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APPLICATION PROCESS CITY OF LAKE FOREST - CODE (City of Lake Forest)

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CITY OF LAKE FOREST - CODE ENFORCEMENT DIVISION
100 Civic Center Dr
Lake Forest, CA 92630
Phone: (949) 461-3474
Email: arashidian@lakeforestca.gov
APPLICATION PROCESS
Application Submittal
To assure that your project is reviewed as expeditiously as possible, please submit a complete
package as summarized above. An incomplete application will not be accepted and will delay the
processing of your Massage Establishment License. If you have questions regarding this
application, what documents are needed, or what constitutes a complete application, please
contact the Code Enforcement Division at (949) 461-3474 or arashidian@lakeforestca.gov
.
Application Review
Each application for a Massage Establishment License will be reviewed to ensure that the
application is consistent with the Lake Forest Municipal Code. As part of this review, any applicant
for a license may be required to personally appear at the city and produce proof to the Code
Enforcement division that the nonrefundable application fee has been paid to the city together
with any additional fees required for additional applicants, and then provide a complete
application as described above.
A Massage Establishment License application review is initiated when the City Manager or his/
her designee, receives a complete application package including the required information
and materials specified in the Lake Forest Municipal Code, and any additional information
required during the review of the existing or proposed establishment.
Upon receipt of a complete application, the staff will review the application to ensure accuracy
of the application materials, and whether the application meets the requirements for a
Massage Establishment License (pursuant to Lake Forest Municipal Code, Chapter 5.07,
Massage Establishments) and any other related code or policies.
During the course of the review process, the reviewing authority may require the submittal of
additional information:
a. The applicant shall be notified in writing of any revis
ions or additional information
required and shall submit the requested information to the City Manager or his/her
designee within 90 days after the date of the notice or within the period designated by
the reviewing authority.
b. Failure to submit the required information within the 90-day period or within the period of
time designated by the reviewing authority shall be cause for denial.
On-site inspection: An application for a Massage Establishment License may require City staff to
perform an on-site inspection of the subject premises before confirming that the request
complies with all the applicable criteria set forth in the Lake Forest Municipal Code and any
other related code or policies.
Page 1 of 10
Page 2 of 10
CITY OF LAKE
FOREST
| CODE ENFORCEMENT DIVISION
100 Civic Center Dr
Lake Forest, CA 92630
Phone: (949) 461-3474
Email: arashidian@lakeforestca.gov
APPLICATION FOR MASSAGE ESTABLISHMENT LICENSE
REQUIREMENT FOR LICENSE
A Ma
ssage Establishment License is required for all businesses at fixed locations within the City
that provide massage services as defined within Chapter 5.07 of the Lake Forest Municipal Code.
It is unlawful for any person to operate or conduct a massage business or to permit a massage
establishment to be operated or conducted, in or upon any premises within the City, or to render a
massage or permit a massage to be rendered within the City at any location not licensed as a
massage establishment, in accordance with the provisions set forth in Chapter 5.07 of the Lake
Forest Municipal Code.
MASSAGE ESTABLISHMENT LICENSE EXPIRATION AND RENEWAL
Each Massage Establishment License shall expire after one (1) year from the date of issuance of
the license unless renewed in accordance with Chapter 5.07. The licensee requesting renewal of
its Massage Establishment License is required to file an application for renewal with the City
Manager or his/her designee at least ninety (90) calendar days prior to the scheduled expiration
of the license. The renewal application is required to provide all information required under Section
5.07.210, Application for Massage Establishment License (as described in this packet) and must
also state that the licensee is currently operating under a Massage Establishment License, the
scheduled date for expiration of the license for which the licensee is seeking renewal, and provide
either a current copy of the lease agreement under which the licensee has operated the massage
establishment or evidence that the licensee owns in fee the property at which the licensee
operates the massage establishment.
ADDITIONAL REQUIREMENTS
In addition to the requirements set forth in Chapter 5.07 of the Lake Forest Municipal Code
regarding an application for a Massage Establishment License, Massage Establishments are also
required to meet the City’s Zoning Code requirements, in compliance with Section 9.72.090 (A)
of the Lake Forest Municipal Code. Massage Establishments are permitted in the Commercial
Zoning Districts with the approval of a Use Permit. Please contact the Planning Department at
(949) 461-3491 for additional zoning code requirements.
APPLICATION CONTENT
Al
l applications for a Massage Establishment License shall set forth the exact nature of the
massage, bath, or health treatments to be administered; the proposed place of business and
facilities; and the current and valid name and address of the applicant. The applicant shall also
furnish the following information:
1. A c
ompleted Massage Establishment License Application Form (provided in this packet);
2. Two (2) prints of a recent passport-size photograph of applicant;
3. Such other information as may reasonably be deemed necessary by the City Manager or
Page 3 of 10
his/her designee or determined to be necessary by the Orange County Sheriff’s Department
to investigate the accuracy and veracity of the information required in the application;
4. If the applicant is not the owner of the property proposed at the location for the massage
establishment, the applicant shall submit a statement (provided in this packet or similar form
approved by City Manager or his/her designee) signed by the property owner, consenting to
the operation of the massage establishment at the location by the applicant and a copy of
any lease between the property owner and applicant for the subject property;
5. A sketch or diagram showing the complete interior configuration of the business, including
without limitation, the location of the restrooms, massage rooms, customer areas, employee-
only designated areas, and any facilities requirements as identified in Section 5.07.230,
Massage establishment facilities and operations requirements. The form need not be
professionally prepared, but must accurately depict all interior areas identified in this section
and Section 5.07.230;
6. A statement in writing by the applicant that he or she certifies under penalty of perjury that
the foregoing information contained in the application is true and correct, said statement
being duly dated (provided on page 7 of this packet);
7. Authorization for the City, its employees and agents to seek information and conduct an
investigation into the truth of the statements set forth in the application and the qualifications
of the application for the license. Upon receipt of a completed application, the City Manager
or his/her designee will cause the massage establishment’s proposed site to be inspected
for compliance with the requirements of this code and chapter. The City will not issue a
massage establishment license unless and until inspection of the proposed place of business
confirms that the facility complies with the requirements of this code and chapter;
8. A copy of each applicant’s social security card;
9. A copy of each applicant’s recently completed Service for Live Scan (provided in this packet);
10. Acknowledgement in the application that the appointment of a manager by the applicant
constitutes consent by the applicant for assumption of responsibility for all acts and conduct
of the manager, including service of notices by the City; and
11. All applicable fees.
Page 4 of 10
MASSAGE ESTABLISHMENT APPLICATION
CITY OF LAKE FOREST
100 CIVIC CENTER DR
LAKE FOREST, CA 92670
GENERAL INFORMATION (All fields must be filled in. If one field does not apply, write “N/A”)
Business Name:
Business Phone No.:
Owner/Entity (List All Officers and Titles, include additional names on separate sheet):
Alternate Phone No.:
Email:
Business Address:
City:
State:
Mailing Address:
City:
State:
Application Is For: New Business, Renewal, Change of Address, Ownership, or Business Name to Existing Business (Provide Details in
Box Below)
Previous Address, Ownership, or Business Name:
Type of Business (Be Specific):
Business Start Date:
Type of Ownership:
Partnership: Provide a list of the name and residence address of each of the partners, including limited partners.
LLC: Provide a list of the name and residence address of each of the limited liability company’s current officers, and/or
directors, and/or each member, or other person who has an ownership interest in the limited liability company.
Corporation: Attach a list of the name and residence address of each of the corporation’s
current officers, and/or directors, and/or
each member, or other person who has an ownership interest in the corporation.
Sole Ownership: Complete the information below.
APPLICANT’S INFORMATION
Last Name:
First Name:
Middle:
Alias or Maiden Names:
Home Address:
City:
State:
Zip:
Phone:
PLEASE CONTACT THE CODE
ENFORCEMENT DIVISION FOR
FILING INSTRUCTIONS AT:
(949) 461-3474
arashidian@lakeforestca.gov
Page 5 of 10
Date of Birth:
Place of Birth:
US Citizen:
Yes No
Sex:
Height:
Weight:
Hair:
Eyes:
Driver’s License No.
State:
SSN:
Other Licenses Held:
Preferred Language: Email:
APPLICANT’S RESIDENCY
Complete Residence Address for the last five (5) years.
# of years
1.
2.
3.
4.
5.
APPLICANT’S EMPLOYMENT HISTORY
Employment History for the last five (5) years. Include name, address and phone number.
Type of work
1.
2.
3.
4.
5.
CRIMINAL RECORD
Have you ever been convicted in a c
ourt of any crime, including, but not limited to, a violation in conjunction with or as a result of the
operation of a massage establishment or a sex related crime or other crime involving dishonesty, fraud, deceit, or moral turpitude within
the last ten (10) years?
Yes No
Attach a list if needed.
Original Arrest Charge (Crime):
Arresting Agency:
Date of Violation:
Disposition of Charge:
Final Charge:
Date of Disposition:
Original Arrest Charge (Crime):
Arresting Agency:
Date of Violation:
Page 6 of 10
Disposition of Charge:
Final Charge
Date of Disposition:
MASSAGE HISTORY
Name of Issuing Agency Date Issued
Denied/Revoked/Refused/Subject to
Abatement Proceeding/Other
1.
2.
3.
4.
5.
PRODUCTS AND SERVICES
Describe all products and services to be provided to customers of the business.
HOURS OF OPERATIONS
List Hours of Operation
MON
_____to_____
TUES
_____to_____
WEDS
_____to_____
THURS
_____to_____
FRI
_____to_____
SAT
_____to_____
SUN
_____to_____
Name of Property Owner/Lessor:
Address:
Phone Number:
Email:
If the applicant is not the legal property owner, attach the following two documents:
Lease Agreement Executed Property Owner/Landlord Affidavit
Page 7 of 10
EMPLOYEE INFORMATION (Attach a list if needed. Provide a copy of California Massage Therapy Council (CAMTC) Certificate and
CAMTC Identification Card)
State the full, true names and residence addresses of all persons employed, or intended to be employee, as practitioners.
Full Name/Address:
CAMTC ID #
Full Name/Address:
CAMTC ID #
Full Name/Address:
CAMTC ID #
Full Name/Address:
CAMTC ID #
Full Name/Address:
CAMTC ID #
Full Name/Address: CAMTC ID #
Full Name/Address:
CAMTC ID #
Will you employ any managers to be in charge of the operations at this business location? Yes No
If yes, please list all managers who will work at this business location. Please provide names and residence addresses of each.
Will any other people be employed at this business location? Yes No
If yes, please list all non-practicing massage license therapist who will work at this business location. Please provide names and residence
addresses of each.
OTHER BUSINESS OPERATION ON PREMISES:
Will other businesses be operated on the premises of the massage establishment? Yes No
If yes, attach a list of other businesses to be operated on the premises of the massage establishment. This list shall contain the names and
description of any such business.
OTHER BUSINESS INTEREST:
Are there any other businesses within the city or state that are owned and/or operated by the applicant? Yes No
If yes, attach a list of other business[es]. List shall include the name, locations, and descriptions of each.
Page 8 of 10
CITY OF LAKE FOREST | CODE ENFORCEMENT DIVISION
100 Civic Center Dr
Lake Forest, CA 92630
Phone: (949) 461-3474
Email: arashidian@lakeforestca.gov
____ I
have read Lake Forest Municipal Code Chapter 5.07 Massage Establishments in its entirety and I understand the
provisions, requirements and responsibilities set forth in Lake Forest Municipal Code Chapter 5.07.
____ I a
uthorize the City, its officers, agents, and employees to seek information and conduct an investigation into the truth
of the statements set forth in the application and to ensure compliance with the provisions of Lake Forest Municipal
Code Chapter 5.07 and other applicable City, State, and Federals laws.
____
I confirm that the Massage Establishment shall only permit certified massage practitioners to provide, perform, and
administer massage services at the Massage Establishment.
____ I
acknowledge that the applicant, owner(s), operator(s), and manager(s) shall each be responsible for the conduct of all
employees, as defined in LFMC 5.07.235 on the premises of the Massage Establishment, and that failure to comply
with this chapter, or any local, state, or federal law, including California Business and Professional Code Section 4600
et seq. (Massage Therapy Act), may result in the suspension, revocation, or no-renewal of the operator’s permit and
civil, administrative, and/or criminal penalties.
____ I acknowledge that if any of the provided information on this application changes, I will notify the Lake Forest Code
Enforcement Division in writing within ten (10) days of such change.
Signature: __________________________
Print Name/Title: ___________________________
Date: ____________
I, the undersigned, understand that before I can operate my business in Lake Forest, the establishment must comply with all
applicable City laws and regulations and must rec
eive all necessary Federal, State and local permits. I declare that I am
authorized to complete this application and that the information and statements provided are true and correct,
under penalty of perjury.
ACKNOWLEDGMENT TO BE COMPLETED BY OWNER(S) OR PRINCIPAL OFFICER(S)
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Page 9 of 10
Landlord Permission Letter
Re: Massage Establishment
I , as (circle one) owner/agent of the property
located at (address) , give my permission for
(name of tenant/lessee) , to operate a Massage
Establishment business at the above address.
Signature of Owner/Agent
Date
Address of Owner/Agent
Phone Number of Owner/Agent
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Completed 3 August 2020

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