LOS ANGELES FIRE DEPARTMENT CANNABIS UNIT "STATEMENT OF INTENDED USE" Various processes and situations in commercial and industrial establishments can create fire and life safety hazards. In order to provide a reasonable degree of safety to life and protection of property, specific requirements have been established in the Fire, Building, and Life Safety Codes. To help us assess what particular laws apply to your business, please provide the following information: PART 1-BUSINESS AND BUILDING INFORMATION Business Name: Business Address: Name of person filling out this form: Contact Phone Number: Email: Assessor's Parcel NO: Building and safety occupancy class: Number of Buildings: Sq. Ft: Number of employees? Hours of operation? YES 1 Will your business be conducting any plant extraction? 2 Will your business store, dispense, use or handle compressed gases? 3 Will your business store, dispense, use or handle flammable or combustible liquids? 4 Will your business store, dispense, use or handle liquified petroleum gases? 5 Will your business store, dispense, use or handle cryogenic fluids? 6 Will your operations require the use of a fume hood system? 7 Will your operations require the use of an engineered mechanically ventilated room? 8 Will you be conducting any carbon dioxide enrichment? 9 Will your operations utilize any industrial ovens? 10 Will your operations require gas detection equipment including sensors and alarms? 11 Will your business operations require emergency back up power (generator)?
NO
Yes
NO
12 Will your operations utilize any rated refrigeration units? 13 Is your building equipped with automatic fire sprinklers? 14 Is your building going to store/use hazardous materials or a mixture which has a quantity at any one time during the reporting year equal to or greater than a total weight of 500 pounds, 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure?
By selecting below, I declare that the above named business, organization, or occupant will not handle a hazardous material or mixture containing hazardous material which has a quantity at any one time during the reporting year equal to, or greater than, a total weight of 500 pounds, or a total of 55 gallons, or 200 cubic feet at standard temperature and pressure for compressed gas.
TO OBTAIN APPROVAL FROM THE LOS ANGELES FIRE DEPARTMENT YOU MUST EMAIL THE FOLLOWING ITEMS TO LAFDCANNABIS@LACITY.ORG. ON APPROVAL YOU WILL RECEIVE A STAMPED VERSION EMAILED BACK TO YOU. Submit a signed, legible letter (preferably type written and on your company's letterhead) stating your intended use for the property. In the letter, describe materials you will be storing and using on the property. Explain the method of storage (e.g. racks, pallets), storage dimensions, and where the materials will be located on the property. Describe how you will be using the materials. Explain any alterations to the building that are planned. Many of the requred fire safety plan items may be placed on a map/site plan that is drawn to rough scale showing the property size and locations on the property. Please include the follwing items in your plan.
1. The procedure for reporting a fire or other emergency 2. The life safety strategy including the following A. Procedures for notifying occupants B. Procedures for evacuating occupants, including those who need evacuation assistance 3. Site plans indicating the following: A. The occupancy assembly point B. The locations of fire hydrants C. The normal routes of fire department vehicle access 4. Floor plans identifying the locations of the following: A. Exits B. Primary evacuation routes C. Secondary evacuation routes D. Accessible egress routes a. Areas of refuge b. Exterior areas for assisted rescue E. Refuge areas associated with smoke barriers and horizontal exits F. Manual fire alarm boxes G. Portable fire extinguishers H. Occupant-use hose stations I. Fire alarm annunciators and controls 5. A list of major fire hazards associated with the normal use and occupancy of the premises, including maintenance and housekeeping procedures 6. Identification and assignment of personnel responsible for maintenance of systems and equipment installed to prevent or control fires 7. Identification and assignment of personnel responsible for maintenance, housekeeping, and controlling fuel hazard sources
STAMP OF APPROVAL
This stamp is verification of receipt of notification by the Fire Department only. This is not to be construed as a certification, approval, permit, or permission to proceed with activity requiring authorization by the Los Angeles Fire Department or other approving agencies
REQUIRED PERMITS (Filled out by the Los Angeles Fire Department) 1 2 3 4 5 6 7 8