PRE-INSPECTION/CONSULTATIONREQUEST
LOSANGELESFIREDEPARTMENT
ValleyPublicSafetyUnit:lafdvpsu@lacity.orgor(818)374-1110
SchoolsChurches&Institutions: lafdsci@lacity.orgor(213)978-3664
TYPEOFREQUEST(NeworExisting):_____________________________
TYPEOFFACILITY(ex:RCFE,ARF,Drug/Alcohol):________________
STATUSOFCLIENTS(ex:Ambulatory,Non-Ambulatory,orBedridden):
TOTAL#OFCAPACITYREQUESTED:________ 25ORLESSCLIENTS-$1,146.00FEE 25ORMORECLIENTS-$1,528.00FEE
FACILITYADDRESS:__________________________________________________
FACILITYNAME:_____________________________________________________
FACILITYOWNER:___________________________________________________
CONTACTPHONENUMER:
CONTACTEMAIL:____________________________________________________
L.A.M.C.57.4703.7.1Preinspection.
Asprovided bytheCaliforniaHealthandSafetyCodeSection13235,aprospectiveStatelicenseeofacommunitycarefacility,as definedinSection1502 oftheCaliforniaHealthandSafetyCode,orofaresidentialcarefacilityfortheelderly,asdefinedinSection 1569.2oftheCaliforniaHealthandSafetyCode,mayrequestapreinspection ofthefacilitypriortofinalclearanceapprovalin connectionwiththeissuanceofsuchStatelicense.Afeeequalto,butnotexceeding,theactualcostofthepreinspectionservicesshall becharged forthepreinspectionofthesefacilities.SuchfeeshallbepaidtotheDepartmentpriortothepreinspectionbythe Department.Thefeeshallbeestablishedin thesamemannerasprovidedfortheestablishmentoffeesunderSection106.7.1.1.
L.A.M.C.57.4703.7.2FinalClearance.
TheDepartmentshallchargeandcollectafeeforthefinalclearanceapprovalinspectioninconnectionwiththeissuanceofaState licensetooperatearesidentialcarefacilityhousingnonambulatoryelderlypersons.Thefeeshallbeestablishedinthesamemanneras providedfortheestablishmentoffeesunderSection106.7.1.1,butshallnotexceedanyfeeforsuchinspectionestablishedbythe StateFireMarshalpursuanttoSection13131.5(f)oftheCaliforniaHealthandSafetyCode
AllLADBSPermitsshallbe approvedpriortoFinalInspectionorFireClearanceWILLbe denied.
FORFIREDEPARTMENTUSEONLY RECIEPTNUMBER#______________
FeeReceivedby:______________________________ Date:______________________