Attachment A
CITY OF SIGNAL HILL
2175 Cherry Avenue Signal Hill, CA 90755-3799
Application for a permit to operate an Institutional Business in the City of Signal Hill, California, pursuant to Chapter 8.16 of the Signal Hill Municipal Code.
Select one: New Application Renewal Application
Select type: Home for the Aged Mental Institution Private Day School Day Nursery Private Boarding School/Children’s Boarding Home
Business Name:
Business Address: Business Phone:
On-Site Contact Name: Contact Phone:
Applicant Name: Applicant Phone:
Name/Address/Phone of Partners/Officers/CEO:
Emergency Contact: Emergency Phone:
Emergency Email:
Describe Business Operation:
Person/Title Responsible:
Investigation Fee based on number of accommodations:
1 – 10 children/persons: $10.00 51 – 100 children/persons: $75.00 11 – 25 children/persons: $20.00 101 or more children/persons: $100.00 26 – 50 children/ persons: $40.00
I __________________________ hereby affirm that the statements made in this application are true and correct.
Applicant Signature Title Date
************************************************************************************************************* For office use only: Finance code: 100-32-4632
Health Department Inspection Date:
LAC Fire Department Inspection Date:
Permit Expiration Date:
Other: Day Program for Intellectually and Developmnetally Disabled adults Dungarvin California LLC
695 East 7th Street, Signal Hill, CA 90755
Jesse Hansen, State Director (707) 528-9155
Beverly Ruiz (562) 270 - 6416 ext 4181
(562) 270 - 6416
Jesse Hansen
Stat Director 11/17/2023
Lori Kress, CEO, Emily Sheevel, CFO,
Jesse Hansen, State Director (707) 528-9155
[email protected]
Jesse Hansen, State Director
skill development, and employment training. Program offers a morning session (8a-1p) and an afternoon session (2p-6p) M-F.
Day program assisting individual with daily living skills, accessing community activities, 1444 Northland Drive, Suite 200, Mendota Heighs MN 55120, 651-699-0206