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2. ATTENTION HOME-BASED BUSINESS OWNERS:

   If you operate your business out of your home and do not use any hazardous materials as part of your business, please go to the Fire Prevention page and complete the HOME-BASED BUSINESS CERTIFICATION FORM. Once we receive this form we will update our records and remove your business name from our self-inspection list.

4. BUSINESS OWNERS - Answer all questions below.

   This inspection pertains to your suite or space only and does not include any area in common with other tenants or with the building owner with exception of the fire sprinkler system. If any item that is the landlord’s contract responsibility is not in compliance, please contact the landlord to make repairs.  Repairs must be corrected before submitting the completed inspection.

   NOTE: If it is determined that your business is a high-hazard occupancy (poses a risk due to fire, explosion, toxicity, potential for a high loss of life, etc.), a physical inspection will be conducted by the Fire Department. Please complete the self-inspection and submit the processing fee, the processing fee will be applied towards the inspection fee after the fire department completes an inspection. Fees will be charged in accordance with W.M.C 8- 9.106.5.9.

6. BUSINESS NAME*
7. BUSINESS TYPE*
9. BUSINESS ADDRESS*
10. BUSINESS PHONE #*
11. BUSINESS LICENSE #*
13. BUSINESS OWNER NAME*
15. BUSINESS OWNER PHONE*
16. BUSINESS OWNER EMAIL*
18. EMERGENCY CONTACT NAME*
19. CONTACT PHONE #*
21. PROPERTY OWNER NAME*
23. PROPERTY OWNER PHONE*
24. PROPERTY OWNER EMAIL*
26. Address numbers for the building are visible from the street.*

    The address numbers must be 4 inches in height with a minimum width of 1/2 inch in a contrasting color to the building.

    Where access is by means of a private road and the building cannot be viewed from the public way, a monument, pole, or other sign or means shall be used to identify the structure.

    1. Yes
    2. Address numbers for the building are now 4 inches in height and a contrasting color to the building.
28. The exterior fire department access is unobstructed.*

    1. Yes
    2. The exterior fire department access is now unobstructed.
30. My building has a KnoxBox.*

    If yes, the keys should open all doors. If locks have been changed, contact the fire department to install the new keys.

    What is a KnoxBox?

    A Knoxbox is a safe, tamper-resistant lock box that can hold keys, access cards, or other important items needed for emergency entry.  Fire Departments have a master key that lets them quickly open these boxes without having to break any windows or doors.

    1. Yes
    2. I've contacted the fire department.
    3. I don't have a KnoxBox.
32. Combustible vegetation (weeds) are removed so as not to create a fire hazard.*

    1. Yes.
    2. Combustible vegetation has been removed.
    3. There is no combustible vegetation surrounding the business.
34. There is a minimum 3' clearance around fire hydrants.*

    1. Yes
    2. A minimum of 3' clearance has been created around fire hydrants.
    3. There is no fire hydrant on the business property.
36. The exit doors are unlocked during business hours, and operable from the inside without the use of a key or special knowledge.*

    1. Yes
    2. The exit doors have been corrected to remain unlocked during business hours, and operable from the inside without the use of a key or special knowledge.
38. Exit ways and doors are easily recognizable, unobstructed, maintained, and functional.*

    If the main exit door has key-locking hardware there should be a sign above the door that states "THIS DOOR MUST REMAIN UNLOCKED WHEN BUILDING IS OCCUPIED."

    1. Yes
    2. The main exit door is unobstructed and now has a sign that states "THIS DOOR MUST REMAIN UNLOCKED WHEN BUILDING IS OCCUPIED."
40. Exit signs are fully illuminated in the normal and backup modes.*

    1. Yes
    2. Exit signs have been corrected to fully illuminated in the normal and backup modes.
42. Access to all exit doors, corridors, hallways, and stairways are clear of obstruction.*

    1. Yes
    2. Access to all exit doors, corridors, hallways, and stairways has been corrected to being clear of obstruction.
44. If the building is equipped with a fire alarm, the required annual service of the fire alarm system has been performed by a certified alarm company.*

    1. Yes
    2. The building is equipped with a fire alarm, and the required annual service of the fire alarm system has been performed by a certified alarm company.
    3. The building is not equipped with a fire alarm system.
46. The sprinkler system has been inspected at least once in the last year.*

    1. Yes
    2. The business does not have a sprinkler system.
48. If YES: Date of annual inspection. Traditionally found on sprinkler riser.

    Must be completed if you marked YES on the above question. 

    A sprinkler riser is a vertical pipe that connects the underground water supply to the overhead fire sprinklers in the building. Please contact property manager if the business has sprinklers and you are unable to locate the riser.

    

    
    

50. The sprinkler has been tested by a licensed contractor at least once in the last 5 years.*

    1. Yes
    2. The business does not have sprinklers.
52. Upload 5yr Sprinkler Sticker. Traditionally found on sprinkler riser.

    Must be completed if  you marked YES on the above question.

    

54. All electrical outlets, switches, and junction boxes are covered with proper cover plates.*

    1. Yes
    2. All electrical outlets, switches, and junction boxes have been corrected to proper cover plates.
56. The electrical panel is clear of clutter at least 30 inches in all directions.*

    1. Yes
    2. The area in all directions of the electrical panel have been cleared at least 30 inches in all directions.
58. Circuit breakers in panels are labeled to identify the area protected*

    1. Yes
    2. All circuit breakers in panels have been corrected to be labeled to identify the area protected.
60. Extension cords are used ONLY for powering portable appliances, such as a fan, radio or power tool*

    1. Yes
    2. All extension cords are now corrected to be used only for the temporary powering of portable appliances, such as a fan, radio or power tool.
    3. No extension cords are used in the business.
62. Power strips, with a built-in breaker, are plugged directly into approved electrical outlets only and not into another power strip*

    1. Yes
    2. Power strips, with a built-in breaker have been corrected to be plugged directly into approved electrical outlets only and not into another power strip.
    3. NO power strips are used in the business.
64. Portable electric space heaters plugged directly into wall outlets and operated a minimum of 3 feet away from combustibles*

    1. Yes
    2. Portable electric space heaters have been corrected to be plugged directly into wall outlets and operated a minimum of 3 feet away from combustibles.
    3. No portable heaters are used in the business.
66. Water heater(s) have a seismic restraint.*

    1. Yes
    2. Water heaters have been corrected to have seismic restraints.
    3. There is no water heater in the business.
68. All removable ceiling tiles and fire barriers in place.*

    This allows the ceiling to act as a heat collector for fire protection systems and to prevent the passage of smoke and fire.  Sheetrock serves as a fire barrier and should be intact.

    1. Yes
    2. All removable ceiling tiles and fire barriers have been repaired/replaced.
70. There are an adequate number of required type and kind of fire extinguishers*

    Please contact a local fire extinguisher servicing company to service any outdated extinguishers and confirm your business is current with the fire code.

    1. Yes
    2. An adequate number of required type/kind of fire extinguishers are now in place.
72. The pressure gauge of the fire extinguisher is in the operable (green) range*

    1. Yes
    2. The gauge of the fire extinguisher is now in the operable (green) range
74. The fire extinguisher(s) has been inspected and tagged to indicate a current annual inspection.*

    1. Yes
    2. The fire extinguisher(s) were inspected and tagged to indicate a current annual inspection
    3. The fire extinguisher(s) inspection tag is replaced with a receipt taped to the extinguisher indicating it was purchased within the last year.
76. Date on tag OR Date of Purchase*

    

79. The fire extinguisher(s) are properly mounted to a stable structure -- visible, accessible, and ready for use. Free standing is NOT acceptable. *

    Extinguishers must be mounted no higher than 5 feet and no lower than 3 feet measured from the top of the extinguisher.

    1. Yes
    2. The fire extinguishers have been properly mounted to a stable structure.
81. Compressed gas cylinders, such as oxygen, acetylene, argon, nitrogen, and nitrous oxide, secured to a fixed structure or on carts to prevent them from falling*

    1. Yes
    2. Compressed gas cylinders, such as oxygen, acetylene, argon, nitrogen, and nitrous oxide, are now secured to a fixed structure or on carts to prevent them from falling.
    3. There are no compressed gas cylinders in the business.
83. Provide the name of the compressed gas and the quantity of each.
85. Flammable liquids stored properly. *

    A quantity of 10 gallons or less of flammable liquids is allowed to be stored outside of a flammable cabinet when in approved containers. 

    1. Yes
    2. Flammable liquids have been measured and are now stored properly.
    3. There are no flammable liquids in the business.
87. Boiler rooms, mechanical rooms, and electrical equipment rooms clear of all combustible materials.*

    1. Yes
    2. Boiler rooms, mechanical rooms, and electrical equipment rooms are now clear of all combustible materials.
89. Storage is maintained 2 feet or more below the ceiling in non-sprinklered areas of the building and 18 inches ore more below sprinkler head deflectors in sprinklered areas of the building.*

    1. Yes
    2. Storage has been cleared and is now maintained 2 feet or more below the ceiling in non-sprinklered areas of the building and 18 inches or more below sprinkler head deflectors in sprinklered areas of the building.

91. By signing this form, you are certifying that you have checked your business for all the above listed items; declare your business safe for all occupants; and that there are no fire code violations.

    Thank you for your cooperation. Completion of this form does not eliminate all fire inspections conducted by the Watsonville Fire Department.

93. Name*
94. Email Address
95. Phone Number*
97. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
99. Electronic Signature*
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103. 1. Receive an email copy of this form.
104. Email address

     This field is not part of the form submission.

105. Submit Submit and Print

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