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LOS ANGELES FIRE DEPARTMENT Bureau of Fire Prevention & Public Safety

FILM UNIT 200 N. Main Street, Suite 1710 Los Angeles, CA 90012 (213) 978-3670

Email request to: lafdfilm@lacity.org

Subject line of the email shall be formatted as follows: Fire Performer Request [1st Date of Work] [Address] * EXAMPLE: Fire Performer Request 10/21/15 200 N Main St

FIRE PERFORMERS APPLICANT Permit Applicant Business Name :

Applicant 1: Last Name (Legal Name Required)

Ml

First Name

Stage Name (If Applicable)

Applicant 2: Last Name (Legal Name Required)

Ml

First Name

Stage Name (If Applicable)

If additional applicants, please attach an additional page(s) with names listed. Mailing Address City State I Country

Street Address (if different from above) Email

Phone No. - ext. City

I

Zip Code Zip Code

State

Event Sponsor/Promoter

Business Name:

Contact Person : Last Name Mailing Address Phone No. 1 Phone No. 2 -

First Name

Ml

City

State

ext.

Email Address

ext.

Date & Time of Fire Performance

Venue Description

I

Zip Code

Venue Name:

On Site Contact Person:

On Site Contact Phone Number:

Venue Street Address

City

Zip Code

Event Description:

Describe the location of the hazard area within the venue:

Is the Performance Indoors or Outdoors

I I

Stage/floor materials Concrete

I I

Ceiling/overhead clearance 7-10 Feet

I I

Outdoors J Wood 10-15Feet

I I

I

I I

Tile 15-20 Feet

I I

Venue Phone No. -ext.

I I

Indoors Other 20 + Feet

I


Any additional site-specific information

Performance Description

Number of sets in Approximate sq. footage I performance of hazard area Number of Flame Number of Fire Performers Effect Assistants Description of different Flame Effect Assistant roles (Fire Safety, Photographers, etc) Duration of performance

â–Ą

I

Flame Effect Devices to be activated on stage. Please check all those that apply. Fire Poi

Fire Staff

Fire Hoop

Fire Knives/Swords

Fire Torches

Fire Breathing

Paraffin

Other (Please specify)

Fuel to be used. Please check all those that apply. White Gas Kerosene

lsopropyl

Insurance

other* (Please specify)

YES

NO

Additional Information? (Optional)

Insurance

Holdina Area Description

Number of Fire Extinguishers I

Number of "No Smoking" Signs

Description or Method of Extinguishing Flame Effect(s)

Type of Fire Extinguishers

Please check all those that apply. If "NO", please explain. Holding Area Description

YES

NO

If "NO", please explain.

Fuel Station

Spin Out Area Staging Area

Certification

I certify that I am qualified by reason of training, knowledge, and field experience in safe storage, use and handling of flammable materials applicable to this permit. I further certify that the information provided on this permit is truthful to the best of mv knowledQe. Applicant 1 Date: Print Name: Signature: Appllcant2 Date: Signature:

Print Name:

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Fire Performers Applicant Form  

Fire Performer's applicant form.

Fire Performers Applicant Form  

Fire Performer's applicant form.

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