HomeMy WebLinkAbout04-2809D (2) STATE OF CALIFORNIA 270562
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 5.1INSPECTION DATE
6. 7. UNIT ID 8. BATTALION NUMBER 9. STATION IUMBER
PROTECTION RESPONSIBILITY SRA LRA ERA F7riA.
(2 ,
BIA ❑ ❑ ❑ 10.AP BOOK 11.AP PAGE 12.AP PARCEL#
BLM El
CAL FIRE ❑ Ei Z .3 q C�
Contract County El El13. LATITUDE (Datum=WGS84) 14. LONGITUDE (Datum=WGS84)
USFS ❑ ❑ ❑ (Decimal Degrees;ex:38.5761) (Decimal Degrees;ex: 121.4969)
Other El El El
15.
If mailing address for notices is other than inspection location,check here: ❑ and write complete address in comments section.
16. NAME(LAST FIRST)
w 17.ADDRESS,
Lau_ 18.CITY 9 r..- /t✓'!�%l.t Pv
19.STATE 20.ZIP
4 CA
z 21. PHONE NUMBER #1 22. PHONE NUMBER #2 23. E-MAIL ADDRESS
24. COMMENTS:
i3 0 - 9.
IF YOU HAVE QUESTIONS CONCERNING THIS INSPECTION NOTICE, CALL THIS PHONE NUMBER:
25. 26. I PECTION# 27. CITATION# 28. FOLLOW-UP INSPECTION DATE:
VIOLATION REIN PECTION? El El El ❑ XN/A
ElYES NO 1 2 3 1 2 3 (MMIDD/YYYr)
31.
30. ❑ Alternative practices approved having same practical
29.` No violations observed. ACTIONS TAKEN
/� ''��(check if applicable) effect. See comments section above(14 CCR 1299(c)
(check if applicable) Left information material
4L�J Discussed clearance with resident
32. 4vrg Left copy of this inspection notice
❑ Violations were observed. Additional clearance is needed for the following areas: Citation issued
El(check applicable sections) Recommend citation to prevention
El 30 foot zone, PRC 4291(a); 14CCR 1299 a 133.
OO ElGrass ❑ Brush ❑ Trees ❑ Shrubs GENERAL BUILDING
❑ Reduced Fuel Zone(30'-100')PRC 4291(b); 14CCR1299(a)(2) ❑Grass ❑ Brush ❑Trees❑Shrubs CONSTRUCTION TYPE
El Remove specific hazardous fuel identified by inspector-14CCR 1299(b) �J Wood Siding
❑ Dead and dying woody surface fuels-14CCR1299(d) ❑!Wood Roof
❑ Non-combustible siding
❑ Remove portion of any tree that extends within 10 feet of the outlet of a chimney or stovepipe PRC 4291(c) ❑ Manufactured (Mobile)Home
❑ Maintain any tree adjacent to or overhanging a building free of dead or dying wood-PRC 4291(d)
❑ Metal
❑ Concrete/Block
El Maintain the roof of a structure free of leaves, needles,other dead vegetation-PRC 4291(e) El Other
El Provide and maintain at ail 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❑ YES [(NO
nonflammable material with openings of not more than one-half inch in size. PRC 4291(f)
34.
FOR ADDITIONAL INFORMATION ON HOW TO COMPLY WITH DEFENSIBLE SPACE CLEARANCE REQUIREMENTS, PLEAS •
WWW.FIRE.CA.GOV