applicant. Planning requirements: Building Department Occupancy classification Building Requirements: Other: CC: O. Morris Chrono File Copy ka MEMORANDUM so To: Glenn From: Steve Date: January 8, 2001 Re: Larkspur Lodge—Fire Department Plan Check Results Sheet 4 Install automatic fire doors at location shown per 1998 CBC Section 308.2.2.1; including but not limited to vision panels, tight -fitting 20 minute doors with no center mullion, opposite swing with positive latching and panic hardware. Per 1997 U FC Standard 10-1 Chapter 3 wal I mount (top no more than 5 feet above floor) 2A,1OBC fire extinguishers where shown on plan. Signs required by fire department to be installed after extinguishers have been mounted but prior to "final". In kitchen, wall mount (top < 5 feet above floor) one 40 BC fire extinguisher at location shown on plan. Commercial hood system? Sheet 11 Add, move or delete exit signs as shown on plan. Sheet 113�& - P P Plan requires "wet stamp and signature" of C-16 sprinkler contractor. Need 3 copies of automatic fire sprinkler calculations. This system will require that a fire department approved fire protection engineering firm recalculate the figures for accuracy due to the complexity and its connection to an older system riser. The cost will be borne by the owner or contractor—approximately $65 per hour. Sheet 14 Sheet 15 The automatic fire sprinkler system must meet NFPA 13 Standards and be stated so on the plan. Add "wet stamp and signature" of C-16 contractor to page. Add one strobe/fire hom (chimes) where shown on plan. Visual/audible fire warning system as well as the fire alarm system must comply with NFPA 72 Standards. State on plan. Per 1998 CBC Section 308.9, audible devices placed in patient areas shall only be chimes or similar sounding devices for alerting staff. e-oo .ssC �- t.� W, A -PA' 9 V/%/ a . Ile 9 w 400000,�i� S .�- ;1 1110 J7 no or 0000" LO Fj� D-onKs I TB,ti ie.� ! Dm.ts Gi7.- L11 6:0 7-0 Ail, 7— /J�Z2A.) *,o 0 �o<ti da � 5 � /00� .40 01 i 4--0011 .0 "000L .40 S OFCALIFORNIA .IRE SAFETY INSPECTION REQUEST D. 850 (REV. 10-94) See instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DSS/COMMUNITY CARE LICENSING 530 895-5033 8-1-00 VALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 0207/GURRIERE 045000959 1A r - LICENSING ( DEPARTMENT OF SOCIAL SERVICES AGENCY COM11UNITY CARE LICENSING NAME AND 520 COHASSET ROAD, SUITE 6 ADDRESS CHICO, CA 95926 L ' 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 34 1. FIRE CLEARANCE GRANTED 34 FACILITYNAME LICENSE CATEGORY LARKSPUR LODGE RESIDENTIAL -ELDERLY TREETADDRESS (Actua/Location) ADDRESS NUMBER OF BUILDINGS i 9 G 20TH I S ET A. EXITS 1 RESTRAINT ITY OROVILLE NO ACILITY CONTACT PERSON'S NAME C. FIRE ALARM HOURS CARRIE LIEGMANN, 538-8200 24 ALCONDITIONS TO- BE COMPLETED BY: INSPECTING* AUTHORITY CLEARANCE /DENIAL CODE F—BuTTE CFD CODES FIRE' 176 NELSON AVENUE 1. FIRE CLEARANCE GRANTED AUTHORITY OROVILLE, CA 95965 NAME AND 2. FIRE CLEARANCE DENIED ADDRESS A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS INSPECTOR'S NAME (Typed orPrinted) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY GLASS E. HOUSEKEEPING 2 F. SPECIAL HAZARD INSPECTION DATE INSPECTOR'S SIGNATURE(TypedorPrinted) G. OTHER �D EXPLAIN DENIALOR LIST SPECIAL CONDITIONS .Aft., ENGINEERED FIRE SYSTEMS, INC. AUTOMATIC SPRINKLER "SPECIALISTS" Steve Fowler Butte County Fire Department 176 Nelson Avenue Oroville, CA 95965 r January 22, 2001 REVIEWED BY BUTTE CO. FIRE DEPT. CAU.'r. DEFT . cf FORESTRY �j �La i -c1 Re: Plan Review Larkspur Lodge Dear Captain Fowler: I have reviewed the above referenced project and have the following comments: 1. Size the main, noted on the piping plan, as 3 inch in order to not effect the existing pipe schedule system. NFPA 13 Sec. 6-5 Plans and calculations have been returned APPROVED AS NOTED. If you have any questions about my plan review comments please do not hesitate to call me at (530) 274-9400. Sincerely, Enc Plan view ref. 6974-3.0 enc. 13457 Colfax Highway email: info@efst.com (530) 274-9400 Grass Valley, CA 95945 www efst.com Fax (530) 274-9488 Hydraulics Summary Sheet WILLIAM SQUYRES,JR. FIRE PROTECTION Designer: MARTIN PATTON 164 E. 3RQ, STREE"i" CH1C0 CALIF. 9592 8 Gale By! MARTIN PATTON LIC. NO. 275205 530-345-1012 Date: 04-17-00 Project Information LARKSPUR LODGE 1912 20TH STREET OROVILLE CALIF. RESIDENTIAL CARE FACILITY EviE vVE 11 DEPS'. Controct No: t . C4 FCCS;-y Bu ild in ,-- . i�Iv System ID: RA #2 Ref. Drawing No: 2 OF 2 g- r �s ..,onf TtonS Construction: ;} Occupancy:�.�� y Date Authority: OROVILLE FIRE DEPT. System Information ____Hydraulics resign Criteria_, System Type: WEA' Density: ,10 GPM/SgFt Remote Area: 1500 SgFt Sprinkler Coverage: 130 SgFt DeSign Standard: NFPA 13 Hazard: LIGHT Figure: 5-2. � Curve: ,Sprinklers I Nozzles Manufacturer: CENTRAL I Model,. G9 -QR Size- 1/2 K—Factors S-6 Temp, Roting: IS5, 200 Hydraulics PSI@ 0.0 GPM Information (NA) Demand... Discharge Pres: (NA) Spr Req'd Pres: 50.98 PSI Spw••Req-'d • Flow:-• 21'9:68 ,GPI A.dd'l Flows: 0.00 GPM Hose of Srce: 100.00 GPM Total Flaw. 319.68 GPM Total Pres: s0.98 PSI Static Elev; 0.00 Ft supply... ,Wafer Flow Test Stotic. 80.00 PSI Residual: 60.00 PSI Qty Flow ung; 1500,100 GPM Elevation. 0.00 Ft Date: Time: By: Pump Date Roted: 0.0 PSI@ 0.0 GPM Boost Pres: (NA) PS I Discharge Pres: (NA) PSI Discharge Flow: (NA) GPM ,Combined S to t ic: (NA) PS I Residual: (NA) PSI Qty Flowing: (NA) GPM Available... P) 78.85 PSI@ 319.68 GPM F) 50.98 PSI@ 1833.80 GPM Margin... Pressure: 27o97 PSI Flow: 1S14.12 GPM Sigma Dyhamica CoIrporotion 7700 Summary Sheet -tj JZ Cf O 470 -Cll- 171,E / RE51DEN11NL CHftE PpCll(T% fa111 I IMA F. �,nnvtzF�, �u F�rcG nrrn�rcr-r�nn� u� � STK�T `_E1ltF, KLI� PLF�N RIIZA6MD VIYfK3ts\ 119 C. 3RD STTCE� CH1 CD S°1'LB LIG, MD,. T)S*'L.OLo 501Y0 -395—I lo3 D M LZA" U- a LNRI 26 MUM Icl-1k) L, INVDAEU. ME. QRMNILU-- t INUT- 53b-533-9501 > co 1:30 D) CD CD q rn rn ni CD w 0 M % -n rn :J3 Chi i�l rn rn U) -0 -Cll- 171,E / RE51DEN11NL CHftE PpCll(T% fa111 I IMA F. �,nnvtzF�, �u F�rcG nrrn�rcr-r�nn� u� � STK�T `_E1ltF, KLI� PLF�N RIIZA6MD VIYfK3ts\ 119 C. 3RD STTCE� CH1 CD S°1'LB LIG, MD,. T)S*'L.OLo 501Y0 -395—I lo3 D M LZA" U- a LNRI 26 MUM Icl-1k) L, INVDAEU. ME. QRMNILU-- t INUT- 53b-533-9501 October 2, 2000 Monte Pratt 5280 Lower Wyandotte Oroville, CA. 95965 Department of Development Services Building Division 7 County Center Drive Oroville, CA 95965 (530) 538-7541 (530) 538-2140 FAX Time Care LTD Assessor Parcel Number: 030-462-009 Building Permit Number: 00-2159 This office reviewed building plans for the permit application referenced above. The plan examiner's comments are listed in PART - I below. Please respond in writing to each comment in PART - I by completing and returning the enclosed PLAN REVIEW RESPONSE FORM. Indicate which detail, specification, or calculation shows the requested information. Additional response information is included on the response form. Your complete and clear response will expedite the re -check and approval of this project. PART — I Provide additional information and/or make revisions to plans, specifications and calculations as follows: 1. A California licensed architect or registered engineer must prepare the building plans. Please be sure to include on the resubmittal the engineer's "wet" stamp, signature, registration number and expiration date on all sheets of plans depicting the designed elements and cover sheets of calculations. The drawings must include a complete plot plan with the location and occupancy classification for all buildings on this parcel. 2. Classification of the building is the critical first step in the effective use of the Uniform Building Code. To an even greater degree, the proper determination of occupancy and type of construction is the basis for all other code determinations. Provide a complete code analysis for the entire building and include the mixed occupancy ratio. This analysis must include the exit access, the exit, and the .exit discharge. 3. Expansive soil is indicated on this parcel and the foundation must be designed if this condition exists at the construction location. 4. Occupant loads shall be determined in accordance with the requirements of Uniform Building Code Chapter 10. In determining the occupant load, all portions of a building shall be presumed to occupied at the same time (Uniform Building Code section 1003.2.2.2.1). 5. Minimum Plumbing Facilities: The total occupant load shall be determined by minimum exiting requirements. The minimum number of fixtures shall be calculated at fifty (50) percent male and fifty (50) percent female based on the total occupant load (Uniform Plumbing Code Table 4-1). 1 of 2 6. The number of parking spaces will be determined by the Butte County Planning Division and the number of disabled parking spaces are based upon the amount of parking spaces. Disabled parking spaces must be located at the main entrance. Obtain Butte County Planning Division approval for use and parking requirements. 7. Provide verification of compliance with National Electrical Code Article 517. 8. Indicate the flame spread classification throughout the building. 9. Plan review will continue upon receipt of the above items. Additional comments may be generated from your response above where plan documents were incomplete, inconsistent, or not adequate to depict code compliance. 10. Review of the building plans by the Butte County Building Division engineer has not been completed at this time. Any additional comments from the engineer will be addresses in separate correspondence. PART - H The items identified below must be submitted prior to permit issuance. These items were noted at time of permit application on the PERMIT APPLICATION DATA SHEET. 1. Provide 3 sets of California licensed architect or registered engineer -designed plans. Please be sure to include on the resubmittal the designer's "wet" stamp, signature, registration number and expiration date on all sheets of plans depicting the designed elements and cover sheets of calculations. 2. Balance of Building Permit fees will be determined when the above items have been received and reviewed. 3. Pay impactfees: 3.1. Thermalito Drainage Area 3.2. Complete and return the Butte County School Impact fee certification form. 3.3. Sheriff fees will be determined when the above items have been received and reviewed. 3.4. Thermalito Urban Area fees 4. Contact the Butte County Planning Division to obtain approval for Use and Parking. 5. Contact the Butte County Land Development about Improvements, Drainage, and Legal Parcel requirements. If you wish to discuss any requirements in PART - I, you may contact me at (530) 538-7541 between the hours of 1:00 p.m. and 4:00 p.m., Monday through Friday. The attached checklist must accompany corrected items. Sincerely, Glenn Gibbons Plans Examiner 2 of 2 COUNTY OF BUTTE - DE. _,RTMENT OF DEVELOPMENT SERVIC'- BUILDING DIVISION County Center Drive a Oroville, California 95965 •Telephone (530) 538-7541 0 � PERMIT N0. "(Rev.t /96) APPLICATION AND PERMIT a FRE SOPARCEL NUMBER /11/1_ �_-ZONING BUILDING PERMIT CONMY CO,RAC;OB DRES l CO TRUCTION LENDER LEN ER'S MAIUNG ADDRESS M rAV - %&__ 'j ** am I•rsl01M■BUILDING. VALUATIO� 11I1�i_Mrr1:i TELEPHONE Fireplace Total Valuation $ ARC HITECT OR ENGINEER ARCHITECT OR ENGINEER'S MAILING ADDRESS LICENSE NO. Filing Fee $ Permit Fee $ Plan Checking Fee $ BUI DING , 600V OR LESS 200A OR LESS Energy Plan Checking Fee $ 200A TO 1000A NEW CONST. OR ADDNS. $ NEW CONST. NON-RESiD. MULTI -OUTLET BRANCH CIRCUITS PERMIT FEE $ LA No. SUBDNISIOWS NAME PARCEL MAP PLUMBING PERMIT .�_l r - - Each Trap USE OF STRURE Misc. Wiring Solar or heat pumpwater heater ' ,�� S ❑ Duplex ❑ Mobllehome �, Other / Water piping SPECIFY Each gas water heater or vent TYPE OF WORK Gas piping system 1 - 5 outlets ew ❑ Addition Remodel 1 Utilities ❑ Installation ❑ Other ❑ Buildingsewer _;b4/f4 Mobile Home S G W 1 - qescribe Work:0 Receipt No. WHITE-D.D.S.-B.D. CANARY -ASSESSOR j PINK -INSPECTOR GOLDENROD -APPLICANT a O 20.00 fling Fee 2 0.0 0 01 7.00 23.00 15.00 15.00 15.00 15.00 / @20.00 Fling Fee 2 0.0 0 23.00 C. 6.001 61V' 3.5QF T. ! @7.50 200 1.00 BALL @ .s0 5.00 23.00 20.00 23.00 PERMIT FEE $5U MECHANI AL PEPM Filing Fee 0.00 Heating P'c.- Cooling Hood 6.50 Ventilation PERMIT FEP_ $ l U� Mobile Home Installation Fee $ . ff - 0 " Energy Inspection Fee $ occ c°"ST.'Y?E- TOTAL FEE $ 3 70(9 HAL D, FEES SMP 0 CDF P PD HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. By Date PERMIT EXPIRES ON PERMIT FEE $ ELECTRICAL PERMIT Main Service 600V OR LESS 200A OR LESS Main Service 200A TO 1000A NEW CONST. OR ADDNS. DWELLING OCCUP. { & ACC. BLDS. NEW CONST. NON-RESiD. MULTI -OUTLET BRANCH CIRCUITS — POWER APPARATUS a SINGLE OUTLET CIR Ex. Occu , OUTLET OR FDCTURES Ex. Occu FIXED APPLNS. OR OUTLETS RESio. EA. Temporary Service Mobile Home Facilities Misc. Wiring t a O 20.00 fling Fee 2 0.0 0 01 7.00 23.00 15.00 15.00 15.00 15.00 / @20.00 Fling Fee 2 0.0 0 23.00 C. 6.001 61V' 3.5QF T. ! @7.50 200 1.00 BALL @ .s0 5.00 23.00 20.00 23.00 PERMIT FEE $5U MECHANI AL PEPM Filing Fee 0.00 Heating P'c.- Cooling Hood 6.50 Ventilation PERMIT FEP_ $ l U� Mobile Home Installation Fee $ . ff - 0 " Energy Inspection Fee $ occ c°"ST.'Y?E- TOTAL FEE $ 3 70(9 HAL D, FEES SMP 0 CDF P PD HD ISSUE This permit is hereby issued under the applicable provisions of the Butte County Code and/or Resolutions to do work indicated above for which fees have been paid. By Date PERMIT EXPIRES ON October 23, 2000 Monte Pratt 5280 Lower Wyandotte Oroville, CA. 95965 OWN Department of Development Building Division 7 County Center Drive Oroville, CA 95965 (530) 538-7541 (530) 538-2140 FAX Time Care LTD Assessor Parcel Number: 030-462-009 Building Permit Number: 00-2159 Services ,-- S�V_t This office reviewed building plans for the permit application referenced above. The plan examiner's comments are listed in PART - I below. Please respond in writing to each comment in PART - I by completing and returning the enclosed PLAN REVIEW RESPONSE FORM. Indicate which detail, specification, or calculation shows the requested information. Additional response information is included on the response form. Your complete and clear response will expedite the re -check and approval of this project. PART — I Provide additional information and/or make revisions to plans, specifications and calculations as follows: 1. Classification of the building is the critical first step in the effective use of the Uniform Building Code. Your application with the Department of Social Services — Community Care Licensing is for nonambulatory elderly patients. Nursing homes with nonambulatory patients are defined as Group I, Division 1.1 occupancy. The occupancy group, indicated on the building plans, is Group I, Division 1.2. Building code requirements are different for each occupancy classification. Please provide clarification about the different occupancy classification's and compliance with the Uniform Building Code requirements. 2. Accessibility for Group I Occupancies — 1109B.2 Entrance At least one accessible entrance shall be protected from the weather by canopy or roof overhang. Such entrances shall incorporate a passenger -loading zone. Passenger loading zones shall provide an access aisle at least 60 inches wide and 20 feet long adjacent and parallel to the vehicle pull-up space. The covered area located at the front of the facility and the planter are located in the front setback. Please contact the Butte County Planning Division regarding this requirement. 3. Occupant loads shall be determined in accordance with the requirements of Uniform Building Code Chapter 10. In determining the occupant load, all portions of a building shall be presumed to occupied at the same time (Uniform Building Code section 1003.2.2.2.1). Therefore, the occupant loads for each of the gathering areas and the dining area will need to be added to the occupant load. Provide the occupant load breakdown on the building plans. 1 of 2 4. Exiting and smoke barrier requirements are based upon the exact occupancy that must be clarified in item #1 above. Exiting through the gathering area (11) appears to be obstructed by the patio (1) area. If this patio area is enclosed, the exiting will not comply with exiting requirements. 5. Long -term -care facilities, including skilled nursing facilities, intermediate -care facilities, bed and care, and nursing homes shall have at least 50% of patient room, and all public -use and common -use areas, accessible CBC 1109B.3. 6. The flame -spread classification indicated on the building plans exceeds the maximum flame spread class in Uniform Building Code Table 8-B for this occupancy. Provide clarification. 7. CBC section 1117B.1 Water Fountains (Drinking). There shall be a drinking fountain that is accessible to individuals who use wheelchairs in accordance with Plumbing Code Section 1507.0 and one accessible to those who have difficulty bending or stooping. This can be accommodated by the use of "hi -low" fountains, or by such other means as would achieve the required accessibility for each group on each floor. The water fountains shall be located completely within alcoves or otherwise positioned so as not to encroach into pedestrian ways. 8. Plan review will continue upon receipt of the above items. Additional comments may be generated from your response above where plan documents were incomplete, inconsistent, or not adequate to depict code compliance. 9. Review of the building plans by the Butte County Building Division engineer has not been completed at this time. Any additional comments from the engineer will be addresses in separate correspondence. PART - H The items identified below must be submitted prior to permit issuance. These items were noted at time of permit application on the PERMIT APPLICATION DATA SHEET. 1. Balance of Building Permit fees will be determined when the above items have been received and reviewed. 2. Pay impact fees: 2.1. Thermalito Drainage Area 2.2. Complete and return the Butte County School Impact fee certification form. 2.3. Sheriff fees will be determined when the above items have been received and reviewed. 2.4. Thermalito Urban Area fees 3. Contact the Butte County Planning Division to obtain approval for Use and Parking. 4. Contact the Butte County Land Development about Improvements, Drainage, and Legal Parcel requirements. If you wish to discuss any requirements in PART - I, you may contact me at (530) 538-7541 between the hours of 1:00 p.m. and 4:00 p.m., Monday through Friday. The attached checklist must accompany corrected items. Sincerely, Glenn Gibbons Plans Examiner 2 of 2 October 23, 2000 Monte Pratt 5280 Lower Wyandotte Oroville, CA. 95965 A Department of Development Services Time Care LTD Assessor Parcel Number: 030-462-009 Building Permit Number: 00-2159 Building Division 7 County Center Drive Oroville, CA 95965 (530) 538-7541 (530) 538-2140 FAX 2 This office reviewed building plans for the permit application referenced above. The plan examiner's comments are listed in PART - I below. Please respond in writing to each comment in PART - I by completing and returning the enclosed PLAN REVIEW RESPONSE FORM. Indicate which detail, specification, or calculation shows the requested information. Additional response information is included on the response form. Your complete and clear response will expedite the re -check and approval of this project. PART — I Provide additional information and/or make revisions to plans, specifications and calculations as follows: 1. Classification of the building is the critical first step in the effective use of the Uniform Building Code. Your application with the Department of Social Services — Community Care Licensing is for nonambulato �elderlypatients. Nursing homes with nonambulatory patients are defined as Group I, Division 1.1 occupancy. The occupancy group, indicated on the building plans, is Group I, Division 1.2. Building code requirements are different for each occupancy classification. Please provide clarification about the different occupancy classification's and compliance with the Uniform Building Code requirements. 2. Accessibility for Group I Occupancies — 1109B.2 Entrance At least one accessible entrance shall be protected from the weather by canopy -or roof overhang. Such entrances shall incorporate a passenger -loading zone. Passenger loading zones shall provide an access aisle at least 60 inches wide and 20 feet long adjacent and parallel to the vehicle pull-up space. The covered area located at the front of the facility and the planter are located in the front setback. Please contact the Butte County Planning Division regarding this requirement. 3. Occupant loads shall be determined in accordance with the requirements of Uniform Building Code Chapter 10. In determining the occupant load, all portions of a building shall be presumed to occupied at the same time (Uniform Building Code section 1003.2.2.2.1). Therefore, the occupant loads for each of the gathering areas and the dining area will need to be added to the occupant load: Provide the occupant load breakdown on the building plans. 1 of 2 4. Exiting and smoke barrier requirements are based upon the exact occupancy that must be clarified in item #1 above. Exiting through the gathering area (11) appears to be obstructed by the patio (1) area. If this patio area is enclosed, the exiting will not comply with exiting requirements. 5. Long -term -care facilities, including skilled nursing facilities, intermediate -care facilities, bed and care, and nursing homes shall have at least 50% of patient room, and all public -use and common -use areas, accessible CBC 1109B.3. 6. The flame -spread classification indicated on the building plans exceeds the maximum flame spread class in Uniform Building Code Table 8-B for this occupancy. Provide clarification. 7. CBC section 1117B.1 Water Fountains (Drinking). There shall be a drinking fountain that is accessible to individuals who use wheelchairs in accordance with Plumbing Code Section 1507.0 and one accessible to those who have difficulty bending or stooping. This can be accommodated by the use of "hi -low" fountains, or by such other means as would achieve the required accessibility for each group on each floor. The water fountains shall be located completely within alcoves or otherwise positioned so as not to encroach into pedestrian ways. 8. Plan review will continue upon receipt of the above items. Additional comments may be generated from your response above where plan documents were incomplete, inconsistent, or not adequate to depict code compliance. 9. Review of the building plans by the Butte County Building Division engineer has not been completed at this time. Any additional comments from the engineer will be addresses in separate correspondence. PART - H The items identified below must be submitted prior to permit issuance. These items were noted at time of permit application on the PERMIT APPLICATION DATA SHEET. 1. Balance of Building Permit fees will be determined when the above items have been received and reviewed. 2. Pay impact fees: 2.1. Thermalito Drainage Area 2.2. Complete and return the Butte County School Impact fee certification form. 2.3. Sheriff fees will be determined when the above items have been received and reviewed. 2.4. Thermalito Urban Area fees 3. Contact the Butte County Planning Division to obtain approval for Use and Parking. 4. Contact the Butte County Land Development about Improvements, Drainage, and Legal Parcel requirements. If you wish to discuss any requirements in PART - I, you may contact me at (530) 538-7541 between the hours of 1:00 p.m. and 4:00 p.m., Monday through Friday. The attached checklist must accompany corrected items. Sincerely, Glenn Gibbons Plans Examiner 2 of 2 August 18, 2000 Kurt Liegmann --- x -3.24 -20th Street - - - Oroville, CA 95965 rp. .l,.l _ A^ _ - - LANU Ur NAI URAL "WEALTH AND BEAUTY PLANNING DIVISION DEPARTMENT OF DEVELOPMENT SERVICES 7 COUNTY CENTER DRIVE • OROVILLE, CALIFORNIA 95965-3397 TELEPHONE: (530) 538-7601 FAX: (530) 538-7785 Re: Canf rma#ion -- no Use Permit is necessary for elderly care facility on APN 030-462-0 09 Dear Mr. Liegmann: As per your request, I have researched the file an • d reviewed the history of uses on the above Parcel. The purpose of this letter is to inform e you that an additivaa� Use Permit to conduct a facility for the elderly is not necessary.care If you have any further questions lease feel p free to contact me at 538-7601 Very truly yours, 4---4y1VV-S i-%�Ljj Stephen Hackney Associate Planner J. I& T•Z:d L92022S:01 : W06J Z t7: T T 0002 - 9 - d3S 3d —q(A 2- o Inter.,Departmental Memorandum To: Building Department - V/ Planning Department From: Ted Crawford, Fire Department 0 Subject: Community Care Licensing Request, STD 850 for Larkspur Lodge, 1900 20th Street, Oroville Date: August 30, 2000 The attached Std 850 form from Community Care Licensing has been received for our approval. Prior to the Butte County Fire Department making a fire clearance inspection it is requested that your department check for compliance with Butte County ordinances (use permit and zoning) and building requirements and occupancy based on the requested category. Please forward your requirements to this office and we will forward them to the applicant. Planning requirements: (���` 4.&, Building Department Occupancy classification Building Requirements: �3 5 d 0" /"Y Other. & -T 4V -�"e 4&&� CC: G. Morris Chrono File Copy e - r