C of F Application 1/5/2026 F-322 R4, REV. 010/10/20223
LOS ANGELES FIRE DEPARTMENT
APPLICATION FOR CERTIFICATE OF FITNESS NAME, (Last, First, MI) BUSINESS NAME
DBA
BUSINESS ADDRESS (Street, City, State, ZIP)
BUSINESS PHONE
HOME ADDRESS (Street, City, State, ZIP)
CELL PHONE
CALIFORNIA DRIVER’S LICENSE NUMBER
EMAIL ADDRESS
TYPE OF APPLICATION: INITIAL APPLICATION: (RESUME AND FULL FEE REQUIRED) Full fee = $2,274.00 per box REAPPLICATION: MORE THAN 30 BUT LESS THAN 90 DAYS AFTER FAILURE. (50% FEE REQUIRED) REAPPLICATION: MORE THAN 90 DAYS AFTER FAILURE. (FULL FEE REQUIRED) ADDITION TO CERTIFICATE: (FULL FEE REQUIRED) RENEWAL OF CERTIFICATE # PRIOR TO EXPIRATION. (50% FEE REQUIRED)* RENEWAL OF CERTIFICATE # AFTER EXPIRATION. (FULL FEE AND COMPLETE TESTING PROCESS)* ADD/CHANGE/RENEW OF BUSINESS AFFILIATION. (MINIMUM FEE REQUIRED) Minimum fee = $382.00* *Current copy of Los Angeles City Tax Certificate and State License if applicable)
PER CHAPTER 1 OF THE FIRE CODE, I SUBMIT THIS APPLICATION FOR CERTIFICATE OF FITNESS TO: PERFORM AS A FIRE SAFETY OFFICER Revenue code: (675) CONDUCT BLASTING OPERATIONS (665) RECHARGE OR SERVICE PORTABLE EXTINGUISHERS PERFORM AS A HEALTH CARE FACILITY INSTRUCTOR (680) PERFORM AS A HIGH-RISE LIFE/SAFETY SERVICE (685) CONDUCT TEST OF FIRE PROTECTION EQUIPMENT AND SYSTEMS (SEE REVERSE FOR CHIEF’S REGULATION 4 CATEGORIES) (670)
REQUIRED RESUME FOR INITIAL APPLICATIONS & ALL ADDITIONS TO CERTIFICATE SHALL INCLUDE: 1. AT LEAST TWO LETTERS OF REFERENCES FOR EXPERIENCE AND PERFORMANCE. 2. EMPLOYMENT RECORD FOR AT LEAST THE PAST FIVE YEARS. 3. EDUCATION BACKGROUND RELATIVE TO FIRE PROTECTION EQUIPMENT. 4. PERSONAL INFORMATION PERTINENT TO CERTIFICATE OF FITNESS. 5. COLOR COPY OF VALID FORM OF IDENTIFICATION. SIGNATURE OF APPLICANT
BILLING & ACCOUNTS RECEIVABLE (OFFICE USE ONLY)
AMOUNT PAID $_____________ CHECK #___________________ SIGNATURE:
DATE
OFFICIAL USE ONLY FIRE CODE SECTION #57.06.15A
CERTIFICATION NUMBER & NEW EXPIRATION DATE
APPLICATION PROCESSED BY:
DATE SUBMITTED
RENEWAL MONTH
FEE AMOUNT
CHECK REGISTRATION NO.