Section 1405 Of Article 1. General Provisions From California Health And Safety Code >> Division 2. >> Chapter 2.3. >> Article 1.
1405
. Any person, partnership, firm, corporation or association
desiring to obtain a license shall file with the department an
application on forms furnished by the department. The application
shall contain all of the following:
(a) Name of applicant, and if an individual, whether the applicant
has attained the age of 18 years.
(b) Name of referral agency.
(c) The location of the referral agency.
(d) The business or occupation engaged in by each applicant, and
by each partner, officer and director, for at least two years
immediately preceding the filing of the application. In addition,
each such person shall submit a statement setting forth whether he or
she has previously engaged in the operation of a referral agency,
whether he or she has been involved in, or the subject of, a refusal
or revocation of a referral agency license, and whether he or she has
been convicted of a crime other than a minor traffic offense.
(e) If the applicant is a corporation, the name and principal
business address of each officer and director of the corporation; and
for nonpublic corporations, the name and business address of each
stockholder owning 10 percent or more of the stock and the name and
business address of any corporation member who has responsibility in
the operation of the facility.
(f) If the applicant is a partnership, the name and principal
business address of each partner.
(g) Evidence of the right to occupy the premises where the
referral agency is to be located.
(h) A copy of the partnership agreement of the Articles of
Incorporation, if applicable.
(i) A copy of the current organization chart.
(j) A schedule of fees to be charged and collected by the referral
agency, and a statement of the method by which each fee is to be
computed or determined.
(k) A declaration that the licensee will not have any financial
interest in any health facility doing business with the referral
agency.
( l) Evidence satisfactory to the department that the applicant
demonstrates reputable and responsible character and the capability
to comply with this chapter.