FOOD MARKET (Supermarkets - see below)
Prepackaged Foods Only (No Drink Dispensing, Bulk Foods, Cut Produce)
Potentially Hazardous Foods
MISCELLANEOUS (i.e., additional plan reviews or inspections,
site or equipment evaluations):
Reason for additional fees incurred:
SUPERMARKET (Each department, based on Sq. Ft.)
RESTAURANT (Each department, based on Sq, Ft.)
PLAN CHECK NUMBER
OFFICE USE ONLY
COUNTY OF LOS ANGELES ♦ DEPARTMENT OF PUBLIC HEALTH
ENVIRONMENTAL HEALTH - PLAN CHECK PROGRAM
5050 Commerce Drive, Baldwin Park, CA 91706-1423
(626) 430-5560 www.publichealth.lacounty.gov/eh
RETAIL PLAN CHECK APPLICATION
3 sets of plans are required. Incomplete applications will not be processed. For correct fees, please refer to the Plan Check Fee Schedule.
PERSON SUBMITTING: TITLE: PHONE:
6,000 - 19,999 Sq. Ft.
500 Sq. Ft. or less
501 - 1,999 Sq. Ft.
2,000 - 3,999 Sq. Ft.
2,000 - 5,999 Sq. Ft.
51 - 1,999 Sq. Ft.
25 - 50 Sq. Ft.
10,000 Sq. Ft. or more
5,000 - 9,999 Sq. Ft.
501 - 4,999 Sq. Ft.
0 - 500 Sq. Ft.
REMODELING OF CURRENTLY OPEN FOOD FACILITY
WITH VALID PERMIT/LICENSE
**PROVIDE COPY OF HEALTH PERMIT/LICENSE**
*Mark appropriate business classification box to the left* For remodels
exceeding 300 Sq. Ft., select appropriate fee (at left) based on the size of the
facility. Describe the scope of remodeling in space below:
ANSWER THE FOLLOWING QUESTIONS
New building construction after 1/1/04
Approximate date business closed:
New owner of business
New food facility
Plans for on - site consumption of alcoholic
beverages, either now or future
Re - usable tableware
OWNER REPRESENTATIVE DECLARATION: I understand the amount of fee paid is NON-REFUNDABLE and the application is NON-TRANSFERABLE. The fee paid is based on my declaration of the business classification indicated
above. If this declaration is incorrect, I understand that the plans will not be reviewed until the correct fee is paid. I also understand that plans shall be reviewed within 20 (regular) or 10 (expedited) working days after receipt of
payment and the REVIEWED PLANS (WHETHER APPROVED OR NOT) ARE VALID FOR ONE YEAR. FINALY, I UNDERSTAND PLANS MUST BE APPROVED PRIOR TO COMMENCING CONSTRUCTION OR INSTALLING ANY
EQUIPMENT, AND IT IS A MISDEMEANOR VIOLATION TO BEGIN OPERATION WITHOUT A FINAL INSPECTION, APPROVAL, AND VALID HEALTH PERMIT/LICENSE
CONTACT OFFICE PAYMENT
Fee paid: ___________________________________________
Check no, or cash: ___________________________________
Date paid: __________________/_______/_______________
Cashier's initials: _____________________________________
Grand Total: $
LESS than 300 Sq. Ft.
20,000 Sq. Ft. or more
4,000 - 9,999 Sq. Ft.
10,000 Sq. Ft. or more
Main Food Market