Form LIC 9054 at a glance
What it is: This form is the local fire inspection authority information required by the Department of Social Services, Community Care Licensing Division.
Where and when to file: Return this form with your completed application.
The licensing agency is responsible for obtaining a fire safety inspection from the local fire inspection authority having jurisdiction in the area where your facility is located. To expedite this process, you identify the local fire inspection authority that is responsible to inspect your facility and issue a fire clearance.
A filled-in Form LIC 9054 example: an applicant names the local fire authority
How to fill out Form LIC 9054, box by box
Date, applicant name, facility name and facility address
Enter the Date, the Applicant Name, the Facility Name and the Facility Address.
Local fire inspection authority, address, city and zip code
Enter the Local Fire Inspection Authority, its Address, and its City and Zip Code.
Common questions about Form LIC 9054
Where do I file it?
Return this form with your completed application.
Sources
[1] Form LIC 9054 (3/99), California Department of Social Services, Community Care Licensing (the Official source link on this page).
