2175 Cherry Avenue• Signal Hill, CA 90755-3799
Application for a permit to operate a certain business in the City of Signal Hill, California, pursuant to Chapter 8.16 of the Signal Hill Municipal Code.
Business Type: AdultDayServicing-SeMnqAdultsW/DlsabiitieS Code Section: 8.16 Business Name: ___ __,.cl!ll912...,v,,,2c;,""1""; 9n ... a1'-"sl!l:erv..,.,c,..os�----------On-Site Contact:
Address: _..,m ....... n•,,...m .... •,,,/\x:a..c .,.§;oo;Jl""'-"H:,..� C"°A'-"90""'80"-Z -------------- Name: EJinWelch Telephone: .......:.<ss;....2..:..>_91_2.1_34...co _________________ Telephone:......::::,,..,,::..:.c.:.,,.,..,,=----- Type of Organization: Adu1,c1a,m·•"'""•evejopmen'"!r ........ - Applicant: Cole Vocational Services Name, Business Address, Telephone Number of Partners/Officers/CEO: _______ _ 916§ Affi[?etm Place Syhe Ranc:no Cycamong;, Cfl 91 no
Executive Director Tammi Castilo (909) 483-2505
Number of Accommodations: ....!:3::..::0�--------------------- Emergency Contact: ....iE:!!rin�Wc,,.,el,:::ch.:..:,l.:...,Prog=ra"'-m�dlre:.:,:dO=-r ----------------------- Telephone (including area code): _ _..::.C562:.::,_;>1..:..61c...:·52..:..85..:..-__________________ _ Email Address: [email protected]
Describe Business Operation: AdultdayproaramtordevelopmentaUydisabledin<fMduals Person/Title Responsible: Tamm, Castillo Exeaitlve 0,rectQ( (9091566-8332 1 _Ta_etM.m ___ ,_·--=�:..:....:.:::...!.!....:/�/!....=----b --hereby affirm that the statements made in this application are true
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and correct.
Applicant signature
6e.cuA�iJr�
Title
Ii....( :i..o(2.LJ2-1
Date
*********************•�•••***************•****************************************************************** * For office use only: Investigation Fee $100 $tt6D.lJD Finance code: 100-32-4632
Health Department Inspection Date: ----------
LAC Fire Department Inspection Date: ---------
Permit Expiration Date: ---------------
Attachment A
CITY OF SIGNAL HILL
2175 Cherry Avenue • Signal Hill, CA 90755-3799
Application for a permit to operate a certain business in the City of Signal Hill, California, pursuant to Chapter 8.16 of tlhe Signal Hill Municipal Code.
Business Type: S;::..i\\e� Nv1.11-sivt@ flMik�
Business Name: @M\(,atB.o\ C6:at levi4etL
Address: IS'ho \')21� Piv.t. <i$MI UjU, l/4 q0]55
Telephone: (5ll1-) LltilY- '3l�
Code Section: 8.16 ·
On-Site Contact: .JoiAti h �qq�icName:J O Mltl ??�S\c
Telephone:Csvi >.fio-5-Z. !S
Type of Organization:---'5'--"G=?\9-.:-.:;:.yl=\?U\:...;.· ....,_+i.,__,·"'--M:...;.__ __________________ _ Address: ______ _
Name, Business Address, Telephone Number of Partners/Officers/CEO:-------- Number of Accommodations: ---"-"--------------------- 6'1 Emergency Contact: Jo� h (;.� �-c
Telephone (including area code): -�_..,,.t;_;;_t.Q..;...7_)_Lf_,_q-'-4 __ --"<;_,_(_�_B _____________ _ Email Address: JBA:ft',lC@ Ct:Mr:2.l\l,:\it-0 � lfMT�. COW\ Describe Business Operation: Lgri.0·1�W1 � S'� -t-8\a.M tztliit:i�lt·t.t?1..tjovi Person/Title Responsible: Jt1viab �1/fgff" I At::tVl:'.l,nis:�� Title Date
--=*v·***************'******'*********************"*"*i"**",/'****·******"*************************** *
Finance
For office
code:
use
100-32-4632
only: Investigation Fee $100 _j1_
Health Department Inspection Date: ----------
LAC Fire Department Inspection Date:---------
Permit Expiration Date:---------------
2175 Cherry Avenue• Signal Hill, CA 90755-3799
Application for a permit to operate a certain business in the City of Signal Hill, California, pursuant to Chapter 8. 16 of the Signal Hill Municipal Code.
Business Type: Aduit Day Program
Business Name: Dungarvin CA LLC
Address: 695 E 27th, Street Signal Hill CA 90755
Telephone: (562) 2 7
0-6416 ext 4181
Type of Organization: Limited Liability Corporation
Applicant: Dungarvin CA LLC
Code Section: 8.16
On-Site Contact: Ollie Martin
Name: Ollie Martin
Telephone: _____ _
Address: 19300 S Hamilton Ave Ste 140
Garciena CA 90245
Name, Business Address, Telephone Number of Partners/Officers/CEO:-------- Tim Madden, CEO, 1444 Northland Drive, Suite 200 , Mendota Heighs MN 55120, 651-699-0206 Joe Regescheid, CFO, 1444 Northland Drive, Suite 200, Mendota Heighs MN 55120, 651-699-0206 Number of Accommodations: --Pleas---------------------
e See Attached Letter
Emergency Contact: Jesse Hansen, Dungarvin State Director Telephone (including area code): ....:(_70_7....:.)_52__8_-9_1_5_5 _______________ _ Email Address: [email protected]
Describe Business Operation: _P_le_a_se_ _s_e_e_A_t_ta_c_h_e_d _L_ et_te_r ____________ _
Person/Title Responsible: Jesse Hansen, Dungarvin State Director I _Je_ss__e_H_an_se_n _______ hereby affirm that the statements made in this application are true and correct.
State Director
Title
*'*'***************'k*·k*******""'V****"*********'lrk*1'r********�***°"W*********W*******•***+*********°*"k*************.,_.* "For office use only: Investigation Fee $100 __ _
Finance code: 100-32-4632
Health Department Inspection Date: ---------
LAC Fire Department Inspection Date: ---------
Permit Expiration Date:---------------
CITY OF SIGNAL HILL
2175 Cherry Avenue• Signal Hill, CA 90755-3799
Application for a permit to operate a certain business in the City of Signal Hill, California, pursuant to Chapter 8
.16 of the Signal Hill Municipal Code.
Business Type: Child Development Center
Business Name: Long Beach Community Improvement League
Address: 2399 California Avenue, Suite A, Signal Hill, CA 90765 Telephone: 562-951-3500
Type of Organization: Non-profit, Social and CMc Service Organization Code Section: 8.16
On-Site Contact: Laura Sidney
Name: Laura Sidney
Telephone: 562-989-5766
Applicant: Long Beach Community Improvement League Address: 2222 Olive Avenue. Long Beacil. CA 9080€ Name, Business Address, Telephone Number of Partners/Officers/CEO: CEO: Dr. Farah Naz Kha leghi
Officers: Mr.Ahmed Saafir {Board Chair), Ms. Coffeen Bentley Treasurer), I Ms. Terri McAdams (Secretary) 2222 Olive Avenue, Long Beach, CA 90806, Tel: 562-951-3500 & 562-426-8897 Number of Accommodations: ------------------------ 141
Emergency Contact: _L_a_u_ra_S_i
d
_
n_e-'y'----------------------
Telephone (including area code): _5_
62_-_
9 _89-_5_7_66 _________________ _
Email Address: [email protected]
. . _ Provi.d" g chnd care ano deve!opement for ages 2-5 and before/after school care for6-13 years old Descnbe Business Operation: year-round, M-F. 7 a.m. to 6 p.m. Programs and services are subsidzed by califo ia O§)artmerrt or Eaucnon and Oepaitmem ot ::;oaaf'SeMces_
Person/Title Responsible:_. ________________________ _
Dr. Farah Naz Khaleghi, Executive Director/CEO
__ Fa_ _rah_ _N_a_z_K_h_ al_ _e..._g_hi _ ___ hereby affirm that the statements made in this application are true and correct. �� Executive Director, October 12, 2021 Applicant signature Title Date
IC'fc*******�*****************'"***�****•*""""****************"'""*""************************ "'� ..... ******•*+*-********** * For office use only: Investigation Fee $100 }?
Finance code: 100-32-4632
Health Department Inspection Date: -----------
LAC Fire Department Inspection Date: _________ _
Permit Expiration Date:----------------
CITY OF SIGNAL HILL
2175 Cherry Avenue • Signal Hill, CA 90755-3799
Application for a permit to operate a certain business in the City of Signal Hill, California, pursuant to Chapter 8.16 of the Signal Hill Municipal Code.
Business Type: Adult Day Se rvice- Serving adults w/ disablities i Code Section: 8.16 Business Name: ------------------ Unlimi ted Quest On-Site Contact: ----- Address: 3350 Olive Ave. Signal Hill, CA 90755
Telephone: 562-595-0730
Name: losepbioe Santos
Telephone: 818-913-638 2
Type of Organization:_c_o�rp_o r_a_t,o_n ______________________ _ Applicant: I lo limited Q11est Address: 9J 66 Anaheim Place Suite 200 Name, Business Address, Telephone Number of Partners/Officers/CEO: Rancho Cucamonga, CA 91730 Unlimited Quest, Inc. - 9166 Anaheim Place Suite 200 Rancho Cucamonga, CA 91730 Tammi Castillo 909-483-2505
Number of Accommodations:-----------------------
Emergency Contact: Ryan Rieger - Area Direc to r
Telephone (including area code): __ 5_6_2_-7_6_1-_5 28_5 _________________ _ Email Address: R�[email protected]
Describe Business Operation: -----------------------
Person/Title Responsible: Josephine Santos - Program Director I _T
am_m_i _c_as_u1 _10 ________ hereby affirm that the statements made in this application are true
��
and correct.
Executive Director
Applicant signature Title
* For office use only: Investigation Fee $100
$16')
Finance code: 100-32-4632
Health Department Inspection Date: __________ _
LAC Fire Department Inspection Date: ---------
Permit Expiration Date: ----------------
'Oat�