Request For Information Form

Page 1

Los Angeles City Fire Department 200 N. Main St., 17th Fl., Los Angeles, CA 90012

CUPA Section Request for Information

*Requester's Name/Business:_________________________________________ Request Date:___________________ *Email Address: ______________________________________________

*Phone: ___________________________

INFORMATION REQUESTED FOR:

Provide the required FA or Auto ID Number corresponding to the records you are requesting. The FA and Auto ID Number can be found on the CUPA Public Records website (https://www.lafd.org/fire-prevention/cupa/public-records). If the address you are searching for is not located within the active or historical lists, the Los Angeles City Fire Department CUPA does not have any information pertaining to that address. Do not submit a public record reqest if the address you are searching for is not found on these lists as we will not be able to process your request.

*Site Address (one address per request form):________________________________________________________________

Unit/Ste: _______________

*City:

*Zip Code: ______________

_______________________________________________

*Type of Records: Selected records must be accompanied by a FA or Auto ID Number. FA & Auto ID Number can be located at https://www.lafd.org/fire-prevention/cupa/public-records. If the address you are searching for does not have an associated FA or Auto ID Number, Los Angeles City Fire Department CUPA does not have any information pertaining to that address. We will not be able to process your request without a FA or Auto ID Number.

List 1 - Active Hazardous Materials (HM) Records

FA:

_____________________

List 2 - Historical Hazardous Materials (HM) Records

FA:

_____________________

List 3 - Active Underground Storage Tank (UST) Records

FA:

_____________________

List 4 - Historical Underground Storage Tank (UST) Records

FA:

_____________________

List 5 - Historical Underground Storage Tank (UST) Records

Auto ID: ____________________

CREDIT/DEBIT CARD PAYMENT SERVICE FEE ADVISORY: EFFECTIVE JULY 1, 2020, CREDIT OR DEBIT CARD PAYMENTS ARE SUBJECT TO A NON-REFUNDABLE 2.70% SERVICE FEE WHICH WILL BE PROCESSED BY OUR THIRD PARTY PAYMENT PROCESSOR, EVALON INC. THIS RATE IS SUBJECT TO CHANGE BASED ON CREDIT/DEBIT INTERCHANGE RATE. Fire Prevention Report Fee: $11.00 You will be contacted by phone for payment and record release. Be advised a record search is conducted post payment and it is possible no records will be available for release. You will be notified in writing if the requested record is not available. Fees are non-refundable. *Required information

I have confimed site has a valid FA Number or Auto ID Number I am willing to pay $11 for this request I have included contact information on this form

Requester Signature:________________________


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