Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419929
Report Date: 11/20/2015
Date Signed 01/06/2016 10:01:16 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:MUSICAL GANFACILITY NUMBER:
197419929
ADMINISTRATOR:HAGBI,RUCHAMAFACILITY TYPE:
850
ADDRESS:13624 BURBANK BLVDTELEPHONE:
(818) 786-7800
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91401
CAPACITY:35CENSUS: 0DATE:
11/20/2015
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:John DallasTIME COMPLETED:
12:55 PM
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Licensing Program Analysts (LPAs) Silva Garibyan and Myriam Saullo Luga conducted a collateral visit at Los Angeles Fire Department at 6262 Van Nuys Blvd, Van Nuys, Ca 91401 to verify the certificate of occupancy and the fire clearance that was sent to the department. LPAs met with 2 fire marshals and another staff to verify the fire clearance information. LPAs were notified that the facility maximum occupancy would depend on the zoning of the address of the facility.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (310) 337-4826
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (310) 337-3754
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2015
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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