Section 71107 - Content of Application(a) Any person, firm, partnership, association, corporation, political subdivision of the State, state agency or other governmental agency desiring to obtain a license shall file with the Department an application on forms furnished by the Department. The application shall contain the following: (1) Name of applicant, and if an individual, verification that the applicant has attained the age of 18 years.(2) Type of facility to be operated and types of services for which approval is requested.(3) Location of the hospital.(4) Name of person in charge of the hospital.(5) If the applicant is an individual, satisfactory evidence that the applicant is of reputable and responsible character.(6) If applicant is a firm, association, organization, partnership, business trust, corporation or company, satisfactory evidence that the members or shareholders thereof and the person in charge of the hospital for which application for license is made are of reputable and responsible character.(7) If the applicant is a political subdivision of the State or other governmental agency, satisfactory evidence that the person in charge of the hospital for which application for license is made is of reputable and responsible character.(8) If the applicant is a partnership, the name and principal business address of each partner.(9) 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 five percent or more of the stock and any corporate member who has responsibility in the operation of the hospital.(10) Copy of the current organizational chart.(11) Certificate of Need or a Certificate of Exemption from the Department if required by Chapter 1, Division 1, Division 7 of this title.(12) Such other information or documents as may be required by the Department for the proper administration and enforcement of the licensing law and requirements.Cal. Code Regs. Tit. 22, § 71107
1. Amendment filed 11-12-76 as an emergency; effective upon filing (Register 76, No. 46).
2. Certificate of Compliance filed 3-8-77 (Register 77, No. 11).
3. Amendment of subsection (a)(11) filed 5-25-77; effective thirtieth day thereafter (Register 77, No. 22).