Applications for massage clinic and massage technician permits, or renewal of such permits, must be filed with the Director, in a form prescribed by the Director, and contain all of the following information under the penalty of perjury:
(A) For all permits:
(1) Name. The applicant's full name and any aliases previously used or currently used and current business address and mailing address and the names and residence addresses of all officers, directors, and each stockholder holding more than 10% of the stock, if a corporation, or partners, if a partnership;
(2) Addresses. All proposed, current and previous businesses, and where applicable, the residential addresses of the applicant or applicant's principal officers, directors, and stockholders holding more than 10% of stock, if a corporation, or partners, if a partnership, for the five years immediately preceding submission of the application;
(3) Physical description. Height, weight, color of eyes and hair of applicant or each of the applicant's officers, directors, and each stockholder holding more than 10% of stock, if a corporation, or partners, if a partnership, together with at least two current color photographs at least two inches by two inches in size for each individual;
(4) Proof of age. A certified birth certificate, immigration papers, passport, or current California Driver's Permit evidence the fact the applicant is no less than 18 years of age;
(5) Business information. The business, occupation, or employment of the applicant or the applicant's officers, directors, and each stockholder holding more than 10% of the stock, or partners, if a partnership, for the three years immediately preceding the date of the application. If the applicant is a corporation, the name of the corporation must be set forth exactly as shown in its Articles of Incorporation and a copy of the Articles of Incorporation attached to the application;
(6) Location for massage activities. Each location where the permitted activities will be conducted and the names and addresses of all massage technicians employed at those locations;
(7) Prior permits. A statement of any business permit history relating to massage of the applicant and of applicant's partners, if a partnership, or each of the officers, directors, or persons who hold more than 10% of the stock, if a corporation, including a statement of whether such person, in previous operations, has had such permit revoked or suspended, the reason therefor, and a statement setting forth all massage business history or occupation subsequent to such suspension or revocation;
(8) Criminal convictions. A statement of whether the applicant, and any partners, if a partnership, or officers, directors, or persons holding more than 10% of the stock, if a corporation, were convicted of an offense involving conduct which requires registration under Cal. Penal Code §290; conduct which violates Cal. Penal Code §§ 315, 316, 318, 647(b), or 2661; any felony involving the sale of a controlled substance specified in Cal. Health & Safety Code §§ 11054 through 11058; was convicted in another state of an offense, which, if committed or attempted in this state would have been punishable as one or more of the offenses enumerated in this section; or was convicted of one or more other offenses as may be described under Cal. Gov’t Code § 51032;
(9) Fingerprinting. A statement that the applicant consents to being fingerprinted to determine whether the applicant has a criminal record; and
(10) Notice address. The address to which all notices and communications from the city to the applicant or permittee must be directed. It must be the responsibility of the applicant or permittee to immediately inform the Director, in writing, of any changes of the applicant or permittee's notice address.
(B) For massage technician permits, an applicant must also submit the following:
(1) Diploma. A diploma or certificate of graduation from a recognized school, together with a certified transcript or record establishing that the applicant attended a resident course of study of no less than 300 hours in theory, ethics, practice and profession and work of massage, and setting forth the beginning and ending date of applicant's course of study. In lieu of the above, the applicant may submit a certificate from a recognized school in the State of California stating the applicant has completed a resident course of study in massage in another state and has passed the examination required of a graduate from the recognized school in the State of California; and
(2) A written and signed statement from a physician permitted to practice medicine in the State of California and dated within 30 days of the date of the application, certifying that the applicant is free from communicable diseases.
(Ord. 1123, passed 10-20-04)