HomeMy WebLinkAbout03-1213 CAL FIRE LE 100 (2) STATE OF CALIFORNIA 328 4 5 2
DEPARTMENT OF FORESTRY AND FIRE PROTECTION
NOTICE OF DEFENSIBLE SPACE INSPECTION
LE-100 (NEW-5/2006)
NOTICE OF DEFENSIBLE SPACE INSPECTION
THIS IS A LEGAL NOTICE OF FIRE HAZARD VIOLATIONS (IF NOTED IN BLOCK 32)
SHADED BOXES MANDATORY-ALL OTHERS OPTIONAL
1.INSPECTOR'S FULL NAME(FIRST,M.I.,LAST) 2.INSPECTOR'S TITLE 3. BADGE NUMBER 4.INSPECTOR'S AGENCY 5.INSPECTION DATE
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6. ` 7. UNIT ID 8. BATTALION NUMBER 9. STA N NUMBER
PROTECTION RES N IBI'LITY SRA LRA FRA
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BIA 0 0 ❑ 10.AP 1800K 11.AP PAGE 12.AP PARCEL
BLM ❑ ❑ ❑ 9/ % / v 61
CAL FIRE i ❑ ❑
Contract County ❑ ❑ 0 13. LATITUDE (Datum=WGS84) 14. LONGITUDE (Datum=WGS84)
USFS 0 0 0 (Decimal Degrees;ex:38.5761) (Decimal Degrees;ex: 121.4969)
Other 0 0 0
15.
If mailing address for notices is other than inspection location,check here:,0 and write complete address in comments section.
16. NAME(LAST,FIRST)
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0 18.CITY k 19. TATE 20.ZE9 /
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21. PHONE NUMB R #1 22. PHO^NENUMBER •2 23. E-MAIL ADDRESS
24.COMMENTS:
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IF YOU HAVE QUESTIONS CONCERNING THIS INSPECTION NOTICE, CALL THIS PHONE NUMBER:
25. 26. INSPECTION# 27. CITATION# 28. FOLLOW-UP INSPECTION DATE:
VIOLATION REINSPECTION? 0 0 0 0 0 0
❑YES p NO 1 2 3 1 2 3 (MM/DD/YYYY) 0 N/A
31.
29. 0 No violations observed. 30. 0 Alternative practices approved having same practical ACTIONS TAKEN
effect. See comments section above(14 CCR 1299(c)
(check if applicable) (check if applicable) 0 Left information material
❑ Discussed clearance with resident
32.
0 Left copy of this inspection notice
0 Violations were observed. Additional clearance is needed for the following areas: ❑ Citation issued
(check applicable sections) ❑ Recommend citation to prevention
0 30 foot zone,PRC 4291(a); 14CCR 1299(a)(1) ❑Grass 0 Brush 0 Trees 0 Shrubs 33.
GENERAL BUILDING
O Reduced Fuel Zone(30'-100')PRC 4291(b): 14CCR1299(a)(2) 0 Grass 0 Brush 0 Trees 0 Shrubs CONSTRUCTION TYPE
O Remove specific hazardous fuel identified by inspector- 14CCR 1299(b) 0 Wood Siding
Dead and dying woody surface fuels-14CCR1299(d) ❑ Wood Roof
ANon-combustible siding
❑ Remove portion of any tree that extends within 10 feet of the outlet of a chimney or stovepipe PRC 4291(c) 0 Manufactured(Mobile)Home
0 Maintain anytree adjacent to or overhanging a buildingfree of dead or dying wood-PRC 4291 d H
Metal 1 9 9 Y 9 { ) Concrete/Block
❑ Maintain the roof of a structure free of leaves,needles,other dead vegetation-PRC 4291(e) ❑ Other
❑ Provide and maintain at all times a screen over the outlet of every chimney or stovepipe that is attached to
a fireplace,stove,or other device that burns any solid or liquid fuel. The screen shall be constructed of Deck Present 0 YES NO
nonflammable material with openings of not more than one-half inch in size. PRC 4291(f)
34.
FOR�NAL INFORMATION ON HOW TO COMPLY WITH DEFENSIBLE SPACE CLEARANCE REQUIREMENTS, PLEASE VISIT:
WWW.FIRE.CA.GOV