HomeMy WebLinkAboutFAI15-0027 Fire Annual Inspection ArchiveSTAI E OF CALIFORNIA
FIRE SAFETY INSPECTION REQUEST
SZ1150 (REV. 10-94T
See Instructions on reverse.
AG6,rcy CONTACTS NAME
TELEPHONE NUMBER
REQUEST DATE
PROGRAM
DSS/COMMUNITY CARE LICENSING
530 895-5033
3-5-09
540
EV ATOR'S NAME
REQUESTING AGENCY FACILITY NUMBER
REQUESTCODE
03 1/Bakke FAX 895-5934
045002239
5a
CODES
i. ORIGINAL A. PRECLEARANCE
LICENSING DEPARTMENT OF SOCIAL SERVICES
2. RENEWAL B. LIFE SAFETY
GENCY
COMMUNITY CARE LICENSING
3. CAPACITY CHANGE
N ME AND
DDRESS 520 COHASSET ROAD, SUITE 170
4. OWNERSHIPCHANGE
CHICO, CA 95926
5. ADDRESS CHANGE
L—
6. NAME CHANGE
T OTHER
AMBULATORY
NONAMBULATORY
BEDRIDDEN
TOTAL CAPACITY
C ACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
CAPACITY
PREVIOUS CAPACITY
6
6
F LITY NAME
LICENSE CATEGORY
R CK CREEK HOMES CHICO TWO
GROUP HOME
ST IEJET ADDRESS (Actual Location)
NUMBER OF BUILDINGS
3`21 ESPLANADE
1
cny
RESTRAINT
CHICO, CA 95973
NO
F LTfY CONTACT PERSONS NAME �^^�^�
D VID GUTIERREZ 895-8363 24
CONDITIONS
:CTORS NAME (TyWd or PrhNd)
05 -rr S �
Ir
INSPECTORS SIGNATURE (TyT
F 1 01) t '-/
N 6WAL OR UST SPECIAL CONDITIONS
CLEARANCE /DENIAL C DE / \
cobEs-
- ! SIRE CLEARANCE GRANTED
2.. FIRE CLEARANCE DENIED
LC'�C I�jLC� L � A BUTS
J B. CONSTRUCTION
C. FIRE ALARM
TELEPHONE NUMBER CRRS NUMBER OCCUPANCY CLASS D SPRINKLERS
r� z E. HOUSEKEEPING
F. SPECIAL HAZARD
°rtntd) f G. OTHER
FIRE
7HO AT
RIITY
� R�
ME AND Qin Snl EAn
..,--rr—�7=CTpT
STt-•�r
�7 I tZ r ET
IDRESS
540
L'
:CTORS NAME (TyWd or PrhNd)
05 -rr S �
Ir
INSPECTORS SIGNATURE (TyT
F 1 01) t '-/
N 6WAL OR UST SPECIAL CONDITIONS
CLEARANCE /DENIAL C DE / \
cobEs-
- ! SIRE CLEARANCE GRANTED
2.. FIRE CLEARANCE DENIED
LC'�C I�jLC� L � A BUTS
J B. CONSTRUCTION
C. FIRE ALARM
TELEPHONE NUMBER CRRS NUMBER OCCUPANCY CLASS D SPRINKLERS
r� z E. HOUSEKEEPING
F. SPECIAL HAZARD
°rtntd) f G. OTHER