Home
Form

Online Fire Hazmat & Medical Gas Application

* Indicates required field

This online permit application is for new permits only. Modifications will be handled outside of the online permit application portal.
Please contact your Plan Review Team or fdpermits@beverlyhills.org if you have questions.
1. PROJECT DETAILS
APPLICATION TYPE*
Select at least one permit type. You may select both if applicable.
Selecting Medical Gas System automatically requires a Hazmat Permit.
Review the guidelines here: Medical Gas / Hazmat Analysis Guidelines
BUILDING PERMIT NUMBER*
Enter the Building Permit Number to auto-fill the project address. If you are submitting Hazmat only, you may type NA and enter the address manually.
PROJECT ADDRESS
Enter the street number where work will take place.
Select the street name where work will take place.
Enter the unit or suite, if applicable.
DESCRIPTION OF WORK*
Describe the work clearly. Example: Install new medical gas piping and storage system for tenant improvement.
WORK PROPOSED ON* MAIN BUILDING
ACCESSORY STRUCTURE (Garage, Pool House, Trellis, BBQ, Accessory Dwelling Unit)
VALUATION*
Enter the total estimated cost of construction materials and labor.
FLOOR
Indicate the floor where the work will take place, if applicable.
 AREA OF WORK (ESTIMATED SQ. FT.)*
Enter the estimated area of work in square feet. Value must be greater than 0.
Please select or add at least one material with quantity greater than 0.
2. MATERIALS*
Report each hazardous material with the appropriate quantity. You may also add custom materials under each category.
Compressed Gas (Report each material in cubic feet)
Oxygen
Carbon Dioxide
Nitrogen
Nitrogen Oxide
Propane
Liquids (Report each material in gallons)
Gasoline
Oil
Chlorine
Cryogenic
Oxidizer
Unstable
Solids (Report each material in pounds)
Combustible Dust
Combustible Fibers
Flammable Solids
Water Reactive
2 (a). APPLICANT    
COMPANY NAME
FIRST NAME* LAST NAME*
EMAIL* The email address entered here will be used for your Electronic Plan Review login.
ADDRESS*
Enter the applicant mailing address.
 CITY, STATE, ZIP
PHONE* OFFICE PHONE
2 (b). PROPERTY OWNER INFORMATION      
COMPANY NAME
FIRST NAME LAST NAME
EMAIL
ADDRESS CITY, STATE, ZIP
PHONE WORK PHONE
2 (c). CONTRACTOR      
SAME AS APPLICANT
LICENSE NO*
Enter the contractor license number. License details will auto-fill when a valid number is found.
LICENSE EXP DATE* COMPANY NAME*
FIRST NAME* LAST NAME*
EMAIL
ADDRESS CITY, STATE, ZIP
PHONE OFFICE PHONE
3. DECLARATIONS      
3.1 WORKER'S COMPENSATION DECLARATION
Select the one statement that applies:

I have and will maintain a certificate of consent to self-insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.

I have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are:

I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the worker's compensation laws of California, and agree that, if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.

Name of Declarant:
I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this City and County to enter upon the above-mentioned property for inspection purposes.
Applicant/Agent Name:
By checking this box, you are electronically signing
FILE ATTACHMENTS      
CONTRACTOR AGENT AUTHORIZATION LETTER
Accepted file types: PDF, JPG, PNG, GIF, EPS, Word, and Excel.