HomeMy WebLinkAboutFAI15-0095 Fire Annual Inspection Archiveire Prevention Bureau
76 Nelson Avenue
lroville, CA 95965
telephone 530-538-7888
'ax 530-538-2105
Address: 9Z -0 ,
Iwnerftwager: ,
►ssistant Manager:
wilding Owner:
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Ae County Fire Rescue
California Department of Forestry
and Fire Protection
Facility Inspection Report
'bite Copy - Business
Yellow Copy — Occupancy File
Pink Copy — Station File
Occ. Class.
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Bus: Hm:
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A w Tw cDrnrrrTf%W rniV WITTO VA fM.ITV uF VF. A T .F.D IrF . ] [1T .T .OWING
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
16.
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
19. Fire Drill Witnessed Yes 0 No ❑
18. Other
DETAILED EXPLANATION AND COMAEUTIUA a: UvAMML i M„=
Date: Discussed with:
Sired:
(Print) �'r .
w
lispi ecting Ofd' er:
.� }�
Battalion 1
2 3 4 5 6 7 Station:'" FPB /,Za /171t 41L 10<
FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. - YOUR COOPERATION WITH
CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED., RE -INSPECTION DATE:
ire� 'bite Co -Business
re Prevention Bureau itte County Fire Rescue Copy
76 Nelson Avenue California Department of Forestry Yellow Copy — Occupancy File
oville) CA 95965 and Fire Protection Pink Copy — Station File
elephone 530-538-7888 Facility Inspection Report Occ. Class.
ax 530-538-2105 _
Address: -23 5 // � �.�. Business Name: le,� - -4 XV
Rerflviaaager: ' Bus: -- l `, ,. Hm: Fax:
stant Manager: Bus: Hm.
ii1ding Owner. Bus: Hm•
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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.
Exits* 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. Firewalls, ceilings, fire doors, draft stops
16. Heating system: Defective appliance, flue combustibles
8. Knox Box keys
17.
Address posted and visible from road
1-9. Fire Drill Witnessed Yes ❑ No ❑
18.
Other
DETAILED EXPLANATION AND CORRECTIONS: UUXKI U,.1 Z.V:
Date:
Discussed with:
Si ,+ ed: -
(Print) ..0 )60 6
Ins ecting 4 cer:
Battalion 1 2 3 4 5 7
. -,.
Station: FPB
M Q PNItAk
FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COUPL+'RA11UN Wfl'!i
CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED,, RE -INSPECTION DATE:
- utte County Fire Departmen,
D530E CC3 California Department of Forestry and Fire Protection
�.� Fire Prevention Bureau
176 Nelson Avenue, Oroville, CA 95965
r���
-538-7888/530-538-2105(fax)
Fire Safety Inspection
PA t .f; n✓� �� G i .u..,v�-� i �4.'''ti'i, � i�t�.� r < <J,�.9 L
usiness Address:
�a)ev W,x, Business Name: PALJ f� ^0C
r{00L—
wner/Manager:
Bus: 5'? -,z - '42"S
Other:
ther Contact: ti �.^
1 2 / :11� s .� . �i J�Hti:� - Bus:
Other:
uilding Owner:
Bus:
Other:
ddress:
Fire alarms stem defective
Occ. Class: 61
■ _10110RU=10 IIQkL[•]wY•lllr-411ANI■IWdNATJOA■:11 91 0• .
L 1.
Fire extinguishers: required, service due
J-- 10.
Exit(s): obstructed, inadequate
k. 2.
Extension cords: Excessive use, defective
11.
Exit sign(s): required, illumination, photo luminescent
zw 3.
Excessive rubbish, trash, debris
12.
Exit sign lights: obstructed, defective
— 4.
Fire alarms stem defective
13.
Exit lighting: required, defective
5.
Sprinkler system: service required, defective
J— 14.
Heating system: defective appliance, flue combustibles
6.
Kitchen hood ext. system: service due
15.
Wiring: exposed, damaged connectors, etc.
7.
Fire walls, ceilings, fire doors, draft stops
16.
Address posted and visible from road
8.
Smoke detectors: required, defective
17.
Other
9.
Fire drill log checked Yes No ❑
18.
Other type of inspection — State below
JUL I AILLU EXPLANATION AND GORREGTIONS: CORRECTED -
Date:
" ✓
Discussed with:
(Print) M S C1'-
S' ed:' ;
/ 1,4 .
Battalion 1 2 3 4 5 6 7
_
Station: FPB
Inspecting Officer:
PA L Ai , Q.2`1 v"
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 re -inspection will be conducted on F -T-- Willful failure to comply with this notice is a
misdemeanor. Violations that are not corrected immediately and/or remain after the re -inspection may be processed as a criminal
offense. Thank you for your assistance and cooperation in minimizing the fire and life loss in our community. (H & S sec. 13112)
White Copy — Station File Yellow Copy — Re-inspect/business Pink Copy — Business Vch' eck when sent to prevention
J (rin- - Iq
STATE' F CALIFORNIA
FIRE SAFETY INSPECTION REQUEST
See instructions on reverse.
STID.850(REV. 10-94)
AG ENCY CONTACTS NAME
TELEPHONENUMBER
REQUESTDATE
PROGRAM
SS CCL
530 895-5033
04/06/01
CCL
EVALUATOR'S NAME
REQUESTING AGENCY FACILITY NUMBER
REQUESTCODE
105/PAM SEXTON
041372369
3A
G.
CODES
1. ORIGINAL A. FIRE CLEARANCE
DEPARTMENT OF SOCIAL SERVICES
LICENSING
2. RENEWAL B. LIFE SAFETY
AGENCY COMMUNITY CARE LICENSING
AME AND 520 COHASSET RD., STE. 6
3. CAPACITY CHANGE
ADDRESS CHICO, CA 95926
4. OWNERSHIP CHANGE
5. ADDRESS CHANGE
L
6. NAME CHANGE
T OTHER
AMBULATORY
NONAMBULATORY
BEDRIDDEN
TOTAL CAPACITY
C1 PACITY
PREVIOUS CAPACITY
CAPACITY PREVIOUS CAPACITY
i
CAPACITY
PREVIOUS CAPACITY
6
24
0 0
0
0
96
FACILITYNAME
LICENSECATEGORY
PALERMO STATE PRESCHOOL
CCC
STREETADDRESS(Actual Location)
NUMBER OF BUILDINGS
350 BULLDOG WAY
I
CI
RESTRAINT
ALERMO, CA 95968
NONE
F ILITYCONTACTPERSON'SNAME HOURS
ONNIE LAWTON (530) 533-4730 DAYS
ING CAPACITY. PLEASE RUSH THIS VISIT.
Steven J. Fowler
Fire Captain
n Life Safety Officer
F
Office (530) 538-3859
Pgr. (530) 871-8381
Cell (530) 521-8768
Department or Forests an/I Fire Projection
1utte
County Also Serving Cities of
76 NelsonAvenue,Oroville, California
95B-1996 &Gridley
"O R'S NAME (Types o,
VEA) tok) LJF-le— (00
ION ATE INSPECTOR'S SIGNATURE (Typed orPrinted)
Q
DENIAL OR LIST SPECIAL CONDITIONS
'LETED BY INSPECTING AUTHORITY
7
i
UMBER CFIRS NUMBER OCCUPANCYCLASS
X38 389 D�oj.� E- �
CLEARANCE/DENIAL CODE /
CODES
FIRE CLEARANCE GRANTED
2. FIRE CLEARANCE DENIED
A.
EXITS
P.
CONS TRI ICTION
C.
FIRE ALARM
D.
SPRINKLERS
E.
HOUSEKEEPING
F.
SPECIAL HAZARD
G.
OTHER