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Cust # <br /> STOCKTON FIRE DEPARTMENT • FIRE PREVENTION DIVISION <br /> ' 345 NORTH EL DORADO STREET • STOCKTON , CA 95202 • (209 ) 937 -8271 <br /> ANNUAL FIRE INSPECTION <br /> BUSINESS NAME ,% I:1 / zoS / Ss/irler IAb ADDRESS : r.� � .� CF' "/ % Gi�.� Ste # _ <br /> STOCKTON BUS LIC : ❑ Yes ❑ No 2-Lic # ,& -ri'/J /C: 5aV?3/ FIRE PERMIT CERTIFICATE : [:] Yes ❑ No ❑ N/A <br /> BUSINESS OWNER / REP <br /> / / 'S �U1/dc(1 /NC PHONE: .S �r &. /oJ� 3 /�t� Ca'e; v . .i A. <br /> f // ,r // ' � ' � � ^-" <br /> CELL PHONE : EMAIL ADDRESS : <br /> DATE OF INSPECTION : _ 2nd Inspection Code Compliance _ <br /> HAS INFORMATION CHANGED? ❑Yes ❑ NO <br /> OCCUPANCY INFORMATION (Check Business Type) <br /> ❑ A - Place of Assembly ❑ KNOX BOX ❑ FACP ❑ See attached FD- 18 B <br /> Occupancy Load Current Keys ❑ YES ❑ NO "Normal" ❑ YES ❑ NO <br /> Annual Service ❑ YES ❑ NO <br /> ❑ R-1 HOTEL ❑ R-2 RESIDENCE 171 FIRE ALARM SPRINKLER ❑ OTHER <br /> Number of Units Monitored ❑ YES ❑ NO Annual [:] YES ❑ NO Date_ <br /> Number of Units Checked Company , 5-Year ❑ YES ❑ NO Date <br /> Unit # Inspected <br /> LIST OPERATIONAL FIRE PERMIT(S <br /> Permit Type Required Permit Type Required Permit Type Required <br /> T� <br /> NOTICE OF VIOLATION : Number corresponds with violation (s ) on back of this form : <br /> 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 <br /> A : Electrical <br /> B : Special Hazards <br /> C : Ext / Fire Protection System <br /> D : Exiting <br /> E : General Housekeeping <br /> CFC Sec. 105 Permit(s) Needed <br /> Initial Inspection . . . . . . . . . . . . . . . . . . . . . . ❑ No Hazards Noted ❑ Violation (s) Noted Reinspection date: <br /> Second Inspection . . . . . . . . . . . . . . . . . . ❑ Violation (s) Corrected ❑ Violation (s ) not Corrected : Reinspection date: <br /> Third Inspection ' . , , . , . , . , , , . , ' . . . , . . ❑ Violation(s) Corrected ❑ Violation(s) not Corrected : Notify FPD date : <br /> J' 7 AW, rrTi�i ir.'r <br /> Inspector �r��.�/� , ' �%` ID Unit . Shift : Contact Phone # -j <br /> Responsible Signature : Date: <br /> White Original - Fire Prevention ■ Yellow Copy — Co File FPD Office use <br /> Database <br /> Scan/SharePoint <br /> Firehouse <br /> FD- 18 Revised 08- 19- 19 <br />