HomeMy WebLinkAbout04-3411 (3) STATE OF CALIFORNIA 278192
DEPARTMENT OF FORESTRY AND FIRE PROTECTION
NOTICE OF DEFENSIBLE SPACE INSPECTION 4.
LE-100 (NEW-5/2006) --
NOTICE OF DEFENSIBLE SPACE INSPECTION
THIS 1S 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 1.,LAST) 2. INSPECTOR'S TITLE_.._ 3.BADGE NUMBER.rt-..4. INSPECTOR'S AGENCY_ 5. INSPECTION DATE
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6. , 7. UNIT ID 8. BATTALION NUMBER 9. STATION NUMBER
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PROTECTION RESPONSIBILITY SRA LRA FRA 7 Z ' z (
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BEA 0 0 ❑ 10.AP BOOK 11.AP PAGE 12.AP PARCEL#
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CAL FIRE ❑ 0
Contract County ❑ 0 13. LATITUDE (Datum=WGS84) 14. LONGITUDE (Datum=WGS84)
USFS ❑ ❑ ❑ (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: ❑ and write complete address in comments section.
16. NAME(LAST, FIRST)
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0 17. AI o -5 y 9/ac5 1-11
o- 18. CITY 19.STATE ; 20. ZIP
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Z 21. PHONE NUMBER #1 22. PHONE NUMBER 42 - 23_ E-MAIL ADDRESS
24. COMMENTS: T- -
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IF YOU HAVE QUESTIONS CONCERNING THIS INSPECTION NOTICE, CALL THIS PHONE NUMBER:
25. i 26. IN PECTIC{# 1 27. CITATION# 28. FOLLOW-UP INSPECTION DATE:
VIOLATION REINSPECTION? ❑ 0 0 0 ❑
❑ YES ❑ NO I 1 2 3 1 2 3 (aMSW)D/YYYY) ❑ NIA
3 Alternative practices approved having same practical
29_ No violations observed_
eck if applicable) ACTIONS TAKEN
effect. See comments section above(14 OCR 1299{c} eft information material
{check if applicable) 31.
Discussed clearance with resident
32. •
Left copy of this inspection notice
IV.,..,_Violations were observed. Additional clearance is needed for the following areas: ' ❑ Citation issued
(check applicable sections) 0 Recommend citation to prevention
0 30 foot zone, PRO 4291(a): 14CCR 1299(x)(1) ❑ Grass ❑ Brush 0 Trees ❑ Shrubs 133. GENERAL BUILDING
❑ Reduced Fuel Zone(30'-100')PRC 4291(b); 1400R1299(a)(2) 0 Grass 0 Brush ❑ Trees 0 Shrubs CONSTRUCTION TYPE
E
❑ Remove specific hazardous fuel identified by inspector- 14CCR 1299(b) ❑ Wood Siding
❑ Dead and dying woody surface fuels- 14CCR1299(d) ❑ Wood Roof
919,7, Non-combustible siding
❑ Remove portion of any tree that extends within 10 feet of the outlet of a chimney or stovepipe PRO 4291(c) le Manufactured (Mobile) Home
0 Metal
❑ Maintain any tree adjacent to or overhanging a building free of dead or dying wood-PRC 4291(d)
❑ Concrete/Block
❑ Maintain the roof of a structure free of leaves, needles,other dead vegetation-PRO 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 bums 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. PRO 4291(f) {
34.
FOR ADDITIONAL INFORMATION ON HOW TO COMPLY WITH DEFENSIBLE SPACE CL RANCE REQUIREMENTS, PLEASE VISIT: i
WWW.FIRE.CA.GOV I