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Home My WebLink AboutFAI15-0034 Fire Annual Inspection ArchiveSTAT1 OF CAUFORNIA FIRE SAFETY INSPECTION REGur-ST sTD. (REV. 10-94) See instructions on reverse. AGE Y CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DSS/COMMUNITY CARE LICENSING 530 895-5033 12-9-08 EV ATORS NAME REOUESTING AGENCY FACILITY NUMBER REQUEST CODE 03 1 /Bakke FAX 895-5934 045001285 3a CODES 1. ORIGINAL A. FIRE CLEARANCE LICENSING DEPARTMENT OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY A13ENCY MEAND COMMUNITY CARE LICENSING 3. CAPACITYCHANGE ADDRESS 520 COHASSET ROAD, SUITE 170 4. OWNERSHIP CHANGE CHICO, CA 95926 5. ADDRESSCHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAP kCITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 6 6 FAC LITY NAME LICENSE CATEGORY ALTERNATIVES - NIGHTHAWK GROUP HOME -ENVIRONMENTAL S ADDRESS (Actual L"H n) NUMBER OF BUILDINGS 41 5 NIGHTHAWK WAY CITY RESTRAINT C ICO, CA 95967 1 110 7345F CONTACT PERSONS NAME HOURS R BIN COX -HENRY -1144 24 SPEbUkIL CONDITIONS Ur � CLEARANCE /DENIAL CODE "Aff i COUNTYFIRE DEPARTMENT CODES i. RE CLEARANCE GRANTED Steve Fowler 2. FIRE CLEARANCE DENIED Battalion Chief/Fire Marshal 9) 538-7888, ext 167 office (530) 538-2105 Fax EXITS 176 Nelson Ave, Oroville, CA 95965 B. CONSTRUCTION steve.fowler@fire.ca.gov C. FIRE ALARM JIMNAMETPKnW Tc'LEPHONE NUMBER �CFIRS NUMBER OCCUPANCY CLASS D. SPRINKLERS r� / E. HOUSEKEEPING F. SPECIAL HAZARD ION DATE INSPECTORS SIGNATURE a Pring G. OTHER DENIAL UST SPECIAL CONDI S IYl STAOF CALIFORNIA FI E SAFETY INSPECTION REQUEST STD BW (REV. 10-84) See Instructions on reverse. AGE 4CY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM DSS/COMMUNITY CARE LICENSING 530 895-5033 10-28-08 B. CONSTRUCTION EV ATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 03 1/Bakke .� FAX 895-5934 045001285 3a CODES 1. ORIGINAL A. FIRE CLEARANCE D 0� LI ENSING DEPARTMENT OF SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY AGENCY NJ IAEAND COMMUNITY CARE LICENSING 3. CAPACITY CHANGE ADDRESS 520 COHASSET ROAD, SUITE 6 4. OWNERSHIP CHANGE CHICO, CA 95926 5. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAP CITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 4 3 4 FAC LITY NAME LICENSE CATEGORY ALTERNATIVES - NIGHTHAWK GROUP HOME -ENVIRONMENTAL STR ET ApMESS (Actual Location) NUMBER OF BUILDINGS 41 55 NIGHTHAWK WAY 1 CITY RESTRAINT C ICO, CA 95967 NO FAC UTY CONTACT PERSONS NAME HOURS RC BIN COX -HENRY 345-1144 24 � a TE COUNTY FIRE DEPARTMENT Steve Fowler { Battalion Chief/Fire Marshal i (530) 538-7888, ext 167 office (530) 538-2105 Fax 176 Nelson Ave, Oroville, CA 95965 steve.fowler@fire.ca.gov r'S NAME (rjpW or PrhW) TELEPHONE NUMBER V TE INSPECTORS SIGNATURE (Typd Prhf#0 ?NAL OR LIST SPECIAL CONDITIONS CLEARANCE /)ENIAL CODV / 1. RE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS CFIRS NUMBER OCCUPANCY CLASS E. HOUSEKEEPING D 0� F. SPECIAL HAZARD G. OTHER Fire Prevention Bureau 176 Nelson Avenue Oroville, CA 95965 Telephone 530-538-7888 Fax 530-538-2105 Address: L G Owner/Manager: Assistant Manager: Building Owner: " 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 File Occ. Class. Hrn: Fax. Hrn: Hm: AN INCPFCTIf1N OF Y(IITR FACH.ITY REVEALED TAF FOLLOWING: 1. Fire Extinguishers: Required, service due 10. Exit(s) obstructed, inadequate 2. Extension cords: Excess use, defective 11. Exit sign(s) required, illumination 3. Excessive rubbish, trash, debris 12. Exit sign lights need replacing 4. Fire alarm system defective 13. Exit lighting: Required, defective 5. Sprinkler system: Service required, defective 14. Smoke detectors: Required, defective 6. Kitchen hood extinguishing system service due 15. Wiring: Exposed, damaged connectors, etc. 7. Fire walls, ceilings, fire doors, draft stops 16. Heating system: Defective appliance, flue combustibles 8. Knox Box keys 17. Address posted and visible from road 9. Fire Drill Witnessed Yes ❑ No ❑ 18. Other (DETAILED EXPLANATION AND CORRECTIONS: CORRECTED: Date: Discussed with: Signed: (Print) ---. Inspecting Officer: Battalion 1 2 3; 4 5 6 7 Station: FPB FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION W11M CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: Ai ;tion Bureau Butte County Fire Rescue hite Copy - Business .:son Avenue California Department of Forestry Yellow Copy - Occupancy File iville, CA 95965 and Fire Protection Pink Copy - Station File ..elephone 530-538-7888 Facility Inspection Report Occ. Class. ,C_ c ax 530-538-2105 Address: ! Business Name: Dwiier/Mamger: j F� .� Bus: Hm: Fax: Assistant Manager: Bus: Hm: uildinQ (honer: Bus: Hm: AN JNCPF.C'TI(nN nF V01TR FAC H.TTV REVEALED TAE FOIJ,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 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: D�ate- / Discussed with: / f (Print) Signed: 15�7 -' /j/'; Battalion 1 2 3 4 15 6 7 Station: C ! FPB Inspecting Officer: tt Ui lr /A/ FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION WITH CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE: ATE OF CALIFORNIA %-- RE SAFETY INSPECTION RE(dvEST 1. 850 (REV. 10-94) See Instructions on reverse. AGENCY CONTACTS NAME TELEPHONE NUMBER REQUEST DATE PROGRAM OSS/COMMUNITY CARE LICENSING 530 895-5033 07/18/02 ALUATOR'S NAME REQUESTING AGENCY FACILITY NUMBER REQUEST CODE 301/KATHY BAKKE 045001285 1A CODES I. ORIGINAL A. FIRECLEARANCE LENSING DEPARTMENT OF SOCIAL SERVICES AGENCY 2. RENEWAL B. LIFE SAFETY AME AND COMMUNTIY CARE LICENSING 3. CAPACITY CHANGE DDRESS 520 COHASSET ROAD, SUITE 6 4. OWNERSHIP CHANGE CHICO, CA 95926 S. ADDRESS CHANGE L 6. NAME CHANGE 7. OTHER AMBULATORY NONAMBULATORY BEDRIDDEN TOTAL CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY 6 0 0 6 FACILITY NAME LICENSE CATEGORY E VIRONMENTAL ALTERNATIVES -NIGHTHAWK GROUP HOME GH/730 STI EET ADDRESS (Actual Location) NUMBER OF BUILDINGS 4'55 NIGHTHAWK WAY X 1 RESTRAINT C ICO, CA 95973 NO F LITY CONTACT PERSONS NAME HOURS R BIN COX -HENRY 530 345-1144 24 BUTTE CFD FIRE 'HOBBY 176 NELSON AVENUE WE AND OROVILLE, CA 95965-3425 DRESS L I C Cie S NAAi E ( yp*d.:r ':) TELEPHONE NUMBER T" -DATE INSPECTORS 1 DENIAL OR LIST SPECIAL CONDI' CFIRS NUMBER 3 OCCUPANCY CLASS ; . .- L I CLEARANCE /DENIAL CODE 1. FIRE CLEARANCE GRANTED 2. FIRE CLEARANCE DENIED A. EXITS B. CONSTRUCTION C. FIRE ALARM D. SPRINKLERS E. I-101ASEKEEPING F. SPECIAL HAZARD G. OTHER ! ,rALIFORNIA .. SAFETY INSPECTION. REQU-L.�,-T _ Z, 50 REV. 10-94 See- instructiOns on reverse. % AGEN Y ONTACT'S NAME TELEPHONE NUMBER REQUEST DATE PROGRAM / D S /C%k=ITY CARE LICENSING 530 895-5-033. 03/15/99 -EVAL' A OR'S NAME` REQUESTING AGENCY FACILITY: NUMBER REQUEST CODE 0::. /AY BAKKE 045000742 1A "CODES_ - 1. ORIGINAL A. FIRE CLEARANCE LI E SfNG`j� OF.,,SOCIAL SERVICES 2. RENEWAL B. LIFE SAFETY G _NCY CO MITY CARE -LICENSING LICENSING - N M =AND 3. CAPACITY CHANGE 520 COHASS T ROAD , SUITE 6A RESS�' 4. OWNERSHIP CHANGE CiIICO , CA. 95926 5. ADDRESS CHANGE 6. NAME CHANGE 7. OTHER " AMBULATORY' NONAMBULATORY BEDRIDDEN TOTAL. -CAPACITY CAAITY _ ..PREVIOUS CAPACITY CAPACITY PREVIOUS CAPACITY CAPACITY PREVIOUS - CAPACITY. _' 6 CODES 0 FIRE �� $�� LANE, SUITE � 6 1. FIRE CLEARANCE GRANTED THORITY , LICENSE CATEGORY o a SKYWAY HOM 2. FIRE CLEARANCE DENIED - 84730 . S, E ADDRESS (Actual Location) A. EXITS I NUMBER OF BUILDINGS 1211 SY.Y AY AVENUE - VENUE -C1 C. FIRE ALARM C11 Y � • �. .. -�.A � __. - ,. � � - - ...• -p D. SPRINKLERS RESTRAINT 'TIC09C 95926 CFIRS NUMBER OCCUPANCY CLASS No FA I TY CONTACT PERSON'S NAME HOURS VIAN WILKENSON (530) 345-1144 24 SF EC AL CONDITIONS .. .. .. .•, , ., . .,.... •, , , t . .., !. ., .. .Y- ; .. ... ... w.•J. .v.:: y... ...: Y •. •,•{ , • •,yh; • , }• .+...,; 'J: ' YJ: V ...., .. y. y.J . y., ....y ,.. • • y..; . . .. , :y,• :•'. `• :+r ..Jt•J y�2•�',.�hs •'w`'• •., \,�.},a:•. .t+,,..,.,{..�,;,; <,rr.r.,�, .c :, .. x..,.,. y �.,�f.;,.}y,....,1{,.;at•:'':+:a.: ,,$;y:x k f:^:...{... ..,. ,�. v�.,.,,h �, „{.. { ..,�.x.. \:;�{.��,,� ?.. .�;,. . ,, •,;.�,,{•�h'�.;,:.;{,•• , ?\ ,v "�k�h�wo\,;,, �y:• ,$^C{.; , tS,''•}'��:•�v'�� •J �,,2 },;. .;J. J. �!k' } � rr roY.. i•vJ .h.: JJ;:; ,:•, {:.,.;�Y.•..,.J{;;,,n;�,h, �� h �i}t .:;�,.;Jt;.Y,}k.:,� . #iF• „ �? ._. ., ;• . : �•'• ,�- . ,1,(l. {,:} ,3J} { • ::.{, • J �:JJ{x1},x { �•�•., � \ {,� ,,r J��••.. } �{)}� �• ht. 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JC21kk:,..vi.Jh+S, �++'•?i:. .�\:l'? n'{!{BF:L: •.: fr: C'}:7••r.•� { } J' +�}p „ . }M} J {�:' .: ��• \,' }h: ,,,\{. .a,• ., •r :w'• r.•':•..... 2ND REgUEST - CLEARANCE /DENIAL CODE. - _' CODES STATE TIRE DIARS11AL FIRE �� $�� LANE, SUITE � 1. FIRE CLEARANCE GRANTED THORITY , NME AND CHICO CA 95926 2. FIRE CLEARANCE DENIED - ADDRESS A. EXITS I B. CONSTRUCTION C. FIRE ALARM _' i.�� } - 1� S _ _ F '.1+--_ --y'. � .. '. '� .L•�-ire-'='i� � - - � � .. ' w � • �. .. -�.A � __. - ,. � � - - ...• -p D. SPRINKLERS 4.I S ECTOR'S NAME (.Typed or -Printed) TELEPHONE NUMBER CFIRS NUMBER OCCUPANCY CLASS E. HOUSEKEEPING F. SPECIAL HAZARD. NSrECTI N DATY INSPECTOR'S SI ICATU d or Printed) G. OTHER �D woo )I LAIN tENIA O LI T"SPECIAL CONDITIONS 1 I 'Office of the State Fire Marshal Fire Safety Correction Notice File No: ao - 01- ---! 7 Name: �f A • S�CYGys�-�✓ ! 7V�'R'iE Address: 101 59IW A�j A"V C -7 - SF � I CALIFORNIA STATE FIRE MARSHAL The California Health and Safety Code deficiencies be corrected. and the State Fire Marshal's regulations require the following fire safety I (�40M Crf 0,6 / IS f C CV -11 /5SC/C`6 ekle, 001 CIE- arofro-Azei67Z t The above deficiencies are to be corrected within =' days. When ALL deficiencies have been corrected, sign and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State Fire Marshal at ISSUED BY (Deputy State Fire Marshal) RECEIVED BY DATE EN -I I (Rev. 7/86) .' 89 88751 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field Am%, Office of the State Fire Marshal Fire Safety Correction Notice File No: _00- 04-4-7 Name: LA % Address: C_ SF I I CALIFORNIA STATE FIRE MARSHAL I The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety deficiencies be corrected. 0 10 Ar .4 +r CA- L F .Pr kJ :SWC -Cr ()tJ The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State Fire Marshal at ( ) ISSUED BY (Deputy State Fire Marshal RECEIVED BY DATE EN -11 (Rev. 7/86) 89 88751 DISTRIBUTION: GREEN—Facility WHITE—Region i YELLOW—Field E.A. CHICO Fax:343-1176 Jan 20 '99 14:16 Lf t. 400ic 1i P. 02 r ,/ E. A. CHICO Fax : 343-1 176 nn,Yf FIRE PROTECTION P.O. Box 1504 0 Paradise, CA 95967 1-800-417-0440 OLD ■ O A14? j L! t -*A I if & S rATF , 1 1 t Gr'r ► CASH CHG ti SYSTEMS SEAVICEU DRY C"SM. EXTIMQ UISHER SERVICED DpY CNEM. EXTINGUISHER SERVICED DAY CREM. EXTINGIUISHRR SERVICED DRY CHEM. EXTINGUISHEA SERVICED CWHALON EXTI4fiU15HEA SLRVICED WATER EXTINGUISHERS SERVICED HYDROSTATIC TESTS Joe) L8 S. CifEMICAL liv-m— Pmrr .� E Jan 20 '99 I4-:16 P.01 HOME DFP 2580 NOTRE UME BLVD. CHICO, CA 95920 (530)342-0477 6609 OwDs 80169 12/21/98 SALE It 439 0342 52 Pik r 2469 � - NEW 11 ANMAL CUSTOME. Pike SALESMAN GNATUPE PLE PAY FROM TH! INVOICE A VVILO E SENT To rros- N: 3 Day -131-1 me act 0;& late chimp of 1-V5% R,e r• muni h (10% per annum) .r . . Pil oil M511 of cxAleclioneuil-anattomey's fees. I TaTML mr1� e s&woo r► , 0 1 � t- )4 '. UA. 4A., v� � t.4:tiv � ��'� qS 0228 673.mtS"IN5 0. �CcPF, • '�`431%973996 GFQ PRI - f ••YM....r •••1_. .... 36-92 •�F —g=q' D301SIC07054- 75029 8163263 R' WW/*PF 5 2424 15429815325x3 e ` W/SPF S 2.2x4 'Lim 750299153263 S'W/SPF S 2»24 748254033657 S' WW/SPF' S 2.24 750298153263 S'%SPE S 2.24 150298153253 8 `WW/SPF S 2.24 750298153253 8' ItW/SPF S 2024 760298153253 8'bW/SPF S 7,24 7SO295163253 8' WW/SPF S 2.244 750290163253 BWAPF APF S 2.24 760299153253 B' WWI$ PF 5 2.24 750290153253 S O WS PF 5 2.24 750298153203 8' WW/SPF S 2.24 r 75G2981$3263 82Hof/SPF S 2.24 750298153253 8' iW/SPF S 2624 750299153263 8°W/SPF S 2.24 053608001.566 S70 PART 8 9,94 0536UH001566 5/8 PART 6 9.84 _ r•� , SUBTOTAL 174,19 .., 174.19 TAX OA 7.2250 12+63 • ^- • TOTAL 5186.82 60 21000670192249 DISCOVER 106 M 82 RUTH CODE 021122/0050697 TA sea I 6609 05 50169 12/21/98 89699 ORIGINAL RECEIPT REQUIRED FOR REFUND TUANK YOU FOR SHOPPING AT THE HOME DEPOT 'WAREHOUSE PRICES - DAV IN, DAY #TETT SALES t AX ON TaTML mr1� e s&woo r► , 0 1 � t- )4 '. UA. 4A., v� � t.4:tiv � ��'� qS 'age of No.:. () `L 0-1 of Facility: of Building: .,rfice of the State Fire Marshal INSPECTION REPORT 2A CL,�,o *FIRE HAL ck--, cL S'��x �� sri �R'' s�`*., g,�;g�{ppp��-%'� � ��J `3 � i tk . i� .�'� y {• }' ti%$.t �+f' ,_ s M-.�'Y';*� �0b 'x �i s iY y✓^a .. rf2 az r ,d ,dx.� r Accompanied ofi BATE y , ,{ds s cti STATUS .'�Y� `k tom' SLC- c,.( -►J� 2 �� (�- DEPlfT1(S ATE FIRE RSFIAL; DATE OF NLSPEGiION : tis a` yi ✓ } LE22'. ' TF.1`' y +t'SC p. R k ' �' pk 3 : �. , FIRE QEARANCE GWWTED �r �, r;T BATE y , ,{ds s cti STATUS .'�Y� `k DEPlfT1(S ATE FIRE RSFIAL; DATE OF NLSPEGiION : tis a` yi ✓ } LE22'. ' TF.1`' y +t'SC p. R k ' �' pk 3 : �. , -6 (Rev. 7/86) Page of -- FKf Office of the State fire Marshal � 0 INSPECTION REPORT STATE FIRE MA AL �I ile No.:. 00 - 04 - 47 _Q1 LL Q%30 9 Y9 -q me of Facility: SKYWAY GARDENS GROUP HOME ame of Building: dress: 721 SKYWAY AVE, CHICO, CA 95926 Discussed with: Title: Accompanied by: NO CONTACT __ ,r. Title: AN ANNUAL INSPECTION WAS ATTEMPTED TT THE ABOVE FACILITY. NO ONE WAS HOME, AN EN -12 WAS LEFT AT THE DOOR. NU CLEARMJCE GRANTED 7 -DATE STATUS F-9301 DEPUTY STATE W MARS M DATE Of VZ KCDON SLAUGHTER- # DEC 92 W - 6 (Rev. 786) i Jffice of the State Fire Marsha. INSPECTION REPORT No.:. 49 —.7-a4 -x11.4- — _ -QDQ-- — ---:,7-9 ne of Facility: SKYWAY GARDENS GROUP 14OMF ne of Building: cress: 771 Skjzwag Ai.P_ __— Discussed with: Title: Accompanied by: Robin Tide: Owner +ar -%4 STATE. FIRE MARSHAL COPY DISTRIBUTION: ' FIRSAFETY INSPECTION REQUE.'1 13 -STATE FIRE MARSHAL 2 -FIRE AUTHORITY, STD 840 (REV. 8/86) 4 -5 -LICENSING AGENCY SEE REVERSE OF COPIES 2 AND 5 FOR ,INSTRUCTIONS FOR COMPLETION 1. REQUEST DATE 12. PROGRAM 1 3. AGE CY CONTACT 4. TELEPHONE NO. 5. EVALUATOR D S/Community Care Licensing 1(916) R95-9flii I (171 n/Mario qm4 f -h S. SFM REGION 7. SFM I.D. NO. S. REQUESTING AGENCY FACILITY NO. 9. REQUEST CODE f 3:30 0413739 1A CODES 1. ORIGINAL A. FIRE CLEARANCE STRUCTURED ENVIRONMENT. -' FOR CHILDREN 2. RENEWAL B. LIFE SAFETY F_ 3. CAPACITY CHANGE Community e Car Licensing 4.OWNERSHIP CHANGE 10. AG NCY 520 C o h a s s e t R d•,# 6 S. ADDRESS CHANGE NA E Chico, CA 95926 6. NAME CHANGE AN PREVIOUS NAME ADDR SS � _j7. OTHER DATE OF ORIGINAL REO. 11. AM 3U ATORY NONAMBULATORY TOTAL CAP. DATE OF LAST FIRE CLEARANCE CAPAC IT AGE RANGE IVEARSI PREVIOUS CAPACITY ArE RANGE (YEARS) PREVIOUS TO 18 IS TO 65 AND CAPACITY TO 18 18 TO 65 AND CAPACITY 19. FACILITY 6 X 65 OVER 06 65 OVER CODE 730/group home 12. FA IL TY NAME 13. NO. BLDGS CODES S WAY GARDENS GROUP HOME 1 1. GACH 7. ICF/OT 2. GACH/R 8. ICFIDD 14. ST E T ADDRESS (ACTUAL LOCATION) P.O. BOX 13. RESTRAINT 7 ! Skyway Ave, no 3. SH 9. ADHC 4. APH 10. CLINIC CITY ZIP CODE 16. HOURS C co, Ca 95928 24 5. PHF 11. JAIL 6. SNF 12. ICF / DDN 17. FA IL TY CONTACT PERSON TELEPHONE NO. 16A. SPECIAL R in Cox - Administrator 916 343-2988 13. OTHER TO BE COMPLETED BY INSPECTING AUTHORITY 26. CLEARANCE CODE 18. FI Jack Pirisky, State Fire Marshal AUHR #4 Williamsburg Ln., Suite A CODES NA WE Chico, C A 95926 1. FIRE CLEAR, GRANTED AN3 2. FIRE CLEAR, DENIED ADDRESS LI J 3. FIRE CLEAR, WITHHELD 27. DENIAL CODE TO BE COMPLETED BY INSPECTING AUTHORITY CODES 21. INSPECTOR'S NAME TELEPHONE NO. 22. CFIRS 23. T-19 OCC. ID NO. CLASS ' 1. EXITS 2. CONSTRUCTION 24.1TE 2S. SPEC R' SI ATURE 3. FIRE ALARM VL a4. SPRINKLERS 28. E L IN ENI L OR LIST SPECIA ONDITIONS 5. HOUSEKEEPING 6. SPECIAL HAZARD T. OTHER , STATE FIRE MARSHAL USE ONLY R RN TO; f F 20. RE ION. Community Care Licensing _ OF ME 520 Cohasset Rd.,#6 AN Chico, CA 95926 AD R ESS I J Urfice of the State Fire Marshal INSPECTION REPORT Fi a No.:. — i — — �--�, Name of Facility: < N ame of Building: A rens. � vk - 61 (Rev. 7/86) i CLEA T-DATf STATUS [mr STATE W AMRS 4 DATE OF NLSPEC110N ' vk - 61 (Rev. 7/86) i Office of the State fire Marshal REGIONAL FACILITY FILE CHANGE -NOTICE blame Collection/Change I Address Correction/Change ❑ Change File Number ❑ facility Discontinued ' Issue File Number ❑ Other a OLD Nt Address: Name: City:* ounty: (No. ) Name: c. Address* - 21 � -4 s : Cit LI City: County: yz:,tk,331L(No. Fi a No.: _ — _ —_. — lmmwwm-4-now File No.:..—.. — �... 0 cu anc Class: p y T•24 SFM RE Oc n Class: .. � T•24 SFM FU Comments: a O"�e of the State Fire Marshal � FACILITY BUILDING RECORD dFKtQ,. STATE FIRE MA HAL Faci ity� Name: �`� �'� 7 vP��1,�1�Cup i4e-vLtE�.�. c(J �i!1 0I NU I FM G �o • BUILDING ..: t. No1I"';f-ssS!y"tv f1 .. Y s , t .`"� '<� ' e� + �9h z b�Il.hi�V IVAIVlE +L` `'.k s�,Z PN t t� r r. + r s , f41 t s; ., ,r ..�. < 4� ('[ ..t # V4 Vt� r , t,+ ,_� G: f �,•.+ } i Rx .+ 1 ;` f` r 7 • . +5 �7 t + ,c • t t t 1 s r :t +•!,R �` t +' e'',' t: F �':.}, yi:..•� ki)' '. R,f i +. , j¢�. •h',�r >i`,>Y1: !,�` + ;.,/,:�i'.e...<'�- �•'. 1,24 OCCUPANCY ,.� ►SSIFICATION FILE r t. .,�.'►; .,. . age 1 of 2jP CF"�,, %..dfice of the State Fire Marshal BUILDING SURVEY REPORT STATE FIRE MA AL File No.: lame � of Facility: Jame of Building: Address: �IZ1. � �iLlly� t.� �UE_ @AktcU 5eCZ-�v t: Telephone No.: Telephone No.: ( ) :; .,�i.: r• wti'v:<.' bi: �•41^r•�,.:, �. �{f ,t_ ... ,.�". l -i s- t /• '<K` 'a...' `+".> -.ter f <v'.,. + a� yi .T•. ..4 ... V f -'\<'.. V+t 'T..'• 7y ! :•l,Crf :r+ i.. .w. 4'M 1. Occupancy rynr w CAPACQj 2. Construction Type �• NC� .:. YEAR b 3. Area (Sq. Ft.) TOT � � � LARGEST FLOOR BASEMENT N 4. Stories NO. HEIGHT HIGH RISE YES NO Sa. Exterior Wall Construction WS _, Y 6 LAJ b. Opening Protection -Z � � � ..�, ` 6. Interior Wall Construction - lam- �6, L,)f-D-, =' 7. Floor Construction`re—Aw 8. Roof Construction � .�'• � �� - � ��,...�--� � �9. Attic Draft Stops NO. TOa. Occ. Sep. Wall Construction NO. b. Opening Protection 111a. Area Sep. Wall Construction No. b. Opening Protection 1 Fa. Smoke Barrier Wall Construction NO. b. Opening Protection 1 1 3a. Corridor Wall Construction b. Opening Protection ! 14a. Corridor Ceiling Construction b. Opening Protection 16a. Shafts No. TY b. Opening Protection 1 a. Stair Enclosure No. b. Opening Protection (Rev. 786) 1 88 50878 i ) �, 2 Nae of Eacifity: g File No.. _. ._ i Buildinh �rvey Report (GO -4) Page 2 of 2 i CTAT a f;: > 'r ee : t . , I *PCO. ATTAQW84TS ' ) - ) - `.�. � ), y •� SKr• } .�. \ �, • • :� � •Y � •�� By - .R •, •^ } .^ice: �( R "� GY DAT GO -0 (Rev. 7/86) Item Comm ) Description 7J Stairs No. 8. Ramps NO. 9. Interior Finish Class ROOM COR EXIT ENCLOSURE 0. Exits NO. TOTAL WIDTH 1. Exit Hardware Type &�j J ,22a. Exit SignsAllumination . Emergency Lighting B. Auto Sprinkler Coverage 4. Standpipes Class/Location 5. Fire Alarm Type/Coverage y �Vuc L 6. Heating, Ventilation and Air Conditioning r FUEL 7. Electrical Installation � _..._ �` �.�-� 8. Stage/ Platform 9. Hazardous Areas Other CX MMENTS: i CTAT a f;: > 'r ee : t . , I *PCO. ATTAQW84TS ' ) - ) - `.�. � ), y •� SKr• } .�. \ �, • • :� � •Y � •�� By - .R •, •^ } .^ice: �( R "� GY DAT GO -0 (Rev. 7/86) /Omll� e"K�