COUNTY OF LOS ANGELES ♦ DEPARTMENT OF PUBLIC HEALTH

ENVIRONMENTAL HEALTH

 

 COTTAGE FOOD OPERATION (CFO)

"CLASS A" REGISTRATION & SELF-CERTIFICATION CHECKLIST FORM

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1.  
Registration or Permit Type

New
Renewal

Note: If you are renewing, please provide your current registration number.
Registration Number:

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2.
Have you obtained planning approval to operate as a CFO from the City/County Planning Department?

Yes
No

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3.  
Business Name:
Owner Name:
Contact Number:
Address:
City:
Zip Code:
County:
Mailing Address (if different):
Email:
Website:

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4.
Prohibited Items:
Foods containing cream, custard, or meat fillings are potentially hazardous and are not allowed. Only foods that are defined as “non-potentially hazardous” are approved for preparation by a Cottage Food Operation (CFO). These are food items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne illness.

Enter your initials here if you agree with the above statement:

The following are the food products allowed in a CFO operation: Please check the items you will be preparing and/or selling.
Baked goods Herb blends
Dried pasta Granola/Cereals
Honey Jams/Jellies/Preserves
Popcorn Chocolate-covered nonperishable food
Candy Fruit tamales/Pies
Dry baking mixes Nut mixes/Nut butter
Mustard Dried tea/Roasted coffee
Vinegar Nuts/Dried fruits
Churros Sweet sorghum syrup
Fruit butter Pizzelles
Tortillas Fruit empanadas
Waffle cones Trail mix
Dried mole paste


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5.
List all the food products by their common name(s) including all the varieties (ex. Cakes, Chocolate Cake, Lemon Cake, etc.):

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6.
Hours of operation:
Fill in the days and times the CFO will be open

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7.
Approved areas of CFO within the house (i.e. kitchen, dining room, etc.):

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8.
Water Source:
Please check what type of water source will be used in the Cottage Food Facility

City Water
Private Well

Note: If the CFO is serviced by a private well, the water shall be tested by an approved laboratory analysis to verify that it meets State water quality standards for bacteriological and primary inorganic chemicals. Approval to operate will be granted after submitting recent (within 3 months) laboratory results to this Department.

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9.
Disposal of Waste:
Please check what type of treatment is used to dispose of waste

Public Sewer Service
Private Septic System

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10.
Food Processor Course:
Within 3 months of being approved to operate by the Environmental Health Division, please provide proof of completion of the required California Department of Public Health (CDPH) food processor course. The website for CDPH is www.cdph.ca.gov.

Enter your initials here if you agree with the above statement:

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11.
Employee: 
  I understand that I may not have more than one full-time equivalent cottage food employee, not including a family member or household member of the cottage food operator, within the registered or permitted area of a private home where the cottage food operator resides and where cottage food products are prepared or packaged for direct, indirect, or direct and indirect sale to consumers.

Enter your initials here if you agree with the above statement:

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12.
Gross Annual Sales:
I understand that I will lose my CFO status and will need to become permitted in a commercial facility if my CFO business exceeds the following gross annual sales figures for the calendar years in the following tables:

Calendar Year                                  Gross Annual Sales
In 2013     ....................................................$ 35,000
In 2014     ....................................................$ 45,000
In 2015     ....................................................$ 50,000

Enter your initials here if you agree with the above statement:

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13.
I
agree to grant access to the local health department to conduct an inspection of my cottage food operation’s primary domestic residence housing the CFO during normal business hours, during the hours specified on the registration form, or at other reasonable times, for the purposes of inspection or complaint investigation including the collection of food samples.

In addition, I agree to notify Los Angeles County Environmental Health prior to modifying my food list, type of operation, and/or method of selling, distributing, or otherwise providing my CFO products to the consumer or retailers regardless of whether or not the product is sold, consigned or given away.

Enter your initials here if you agree with the above statement:

.

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 COTTAGE FOOD OPERATION (CFO)

 SELF-CERTIFICATION CHECKLIST

The following requirements are outlined in the Cottage Food Operation (CFO) regulations and are provided as minimum standards of health and safety for the preparation of approved cottage foods in the home.


FACILITY REQUIREMENTS

Yes
The CFO shall be located in a private dwelling where the CFO operator currently resides.
CFO food preparation will take place in the private kitchen within that home.
Additional storage used for the CFO will be within the home and used exclusively for storage.
Sleeping quarters are excluded from areas used for CFO food preparation or storage.

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EMPLOYEE AND TRAINING REQUIREMENTS

Yes
All persons preparing or packaging CFO products have completed the California Department of Public Health (CDPH) food processor course. If not, the operator shall complete the course and provide certificate(s) within 5 days of completion.
The CFO has no more than 1 full-time equivalent employee. (Immediate family or household members are not included.

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SANITATION REQUIREMENTS

Yes
Kitchen equipment and utensils used to produce CFO products are clean and maintained in a good state of repair.
All food contact surfaces, equipment, and utensils used for the preparation, packaging, or handling of any CFO products shall be washed, rinsed, and sanitized before each use.
All food preparation and food and equipment storage areas shall be maintained free of rodents and insects.

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FOOD PREPARATION REQUIREMENTS (INCLUDES PACKAGING AND HANDLING)

Yes
Warm water, hand soap and clean towels are available for hand washing.
Hand washing is required immediately prior to handling foods and after engaging in any activity that contaminates the hands such as after using the toilet, coughing or sneezing, eating or smoking.
All food ingredients used in the CFO products are from an approved source.
Potable water shall be used for hand washing, ware washing and as an ingredient.

During the preparation, packaging or handling of CFO products:
Yes
Domestic activities such as family meal preparation, dishwashing, clothes washing or ironing, kitchen cleaning or guest entertainment are not allowed.
Infants, small children, or pets are not allowed.
Smoking is not allowed.
Any person with a contagious illness shall refrain from working in the CFO.

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LABELING REQUIREMENTS

Yes
A sample label will be provided to this Department for review and approval.

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PLANNING REQUIREMENTS

Yes
I have complied with the applicable planning requirements for the CFO.

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By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB1616 (Gatto) as it pertains to a “Class A” Cottage Food Operations. Prior to making any changes, I acknowledge that I must notify Los Angeles County Environmental Health Division of any intended changes to the above statement.

 

Cottage Food Operator Checklist completed and submitted by:

Print Name:
Date:



Note:
 in order to begin the application review process, you are required to submit a non-refundable registration fee of $103.00, sample labels, and a product list. If payment is not received within 30 days from the application submittal date, a new application must be submitted.

An addition fee of $184.00 will be assessed for any complaint investigations.

Please read the instructions in the reply message after submitting this application. 


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