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HomeMy WebLinkAbout05-2980 CAL FIRE LE 100 (2) . "STATE OF CALIFORNIA �;.._ �2f..d4 DEPARTMENT OF FORESTRY AND FIRE PROTECTION NOTICE OF DEFENSIBLE SPACE INSPECTION LE-100 (NEW-5/2006) NOTICE OF DEFENSIBLE SPACE INSPECTION ©`F 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,Mi„LAST) i 2. INSPECTOR'S TITLE 13.BADGE NUMBER 4.INSPECTOR'S AGENCY 1 5.INSPECTION,DATE I D(MM! 6. I 7, UNIT ID 8. BATTALION NUMBER 9.STATION NUMBER PROTECTION RESPONSIBILITY SRA LRA FRA j 1 Yom. F I BIA ❑ ❑ ❑ 10.AP BOOK. 11.AP PAGE 12..AP PARCEL BLM �- CAL FIRE ❑ ❑ ❑ c +�`^ ^` Contract County ❑ ❑' ❑ 13. LATITUDE (Datum=WGS84) 14. LONGITUDE (Datum=.WGS84) USES ❑ ❑ ❑ (Decimal Degrees;ex:38.5761) (Decimal Degrees;ex:121.4969) Other ❑ ❑ ❑ 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 -57.AUUKtJb , 18. CITY 119,STATE 1 20.ZIP { CA - 21. PHONE NUMBER #1 22. PHONE NUMBER #2 23. E-MAIL ADDRESS • 24. COMMENTS: • IF YOU HAVE QUESTIONS CONCERNING THIS INSPECTION NOTICE, CALL THIS PHONE NUMBER: 25. 26. INSPECTION# 27. CITATION# 28. FOLLOW-UP INSPECTION DATE: VIOLATION REINSPECTION? ❑ ❑ ❑ ❑ ❑ ❑ ❑YES ❑- NO 1 :..2 3 1 2 3 (MNVDD/YYYY) ❑N/A 31. 29'.`❑ No violations observed. 30. ❑ Alternative practices approved'having same practical ACTIONS TAKEN .-(check if applicable) effect. See comments section above(14 CCR 1299(c) (check if applicable) I ❑ Left information material ❑ Discussed clearance with resident 32. ❑-Left copy of this inspection notice I ❑ Violations were observed. Additional clearance is needed for the following areas: ❑ Citation issued (check applicable sections) ❑ Recommend citation to prevention ❑ 30 foot zone, PRC 4291(a); 14CCR 1299(a)(1) ❑! Gress ,I_.• Brush ❑ Trees ❑ Shrubs 33. GENERAL BUILDING V Reduced Fuel Zone(30'-100')PRC 4291(b); 14CCR1299(a)(2) 0 Grass ❑ Brush ❑Trees Lf Shrubs CONSTRUCTION TYPE ❑ Remove specific hazardous fuel identified by inspector- I4CCR 1299(b) ❑ Wood Siding - ❑ Wood Roof Dead and dying woody surface fuels-14CCR1299(d) ❑ Non-combustible siding ❑ Remove portion of any tree that extends within 10 feet of the outlet of a chimney or stovepipe PRO 4291(c) ❑ Manufactured (Mobile)Home • ❑ Metal • (❑ Maintain any tree adjacent to or overhanging a building free of dead or dying wood-PRC 4291(d) ❑ .Concrete/Block ID Maintain the roof of a structure free of leaves, needles,other dead vegetation-PRC 4291(e) : ❑ Other • Provide and maintain at lI 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 ill 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,PLEASE VISIT: WWW.FIRE.CA.GOV