Transcription of LOCAL FIRE INSPECTION AUTHORITY …
1 STATE OF california HEALTH AND HUMAN services AGENCYCALIFORNIA department OF social SERVICESCOMMUNITY care LICENSINGLOCAL fire INSPECTION AUTHORITY INFORMATIONREQUIRED BY THE department OFSOCIAL services , community care LICENSINGDIVISIONAPPLICANT NAME:DATE:FACILITY NAME:FACILITY ADDRESS: LOCAL fire INSPECTION AUTHORITY :ADDRESS:CITY AND ZIP CODE:PLEASE RETURN THIS FORM WITH YOUR COMPLETED APPLICATIONAs part of the application process, the licensing agency is responsible for obtaining a fire safetyinspection from the LOCAL fire INSPECTION AUTHORITY having jurisdiction in the area where your facility help us expedite this process, we are requiring that you identify the LOCAL fire INSPECTION AUTHORITY thatis responsible to inspect your facility and issue a fire 9054 (3/99)
