HomeMy WebLinkAboutP2022-0068 - CalcsState Fire Marshall
Fire Safety Inspection Request STD 850
3. Agency Contact
Department of Social Services
1. Request Date
4. Telephone
(714) 703-2800 Fax (714) 703-2831
-00
2. Program
CCL
5. Evaluator
K. DESAIANT 714-743.8635 AE505
ketki.desai(oddss ca oov
6. SFM Region
7. SFM I.D. #
T8.Facility #
9. Request Code
370
371564
1A
10, Response Required
Codes
1. Original A. Fire Clearance
Department of Social Services
2. Renewal B. Life Safety
Community Care Licensing
3. Capacity Change
750 The City Drive #250
4, Ownership Change
Orange, CA 92868
5. Address Change
6. Name Change
NOTE: PRESCHOOL= 42 (AGES 2-6)
7. Note
TOTAL CAPACITY= 42
CLASSROOM 1, CLASSROOM 2 & CLASSROOM 3
Hours: Monday -Friday 7:00am-6:00pm
Date of Original Request:
11. Ambulatory
Non-ambulatory
Total Cap.
Last Fire Clearance Date
Capacity
Medical
Prev.Cap
Capacity
Medical
Prev.Cap
CNo 7
Carel
42
1g
0
No
0
42
18. Facility Code -16 - CCC
12. Facility Name
MONTESSORI WAY LEARNING CENTER, INC.
13. # of Bldgs.
1. GACH 9. ADHC
1
2. GACH/R 10. Clinic
3. SH 11. Jail
14. Street Address (Actual Location)
15. Restraint
2401 IRVINE AVENUE
NONE
4. APH 12. ICF/DDN
5. PHF 13. RCF
6. SNF 14. CCF
7. ICF/OT 15. DAF
City
NEWPORT BEACH, CA
Zip Code
92660
16. Under
24 HRS.
17. Facility Contact Person
Telephone #
16a. Special
MADAGANGODA, SHAMALEE
714-318.2174
NONE
8. ICF/DD 16. Other
To Be Completed by Inspecting Authority
Clearance Codes
Inspector's Name
Telephone #
CFIRS ID#
T-19 OCC
1. Fire Clear/Granted
Nadine Morris
949-644-3105
30055
E
2• FireCleadDenied
3. Fire ClearMithheld
Inspection Data
Inspector's Signature
Clearance Code
05/26/2022
IV U,t
1. Fire Clearance Granted
Explanation of Denial or Special Conditions:
Denial Code
Fire Agency
Denial Codes
NEWPORT BEACH FIRE PREVENTION BUREAU
1.E>ots
2.Construct.
100 CIVIC CENTER DR.
3.Fire Alarm
NEWPORT BEACH, CA 92660
4.Sprinklers
ATTN: NADINE MORRIS
S.Housekeeping
6.Special Hazard
IIUlorrisna new nortbeachca.cov
7.01her
STALE OF CALIFORNIA -HEALTH ANO HUMAN S R ICFA AOEN',
FACILITY SKETCH (Floor Plan)
CALIFORNIA OEPA COMMUNITYCARE
L LICENSING
Applicants are required to provide a sketch of the floor plan of the home or facility and outside yard. The floor sketch must label rooms
such as the kitchen, bath, living room, etc. Circle the names of the rooms that will be used by staff/msidents/difents/children. Door and
window exits from the rooms must be shown in case of an emergency (see Emergency Disaster Plan). Show room sizes (e.g. 8.5 x
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COMMUNITY CARE LICENSING
FACILITY SKETCH (Yard)__
The yard sketch should show all buildings in the yard including the home (With no detail), garage and storage -building.
Include walks, driveways, play area, fencers, gates. Show any potential hazardous area such as pools, garbage storage,
animal pens, etc. Show the overall yard size. Try to keep the sizes close to scale. Use the space below.
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Existing Site Plan -,' 61.1w. I%W.O*