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ii <br /> SAN :10A U I N Environmental Health Department <br /> COUNTY <br /> Greatness <br /> grows here. <br /> DAIRY FARM EMPLOYEE HOUSING <br /> ANNUAL PERMIT EXEMPTION SELF-AUDIT HOUSING INSPECTION CHECKLIST <br /> COMPLETE ONE CHECXLW-7OR EACH HOUSING UNIT <br /> MEN <br /> FACILITY NAME: Yd PRO: <br /> LOCATION' LAPA I FA MAP DE3mmTm: <br /> HMNQ N <br /> Address or Identlllcatlon number of unit �G e Date of lnap.Mon. ?,.Aly=\a1 <br /> Type of Housing Unit I'SbVb Family Dwelling ❑Mobile Horse ❑000 <br /> 6"OEmployem in Unit ( Daus Unit FirM&-"A cy Installed: <br /> al Power Provided By: Cas Provided by: <br /> SING IT INSPECTION <br /> Cheekftt Commenits <br /> Unt lois hot and cold Mft water. El Needs <br /> FMPW <br /> Appraed electrical power and gas fuel being s qAW to Unit <br /> Hester mairdained in hinctioning and sale roamer(No gmcefportsble <br /> had"). ❑Needs Repse <br /> Doors and windows are amessWel operable b Am for sale exiting. ElOw <br /> v <br /> Al rooms ane dean and nifty.No irsedhodent infestations present. <br /> Al applia n(alae,water heaters,air conditioning units,healers)are KOW <br /> renlsd,aftapped and are mWnhdined in a sale,working aider. ❑Needs Repw <br /> An smoke and carbon narrarnlde detectors are p ment and tested b be shorn Rbkoy <br /> All wiring in safe,ww"order(no spices,expoesd wires,unwian d a o t). Ok" <br /> Ir <br /> Al plumbing in safe,wonting order(no leaks,properly maintainem. U10kay <br /> [I NeeO it <br /> At counters,sinks,toilets,tubs,showers are working and in sankary omMan. 0kaY <br /> r- <br /> AdBoom walls,txsiings are free from tales,are not saggirsg or buolig,have 150kay <br /> no water leaks and are dean and in MW condition. C'Needs RWW <br /> EdedorChecidbt ��.�. Cos>amerlts <br /> Roof is p mp&ly maintained with ro holes,lease shingles,leeks,etr, a iP' <br /> Exterior siding is maintained with no loose plaster,peeling paint,holes,atc. - ir' <br /> Stairways am sale with no n>airng,detsrioraling,or Bose parts. 0Mkeyr <br /> Propane tank has barrier prntedion and'No Smoking'signage. <br /> r <br /> The tlach cans are std dent In ft have ids and are pecked up weekly. ❑ <br /> The 0ecm panel is covered and pro K29d tram hanperilg. L60kay <br /> NeedjrRwair* <br /> The gas fuel conn 0m is as appraed and safe. s. <br /> There art:no insect or rodent Inlestetiorts. Repair* <br /> The sewage system is hxcb nisg,with no a daeng wastewater or backup. �f► <br /> L.�Veads r <br /> 'Needs Repair Please Vecffy dale repairs to be wWWW.Any Ming Permit r WMW for repass must be obtained and ttnaled. <br /> I tint have the above noted unit and&d the 6sienrratlon t true and corrrsct to the best of <br /> so= <br /> BY: 4::Acse *2, <br /> ,e TOLE <br /> 11368 meiton Avfu ,Cal'domia 95205 T 209 468-34201 F 209 4640138 l www.sjcehd.com <br /> y <br />