Any person desiring issuance of a license for a residential care facility under this

chapter shall file with the department, pursuant to regulations adopted by the department, an application. The application shall be provided on a form furnished by the department, and shall include, but not be limited to, all of the following: (

a) Evidence satisfactory to the department of all of the following:

(1) The ability of the applicant to comply with this

chapter and of rules and regulations adopted pursuant to this

chapter by the department.

(2) The applicant has sufficient financial resources to maintain the standards of service required by regulations adopted pursuant to this chapter.

(3) Following the department’s adoption of regulations specifying the levels of care to be provided under this chapter, the applicant’s ability to meet regulatory requirements for the level of care the facility intends to provide.

(4) Compliance or ability to comply with

Section 1568.02. (

b) Disclosure of the applicant’s prior or present service as an administrator, general partner, corporate officer or director of, or as a person who has held or holds a beneficial ownership of percent or more in, any residential care facility or in any clinic or facility licensed pursuant to

Chapter 1 (commencing with

Section 1200),

Chapter 2 (commencing with

Section 1250), or

Chapter 3 (commencing with

Section 1500). (

c) Disclosure of any revocation or other disciplinary action taken, or in the process of being taken, against a license held or previously held by the entities specified in subdivision (b). (

d) Any other information as may be required by the department for the proper administration and enforcement of this chapter. (

e) A signed statement that the person desiring issuance of a license has read this

chapter and the regulations adopted pursuant to this

chapter and understands the statute and regulations applicable to a residential care facility.