city of ontario 303 east b street massage … · property owner affidavit state of california )...
TRANSCRIPT
(20161130)
Dear Applicant: In an effort to improve customer service and insure that applications are processed as quickly as possible, the Planning Department finds it necessary to remind its clients that complete application submittals are crucial to the application review process. In the past, accepting incomplete applications has led to errors and time delays at the end of the review process. I do not want this to happen to you. Therefore, the Planning Department staff will only accept complete applications at time of submittal. All items listed on the enclosed Minimum Filing Requirements Checklist must be provided before the counter staff can accept your application for filing. Furthermore, every Massage Establishment Permit Application submittal will be thoroughly reviewed for completeness prior to acceptance of your application for filing. Please note that the counter staff does not have the authority to waive any requirement of the Massage Establishment Permit Application Packet. Please remember that failure to provide all information required by the application will result in significant time delays in the processing of your application. If you have any questions regarding the necessity of any particular item on the Minimum Filing Requirements Checklist or Massage Establishment Permit Application Form, please feel free to contact the Planning Department’s counter supervisor to discuss your questions with us. The Planning Department looks forward to a continued efficient and professional relationship with you in the future. If you have any questions, comments, or concerns regarding this matter, please feel free to contact the Planning Department at (909) 395-2036. Respectfully, Scott Murphy Planning Director Attachments: Massage Establishment Permit Minimum Filing Requirements Checklist
Massage Establishment Permit Application Form Planning Department Fee Schedule
Massage Establishment
Supplementary Application Packet
City of Ontario Planning Department 303 East B Street Ontario, California 91764 Phone: 909.395.2036 Fax: 909.395.2420
(20161130)
ATTENTION!
The City of Ontario strives to provide you with efficient and effective service in a businesslike manner. We are committed to the principle that every interaction you have with the City must be based on honesty and integrity.
City employees are prohibited by law from soliciting or accepting money, services, or gifts of any kind in connection with the discharge of their duties.
If you are approached or are aware of any violation of this policy, please immediately contact any of the following:
Al C. Boling, City Manager ............................................................................. (909) 395-2396 or [email protected] Brad Kaylor, Ontario Police Chief ................................................................... (909) 395-2710 or [email protected] Ethics Line .............................................................................................................................................. (800) 500-0333
(20161130)
MINIMUM FILING REQUIREMENTS
The minimum requirements for filing a Massage Establishment Application are listed below. An application that does not include the below-listed items will not be accepted for processing:
Completed Discretionary Permits/Actions Applications Form, requesting Conditional Use Permit approval for the proposed massage establishment, and compliance with the minimum applications for filing a Conditional Use Permit.
Completed Massage Establishment Supplemental Application Form.
Two portrait photographs, 2 inches in width by 2 inches in height, taken within the previous 6 months, of the applicant or person designated by the applicant, corporation or partnership, to act as its responsible managing officer in charge of the premises.
At least two signed statements by persons who have knowledge of the applicant's background and qualifications, including dates of relationships. Those persons shall have known the applicant for at least 3 years preceding the date of application.
If the applicant/owner will be performing massages at the massage establishment, provide current copies of the applicant/owner California Massage Therapy Council (“CAMTC”) certificate and license card. If the applicant/owner is not CAMTC certified, a separate Massage Therapist Permit is required to be obtained.
A complete description/definition of all services to be provided.
Written proof that the applicant/owner is at least 18 years of age.
Written proof that the person designated by the applicant, corporation or partnership to act as its responsible managing officer in charge of the premises, is at least 18 years of age.
The applicant and any person designated by the applicant, corporation or partnership to act as its responsible managing officer in charge of a massage establishment shall be required to furnish fingerprints for the purpose of
establishing identification. Any required fingerprinting fee will be the responsibility of the applicant.
A floor plan of the unit/building in which you wish to establish your business.
Such other identification and information as the Police Chief may require in order to discover the truth of the matters hereinbefore specified as required to be set forth in the application.
The Police Chief, at his discretion, may require the applicant to appear in person for the purpose of verifying identity, taking additional photographs of the applicant, and/or confirm the height and weight of the applicant.
Any other information that the Planning Director deems necessary to facilitate the processing of the subject application.
Notes:
(1) Review Development Code Section 5.03.270 (Massage Services) for operating requirements and zoning compliance.
(2) The approval of a Massage Establishment Permit does not include employees. Each employee who performs massage as part of the business activity must apply for, and obtain, a separate Massage Therapist Permit, or be certified by the California Massage Therapy Council and provide proof of such certification.
Massage Establishment
Supplementary Application Form;
Minimum Filing Requirements
City of Ontario Planning Department 303 East B Street Ontario, California 91764 Phone: 909.395.2036 Fax: 909.395.2420
WHAT IS A MASSAGE ESTABLISHMENT PERMIT?
The City of Ontario is authorized by virtue of the State Constitution, the provisions of the City Charter, and Government Code Section 51031, to regulate all massage establishments by imposing reasonable standards of massage establishment operators and reasonable conditions on the operation of the massage establishment. The Massage Establishment Permit process has been created to ensure reasonable safeguards against physical injury and economic loss to massage clients, brought about by improperly educated and trained massage therapists. In order to achieve these purposes, the Zoning Administrator is empowered to grant or deny applications for Massage Establishment Permits and to impose reasonable conditions upon the granting of a Massage Establishment Permit.
(20161130)
GENERAL INFORMATION (print or type)
Property Owner:
Address:
Telephone No.:
Email:
Applicant:
Address:
Telephone No.:
Email:
Applicant’s Representative:
Address:
Telephone No.:
Email:
BUSINESS INFORMATION
Business Name:
Business Address:
Telephone No.:
Email:
Website:
Responsible managing officer in charge of the premises:
Managing officer’s current residence address:
Managing officer’s residence telephone no.:
APPLICANT/OWNER INFORMATION
Is the massage establishment business a corporation? Yes No
If yes, below, provide the name of the corporation exactly as shown in the articles of incorporation or Charter. In addition, on a separate sheet of paper, provide the state and date of incorporation, and the names and residence addresses of each of its current officers and directors, and of each stockholder holding more than 5% of the stock of that corporation.
Corporation Name:
Massage Establishment
Supplementary Application Form
City of Ontario Planning Department 303 East B Street Ontario, California 91764 Phone: 909.395.2036 Fax: 909.395.2420
(For staff use only)
File No.:
Related File:
Date:
Rec’d by:
Fees Paid:
Cash Check (# )
Credit Card
Receipt No.:
Approved By:
Approval Date:
Expiration Date:
Massage Establish Supplementary Application Form
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Is the massage establishment business a partnership? Yes No
If yes, on a separate sheet of paper, provide the name and residence address of each of the partners, including limited partners. If the applicant is a limited partnership, provide a copy of the certificate of limited partnership, as filed with the county clerk. If one or more of the partners is a corporation, the provisions pertaining to corporate applicants, above, shall apply.
Applicant/owner full/complete name:
List any other name(s) you have used or been known by:
Current residence address:
Residence telephone no.:
Past two places of residence:
1. Address:
2. Address:
Date of birth: California Driver’s License or ID No.:
Place of birth:
Are you a United States citizen? Yes No
Social Security No.: Gender: Male Female
Weight (lbs.): Height: Feet Inches
Hair Color: Eye Color:
Have you ever possessed an operator’s license issued by any state other than California? Yes No
If yes, provide the following information:
Name license was issued to:
License No.:
Have you ever been fingerprinted by a police agency other than for arrest? Yes No
If yes, provide the following information:
Agency Name:
Date: Purpose:
APPLICANT/OWNER PERMIT/LICENSE HISTORY
Have you had any permit or license issued by any agency, board, city, county, territory or state? Yes No
If yes, provide the following information for each permit or license received (attach additional sheets if necessary):
Permit/License received:
Issuing agency, board, city, county, territory or state:
Date of Issuance:
Was the permit/license revoked or suspended: Yes No
If yes, state the reason for revocation or suspension (attach additional sheets if necessary):
Massage Establish Supplementary Application Form
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(20161130)
Have you had any vocational or professional permit or license issued: Yes No
If yes, provide the following information for each permit or license received (attach additional sheets if necessary):
Permit/License received:
Issuing vocational or professional organization:
Date of Issuance:
Was the permit/license revoked or suspended: Yes No
If yes, state the reason for revocation or suspension:
APPLICANT/OWNER CRIMINAL HISTORY
Have you ever been arrested or detained by the police (excluding traffic violations)? Yes No
If yes, provide the following details (attach additional sheets if necessary):
1. Crime Charged:
Police Agency:
Date: Disposition of Case:
2. Crime Charged:
Police Agency:
Date: Disposition of Case:
3. Crime Charged:
Police Agency:
Date: Disposition of Case:
4. Crime Charged:
Police Agency:
Date: Disposition of Case:
Massage Establish Supplementary Application Form
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(20161130)
APPLICANT AFFIDAVIT
STATE OF CALIFORNIA )
COUNTY OF )
CITY OF )
I, the undersigned, being duly sworn, depose and say that I am the applicant in the foregoing application, that I have read the foregoing application and know the content thereof, and state that the same is true and correct to the best of my knowledge and belief.
Furthermore, I hereby agree to defend, indemnify, and hold harmless the City of Ontario or its agents, officers, and employees, from any claim, action or proceeding against the City of Ontario or its agents, officers or employees, to attack, set aside, void, or annul any approval by the City of Ontario, whether by its City Council, Planning Commission, or other authorized board or officer, as it pertains to this application. The City of Ontario shall promptly notify the applicant of any such claim, action or proceeding, and the City of Ontario shall cooperate fully in the defense.
Date: Signature:
Name (print or type):
NOTARY ACKNOWLEDGMENT
STATE OF CALIFORNIA )
COUNTY OF )
CITY OF )
On ______________________ before me, ________________________________________________________________________, (Date) (insert name of Notary Public)
Notary Public, personally appeared_______________________________________________________________________________, Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature________________________________________ Place Seal Above
Note: A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
Massage Establish Supplementary Application Form
Page 5 of 6
(20161130)
PROPERTY OWNER AFFIDAVIT
STATE OF CALIFORNIA )
COUNTY OF )
CITY OF )
I, the undersigned, being duly sworn, depose and say that I am the owner of the property in the foregoing application, that I have read the foregoing application and know the content thereof and state that the same is true and correct to the best of my knowledge and belief.
Date: Signature:
Name (print or type):
NOTARY ACKNOWLEDGMENT
STATE OF CALIFORNIA )
COUNTY OF )
CITY OF )
On ______________________ before me, ________________________________________________________________________, (Date) (insert name of Notary Public)
Notary Public, personally appeared_______________________________________________________________________________, Name(s) of Signer(s)
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies) and that by his/her/their signatures(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.
WITNESS my hand and official seal.
Signature________________________________________ Place Seal Above
Note: A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document.
Massage Establish Supplementary Application Form
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(20161130)
FOR CITY USE ONLY
Required information provided with application:
Fully completed, signed and notarized Massage Establishment Supplementary Application Form.
Fully completed, signed, and notarized Discretionary Permits/Actions Applications Form for Conditional Use Permit approval.
Two portrait photographs, at least 2-inches by 2-inches, taken within the last 6 months.
Two signed statements by persons who have knowledge of the applicant's background and qualifications.
Applicant/owner will NOT be performing massages at the establishment.
OR
Applicant/owner submitted CAMTC certification and license card OR separate Massage Therapist Permit application.
Description/definition of services to be provided.
Floor plan of building/unit.
Proof that the applicant/owner is at least 18 years of age.
Proof that the person designated by the applicant, corporation or partnership to act as its responsible managing officer in charge of the premises, is at least 18 years of age.
Approved Denied
Police Department, By: Date:
Title:
Planning Department, By: Date:
Title:
Ontario Police Department
Permit Fingerprint Application
Last Name:
First Name: M:
Date of Birth: Sex:
Height: Weight: Hair Color: Eye Color:
The City of Ontario requires that prior to granting certain permits, the person applying for a permit must submit to a fingerprint
process to be completed by the Ontario Police Department. The fingerprint process is required by the California Department
of Justice as a necessary means for the Police Department to conduct background checks as required for the permit being
applied for.
DOJ Results review date: By:
(20161130)
Agricultural Preserve Cancellation ............................................................................................................................................... $5,242.00
Appeal—Homeowner ...................................................................................................................................................................... $125.00
Appeal—Other ................................................................................................................................................................................. $752.00
CC&R Review .............................................................................................................................................................................. $1,744.00
Conditional Use Permit—Homeowner .......................................................................................................................................... $1,663.00
Conditional Use Permit—Nonprofit ............................................................................................................................................... $1,869.00
Conditional Use Permit—Other .................................................................................................................................................... $2,869.00
Conditional Use Permit—Modification ............................................................................................................................................. $994.00
Conditional Use Permit—w/ Development Plan ........................................................................................................................... $1,088.00
Conditional Use Permit Time Extension .......................................................................................................................................... $517.00
Determination of Use ....................................................................................................................................................................... $695.00
Development Agreement .................................................................................................................................................... T & M ($10,000)
Development Code Amendment .......................................................................................................................................... T & M ($2,000)
Development Plan Review—5 acres or more ............................................................................................................................. $10,864.00
Development Plan Review—Less than 5 acres ............................................................................................................................ $5,611.00
Development Plan Revision ......................................................................................................................................................... $2,134.00
Development Plan Time Extension ................................................................................................................................................. $490.00
Environmental Assessment/Negative Declaration ........................................................................................................................ $1,127.00
Environmental Impact Report ............................................................................................................................................... T & M ($7,500)
Fiscal Impact Report—Minor ........................................................................................................................................................... $929.00
Fiscal Impact Report—Specific Plan ............................................................................................................................................ $1,493.00
General Plan Amendment ........................................................................................................................ T & M (Text-$5,000/Map-$7,500)
Historic Preservation—COA-Nonresidential ................................................................................................................................. $1,163.00
Historic Preservation—COA-Residential ......................................................................................................................................... $200.00
Historic Preservation—COEH-Nonresidential ................................................................................................................................. $935.00
Historic Preservation—COEH-Residential....................................................................................................................................... $250.00
Historical Preservation-Removal from Eligibility List ......................................................................................................................... No Fee
Historical Preservation-Waiver ......................................................................................................................................................... No Fee
Historical Preservation-Landmark Designation ................................................................................................................................. No Fee
Historical Preservation-Plaque ................................................................................................................................................... Direct Cost
Inspection—Construction (3 inspections) ........................................................................................................................................ $278.00
Inspection—Field ............................................................................................................................................................................... $83.00
Residential Mills Act ........................................................................................................................................................................ $200.00
Nonresidential Mills Act...…………... ................................................................................................................................ ……….…$546.00
Large Family Daycare ..................................................................................................................................................................... $489.00
Lodging House Permit ..................................................................................................................................................................... $115.00
Massage Permits ............................................................................................................................................................................. $517.00
Master Plan of Streets Amendment .............................................................................................................................................. $3,748.00
Planning Department
Fee Schedule
City of Ontario Planning Department 303 East B Street Ontario, California 91764 Phone: 909.395.2036 Fax: 909.395.2420
Planning Department Fee Schedule
Page 2 of 2
(20161130)
Plan Check—5 or more acres ...................................................................................................................................................... $2,326.00
Plan Check—less than 5 acres .................................................................................................................................................... $1,301.00
Planned Unit Development (PUD) ...................................................................................................................................... T & M ($10,000)
Planning Area Plan ............................................................................................................................................................... T & M ($5,000)
Planning Director Review ................................................................................................................................................................ $265.00
Preliminary Plan Review............................................................................................................................................................... $1,356.00
Public Hearing—City Council .......................................................................................................................................................... $280.00
Public Hearing—Development Advisory Board ............................................................................................................................... $265.00
Public Hearing—Planning Commission ........................................................................................................................................... $450.00
Public Hearing—Zoning Administrator-Homeowner .......................................................................................................................... $70.00
Public Hearing—Zoning Administrator-Other .................................................................................................................................. $477.00
Sign Plan ......................................................................................................................................................................................... $174.00
Sign Program ............................................................................................................................................................................... $1,225.00
Specific Plan ....................................................................................................................................................................... T & M ($10,000)
Specific Plan Amendment .................................................................................................................................................... T & M ($7,500)
Temporary Sign Permit...................................................................................................................................................................... $20.00
Temporary Use Permit .................................................................................................................................................................... $342.00
Tentative Parcel Map ................................................................................................................................................................... $3,544.00
Tentative Parcel Map Modification ............................................................................................................................................... $1,531.00
Tentative Tract Map ................................................................................................................................................ $5,026.00 + $65 lot/unit
Tentative Tract Map Modification ................................................................................................................................................. $1,378.00
Tentative Tract/Parcel Map Time Extension .................................................................................................................................... $777.00
Variance—Administrative Exception ............................................................................................................................................... $549.00
Variance—Homeowner ................................................................................................................................................................... $289.00
Variance—Other .............................................................................................................................................................................. $941.00
Zone Change—5 acres or more ................................................................................................................................................... $4,903.00
Zone Change—Less than 5 acres ................................................................................................................................................ $3,334.00
Zoning Administrator Review—Homeowner .................................................................................................................................... $187.00
Zoning Administrator Review—Other .............................................................................................................................................. $517.00
Zoning/Land Use Verification Letter .................................................................................................................................................. $77.00
Fees for the filing of the Notice of Determination or Notice of Exemption with the Clerk of the Board of San Bernardino County shall be submitted to the Planning Department. All checks shall be made payable to the “Clerk of the Board.” The fees are as follows:
Notice of Exemption Filing Fee .................................................................................................................................................. $50.00
Notice of Determination Filing Fee ............................................................................................................................................. $50.00
Filing of a Negative/Mitigated Declaration (includes Notice of Determination filing fee) ........................................................ $2,266.25
Filing of an Environmental Impact Report (includes Notice of Determination filing fee) ........................................................ $3,128.25
Note:
“T & M” means fees will be charged on a time and materials basis. An initial deposit will be collected at the time of application submittal. Any unused deposit amount will be returned to the applicant following final action on the application.